Treating Hair Loss

When we start to notice our hair falling out more than it has before, this can be upsetting. Before jumping to a remedy, it is very important to understand why your hair is falling out. A consultation is the first appropriate step. During this visit, we will discuss the events leading up to the hair loss and will spend time examining the hair and scalp to uncover the cause of hair loss. It is our routine to take photographs of your hair for your private medical record to track your progress.

It is normal to shed around 50-100 hairs per day. This is most often noticed when brushing your hair or when in the shower.

• Male hair loss is most commonly due to androgenic alopecia (male pattern hair loss), which leads to hairline recession, thinning, and a bald spot. This genetic form of hair loss causes certain predictable hairs to miniaturize and then stop growing. The horseshoe of hair above the ears and in the back of the scalp is often maintained. This is considered a “non-scarring” form of alopecia and does not require further lab workup or biopsy as the diagnosis can be made on examination.
• Female pattern hair loss is also most commonly due to androgenic alopecia, though it presents very differently. The hairline is classically maintained and there is thinning on the top of the hair leading to a widened part.
• Stress-induced hair loss – telogen effluvium can affect both men and women. This can cause rapid shed following a traumatic event.
  -Stresses include the loss of a loved one, surgery, injury, massive weight loss (Ozempic), severe illness (COVID-19), and others
• Loose anagen syndrome
• Anagen effluvium
• Hypotrichosis
• Alopecia Areata
• Tinea Capitis
• Scarring Alopecia – aka cicatricial alopecia -Lichen planoilaris, discoid lupud, folliculitis decalvans, central centrifrifugal cicatricial alopecia, frontal fibrosing alopecia
• Post-partum shedding – after pregnancy, many women see hair shedding. This can last from 3-18 months. There are many ways to reduce shedding, and at HairCareMD, we can assist you if you are suffering from post-partum shedding.
• Hormonal causes
• PCOS – polycystic ovarian syndrome
• Hypothyroid
• Medications
• Menopause (in menopause, there is a significant hormonal shift and this may result in hair loss.)
• Autoimmune (also known as Lupus)
• Infection
  -Bacterial
  -Fungal
• Diet: vitamin deficiency, heavy metal poisoning, anorexia, extreme weight loss
• Anemia -Iron deficiency
• Hairstyle/traction
• Trichotillomania / pulling

Depending on the type of hair loss, additional testing after your consultation and examination may be necessary. A complete blood work panel looking for hormonal, autoimmune, infectious, and metabolic tests may be ordered. At times a biopsy of the scalp is necessary. There are times when we will have you see one of our trusted dermatology colleagues for an additional analysis.

In general, dandruff and seborrheic dermatitis will lead to an itchy scalp. Continued itching may injure hair follicles, but dandruff and seborrheic dermatitis do not routinely directly injure or cause hair loss.

The most common causes of hair loss are genetic and looking at relatives can be helpful to understand your possible pattern of hair loss. There are at least 5 genes responsible for hair loss. It was once believed that the maternal grandfather was the most important relative to determine your fate, but this has been disproven.

Perms may weaken the hair itself leading to breakage. It is unlikely for a hair treatment, such as a perm, to stop hair from growing.

Chemical treatments to the hair that sit on the scalp for too long can damage hair growth. It is possible to burn the scalp leading to inflammation, shock loss and even scarring, Fortunately, this is rare.

Many potential medicines can cause hair loss. Your medicine list will be closely reviewed during your consultation. The most common medicine that we see associated with new hair loss is testosterone supplementation. Likely this is because the testosterone is directly converted into DHT (di-hydro-testosterone) and leads to hair loss in men and women.

Other medicines that are frequent contributors to hair loss include:
Changing birth control, weight loss drugs, blood pressure medicine (ACE-I and Beta-blockers), acne medicine (Accutane), warfarin, chemotherapy, immunosuppressants, and many others.

Hair loss has come such a long way in the past two decades. Hair restoration is now split into surgical and medical treatment arms, and fortunately, there are many advancements.

Hair transplant has improved leaps and bounds as now we transfer single hair follicles to create natural results, and we have fully abandoned hair plugs. The methods of harvest now involve rotational drills and even robots, such as the Artas iX.

Medical hair restoration has improved with more options for men and women. Originally, only topical minoxidil and oral finasteride were considered. Now we consider oral minoxidil, spironolactone, dutasteride, platelet-rich plasma, laser light therapy, microneedling, botox, saw palmetto, ashwagandha, curcuramin, and other treatment options for hair loss. During your consultation, the best treatment options for your situation will be recommended.

Hair transplant surgery is a procedure that permanently transfers a hair follicle from one part of a patient’s body to another part. Classically, hair is extracted from the back or side of the head (the donor site) and transferred into an area of thinning or need (the recipient site). The structure that grows hair is called the hair follicle and this is the smallest fundamental unit of hair growth. By transferring individual hair units, the results look natural, not plugged, and they last a lifetime.

FUT stands for follicular unit transfer, and this is a highly effective form of surgical hair restoration. In a FUT hair transplant, a surgical strip of skin-bearing hair is removed from the donor site and sewn closed. By keeping the hair above the strip harvest site long, the patient will have no evidence of surgery as the suture line will hide inside the hair. Once the strip is removed, it is hand-dissected under magnification on a side table into the individual hair follicles. The follicles are kept in saline on ice. They are then placed into pockets (called sites) in the recipient site. A FUT hair transplant is an excellent form of hair transplant as it allows for many hairs to be transferred quickly and is the gold standard in viability. To learn more about FUT hair transplant, please visit our dedicated page here

FUE stands for follicular unit extraction, and this is the most modern form of surgical hair transplant. In this technique, a micro-punch drill is used to core out the follicular unit from the donor site, often located in the back or side of the head. The procedure allows individual hair follicles to be isolated. The follicles are then placed in the recipient site in pockets. The procedure does not involve any sutures or scalpels. To learn more about FUE hair transplant, please visit our dedicated page here.

PRP stands for platelet-rich plasma. In this procedure, a patient’s blood is centrifuged. The least dense portion of the blood has platelets suspended in plasma. The red and white blood cells are discarded, and the platelet-rich plasma is isolated. The platelets are cells that contain growth factors. The growth factors are then released from the platelets in a step called “activation”. The growth factors are then microinjected into regions of hair thinning to stimulate hair stability and hair growth. Patients see less shedding and improved vitality of their hair. This a highly specialized therapy that patients adore because the growth factors used in treatments come from the patient’s blood. The chance of a growth factor rejection, a viral transmission, or an allergy is essentially zero. The procedure is performed awake within 30 minutes in the office and patients can return to work after the visit. To learn more about PRP, please visit our dedicated page here.

Certain forms of hair loss are due to triggers and can be reversed when the trigger is removed. Examples of reversible hair loss include thinning due to anemia, stress, and medicines.

Many forms of hair loss are progressive and many are permanent. Even patients with an irreversible form of hair loss may receive outstanding benefits through hair restoration treatment at HairCareMD.