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ANDROGENETIC
ALOPECIA
(FEMALE PATTERN HAIR LOSS)
The
most common type of hair loss seen in women is androgenetic alopecia,
also known as female pattern alopecia or baldness. This is seen
as hair thinning predominantly over the top and sides of the head.
It affects approximately one-third of all susceptible women, but
is most commonly seen after menopause, although it may begin as
early as puberty. Normal hair fall is approximately 100-125 hairs
per day. Fortunately, these hairs are replaced. True hair loss occurs
when lost hairs are not regrown or when the daily hair shed exceeds
125 hairs. Genetically, hair loss can come from either parents side
of the family.
There
are two different types of hair loss, medically known as anagen
effluvium and Telogen effluvium. Anagen effluvium is generally due
to internally administered medications, such as chemotherapy agents,
that poison the growing hair follicle. Telogen effluvium, is due
to an increased number of hair follicles entering the resting stage.
The most common causes of telogen effluvium are:
Physical stress: surgery, illness, anemia, rapid weight change.
Emotional stress: mental illness, death of a family member.
Thyroid abnormalities.
Medications: High doses of Vitamin A --Blood pressure medications-
- Gout medications.
Hormonal causes: pregnancy, birth control pills, menopause.
When
the above causes of telogen effluvium are reversed or altered you
should see the return of normal hair growth.
DIET
CONSIDERATIONS
Hair loss may also occur due to dieting. Franchised diet programs
which are designed or administered under the direction of a physician
with prescribed meals, dietary supplements and vitamin ingestion
have become popular. Sometimes the client is told that vitamins
are a necessary part of the program to prevent hair loss associated
with dieting. From a dermatologists's standpoint, however, the vitamins
cannot prevent hair loss associated with rapid, significant weight
loss. Furthermore, many of these supplements are high in vitamin
A which can magnify the hair loss.
PHYSICAL
AND EMOTIONAL STRESS
Surgeries, severe illnesses and emotional stress can cause hair
loss. The body simply shuts down production of hair during periods
of stress since it is not necessary for survival and instead devotes
its energies toward repairing vital body structures. In many cases
there is a three month delay between the actual event and the onset
of hair loss. Furthermore, there may be another three month delay
prior to the return of noticeable hair regrowth. This then means
that the total hair loss and regrowth cycle can last 6 months or
possibly longer when induced by physical or emotional stress. There
are some health conditions which may go undetected that can contribute
to hair loss. These include anemia or low blood count and thyroid
abnormalities. Both of these conditions can be detected by a simple,
inexpensive blood test.
HORMONAL
CONSIDERATIONS
Hormonal changes are a common cause of female hair loss. Many women
do not realize that hair loss can occur after pregnancy or following
discontinuation of birth control pills. It is important to remember
that the hair loss may be delayed by three months following the
hormonal change and another three months will be required for new
growth to be fully achieved.
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MYTHS RELATED TO HAIR LOSS
- Frequent
shampooing contributes to hair loss.
- Hats
and wigs cause hair loss.
- 100
strokes of the hair brush daily will create healthier hair.
- Permanent
hair loss is caused by perms, colors and other cosmetic treatments.
- Women
are expected to develop significant hair loss if they are healthy.
- Shaving
one's head will cause the hair to grow back thicker.
- Standing
on one's head will cause increased circulation and thereby stimulate
hair growth!
- Dandruff
causes permanent hair loss.
- There
are cosmetic products that will cause the hair to grow thicker
and faster.
- Stress
causes permanent hair loss.
- Hair
loss does not occur in the late teens or early twenties.
- Hair
loss affects only intellectuals.
- There
is a cure for androgenetic Alopecia.
These
are only a few of the common myths heard by physicians and other
hair loss specialists on a daily basis. The AHLC suggests that you
first have your hair loss diagnosed by a competent dermatologist
who sees hair loss patients on a regular basis. Once you know the
diagnosis you will have a better understanding of exactly which
treatment option may be best for you.
TREATMENT
OPTIONS
Accepting
and learning to live with hair loss. Professional counseling may
be of help.
Perms, color and other cosmetic options to give a fuller appearance
to hair.
Medical therapy-- Rogaine (topical minoxidil). Rogaine is the only
FDA approved medication currently available for female pattern hair
loss.
Hair Replacement Surgery- - Modern surgical techniques have made
transplantation for females a viable treatment option providing
they are qualified candidates and have realistic expectations.
