Hair Introduction

 The Anatomical Structure of Hair

Our hair is often referred to as a “skin appendage,” meaning that it originates and grows out of
our skin (other skin appendages include: fingernails, toenails and sweat).
One hair follicle produces 1-4 hair shafts. Each hair shaft consists of 3 layers.
Hair follicle layers:

• The outer root sheath (trichelemma) - the outer layer of the hair follicle; pores (from
which the hair grows) form when the dermis combines with the epidermis on the surface
of the skin.
• The inner root sheath - the middle layer of the hair follicle; composed of three parts –
Henle’s layer, Huxley’s layer and the internal cuticle.
• The bulb - the lowest part of the hair follicle; this is where the “inner matrix cells” reside.
We can determine the width of a fully grown hair by the size of its bulb and the number
of accompanying matrix cells.

The hair shaft is primarily made up of a protein called Keratin. Like the follicle itself, the hair
shaft has 3 prominent layers:

• The cuticle - the surface layer of the hair; this layer protects the inner structure of the
hair. The cuticle is made up of transparent, protective scale-like cells.
• The cortex - the middle layer of the hair; this layer gives strength to hair shafts and
contains the pigments which give hair its colour.
• The medulla - the innermost layer of the hair shaft; only present in fully grown hair.

Why do we have hair?

Like most of our other body parts, hair serves several distinct purposes.
• Hair covers our entire body (head, legs, nose, etc.), protecting our skin from dirt, heat and
bacteria.
o The hairs in our ears prevent dirt and water from entering; the hairs on our
eyelashes and eyebrows prevent perspiration and particulates from harming our
eyes; the hairs in our nose protect our bodies from bacteria; etc.
• Hair regulates our body temperature.
o Hair protects our skin from sun-damage and reduces the negative effects of
extreme cold and heat.

The Causes of Hair Loss

Hair loss can be caused by a variety of factors:
- Genetics/hereditary
- Autoimmune diseases
- Medications/current treatments
- Poor diet and stress
There are many rumors surrounding the nature and causes of hair loss. Many of these are
justified, but many are not. It is important to approach our hair loss from a factual standpoint in
order to properly address symptoms ranging from hair breakage and fallout to general thinning.

Male Reactions to Hair Loss

Men can react to hair loss in a variety of different ways. Many men become depressed; their
self-esteem and confidence are largely reduced and they begin multiple treatment regimens in
order to re-grow their lost hair. Often times these regimens are ineffective, little more than an
amalgamation of supplements and topical solutions that aren’t rooted in real science.
Nevertheless, this approach is common for men in the early stages of hair loss.
Although the options for dealing with hair loss are limited, there are still several efficacious
treatments on the market. Information about these existing therapies will be provided later.
It can be easy to become pessimistic at the onset of hair loss. But instead of focusing on negative
feelings such as hopelessness or dissatisfaction, always try to find something positive about your
situation. Regardless of societal stereotypes, many men actually look better with shaved heads.
Plus, savings on haircuts and shampoo are two benefits that cannot be overemphasized.
Acceptance truly is the best starting place for any successful treatment regimen.

You Are Not Alone

It is important to remember that you are not the only one suffering from emotional complications
related to hair loss. There are millions of men around the world that are experiencing the exact
same anxiety, depression and worry.
Losing hair isn’t easy at all. To the contrary it can be extraordinarily difficult. But do not stress
out. I repeat, do not stress out. Often times we are our own worst critics. We expect everyone to
care as much about our hair loss as we do, but most people hardly take notice.
Over 100 million people around the world are affected by different forms of hair loss. Many
aren’t aware of it yet, others may not even care, and most are just like you. Before turning in
desperation to treatments that are risky, harmful or ineffective, take a moment to assess the
situation and realize that you are experiencing a completely normal and acceptable phenomenon.
Staying positive is the first step in developing a worthwhile and effective treatment regimen.

Hair Care and Hair Products

Are you using the right hair care products? 


There are presently hundreds of hair care products on the market. Unfortunately, most don’t
work very well. In fact, there are only 2 treatments that are actually FDA approved for the
indication of treating hereditary alopecia. It is important to choose treatments that are effective,
economical and easy to use on a daily basis.we will help you select the right hair care products for your personal treatment regimen.


Choosing the Right Hair Products


Determining our specific hair type is a crucial step in selecting the shampoos and conditioners
that are best suited to meet our individual needs.
For instance, if your hair is dry, look for shampoos, conditioners, and other hair styling products
that are designed to manage “dry, frizzy hair.” If you have thin or oily hair, find a product that is
formulated “for weak, oily hair.” For additional help on how to determine your own individual
hair type, consult the bullet-points below:
• Normal hair
◦ Holds style without the use of too much styling products
◦ Neither greasy nor dry
◦ Not permed or colored
• Fine hair
◦ Becomes greasy
◦ Tends to be limp (flat), difficult to manage
• Dry hair
◦ Frizzy, rough
◦ Easily tangles
◦ Dull-looking
◦ Treated with perms and other hair colouring products

Now that you are more familiar with the most common hair classifications, take a good look at
your hair and see which type it most closely resembles. Select your shampoo, conditioner and
styling products accordingly. Using a product specially formulated for your specific hair type
will maximize the results you hope to achieve.

Washing and Drying Your Hair


Believe it or not, there is a correct way to wash your hair. Incessant rubbing and aggressive
towel-drying will only exacerbate the hair loss problems that you are already experiencing. There
is a much better approach.
These directions will help you wash and dry your hair properly:
1. Wash your hair every day. Contrary to popular suspicion, washing your hair every day
does not cause hair to dry out. As long as you use hair products that are suitable for your
hair type, it is perfectly safe to wash every day. In fact, it is preferable to shampoo daily
since it will clean dirt, oil and sebum that routinely build up on the scalp.

2. Always wash your hair with warm water. Warm water can dissolve dirt and help hair
follicles breathe freely. But be careful! If the water is too hot, it might damage and burn
your scalp. This deprives your hair of its natural oils, leading to a dry, brittle appearance.

3. Squeeze a considerable amount shampoo onto your palm and work a healthy lather into
your scalp and hair. Gently massage the shampoo on your scalp using your fingertips
(NOT your fingernails). While massaging, periodically comb your hair using your fingers
to avoid tangles.

4. Let your hair hang while thoroughly rinsing off shampoo.

5. If you are not using a 2-in-1 shampoo and conditioner, use a conditioner separately.
Unlike shampoo (which is meant to concentrate on the scalp), conditioner is designed for
the ends of your hair. Let conditioner settle for several minutes before gently rinsing it off
with warm water. Conditioner followed after shampoo can be effective for men with
either short or long hair.

6. Standing under running water to rinse hair is recommended over dipping it in bath water.
Adequate water pressure is necessary for proper rinsing.

7. When towel-drying, gently pat your hair with a towel. Do not rub your hair too briskly
and do not blow dry your hair when it is still soaking wet.

8. Comb your hair with a wide-toothed plastic comb. This will make de-tangling easier and
will not put excess strain on hair follicles.

9. Ideally hair should be dried naturally, but should you need to use a blow-dryer, use it
inches away from your hair and stop while the hair is still a little damp. This will avoid
over-drying your hair, which can lead to brittleness and split ends.

