Dandruff is common among humans. It isn’t simply a dry flaky scalp. In fact, it was found to have a fungal component to it. The fungus responsible is Malassezia Globose. There are three components to be considered to actually have dandruff:
Very early experiments in the 1970’s provided data that treating the scalps of severe dandruff with antibiotics did not help much however treating them with an antifungal definitely decreased the dandruff. Over time however a resistant strain was created from over use of Nystatin (anti-fungal) and this resistant strain caused more flaking of the scalp than the previous strain.
Host susceptibility or an individuals susceptibility to the fungus plays a major role in dandruff. Some individuals simply do not get dandruff. When Oleic acid is placed on the scalp, it will induce dandruff on only the susceptible individuals. The non-susceptible individuals are not affected by Oleic Acid.
Sebum is the last component involved in dandruff. Sebum is produced by the sebaceous gland. Over production of sebum occurs sometimes at birth which it called cradle cap. And puberty can cause an increase in sebum. Sebum is composed of fatty acids, triglicerides, wax esters, cholesterol esters and squalene. When secreted the sebum is broken down by microbes in the scalp. The more sebum, the more dandruff can occur, including during stressful situations.
In today’s times, there is a plethora of antifungal shampoos, that are targeted for dandruff and specifically the fungus causing the dandruff, thus promoting a healthy scalp.
The human head and or scalp can produce somewhere in the area of 100k and 150k hair follicles at any given time. These hair follicles are in groups of 2, 3, 4 and single hairs and randomly arranged on the scalp however the hairline normally only has 1’s and 2 hair follicles. Outside of the scalp the human body can have up to 5 million follicles however these are usually no where near the length, coarseness or have the same growth cycle as scalp hair.
Ninety percent of scalp hairs are in the “growth” phase where upon the hair grows continuously up to as long as 7 years in time before shifting into a resting phase also known as telegen phase. This phase is much shorter and lasts only a few months. Every hair follicle repeats this process approximately between 10 and 20 times over a period of a lifetime. The rate at which hair grows is approximately a 1/2 inch per month or 0.45mm per day.
Another interesting fact is that humans can lose anywhere from 80 to 100 hairs per day. This may seem to alarm people however it really isn’t much when comparing this to the amount of hairs on a scalp.
Chief Surgical Technologist
Platelet Rich Plasma or commonly known as PRP. PRP came onto the scene in the 1970’s/80’s in other parts of healthcare particularly in cardiac surgery. Fast forward into the 2000’s it was used to treat anything from sports injuries to nerve damage to even skin a hair procedures. But what is PRP?
PRP is basically drawing ones own blood in tubes coated with an anticoagulant such as sodium citrate, adding thrombin to concentrate platelets and centrifuging the blood to separate the PRP from the red cells. This effluent is rich in growth factors: platelet derived growth factor, transforming growth factor beta, fibroblasts growth factor, insulin like growth factor 1 and 2, vascular endothelial; growth factor, epidermal growth factor, interleukin 8, keratinocyte growth factor, and connective tissue growth factor. These growth factors are what the human body uses in the healing process in any injury. So it was proposed to be useful in all types of surgeries. But are their hard facts for its efficacy in hair restoration?
There are many hair restoration clinics offering this PRP treatment from a fee of free to thousands of dollars per treatment. And unfortunately there seriously is not much data to back up its use for what the claims are being said at this time. Some clinics are stating the hair is regrown in the extraction sites of FUE. Some say the newly transplanted grafts benefit from a rapid regrowth. But again there really is no data to support these claims.
It the International Society of Hair Restoration “FORUM” publication; Volume 27 Number 1: (http://www.ishrs.org) there is a very small section that has two studies that completely conflict each other. One was a single-blind study that was performed but not repeated and boasted that 75% of the patients in the PRP group had a rapid regrowth in the donor area as compared to non-PRP groups. However no statistical data was shown, and again the study was not repeated.
A second study was a double blind study that showed no significant difference in the either group although a slight difference (13.3%) of subjects that showed some improvement. Again this was a study that was published without a repeated study.
So what does this mean in terms of IF PRP is a scam? The jury is still out because of poorly design studies, repetition in these studies. True placebo on the same patient; that being half of a scalp treated and the other half untreated. This must be completed on hundreds of patient. The data collected must be consistent. This is the true scientific method.
Since the discovery of the correlation of high cholesterol and coronary artery disease, there was a push to lower cholesterol through diet. Until big Pharma discovered a class of drugs called “statins”. These statins are very popular among cardiologist, internal medicine, and general practices in the U.S.. Some of the common names are Lipitor, Atorvastatin, Simvastatin, Zocor, and Crestor. These drugs can lower blood cholesterol as much as 50% and especially low density lipoprotein (LDL), which is considered the “bad” cholesterol or the cholesterol that can clog arteries.