Hair Additions -- Modern forms of hair additions have also made
recent improvements in simulating a natural appearance. A consultation
with a skilled specialist to discuss your options is advised.
MALE
PATTERN HAIR LOSS
(Androgenetic Alopecia)
Dating
as far back as history will take us, baldness has been a part of
the aging process that many men fear the most. Before Rogaine, hair
transplants and hair additions, men coped in various ways from magic
ointments to the styling of their hair. Julius Caesar grew his hair
long in the back and combed it all forward. Napoleon did the same
thing. Somehow we often disregard history and the fact that this
has been an age old condition. We can't imagine or accept the fact
that there is not a cure.
Understanding
the cause of male pattern hair loss may better indicate exactly
why it presently has no cure.
ANDROGENETIC
ALOPECIA -- the modem medical term for either male or female
pattern hair loss -- can be broken down in two parts.
First, Androgenetic, consisting of ANDROGEN (Any of the various
hormones that control the appearance and development of masculine
characteristics such as testosterone). And GENETIC--the inheritance
of genes from either the mother or the father's side of the family.
Add AGE, which when coupled with genetics, represents a time clock
that will signal the hair follicle to produce an enzyme named 5
alpha reductase. When the testosterone present in the follicle combines
with the enzyme 5 alpha reductase, it produces dihydrotestosterone
(DHT). Hair follicle receptors are sensitive to DHT and thereby
start the process of male or female pattern hair loss.
TREATMENT
OPTIONS AVAILABLE FOR ANDROGENETIC ALOPECIA
Learning to live with hair loss. Often the assistance of a professional
counselor can be helpful in coping with hair loss.
Hair
styling and cosmetic techniques such as permanent waves and hair
colors. The proper haircut alone can make a vast difference in diffusing
hair loss.
Rogaine,
the only FDA approved topical treatment for male or female pattern
hair loss. Although Rogaine is not effective in stimulating new
hair growth in many males, it appears to be more effective in retarding
hair loss in a substantial amount of both male and females.
(Available in the U.S. only through prescription).
Hair
Additions have made many advances in both appearance and more secure
attachment methods.
Hair
Replacement Surgery has also made many advances towards more natural
appearing results.
A combination
of #4- Hair Additions with #5 - Hair Replacement Surgery.
To
find out more about options #3, #4, #5 & #6 contact the American
Hair Loss Council for consumer's guidelines to finding qualified
specialists.
Chemotherapy
Related Hair Loss
Chemotherapy consists of the administration of drugs that destroy
rapidly reproducing cancer cells. Cancer cells are some of the most
rapidly reproducing cells in the body, but other cells, such as
those which contribute to the formation of hair shafts and nails,
are also rapidly reproducing. Unfortunately, while chemotherapy
drugs preferentially destroy cancer cells, the drugs also can destroy
those cells responsible for normal growth of hair and nails. Cancer
patients sometimes shed the hair and nails during treatment. Chemotherapy
drugs are poisonous to the cells of the hair root responsible for
hair shaft formation. Usually, the hair is lost rapidly in large
quantities during treatment. NO HAIR GROWTH STIMULANTS, SHAMPOOS,
CONDITIONERS OR OTHER COSMETIC TREATMENTS CAN PREVENT OR RETARD
THE HAIR LOSS. THE GOOD NEWS, however, is that once chemotherapy
is completed, the hair usually grows back.
HOW
AND WHEN HAIR GROWTH OCCURS
Adequate
hair growth may take six months to one year.
Returning
hair may be different from the hair that was lost. Due to the absence
or alteration of pigment the hair may grow back white, gray or a
different color. Eventually, as the pigment cells return to normal,
the original color should return.
It
is common for the new hair returning to be finer in texture initially,
but like color, the texture should return to its original thickness.
It is sometimes difficult to be patient, but as the body is returning
to normal and getting over the significant insult, time is a necessary
ingredient.
HAIR
CARE TIPS FOR NEW HAIR GROWTH
Shampoo
hair twice weekly with a mild shampoo such as those intended for
dry or damaged hair.
The
scalp should also be thoroughly massaged to remove any scale.
Follow
shampoo with a conditioner for fine or limp hair.
Avoid
high heat from blow dryers to the hair and skin.
Keep hairstyling to a minimum due to the new hair being prone to
breakage. Brushing, combing, hair pins and curling should all be
minimized. Curling appliances should be avoided as the scalp is
very tender following chemotherapy.