10. If you are using hair products such as gels, mousse or hair wax, apply them while your
hair is still slightly damp.


How Hair Dyes Work

People dye their hair for a multitude reasons: to look good, to conceal thinning hair patches, to
cover up greying strands, etc.
There are two kinds of hair dyes:
• Semi-permanent – may last for only 1 to 6 weeks, but may wash out more easily with
frequent hair washing. You can also wash this type of dye out with tea, beer or lemon
juice if you are not happy with the colour.
• Permanent – can be applied as highlights, streaks or the entire head. Possible hair damage
may occur if, prior to application, hair has not been washed out with hydrogen peroxide
to remove previous or existing colour.
Both forms of hair dye are popular and can be used at home. Still, it is always important to take
the time to read the packaging and follow the instructions carefully. Hair dyes can make hair
look good, but if used improperly, they can also cause considerable damage.


Effects of Gels, Mousses and Dyes on Hair


Hair styling products such as gels, mousse and hair dyes are part of a man's “hygienic routine.”
Many men get their hair dyed (either by themselves or by professionals) every other month and
apply hair gels, wax or mousse every day after taking a shower. The purpose of these products is
to help style hair in an effective manner that conceals hair loss and flatters facial features. Other
important effects of styling products include:
• Thickening hair - styling gels and mousses provide “volume” to limp, dull-looking hair,
making it appear thicker and fuller.
• Reshaping hair - this can be done by using a blow dryer and a round brush. Water-based
hair sprays, mousses, gels and waxes are used to set the hair in attractive, uniform
patterns.
It may be necessary to try several products before deciding on which gel, mousse or dye works
best with your unique hair type.


How to Avoid Hair Damage


Every day we do cruel things to our hair without even knowing it. Here are some helpful ways to
avoid hair damage:
... avoid blow drying, curling or iron-straightening your hair using extremely hot temperatures.
Our hair contains air pockets that hold in moisture. Excessive heat breaks down these air
pockets, damaging hair strands and drying out our hair. Always use the lowest heat setting
possible and air-dry your hair whenever possible.
...stop aggressively rubbing your hair. After showering, gently pat hair dry instead of rubbing it
vigorously. Too much friction can damage hair shafts and contribute to hair shedding and fallout.
... avoid back-brushing, using metal combs or brushing too much. It is recommended to use a
plastic wide-toothed comb, especially on wet hair. Plastic combs create less friction when
compared to metal combs, and easily de-tangle hair without tugging or breaking hair strands.
... stop perming and using harsh hair chemicals (e.g. hair dyes, bleaches, hair sprays). Perming
and using strong, chemically-derived hair products can damage the hair cuticle and have adverse
effects on the moisture of your hair. This can make hair shafts look weak, wiry and brittle.
Realistically speaking, this might be hard for many working professionals that rely on hair sprays
and chemical treatments for styling. Still, cutting down on the usage and frequency of these
techniques can yield positive changes with regard to hair health.
... avoid too much sun exposure. Similar to blow drying, the direct heat from the sun can cause
hair damage, breakage and aggravation.
... do not style hair too tightly. Applying too much pressure on the hair and the scalp can directly
contribute to another form of hair loss known as traction alopecia.


Maintain a Healthy Scalp


When hereditary hair loss starts to manifest, the blood supply to the scalp diminishes. This
reduction occurs because blood is not needed where there is no hair. Interesting proof of this
occurs after hair transplantation surgery. Blood circulation improves when there are once again
living follicles at the top of the head that need nourishment.
Scalp condition and blood circulation can be directly or indirectly affected by the following
factors:
• Smoking – many doctors believe that there is a connection between smoking and hair
loss, but there is no scientific proof that corroborates this theory. Smoking does, however,
reduce scalp circulation, but this in itself will not cause hair loss.
• Sun exposure – repeated sunburn adversely affects the scalp by shrinking hair-producing
cells. Exposure to intense ultraviolet light can speed up the balding process in those
already affected by genetic hair loss.
• Skin cancer – there are 3 different types of cancer and 2 of them can be deadly if they
spread throughout the body. These 2 are malignant melanomas and squamous cell
cancers, and they almost always appear in skin that is exposed to the sun. The hair gives
the scalp protection from direct sun exposure and produces shade that lessens the risk of
developing skin cancer.
When balding starts, the scalp often becomes exposed to ultraviolet light from the sun
and skin can change from a smooth, uniform color to having dark spots and discoloration.
• Dermatological conditions – there are several different conditions that affect the skin and
scalp (discussed in Chapter 3).
• Folliculitis – an infection of the hair follicles where red and white bumps or acne develop
on the scalp. This can be treated by antibiotics, soaks or minor surgical incisions. The
affected area should not be scratched or picked as this may cause scarring and spread the
infection to other areas of the scalp that were not initially affected.
Folliculitis rarely causes permanent hair loss, but can cause hair to prematurely enter the
telogen (resting) phase.
• Chlorine and salt water – shampooing and conditioning the hair after swimming in a
chlorinated pool or salt water is a must. Chlorine and salt water exposure can dehydrate
the scalp and hair, causing considerable damage.

Why Hair Loss Happens

Why Men Lose Their Hair

There are multiple explanations for how hereditary hair loss develops. But in order to properly
manage the symptoms of Androgenetic Alopecia, it is important to familiarize ourselves with its
causal mechanisms. In this chapter we will discuss why men and women lose their hair, and
provide insight into the nature and causes of several different types of hair loss.

Identifying Androgenetic Alopecia

How can you tell if you are experiencing early-stage Androgenetic Alopecia?
For most people, hair loss isn’t even noticeable until more than 50% of hair strands have
miniaturized. Although excessive shedding is an early indication that hair shafts are becoming
weak, even people without any visible hair loss lose an average of 50-120 hairs a day.
For this reason, we need a better way to identify pattern baldness before it becomes too obvious.
Catching hair loss early is important because existing treatments are more effective when there
are at least some hair follicles still functioning at the top of the scalp.

An image depicting male pattern and female pattern baldness

Common Causes of Hair Loss

Hair loss can be caused by a lot of different factors. Heredity, hormones and stress can all
contribute to hair fallout and miniaturization. Even though genetics is the most common factor,
there are other diseases and skin conditions that can result in hair loss.

Genes and Family History

Androgenetic Alopecia (hereditary hair loss, or AGA) is the most common form of hair loss. It
can be inherited from either parent, however it is most often linked to the mother’s side of the
family. Most males who experience hair loss have a family history of AGA. In females,
however, less than 50% of patients experience hair loss due to genetics.
• Male/Female Pattern Baldness (Androgenetic Alopecia/AGA)
AGA is the most common type of hair loss for both men and women, however it occurs
most often in the male population. In men, a pattern usually develops in the form of a
receding hair line and thinning crown. In women, hair is lost all over the head in a
diffuse, uniform pattern. This progression rarely results in complete baldness.
• Symptoms:
Hair shedding is the most noticeable symptom of hair loss. Observe the amount of hair
that you lose on a daily basis by checking your hair brush, shower strainer, pillow case
and clothes. If you suspect hair loss, look at family photos to see if the condition is
hereditary. Even though there is no clear explanation for the heritability of AGA, it has
been observed that those with a family history of hair loss are at a much higher risk of
losing their hair than others.