Cholesterol and hair go hand in hand because cholesterol is needed for the construction of hair. In fact cholesterol is needed and is a precursor for many hormones such as testosterone, aldosterone, estrogen, progesterone, and cortisone. These aforementioned hormones work together to control blood pressure, sexuality and many other activities including the construction of hair. One can surmise that lowering blood cholesterol could theoretically cause issues with hair. Now combine this with a person that has male pattern loss, then one could further put together a hypothesis that statins possibly could accelerate hair loss.
Well there are many reports of hair loss with certain statins, however there really has not been full studies on this correlation. Some statins such as Crestor have less reports of hair loss but others do have more complaints of hair loss. At this time the mechanism of action is not yet known and big Pharma certainly does not want you the consumer to know that their might be a correlation. The best thing to do is to discuss this with your primary care physician or you hair restoration surgeon. There are medications that combat hair loss such as finasteride or Propecia and there are surgical options such as a hair transplant.
Chief Surgical Technician
Scalp Micro-pigmentation also known as SMP is a modified tattoo using small dots instead of shading as in a typical tattoo. In hair restoration it has become very popular because it can cover old horrific scalp scars or even darken the scalp when there is less density so that ambient light doesn’t shine on the scalp and have a “see through” look. SMP costs differently from company to company and depending on the amount of scalp that needs to be tattooed. Even more popular these days is the follicular unit extraction (FUE) scalp micro-pigmentation combination. The reason for the combination is that the SMP allows for less grafts to be used and the FUE procedure prevents a linear scar from the standard strip excision hair restoration. In this example this patient had previous strip scars and also opted to perform an FUE and then have an SMP. HE cut his hair short and it changed his appearance. This patient was unable to wear his hair short because of his old scars however now he can.
This case was from February 2016 and he received 1000 FUE. He will opt for another 1000 FUE to add into his scars on the back of his scalp.
Hair follicles reside in the scalp in natural groups that comprise of 1- even 7 follicles per grouping. As seen in the picture above there are examples of 1-4 hair follicles per grouping. The question proposed in the late 1990’s in hair restoration was could these groups be divided and thusly individual hair follicles survive outside their group? So with that, a physician by the name of Dr. Beehner took on a task of “intact vs. non-intact follicular unit study. For 1 year, Dr. Beehner took 3 volunteer patients and transplanted follicle hairs from natural groups and divided follicle groups into a bald area (devoid of all hair follicles) and followed these patients for a full year. The follicles grafts were divided uniformly and chilled in saline. The grafts were all transplanted within 3 hours of harvest of the tissue.
The results were eye opening. The overall statistical average of yield between the intact and the non-intact follicular units was insignificant! In other words the growth was basically the same for each group. So what does this mean for hair transplants? It shows that the individual units and even a 1 haired graft divided from a 2 haired graft would grow just fine. Even a 5 haired graft divided into a 2 and a 3 haired graft would theoretically grow just as well.
After this repeatable study was published there was a now drive to be able create softer and more natural hairlines
Trichotillomania as defined is a person that compulsively pulls their hair from their scalp, arm, eyelashes, leg, or even pubic region. This compulsion leads to complete irreversible hair loss and bald areas on the affected area. Although this disorder is found even in infants, its more common in adolescents and adults. There are two sub groups of Trichotillomania; 1. Focused and 2. Automatic.
Automatic trichotillomania is where a person is unaware that they are pulling their hair. If fact it is described as a “day dreaming” of sorts and continually pulling the hair until it comes out. The focused trichotillomania is where a person may become stressed or depressed and begin the act of pulling on the hair, whereupon when it is finally pulled out a gratification occurs.
Children seem to fall into the category of the automatic or unconscious type of trichotillomania. Often children are seen to be in a “trance-like” state and literally do not realize the repercussions of this irreversible hair loss. Children mainly pull hair from the scalp and not other areas. In severe isolated cases a “sleep-isolated trichotillomania” is where an individual will unconsciously will pull out their hair during sleep. Most children outgrow this disorder.
Sometimes the hair pulling goes in a manic form where the individual will suddenly pull his/her hair for hours, days months. Other times the hair pulling rituals stop and do not occur for hours, days, or months. This disorder can be associated with other problems such as anxiety, post traumatic disorder, depression and/or obsessive compulsive disorder. There may be a genetic tie as well.
A hair transplant can be used to treat this disorder, however a full year of psychiatric treatment as well as a full year of no pulling must be completed at most experienced and fully disclosing clinics. Then it would be fine to transplant the affected area.
Shock Hair Loss (shock loss) is a real phenomena that should be spoken about before you undergo a hair transplant. While it is a rare occurrence across the board in all hair restorations, it occurs in approximately 5% of all cases. But what is it and what causes it?
Shock loss is where there is a loss of natural hair whether it is from the donor area or the recipient area AFTER a hair restoration. Shock hair loss is not specific to any one procedure because we have seen it in the donor area in both FUE and FUT surgeries. More commonly it occurs in the recipient area. The cause of shock loss is normally from trauma. The trauma can be physical, chemical, or both.