Hair styling aids such as mousse, hair spray, hair spritz, styling
gel and sculpturing gel may be used in moderation. It is best to
select products with normal to light holding ability as the high
hold products may not be completely removed with mild shampoos.
Hair styling aids can build up on the hair shaft resulting in dullness
and possibly scalp disease.
CHEMICAL
CURLING OR PERMANENT WAVING
Chemical
curling or permanent waving of the hair is best avoided until the
hair is at least three inches long. It is difficult to get nice
curls if the hair is much shorter even with a healthy head of hair.
For best results use a mild body wave with short processing time.
The
hair should be wrapped loosely on the largest size curling rod possible.
Looser curls will be less damaging to the recovering hair shaft,
and will thus minimize hair shaft breakage.
WARNING!
Many patients cannot tolerate the permanent wave solution on their
scalp for some times up to one year following chemotherapy. This
extreme sensitivity of the scalp is not unusual during the regrowth
period. In such cases permanents should not be attempted.
HAIR
COLORING- Hair coloring may also be irritating to the sensitive
scalp and should be avoided until the scalp sensation returns to
normal. Once the scalp is healed, the hair may be colored.
PERMANENT
HAIR COLORINGS ARE THE MOST DAMAGING TO THE HAIR SHAFT and should
be minimized in favor of semi-permanent hair colorings which
are gradually washed away with four to six shampooings.
BLEACHING
to lighten the hair color should not be attempted at this time.
Additionally, the hair should be altered only 3 shades from its
regrowth color as more drastic color changes could increase hair
shaft breakage.
The
period of time following chemotherapy treatment is a time of
healing and rebuilding for the body. Hair growth will gradually
return, and with time most patients regain a healthy head of hair.
Following some of the enclosed hair care tips will insure that the
regrown hair looks and feels its very best!
CHILDREN
A
word of caution to parents with children undergoing chemotherapy.
The absence of hair can be used in a positive manner. It can signal
to others “handle with care.” While undergoing chemotherapy
the child has a low blood count and can be bruised easily.
The
insistence of parents, although well meaning, for a child to wear
a wig or prosthesis can signal the message “YOU’RE NOT
O.K. THE WAY YOU ARE!” A child should have all of the options
but the choice should be his or hers. Hugs and tender loving care
along with your physician’s suggestions for care are
all that is necessary from the parents.
TREATMENT
OPTIONS
At
the onset of hair loss, (the very first hair fall), some patients
choose to shave the total scalp. Their reasons are the following:
The
elimination of uncontrolled hair fall and embarrassing shedding.
Some
feel that total baldness is more attractive than the spotty hair
loss (especially males). Many believe that after 25-50% hair loss,
males or females look healthier with no hair at all.
Shaving
facilitates prosthetic hair security and comfort (i.e. vacuum bases,
two way tape and other adhesives for hair prostheses. What may seem
extreme to some, may not be for others.
Attractive
head coverings are available from a variety of manufacturers as
an alternative to wigs
HAIR
PROSTHESES
Insurance
sometimes covers a wig or hair prosthesis.
Assume
you will lose all of your hair when you begin chemotherapy treatment.
By doing so your advance planning will assist you considerably.
(Custom made wigs and hair prosthetics may take from 6 weeks to
4 months to be delivered and made for you.)
Your
first wig or hair prosthesis should duplicate your hair as closely
as possible. (Be conservative in color, length, thickness and style.)
In chemotherapy related hair loss avoid the following: weaves, hair
extensions, hair integration and hair intensifiers. You will require
a full prosthesis and not a partial hairpiece.
WHAT
IS HAIR REPLACEMENT SURGERY?
Modem techniques in hair grafting (the most frequently performed
method of transplanting hair) are performed by taking small pieces
of hair bearing scalp from the back and sides of the head and moving
them into holes and slits on the top of the head. This technique
is commonly called hair grafting, punch grafting, plug grafting
or hair transplantation. This procedure is performed by many physicians
and in many clinics throughout the world. No new hair is added -
hair and skin are relocated.
Grafting
techniques include the following types of grafts:
Micrograft
- 1 to 2 hair grafts into needle holes.
Small slit grafts- 3 to 4 hairs into a slit recipient site.
Large slit grafts-S to7 hairs into a slit recipient site.
Small minigraft -3 to 4 hairs into a small recipient site.
Large minigraft - 5 to 8 hairs into a small round recipient site.