Testosterone and DHT

There are two primary sex hormones responsible for male pattern hair loss: DHT and
testosterone.
Testosterone is converted by tissues throughout the body into a hormone known as
dihydrotestosterone (DHT). DHT extends the resting phase of the hair follicle cycle and reduces
the growing phase. The natural result of this phenomenon is thinning hair over time. This effect
is especially prominent in men with ANA genes.
The good news for men who have not inherited this gene is that DHT and testosterone do not
cause hair loss by themselves. In fact, they are generally harmless, even to aging hair.
Both hormones are completely natural and necessary. DHT also plays a role in the growth of
body, beard, eyebrow, nose and ear hair.
Blocking DHT is the only way to stop the progression of hair loss in men that are genetically
susceptible. There are 5AR inhibiting drugs, such as finasteride and dutasteride, which are
manufactured solely for this purpose. However, it should be noted that the only FDA-approved
drug that has been proven safe and effective for the treatment of hair loss is finasteride.



Hair Loss Over Time

Merely the presence of balding genes or hormones is not enough to cause hair loss. The extent of
hair loss differs between individuals and can be significantly affected by DHT levels, age,
environmental and other factors.
Hair loss happens in cycles and does not happen instantly. It is still unknown why people who
are losing their hair experience alternating periods of slow and rapid hair loss.
Most men that develop extensive balding do so by the age of 30. However, half of the male
population shows some amount of balding by the time they reach age 45-50. This progression
slowly continues until they reach 60-65. Several clinical reports have demonstrated that
circulating levels of DHT slowly diminish over the course of a man’s life.
Those who begin the balding process into their 30s to 40s normally do not lose their hair as
quickly as those who start balding in their early 20s.
The most common balding patterns are:
• Frontal hairline recession
• Bald spot in the crown area

Stress

Contrary to popular belief, stress does not cause hair loss. Still, excessive stress can contribute to
hair loss through other means (hair pulling, poor hygiene, etc). Many traumatic experiences
(such as being laid off from work) can exacerbate the effects of hair loss like shedding, thinning
and dandruff.
One type of hair loss that can be caused by stress is Telogen Effluvium. TE is a reversible kind
of hair shedding that is distinctly different from AGA.

Lack of Blood Supply

As mentioned earlier, blood circulation to the scalp ceases where hair is nonexistent; essentially
because blood is no longer needed to supply hair follicles with oxygen and nourishment.
Nevertheless, there are doctors who claim that lack of blood circulation to the scalp contributes
to hair loss. This may or may not be true.
What we do know is this: a certain amount of oxygen and nutrition is required for growing hair.
When a person undergoes hair transplant surgery, hair follicles that have been transplanted to
portions of the scalp that were previously devoid of hair have a larger supply of blood than the
bald skin had initially.

Environmental Issues

Environmental causes for hair loss are common, but most of them can be avoided. Harmful
environmental factors include harsh chemical treatments, tight braiding, restrictive head
coverings and other accessories that put stress on hair follicles. Regular perming, dyeing, curling
and exposure to extreme heat can also contribute to hair loss.

Diseases that Cause Hair Loss

Although Androgenetic Alopecia is the most common form of hair loss, there are other causes.
There are lots of different medical conditions that can cause hair loss or “alopecia” (the medical
term for hair loss). Hair loss can also be caused by side effects related to medical treatments.
Alopecia has two categories:
• Non-scarring alopecia – hair has the potential to grow back.
• Scarring alopecia – there is a very small chance of hair regrowth even after treating this
disorder; hair follicles are permanently damaged.

Non-scarring Alopecia

Non-scarring is the most common form of alopecia. It has several different types:
• Androgenetic Alopecia (AGA)
◦ hereditary thinning
• Alopecia Areata
◦ hair loss in localized round patches, or all throughout scalp
• Telogen Effluvium (TE)
◦ diffuse scalp hair loss
• Anagen Effluvium Alopecia
◦ more rapid and pronounced form of TE

An example of non-scarring alopecia.

Alopecia Areata

After AGA and TE, Alopecia Areata is the third most common type of hair loss. AA occurs
when white blood cells mistakenly attack hair follicles in the body. When this happens, the
affected follicles are destroyed, resulting in localized bald patches. Because AA is an autoimmune
disease, its progression is sporadic and quite difficult to treat effectively.
Recently, researchers from Columbia University identified 8 genes that directly contribute to
Alopecia Areata. This discovery will help patients more accurately predict the severity of their
condition at the onset of the disease, and will facilitate the development of more effective
treatment options.


Diagnosing the Disorder

Like most other types of hair loss, the most prevalent symptom of Alopecia Areata is severe hair
shedding. In patients with AA, this shedding generally results in round, bare patches on the skin.
Hair loss from Alopecia Areata is quite variable; some sufferers experience much more hair loss
than others.

Treatment Options

There are still many experimental treatments that can be attempted, however. These include:
• Creams and shampoos for the scalp
• Minoxidil – applied directly onto the scalp. Minoxidil is more commonly used for the
treatment of pattern baldness but shows signs of effectiveness for AA.
• Irritants (anthralin or topical coal tar)
• Topical immunotherapy
• Steroids – specifically for AA treatment. Steroids are used to stop the body's immune
system cells from attacking and destroying hair follicles.
• Cyclosporine – a strong immunosuppressant made specifically to inhibit T cells (immune
system cells) from attacking the hair follicles.
There have also been studies published in the journal Archives of Dermatology (vol. 134, 1998;
49-52) that suggest aromatherapy oils may be effective in treating AA. The results thus far have
been limited, however, and this therapy is not widely accepted.

Telogen Effluvium

Hair loss caused by telogen effluvium hair shedding.

Telogen Effluvium (TE) is a type of non-scarring condition that results in excessive hair
shedding. Although TE is the second most common type of hair loss, there has been relatively
little research conducted to determine its underlying causes. Where the acceptable amount of
fallen hair strands is usually around 100, patients experiencing TE may lose over 400 per day.
Telogen Effluvium can affect people of all ages and races.
Causes:
• Postpartum alopecia (recently gave birth)
• Crash dieting/dietary deficiencies
• Physical trauma (e.g. car accident, etc.)
• Usage of anti-depressants
• Surgery
• Chronic stress
Treatments:
• Treatments for TE depend on what circumstances initiated the condition.
• For short-term TE that was triggered by having surgery or giving birth, follicles will start
to recover and hair will grow back within a relatively short time period.
• For persistent TE, the factor that is causing the condition must be removed (stress, dietary
deficiency, etc.)
Most TE conditions are normally not permanent and hair will eventually grow back. TE usually
lasts between 6 and 12 months.


Tinea Capitis

An image of hair loss caused by tinea capitis.

Tinea capitis is a fungal infection caused by dermatophytes (mould-like fungi). It is also known
as “ringworm of the scalp,” “ringworm of the hair,” “herpes tonsurans,” and “tinea tonsurans.”
Tinea capitis infection is contagious. It can be transmitted either by direct contact or through
contact with a contaminated item. Tinea capitis can occur at any age.
Common symptoms:
- Dandruff
- Bald patches
- Severe itching of the scalp
- Small black dots on the scalp
- Scaly lesions on the scalp that may be inflamed
Treatments:
Oral medicines are usually prescribed to treat tinea capitis infections. These generally require
usage with ketoconazole shampoo.
In order to avoid catching tinea capitis, it is important to maintain good hygiene, avoid contacted
with infected persons and shampoo the scalp regularly.


Thyroid Conditions and Hair Loss


The thyroid is one of the endocrine glands responsible for making hormones. It helps set our
metabolism, which distributes the different nutrients we receive from eating.
There are 2 types of thyroid disorder:
1) Hypothyroidism: This is the most common type of thyroid disorder. Symptoms include weight
gain and constant fatigue.
2) Hyperthyroidism: This is the result of a thyroid that is too active. This can lead to weight loss,
heart palpitations or heat sensitivity.