Chemically this has been known to happen with extended use of epinephrine, lidocaine, and Marcaine during unusually long cases beyond for instance 12 hours. One particular case we observed that occurred at a severely inexperienced clinic from California caused a massive shock loss due partially to an 18 hour (unheard of and unnecessary) excessively using local anesthetics in a donor area. This was a single case that we have ever witnessed in 16 years that this happened in an FUE but this proves that it can happen when clinics with little to no experience perform FUE.
In this particular situation, the patient had had a previous strip FUT and so we theorized that circulation above the strip line was compromised and the excessive anesthetics and FUE procedure led to the massive shock loss. In our opinion if the clinic had performed a normal FUE with normal time constraints then this patient would probably NOT have had this shock loss. Fortunately this type of shock loss is temporary and should have grown back after three months time. However consider this poor guys situation with work, family and friends with donor shock loss for the tree months. It must have been devastating to say the least.
Strip FUT donor shock loss is rather rare but it does occur as well. It is where trauma from the excision of the tissue or even poor suturing techniques can lead to shock loss along the donor scar line. In these cases, again the hair should grow back in three months time.
Last but not least the more common shock loss can occur in the recipient area where the grafts are transplanted. This happens usually during the incision process (making the places for the grafts). Physically traumatizing the follicles that are native are accidentally crushed or cut by the incision making tool. Inexperienced clinics will not use proper magnification to see the native hairs so that he/she does not make an incision on top of a native follicle. Proper magnification ensures making an incision next to a native follicle. Shock loss due to this also should return in three months time although there is one caveat that could have an influence on it’s return. If the patient had miniaturized hairs where the shock loss is occurring, then these hairs might not come back. This is because miniaturized hairs are already on their way out. Shock loss due to trauma may speed up that process.
The bottom line is that Shock Hair Loss is exceedingly rare (<5%) of all hair restoration cases combined. In addition to that, 99% of shock loss cases are temporary with the average of hair return being three months time. And lastly, you as a person seeking a hair restoration should make sure the clinic you choose has years of experience and explains to you thoroughly about ALL complications due to a hair restoration.
A Scalp Reduction defined is simply the removal of a balding area in lieu of transplanting hair into it. Literally surgically removing the balding areas and suturing the wound to reduce baldness. The historical aspect of this procedure dates back into the 1970’s. The first mention of this was in Montreal, Canada and a second person close by named Martin Unger also from Canada began writing about this procedure.
Unfortunately, no one had performed research into the long term outcomes of this procedure and instead, Martin Unger showed the Bosley Corporation and suddenly this procedure was the holy grail of solving hair loss in 1979. In a matter of a few years thousands had been performed as the procedure proliferated. As a consequence to not having an internet, the word about the truth of this procedure trickled out and by the 1980’s there were many men suffering from:
1. Stretch back: In a matter of 2 to 3 months, the central scar would stretch approximately 40% of the portion excised out. So an additional scalp reduction had to be performed. In fact 3 to 4 scalp reductions had to be performed to reduce the balding area and join the sides in the hair.
2. The Central Slot: A secondary problem occurred when the two sides of hairs were joined and the hairs right at the scar line went into two different directions. This left a slot look which was hard to correct if at all and definitely unable to style the hair.
3. The White Side Walls: Basically pulling the scalp together at the top of the scalp pulled the scalp AND hair away from the sides of the head upward thus leaving a rather unsightly look of NO hair above the ears.
The backlash: Thousands of men unhappy. Massive scarring from experimental variations such as the Brandy lift.
Today the Gold Standard in Hair Restoration since the entire industry left the scalp reduction is the FUT and FUE procedures since 1997.
Smoking cigarettes is obviously a topic that has serious implications among many different disciplines in medicine. Smoking cigarettes can cause problems with lungs such as COPD and even is suspect to cause lung cancer. Smoking also has effects on the heart and circulation. Circulation is our topic for this blog and what its effects may be on hair loss.
There are research studies that has found links to cigarette smoking and hair loss. This should be concerning especially if you are a man that has a familial history of baldness. If you are a young man in your early teens or twenties and are beginning to see hair loss you may want to take into consideration why smoking may add to your hair loss.
Evidence has shown that smoking 20 or more cigarettes per day will cause an impediment of blood flow to the extremities and including the scalp. Hair follicles need blood flow for oxygen and nutrients from the tiny capillaries that are connected to the bulb of the follicle. Cigarette smoke contains many chemicals (List below from www.wikipedia.com) that has effects on blood vessels and especially capillaries. Capillaries are the smallest vessels that are connected to each follicle. When a person smkes a cigarette the capillary will restrict and clamp down. This in turn cuts off circulation to the follicle. The follicle can withstand this briefly however over a continuous period of time and couple that with the male pattern baldness that is genetically caused… a speeding up of hairloss can occur.
Cessation of cigarette smoking should be considered for many clinical reasons. Hair loss is now one of them. Below are two links of articles that support this and also the list of chemicals from the largest tobacco companies in the world:
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