Standard round or square grafting - Approximately 9 to 18 hairs
in a 3-45 mm size graft placed into a slightly smaller round recipient
site.
(Marketing terms used by different physicians and businesses may
be confusing. In hair transplants all grafting procedures will be
one of the above or a combination.)
HOW
MANY GRAFTS DOES IT TAKE TO GET ADEQUATE COVERAGE?
A square
of paper 3.3 inches long will give you a realistic idea of the area
that would require approximately 500-600 standard grafts. This will
indicate the importance of strategic planning and precise placement
of grafts to give the illusion of more hair.
THE
FUTURE
Instead
of basing your decision on the immediate results, keep in mind androgenetic
alopecia (male or female pattern hair loss) is progressive. Outstanding
results may be obtained today that may not be there in the future.
Plan your hairline and density conservatively as though you were
already in the future.
FLAPS
Although
flaps transfer the greatest amount of hair in the shortest amount
of time, the surgery is more extensive and specific skill and experience
is required by the doctor.
A much
larger portion of hair bearing skin (a flap) is transferred from
sides and back to the balding area. The flap remains attached at
one end through which it maintains nourishment. Therefore the hair
in the flap can grow continuously unlike grafted hair which falls
out before regrowing.
SCALP
REDUCTION
The
surgical removal of bald areas of the top of the scalp. Usually
multiple scalp reductions are done, with success dependent on the
laxity of the scalp and the limited degree of hair loss as well
as the age of the patient. Almost all scalp reductions are done
with a combination of either flaps or grafts.
SCALP
EXPANSION & SCALP EXTENSION
These are done to accommodate scalp reductions when the laxity of
the scalp is too tight. Expansion is also used to prepare individuals
for flap surgeries.
THE
ESSENTIAL INGREDIENTS NEEDED
TO ACHIEVE SUPERIOR RESULTS
THE
PATIENT - Qualified in respect to age; degree of hair loss, type
and color of hair, cause of hair loss, his expectations
as well as the ability to afford and endure the multi-sessions often
required to obtain excellent results.
THE PHYSICIAN - Credentials, experience, aesthetic vision, honesty
and the ability to educate you BEFORE surgery are all important
elements necessary for successful hair transplantation.
The experienced, qualified physician will be able to inform you
as to being properly qualified for hair replacement surgery.
It is best to consult with several physicians offering hair replacement
surgery before choosing one. Prepare your questions prior to the
consultation.
To
insure the that the physician is capable of offering the results
you desire, ask to meet a patient or two that he/she has recently
completed. Seeing the results firsthand helps to insure you are
in capable hands. This is far superior to photos or advertising.
CHECK THE FOLLOWING FOR REFERENCES
Your
city, county and state medical societies.
Your family physician or any physician you see professionally or
socially.
Your local medical library
Your hairstylist
The Better Business Bureau
HOW MUCH WILL IT COST?
Cost
will vary with the individual's degree of hair loss and the individual
physician. Cost can vary from $4,000.00 for a lesser degree of hair
loss to over $20,000.00 for more extensive hair loss.
WHOM
DO I CONSULT WITH PRIOR TO HAIR TRANSPLANTATION?
Although
there are knowledgeable consultants, the AHLC recommends that you
do not start any type of surgery without consulting with the physician
who will be performing the surgery.
Preferably
the surgeon should be a resident of the community. It is normally
beneficial to continue sessions with the same surgeon and to have
him or her available throughout the entire period of surgical procedures.
WHAT
IS A NON-SURGICAL
HAIR ADDITION?
Any
external hair bearing device added to existing hair or scalp to
give one the appearance of a fuller head of hair. (i.e. Hair weaves,
hair extensions, hair pieces, toupees, non-surgical hair replacements,
partial hair prostheses, hair wefts, etc.) Devices may consist of
human hair, synthetic fiber or a combination of both.
HOW
ARE THEY KEPT ON?
Partial
hair additions are attached in a variety of techniques. Either the
existing hair or the skin are the anchor sites.
EXISTING HAIR ---Weaves, fusion, bonding, cabling, micro links,
beading are general terms of techniques all attached to the client's
existing hair. All are used to provide more security for the active
life-style. They are all dependent on the growing existing hair
and therefore must be reattached or tightened as the existing hair
grows.
TO
THE SKIN---Includes adhesives such as two-sided tapes and new
improved waterproof liquids.
Vacuum bases- held on by suction through an air tight fitting
foundation.