How Thyroid Conditions Affect our Hair


Thyroid disease (whether hyperthyroidism or hypothyroidism) can often cause rapid hair loss.
However, those suffering from thyroid disease may lose hair in places other than their scalp. For
instance, hair loss on the outer edge of the eyebrows is common.


Thyroid Disease Treatments


Treating thyroid disease means keeping thyroid hormones balanced and stable.
Thyroid treatments:
• Medical therapy with anti-thyroid drugs
• Radioactive iodine and the destruction of the thyroid gland
• Surgery to remove the thyroid gland


Scarring alopecia


According to the American Hair Loss Association, Scarring Alopecia (also known as “cicatricial
alopecia”) refers to a collection of hair loss disorders that may be diagnosed in up to 3% of hair
loss patients. Scarring Alopecia occurs around the world in otherwise healthy men and women of
all ages.
In Scarring Alopecia, hair loss happens in areas where scars manifest. No hair will grow back in
the area where scarring alopecia occurs.

Hair loss caused by scarring alopecia.

Lupus

Lupus is an autoimmune disease that causes organ tissues to become inflamed. At some point
during the development of the disease, 50% of those suffering from lupus also experience hair
loss. This mostly occurs in the temple area.
There are 2 types of lupus:
• Systematic lupus erythematosus (SLE) – may cause non-scarring hair loss. Once this
disease is successfully treated, hair eventually grows back.
• Discoid lupus erythematosus – can manifest anywhere in the body, but most commonly
on the head and neck. It may cause scarring hair loss and irregular patches of dark skin
(hyperpigmented) or almost white skin (hypopigmented).
Symptoms:
• Reddish facial rashes
• Sensitive to the sun
• Mouth ulcers
• Arthritis
• Low fevers
• Fatigue
There is no treatment for hair loss that is caused by lupus, but medications for the disease itself
may help restore hair growth.

Other Causes of Hair Loss


Hair Loss as a Result of Medication

There are a number of medications for which hair loss is a common side effect. Listed are some
of the most common ones (courtesy of Hair Loss for Dummies):
• Acne medications, such as isotretinoin (Accutane)
• Anti-inflammatory drugs, such as naproxen (Naprox), indomethacine (Indocin), and
naproxen (Naprosyn)
• Antidepressives, such as paroxetine (Paxil), fluoxetine hydrochloride (Prozac), and
sertraline hydrochloride (Zoloft)
• Beta blockers, such as nadolol (Corgard), propanolol (Inderal), metoprolol (Lopressor),
and atenolol (Tenormin)
• Birth control pills
• Blood thinners, such as warfarin sodium (Coumadin) and heparin
• Cholesterol-lowering drugs, such as gemfibrozil (Lopid)
• Gout medications, such as allopurinol (Lopurin or Zyloprim)
• Seizure medications, such as trimethadione (Tridone)
• Ulcer medications, such as famotidine (Pepcid), cimetidine (Tagamet), and ranitidine
(Zantac)


Rare Causes of Hair Loss

We have already covered the most common conditions that cause hair loss. In this section, we
will outline two conditions that are slightly less common.
OCD: Hair Pulling
Many people aggressively pull their hair when they feel frustrated or upset. This is a fairly
obvious reason for hair fallout.
Every once and awhile hair pulling can be understandable, but it can also be indicative of a
disorder known as OCD (Obsessive Compulsive Disorder); where one literally pulls out his/her
hair repeatedly.
This type of OCD is called Trichotillomania (TTM). Luckily, once pulling and tugging stops,
hair can grow back because TTM is a non-scarring form of hair loss.
TTM is more commonly found in children than adults and is most common among women.
Trichotillomania can be categorized into 2 groups:
1) Those who feel pleasure from pulling their hair / those who intentionally pull out their hair
due to itch or pain.
2) Habitual hair pulling; non-intentional.
Trichotillomania treatment options:
1) Cut hair short (this works well, especially with children)
2) Seek therapy with a professional (i.e. psychiatrist). Medication like Clomipramin (antidepressant)
may reduce symptoms and self-monitoring of the behavior can also be an option.

Traction Alopecia

Traction alopecia refers to the gradual loss of hair due to continuous follicular tension. People
who wear their hair in tight hairstyles (braids, ponytails, pigtails, etc.) are especially prone to
traction alopecia. Traction alopecia can also be a result of tight roller curlers and hair
straighteners.
Traction alopecia is more common in women than in men. Although reversible when it is caught
in its early stages, this form of hair loss can lead to scarring when it becomes persistent. The only
treatment for late-stage traction alopecia is surgical hair transplantation.

Ways to Conceal Hair Loss

Wig It

Wigs and toupees have been present for a very long time. In fact, their lineage can be traced back
thousands of years to ancient civilizations.
Wigs are convenient because they instantly provide thick hair and are available in almost any
style. Although modern wigs can look very natural, many men find them to be tedious and
expensive. People use hair replacement systems for different reasons. We will discuss hair
replacement systems in more detail during this chapter and provide tips on how to use them most
effectively.

A Brief History


Hair loss has been a nuisance since the beginning of time. A man’s hair has often been seen as a
symbol of stature; the fuller a man’s hair, the younger and more powerful he is thought to be.
Here is a short timeline that documents the progression of the hair system:
• 3200-3100 B.C. - a hair system was found in a tomb in Egypt (near the ancient city
Hierakonpolis); we have also seen Pharaohs wearing hair systems.
28
• 17th century – Julius Caesar tried wearing a hair system to cover up his hair loss. King
Louis XIII also began wearing wigs for his balding head and it soon became the “in”
fashion all over France.
• 19th century – the United States followed England’s use of hair systems.
• Present – in America alone, there is an estimated 350,000 men who wear hair systems.
Today, hair systems are heavily promoted. Salons and specialty shops regularly use and
sell hair systems to loyal patrons. Along with their rising popularity, the quality of hair
systems has increased immensely.


Hair Replacement Systems


Hair systems have come a long way since the powdered wigs of the 1700s. Today, the use of real
human hair provides high-quality hair systems with very natural textures, colors and
appearances.
Featured below are several positive and negative aspects of hair systems. They are intended to
help you decide whether or not a hair system is right for your personal situation. The pros and
cons of hair systems are as follows…
PROS:
• Relatively low cost compared to hair transplantation
• Quick results without surgery
• New technology has made hair systems less noticeable and more natural
CONS:
• Systems need regular maintenance and repair
• Insufficient durability
• Attachment mechanisms may cause accelerated hair loss
• Systems can lead to slight feelings of anxiety and paranoia (wondering whether or not
people can notice)
• Costs add up over time
Hair systems are delicate and should be regularly brought to your seller for cleaning and repair.
Systems usually only last for a year or two (even with routine maintenance) because a plethora of
different factors, including heat, perspiration, and strong shampoos, shorten their lifespan.


Where do I shop for hair systems?


Shopping for hair systems can be difficult. Because advertising is minimal, many people find it
hard to research their options. Still, conducting adequate research is a must.
Budget considerations:
When shopping for a hair system, cost is a major factor. Systems can be slightly less expensive
than hair transplantation, but maintenance and replacement costs can add up quickly. For this
reason, patients considering a system should be prepared for a long-term economic obligation.
The price of a hair system is usually determined by two factors – materials and quality:
• Human hair – high quality; has a natural look and feel; prices start at around $1200.
• Animal hair – made of goat or horsehair or other animals such as yak; moderate quality.
• Synthetic – least expensive option; least natural look and feel; minimal maintenance.
o Combinations of human hair and synthetic fibres are also available.
• Machine-made – low quality, low price; normally used for costume parties, not as a hair
replacement.
• Handmade – high quality, natural and realistic; more expensive than other systems.
Finding a specialty shop:
Once budget considerations are taken care of, it is important to locate a shop that can fit your
aesthetic and economic needs. Because word-of-mouth is limited in this industry, the best way to
locate a specialty store is via the internet. Browse the web for “wigs,” “hair systems,” or “nonsurgical
hair replacement” to find a list of outlets near you.
Before making a purchase, one should always ask the following questions:
• How long has this shop been in business?
• What is the owner's background in hair replacement?
• What materials do you use?
• Do you offer a warranty?
• What are the total costs including fitting and adjustments?
• How often will I need maintenance on this product?
• How long does a wig last?
***We know that hair systems need regular maintenance and that no wig, even the most
expensive one, lasts forever. So watch out for their answers! A competent provider should
answers these questions openly and honestly.
Choose your style
Choosing a new hairstyle can be overwhelming. There are so many colours, styles and lengths to
choose from that you may want to experiment with several.
When it comes to picking a look for your new hair, keep in mind the following:
• Choose a hair colour that suits your skin tone
• Choose a style that compliments the shape of your face
o Keep in mind, you can always ask the salesperson or stylist for help finding
the perfect hair for you.

Maintenance and Care for Your New Hair

Caring for hair systems is much more complicated than it seems. There are many maintenance
considerations that should be addressed before a system is purchased. Otherwise, the results will
be inadequate and may become noticeable. The following will help you achieve results that will
lead to an unnoticeable hair system:
• Keeping your hair on even when staying active
Even though hair system providers show advertisements of men wearing systems
while doing labor-intensive physical activities, one should be cautious doing so. It
might work on television, but not in person. Generally speaking, hair systems
work for sports that are not too extreme – like golf, tennis, aerobic exercises and
running.
• Maintain regular care
Hair systems need routine maintenance to look healthy and natural:
• Set up a schedule for your hair system to be washed either by yourself
or by a professional.
• If you have a weave, have it adjusted by a professional two or three
times a month so that it does not become loose as hair grows.
• If your hair system includes wefts, have it serviced before it comes
detached from the hair base.
• Regularly check for potential problems.
• Remember to also maintain a spare hair system in case backup back-up
is needed for any unforeseen circumstances.
• Know when it's time for a replacement.
In summary, keeping your hair replacement system clean and well-maintained is the key to a
natural result. Although maintaining one (or two) can take practice, it is essential that you create
and keep a schedule when it comes to caring for your hair system. This will help you avoid many
future problems such as discomfort, detection and damage.


Fibres, Sprays and Particle Hair Concealers

Hair concealers come in many different forms. These forms differ in how they are applied and
what results can reasonably be achieved. In this section, we will take a look at several different
types and help you choose the best concealer for your personal situation.


How Hair Concealers Work

Hair concealers can be a helpful hair loss solution for many people, especially those that are just
beginning to notice miniaturization. No surgical procedures are involved, detection is difficult,
cost is minimal and results are instantaneous. With many brands, particulates are merely
“sprinkled” on the hair and results are visible in seconds.
In this part, we will be talking about hair concealers; their benefits, their limitations and how
they can be used for optimal results.

An illustration of the before and after results of hair concealers.

The Wonders of Hair Fibres

There are 2 popular fibre products that can make hair shafts appear thicker: Toppik and Xfusion.
These products consist of organic keratin fibres (similar to what makes up the human hair). The
fibres cling to hair through static electricity, making thin areas instantly appear thicker and fuller.
These products are usually sprinkled on, an application process that usually takes less than a
minute.

Spray-on Hair Concealers

Spray-on concealers are quick and easy to use. Unlike fibre concealers, spray-on concealers
darken the scalp, filling in thin areas by creating the illusion of greater coverage. One popular
brand of hair concealer is Fullmore.
• Application is simple: Just hold the spray-can eight inches away from your head and
spray in an even pattern. The tiny fibres that match with your hair colour will naturally
stick to your hair and darken your scalp.
*Spray concealers provide instant results, but may not be as natural looking as fibre concealers.

Disadvantages of Hair Concealers

Hair concealers provide immediate results. They are also inexpensive and easy to apply. Still,
there are many limitations to concealers that buyers should be aware of:
− Sometimes application is messy.
− Concealers do not work on those that are completely bald. Fibres need at least some hair
to hold on to.
− Some brands (and several types, such as spray-ons) may not give a natural look.
− Concealers do not treat hair loss, they merely hide it.
If you are looking for a treatment for your hair loss, hair concealers are not for you. If you are
looking for a temporary solution that can provide you with instant results while waiting for
another treatment to show positive results, then hair concealers might be a great option.
***Remember, keeping your expectations realistic and familiarizing yourself with the
advantages and disadvantages of each hair product are important precautions that will help avoid
confusion and disappointment.

Research and Compare Before Buying

There are different kinds of hair concealers:
− Solid: an example of this would be DermMatch. Solid hair concealers are hard-packed,
coloured powders that are safe to use every day.
− Sprays: this kind of hair concealer can be difficult to apply, and you may need a little
practice before results are acceptable. Prothik and Fullmore are popular spray-on hair
concealers.
− Particles: the most popular choice among consumers. Particle hair concealers are not
creams, cover-ups or any other type of traditional cosmetic product. They come in
custom containers that allow you to shake their contents onto thinning areas. No rubbing
is involved and particles will quickly intertwine with existing hair. These particles will
be difficult to notice and will stay securely in place all day because of their static
electrical charge. Particle-based concealers provide the most natural results and last much
longer than substitutes. Popular brands are Nanogen and Toppik.
There is no doubt that hair concealers are convenient options for instant hair replacement.
Although price can be a problem for some people, concealers are relatively affordable on most
budgets (especially if they are used effectively and sparingly). Many people use DermMatch and
Nanogen together for the best results. The decision of whether or not one should combine
concealers in this fashion ultimately comes down to personal preference, however.
On a day off from work, experiment with different types of concealers (spray, solid, or particles)
to decide which option is the best for you.

Laser, Topical and Pharmaceutical Treatments

Prescribed Medications for Hair Loss

There are relatively few prescription medications available for the treatment of hair loss. At the
present time, there is no “miracle” medication that will completely halt the onset and progression
of hair loss. However, some treatments can provide dramatic improvements. In this section we
will discuss these therapies, outlining their advantages, disadvantages, costs and results.

Level Your Expectations

Many people are disappointed with the results they receive from hair loss medications because
their expectations are not realistic. It is normal to desire the best response, but it is important to
know that results are variable between patients. Before starting any medication, it is always
important to familiarize yourself with the general indications of each treatment.
***When pharmaceutical treatments are used, patience is a virtue. It is not unusual for results to
take between 6 months and a year to become visible. Medication must be taken in perpetuity in
order to maintain the results. For this reason, long-term cost and side-effects are major
considerations.

Finasteride (Propecia)

Finasteride as treatment for hair loss in men.

Finasteride-based treatments are best represented by the adage “an ounce of prevention is worth
a pound of cure.” While they can be quite effective in delaying the progression of male pattern
baldness, they do very little for people that already have extensive hair loss. Nevertheless, 5AR
inhibitors like Propecia and Proscar are currently the strongest weapons available in the war on
baldness.
History: In 1992, Finasteride was approved by the FDA for the treatment of Benign Prostatic
Pyperplasia (BPH). In 1997 Merck and Company marketed the product as a hair loss treatment
(although at a different dosage) after noticing its positive effects on hair growth. 13 years later,
Finasteride remains 1 of only 2 FDA approved medications for the treatment of androgenetic
alopecia.
Method of Action: The enzyme 5-alpha-reductase is involved in the conversion of testosterone
into its active form of dihydrotestosterone (DHT – the androgen primarily responsible for male
pattern baldness). Over time, DHT shrinks hair follicles until they no longer produce visible
hairs. Finasteride is a 5AR inhibitor. By reducing circulating levels of DHT, androgen receptors
in the hair follicle are protected from its adverse effects.
Usage: Finasteride is generally administered in the form of once daily pills. Results are not
typically visible for period of about 6 months (with optimal results occurring around 12 months).
After a period of 5-6 years, these results steadily diminish.

How Finasteride Works

Finasteride is primarily designed to halt the progression of hair loss. Finasteride is most
efficacious at the crown and vertex areas of the scalp, and generally does not affect (positively or
negatively) the frontal scalp.
Starting Finasteride early is the key to its success. At the first sign of hair loss, ask your doctor
about starting a regimen that includes Finasteride pills like Propecia or Proscar. Although new
hair growth will not be visible, it is important to remember that Propecia is working actively to
stop hair loss from becoming worse. Many patients quit Finasteride, thinking that it has not
provided any results, only to lose a great amount of hair shortly after discontinuing regular use.

Side-effects of Finasteride

As with other medications, there are several side-effects that can manifest while taking
Finasteride. Most of Finasteride-induced side-effects are temporary and will diminish quickly if
Finasteride use is discontinued. However, recent studies indicate that many side effects, such as
sexual dysfunction may in fact be permanent. This is still a subject of debate among industry
37
professionals. Although only a very small percentage of men experience side-effects while on
Finasteride, it is important to be aware of these possible complications:
- low sex drive
- temporary impotence
- decreased volume in the amount of semen
Some serious side-effects include:
- changes in breasts (lumps, pain, etc.)
- allergic reactions (itching, rash, hives)
- testicular pain
- permanent sexual dysfunction

Proper Dosing of Finasteride

1 mg of Finasteride is the recommended dose for the treatment of Androgenetic Alopecia.
Taking a higher dosage will not result in any additional benefits.
Finasteride is also available in a 5 mg dosage under the brand name Proscar. Some people
purchase Proscar (because it is less expensive) and cut the tablets into several pieces. Others
simply take the entire 5 mg. Once again, there is no scientific proof that this is as effective as the 1 mg dose of Finasteride.
***Pregnant women should not handle Finasteride. Broken or crushed tablets can be absorbed by the skin, leading to several serious complications.

Combining Finasteride and Minoxidil

The combination of minoxidil and finasteride is popular because both treatments can be used in
synergy. Minoxidil and finasteride work in different ways; minoxidil stimulates hair growth and
finasteride blocks the negative effects of DHT. Together, these effects can produce dramatic and
noticeable results.
Both medications must be used regularly, however, and the discontinued use of either product
will adversely affect results.


Minoxidil (Rogaine)

Minoxidil (distributed under brand names Rogaine™ and Regaine™) is perhaps the best-known
treatment for male pattern baldness. Minoxidil is unique because of its topical formulation and
availability to both men and women.
History: Minoxidil was initially used as a treatment for high blood pressure, marketed under the
brand name Loniten. After hair growth was discovered as a common side-effect, Minoxidil was
reformulated by Upjohn Corporation into a 2% topical solution. In 1988, after clinical trials had
concluded, Rogaine became the first treatment approved by the FDA with the indication of
treating androgenetic alopecia.
Method of Action: Although Minoxidil is the oldest existing medication for AGA, its precise
method of action remains unknown. Minoxidil is a potassium channel agonist; meaning that it
facilitates in the movement of ions between cells within the body. How this function relates to
male-pattern baldness is still being investigated.
Usage: Minoxidil is applied twice daily to the scalp, either in foam or liquid form. Patients often
report excessive shedding when they start regimens that include Minoxidil. This shedding period
is mostly temporary, however, and generally ceases once the body becomes accustomed to the
treatment.
Unlike Finasteride, Minoxidil has the ability to regrow new hair, albeit in very small quantities.
It is most effective rejuvenating hairs in the vertex and crown areas of the scalp. Minoxidil has
also been found to be quite effective in patients with diffuse thinning.
It should be noted that results will only be seen after 4 months of continuous application. Hairs
rejuvenated with Minoxidil are generally sparse, weak and often colorless. Once Minoxidil
treatment is stopped, these minimal gains are lost within a period of 6 months.
Cost: Rogaine can be purchased over-the-counter at most local pharmacies. A month’s supply of
treatment costs approximately 30 dollars, but bulk rates and discounts are available.

How Minoxidil Works

A diagram showing how minoxidil works on the skin.

 

Initially, Minoxidil was marketed as an oral medication for blood pressure. But doctors began to
notice hair growth as a popular side-effect.
Researchers developed a topical formulation of Minoxidil that is directly applied to the scalp.
Studies conducted since have supported the notion that Minoxidil can cause moderate hair
growth.
The exact mechanism that makes Minoxidil so effective remains unknown.


Side-effects of Minoxidil

Since Minoxidil (Rogaine) is a topical treatment, it is only used externally. Avoid getting
Minoxidil into your eyes, nose or mouth. Minoxidil should also be used singularily, as other
topical solutions might increase its absorption rate and exacerbate side-effects. Side-effects are
only minor, but be observant and consult your physician if you experience:
- skin irritation
- itching
- contact dermatitis
- dryness or flaking of the scalp (dandruff)
- nausea or lightheadedness
- swelling of the face, ankles, hands or stomach
- difficulty breathing
- rapid heartbeat
- chest pain

Applying Minoxidil Onto the Scalp

Doctors recommend that Minoxidil is applied directly to the scalp twice a day, once in the
morning and once in the evening. The solution should be applied to all the thinning areas to
regain lost hair.

Low-Level Laser Therapy (LLLT) is a new medical approach used to heal soft-tissue and
provide acute and chronic pain relief. The two primary devices that employ this technology in
relation to hair growth are the HairMax Laser Comb and the X5 Laser.

How Laser Therapy Works

Low level laser therapy is a non-invasive, painless treatment option for hair loss. The laser light
decreases inflammation and cellular metabolism. Cells of LLLT, according to further European
studies, increases the blood and lymph to the root of the hair and scalp, stimulating hair growth.
Whether or not laser therapy is truly effective is a common point of debate among industry
professionals.

Low-level Laser Therapy for Hair Loss

History: In 2007, the HairMax Laser Comb received a 501(k) clearance from the U.S. Food and
Drug Administration. It is currently the only medical device approved by the FDA to be
marketed to individuals suffering from certain classes of male pattern baldness (NW1-NW2V).
Method of Action: The HairMax Laser Comb claims to reverse miniaturization and stimulate
dormant hair follicles with laser photo therapy. This approach has been hypothesized to increase
blood circulation, promote cellular activity and reverse apoptosis (natural degradation of cells) in
various tissues throughout the body. Within the follicle this increased circulation fosters a
nutrient-rich environment and eliminates waste, promoting healthier hair overall.
It is also theorized that the concentrated light energy emitted by the HairMax Laser Comb
increases the production of adenosine triphosphate (ATP). This molecule provides cells with
usable energy, increasing their propensity to grow and repair.
Cost: The most popular LLLT device, the HairMax Laser Comb, costs roughly 500 dollars. It
can be purchased via the HairMax website and comes with a two-year warranty. Various
payment options are available.

Handheld Laser for Home Use

Handheld home use laser.

Usage: Using the HairMax Laser Comb is quite easy. The device is held at the front of the
hairline and slowly moved backward towards the crown at four-second intervals. This
progression is then repeated in the opposite direction. For best results it is recommended that this
process is performed for 15 minutes, 3 times per week.
Results experienced by the HairMax Laser Comb are minimal at best. There is insufficient data
to suggest definitively that this process works, but a recent clinical study performed by the
company confirmed limited efficacy with no major safety concerns.
Advantages of handheld device:
• Less expensive and more convenient than doctor visits
• may permit the laser better access to the scalp
Disadvantages of handheld device:
• can be easy to forget and tedious to use on a regular basis
• it may be difficult to determine whether or not the treatment is working and when use
should be discontinued.

Potential risks of LLLT

Handheld lasers are considerably safe devices for hair/scalp use. Although there are no scientific
studies that specifically promote their efficacy, handheld lasers can provide results for some
people. No safety issues have ever been reported.

Advanced Hair Loss Solutions

Hair Transplant Surgery

Hair Transplantation is currently the only method of restoring terminal hair growth to patients
with established baldness. Although the process still has many limitations, recent advances in
medical technology have made hair transplantation much more desirable. So long as it is
performed by a reputable surgeon, a hair transplant can provide noticeable and natural results.
There are two primary methods of hair transplantation surgery, defined in terms of how hair
follicles are harvested from the “safe zone” donor area:

Hair transplant sketch diagram.

1. Strip (FUT, FUSS) – A hair-bearing strip of scalp is surgically removed from the back of the
patient’s head. This strip is microscopically dissected into grafts (small pieces of tissue) that are
subsequently transplanted into balding areas. The Strip method of hair transplantation results in
an unavoidable linear scar that spans from ear to ear. These scars are easily concealed by existing
hair, but are clearly visible if hair is shaved down. This treatment has an approximate recovery
period of 2 weeks.
2. Follicular Unit Extraction (FUE) – Hair follicles are individually removed from the patient’s
donor area with tiny punches typically .7 mm to 1.2 mm in diameter. These follicles are then
inserted into the patient’s recipient (balding) area. Since this micro-removal harvests hair
follicles one by one, the resulting scars resemble miniature dots. These scars, like those that form
after Strip excisions, are usually concealed by existing hair. This treatment has an approximate
recovery period of 7 days.

Are you a candidate for hair transplant surgery?

Not everyone is a good candidate for hair transplant surgery. It is very important not to make
impulsive decisions with regard to permanent and invasive procedures.
Candidates for hair transplant are mostly men suffering from male pattern baldness, not other
underlying conditions.
In general good candidates have:
• Male pattern baldness
• Sufficient hair in the donor area to provide to the balding areas
• A flexible scalp (referred to as “donor laxity”)
• Coarse hair (hair shaft diameters with reasonable bulk)
• A good and clear understanding of the procedure
• Reasonable expectations
• Enough money to afford future procedures when future loss occurs

Those Who Don't Qualify For a Hair Transplant

People with the following characteristics are most likely not good candidates for hair
transplantation:
• Those who have unhealthy donor supply
• Most women (women tend to lose hair all over the head, including the occipital scalp
where there should be healthy hair for donor use)
• Those with low hair densities, fine hair or inelastic scalps
• Those with limited budgets (continuous surgeries may be needed over time as hair loss
progresses)
• People expecting perfect, thick and youthful results

Those Who May Qualify For a Hair Transplant

The most important determinant in the ultimate success of hair transplantation surgery is a
healthy donor area. Men who are over the age of 30 with a recognizable pattern of hair loss are
traditionally the best candidates. Still, all patients must do extensive research before undergoing
the procedure.
Unfortunately, many surgeons will take advantage of patients that experience hair loss at a very
young age (under the age of 25). In general these patients are susceptible to panic and make
impulsive decisions for instant gratification. Young males should think very carefully before
undergoing a hair transplant surgery – future loss may be iminent!
Ask yourself the following questions:
• Have I considered all other options?
• Have I tried available medications and waited to see the results?
• Have I thought about the amounts it will cost?
• What pattern of hair loss will I ultimately develop?
• Will my results look natural over time?
Hair transplant doctors must always make sure that their patients are emotionally and
psychologically prepared for surgery.
A word of advice: Never undergo an invasive procedure unless you completely understand the
potential risks and limitations.
Those with realistic expectations who are well-educated with regard to hair loss treatment
options are generally the most satisfied with their results.

Having Enough Hair for a Transplant

The primary limitation to hair transplantation is donor availability. Hair transplants are often
described as “zero-sum,” meaning that hair must be removed from one area in order for it to
grow in another. No new hair is actually created, so there is a limited number of hairs that can
actually be moved in this fashion. Patients with large bald areas generally do not have enough
grafts in the “safe-zone” to complete a full restoration. If patients do not plan for future loss,
results may look unnatural.

Considering the Costs

Hair transplantation is generally considered a cosmetic procedure. As such, hair transplants are
not covered by most insurance agreements.
The results of a hair transplant will last a lifetime. For this reason it is crucial to hire the best
possible surgeon to carry out the procedure. Hair transplants become expensive over time, but
that should not deter you from hiring a quality doctor. It might sound harsh, but allocating extra
money towards your procedure is preferable to permanent disfigurement.
Before choosing a doctor, conduct several consultations with various surgeons. Ask
representatives how much their clinic chargers per graft and how much procedures similar to
yours typically cost. Also ask patients that have undergone surgeries with various doctors about
their experiences. Communicate your expectations with your doctor and only choose a surgeon
that is open, honest and concerned with your future satisfaction.
***Although the internet can be an incredible resource for this type of research, always see
several results in person before choosing to undergo a transplant. Costs will add up over time, so
you need to be prepared physically, financially and emotionally to begin the “hair transplant
journey.”

Choose the Right Doctor

Not all hair transplants are the same. Patients considering hair transplant surgery should research
several doctors and make an informed decision based on a variety of personal factors. Given that
the results will last a lifetime, price and location should be nonentities.
Companies like Bosley Medical and New Hair Institute are recognized around the world for their
extensive ad-campaigns and large market share. Unfortunately, their legacy has been tainted by a
history of false advertising and patient dissatisfaction. Because of their large size and highvisibility,
these organizations are often unable to provide the personalized care that patients
deserve during invasive elective procedures.
Although Bosley and NHI have many happy customers, patients considering this hair
transplantation need to be aware that there are other options available.
Looking for a place to start your research? The following physicians are world-renowned for
their consistent, high-quality results and innovative contributions to the hair transplant industry:
Dr. Rahal (Ontario, Canada) – Strip
www.rahalhairtransplant.com
Drs. Hasson and Wong (Vancouver, Canada) – Strip
www.hassonandwong.com
Dr. Alan Feller (Great Neck, New York) – Strip and FUE
www.fellermedical.com
Dr. Bijan Feriduni (Hasselt, Belgium) – Strip and FUE
www.hairdocs.info
Of course there are many other good surgeons, but this list should serve as an important starting
point.

Meeting For the First Consultation

Hair transplantation is not well regulated. For this reason, there are countless clinics that deliver
sub-par results and charge exorbitant prices. Conducting several consultations with various
offices is crucial to finding the best surgeon for you.
Your first meeting should start with these steps:
1. Basic information about the procedure should be provided to you by the doctor or by a
knowledgeable representative (preferably one that has undergone the procedure)
2. Fill out a basic medical history form to determine your candidacy for the procedure
3. A qualified nurse practitioner/assistant or physician may assess your hair loss
4. A more knowledgeable interviewer may try to determine whether your expectations are
realistic
If possible, the consultation should be conducted with the surgeon present. Most reputable clinics
will oblige this request. During the consultation, the doctor should:
− educate you about the procedure
− become familiar with your medical history
− conduct physical examination
− discuss options, persuade you to consider all other options
− estimate the number of surgeries it will take to achieve the desired result
− review the total costs
− provide you with a large list of references, testimonials and results

The Right Questions to Ask

Questions to ponder on before making the final decision to undergo an operation (from Hair Loss
for Dummies):
1. Did the doctor spend time answering all your questions? Did the doctor provide you with
clear explanations and address your long-term goals?
2. Is the doctor experienced in the hair restoration field? How is his reputation in the
medical community?
3. Did the doctor provide you with a document with the full outline of his prognosis? It is
important that the complete details of his proposal are written in paper just in case you
forget some information.
4. How many surgeries will be required?
5. How will the total cost be computed?
6. Are you being pressured to undergo the surgery?
***If you ever get the feeling that a surgeon is trying to “sell” you a hair transplant,
immediately leave. A competent surgeon will be concerned with your health and
safety, not the bottom-line.

Seeing Results for Yourself

This step might seem obvious, but many patients neglect to see results in-person before
undergoing a hair transplant. The only way to develop realistic expectations is by seeing several
patients in-person. Pictures and videos can be deceiving, always see results up close.

Before Surgery

Here are some of the most common pre-surgery recommendations (from Hair Loss for
Dummies):
− Ask if there are any food or drinks you should or should not have before the surgery.
− Stop taking any aspirins or blood thinners (if you're on any) 10 days before the surgery.
− If you are takingany other medications, consult with your doctor prior to the surgery.
− The doctor might ask you to use anti-bacterial soap on your hair and scalp the night
before and the day of the surgery.
Review all the documents you have before the day of the surgery. This should be the proposal we
talked about in “Asking the right questions”. Make sure everything is clear and jot down specific
questions you want to ask the surgeon before your procedure starts.

During Surgery

Hair transplant surgeries are conducted under local anaesthesia so you will be awake during the
entire surgery (although somewhat sedated).
The procedure can either be done sitting up in a surgical chair or lying down. Typical surgeries
last between 4 and 7 hours, depending on the number of grafts being transplanted. Before the
surgery starts, your doctor will design a hairline and discuss hair distributions throughout the
scalp. Your doctor will also review the pertinent legal papers and consent forms. Only after these
steps are completed should you be given a sedative.
Local anaesthesia should be administered with relatively little pain. Aside from small, mosquitobite
shots, there should be minimal discomfort.

Possible Complications

Make no mistake, hair transplantation is an invasive surgical procedure. You need to be
extensively familiar with the risks and shortcomings of hair transplantation before considering it
as a treatment option. Here are some of the most common risks:
• Anaesthesia reactions
General anaesthesia is rarely used for this procedure.
Here are some risks and their percentage that a patient may experience:
- allergic reactions (less than 1 percent)
- irregular heartbeat (less than 1 percent)
- heart attack within one month after the surgery (less than 0.001 percent)
- sensitivity to epinepherine (less than 1 percent)
- temporary light headedness (less than 1 percent)
• Wound healing
Wound healing is a variable occurrence. Wounds take time to heal and often to not heal
perfectly. Here are some wound irregularities that may apply to your donor and recipient
areas:
- temporary effects of redness, pinkness or superficial crusting
- crusting of the skin around the suture edges
- stretched, widened scar, thickened or raised scar
• Pain
Pain is limited during hair transplant procedures due to the use of anaesthesia. Still, mild
discomfort might arise.
Staples or sutures are used to close the patients' wounds. When the staples or sutures are
removed, the pain related to the surgery goes away.
• Numbness
The cutting of fine nerve fibres in the scalp can cause numbness which will slowly
disappear over several months.
Your doctor's experience in hair transplant surgery is of great importance in avoiding
temporary or permanent sensory defects in the back of the head. The probability of such
defects occurring is increased in those that have undergone more than one surgery.
• Swelling
Swelling after surgery is only experienced by a small number of patients. Placing ice
packs or any cold compress over the frontal area may lessen the swelling.
If swelling should happen, it will appear 3-4 days after the surgery and will only last for 2
days at most. Ask your doctor about possible remedies for moderate swelling.
• Infection
Contracting an infection during hair transplantation is rare. Surgical teams generally
administer antibiotics at the beginning of surgery to reduce the probability of patients
acquiring infections. Still, the possibility exists.
Here are some symptoms of infections:
- swelling
- redness
- pus or tenderness
- chills or fever
***Contact your doctor promptly if any of these symptoms occur.

Hair Care Post-Op

In order to stay healthy and ensure maximum graft survival, it is important to take special
precautions after your hair transplant surgery. Every individual surgeon will have specific postoperative
instructions. You must completely adhere to these guidelines in order to achieve the
best result.

Recovering After Anaesthesia

The local anaesthesia used during hair transplant surgeries is similar to that used by dentists.
The effects of this anaesthesia will only last for a day. Although hair transplants are outpatient
procedures, it is not advisable to drive during the remainder of the surgery day.
After 4-6 hours, mild discomfort will arise, but the greatest discomfort is felt during the first
night after the surgery. This typically subsides over several days.

Keeping Your Head Crust-free

Do not be afraid to touch your grafts. The secret to good post operative care is keeping the
recipient area clean. In order to do this, gentle contact must be made.
Crusts will persist if you have poor washing techniques. You can safely remove the crusting
within the first two days after surgery if you follow these simple steps (from Hair Loss for
Dummies):
− Never rub the transplanted area.
− Shampoo once or twice daily. Use a sponge filled with water and shampoo in a gentle
rolling motion over the recipient area (NEVER back and forth as it may pull out the
grafts). A back and forth motion is safe on the donor area.
− Don't rinse your hair with water directly from the shower. Use your hand as a barrier and
place it between the shower head and your scalp. Let the water run off your hand and
onto your transplanted areas. Pat the area dry with a clean towel.
− Do not let the grafts stay wet for too long because the area may swell. Once the scalp
dries however, any raised bumps will disappear.

Hiding Your Head

It is normal to feel self-conscious after hair transplant surgery, and visible wounding can make it
hard for many patients to face the public with confidence. Going to work, seeing family and
explaining the situation to significant others can be very difficult.
Luckily, many patients can undergo hair transplants little visible scarring. If hair is kept long
before surgery, it can be combed down over the removed donor area. The recipient area has
minimal scarring, so very few people will notice that any surgery occurred. Two weeks after
surgery, a hair transplant becomes very difficult to detect.

Limiting Your Amount of Physical Activities

Discuss with your doctor if you are going to participate in any form of physical activities because
the impact of exercise differs between people. A simple jog or exercise may be acceptable, but
extreme sports can damage newly transplanted hair.