SURGERY--Tunnel
grafts are small skin grafts taken from a donor site and formed
into a small loop which is used to insert removable inserts permanently
attached to a hair addition.
SUTURES
-- Not seen as an ethical means of attaching a hair addition.
Subject must live with constant pain, and the sutures often cause
infections and permanent scarring.
(Individual marketers of hair additions often use terms other
than those listed above for exclusive marketing and advertising
purposes.) The above terms are the most widely used attachment
methods.
With
the non-medical techniques, we suggest the following:
Although
most adhesives are safe, it is best to have a patch test done by
a dermatologist if you have a history of allergies. Even if you
do not, its always best to have a patch test done in advance.
Hair weaving and other types of attachment that place prolonged
tension can cause permanent hair loss at the anchor site on fine,
thin hair. (Even temporary clips attached too tightly can also cause
permanent hair loss). When performed properly on the qualified client,
hair weaving does not cause hair loss.
Proper hygiene must be maintained when wearing a hair addition for
extended periods of time. It is essential that one must clean the
scalp and hair on a regular basis.
In reviewing ALL treatment options, the hair addition is the safest
means of obtaining additional hair. (This excludes sutures and tunnel
grafting procedures.)
CAN
THEY APPEAR NATURAL?
Modern
day advancements in products along with the technical skills of
an experienced specialist are essential. The most important factor
is the client him/herself. He or she must spend the required time
to keep the hair addition looking its best.
HOW
MUCH DO THEY COST?
Depending
on the experience and knowledge of the specialist, the materials
and design, the price can range from $750.00 to $2,500.00 for a
quality custom-made hair addition. Although insurance does not cover
male or female pattern hair loss, it may cover the cost of a hair
addition when the hair loss is due to disease or abnormalities.
WHAT
IS BEST, HUMAN HAIR OR SYNTHETIC?
The
choice depends entirely on the attachment technique and life-style
of the individual. Either human hair or synthetic, or a combination
of both can be used successfully when matched to the proper individual.
A competent specialist will advise you as to the proper components
for your individual life-style.
HOW
DO I FIND THE BEST SPECIALIST
IN MY AREA?
Although
the American Hair Loss Council does not endorse or recommend any
individual firm, we can supply you with a list of AHLC specialists
in or near your specific area. All AHLC members sign a statement
that they will honor our Code of Ethics which is centered around
the protection of you, the consumer. Request the American Hair Loss
Council Source Book.
ARE
HAIR ADDITIONS MADE FOR BOTH MEN AND WOMEN?
Yes,
with significant increases in sales by the female consumer. Instead
of opting for wigs, women with female pattern hair loss are now
selecting the more comfortable and natural appearing partial hair
additions or integrated units.
WHO
SHOULD AVOID PARTIAL HAIR ADDITIONS?
Males
and females undergoing chemotherapy and newly diagnosed patients
with alopecia areata should request a full prosthesis. Due to the
nature of chemotherapy, all hair will likely be lost and a partial
hair addition may be useless. With alopecia areata, the condition
may not be stable and focusing in on one area may only be a temporary
solution.
HAIR
ADDITIONS IN COMBINATION WITH HAIR REPLACEMENT SURGERY
Temporary
usage of hair additions while undergoing lengthy hair transplant
sessions is becoming increasingly popular with many men and women
who do not wish to appear "under construction" while in
public.
Many successful transplants will take from 1 to 2 years to complete.
COMBINATIONS
Many
men and women do not qualify for hair transplantation because of
unrealistic expectations given their amount of available donor hair.
Increasing in numbers are those who opt for partial transplantation
and a partial hair addition. EXAMPLE: An individual with extensive
baldness who wants to wear his hair straight back. He may opt for
a transplanted front hairline only (due to lack of donor hair available).
Behind the newly transplanted front hairline, the individual might
have a hair addition designed so that he can now comb his own hair
straight back into the hair addition.
COVERAGE
OF SURGICAL DEFECTS
Have
you ever seen the results of a bad hair transplant? An individual
who had a poor hair transplant may find his only choice is a hair
addition.
OTHER
USES FOR HAIR ADDITIONS
Full
Hair Additions/Prostheses - chemotherapy, alopecia totalis, alopecia
universalis, ectodermal dysplasia, lupus, trichotillomania, telogen
effluvium, monilethrix, bums, radiation and other abnormalities
of the hair and scalp.
Partial
Hair Additions - Male pattern hair loss, female pattern hair loss,
bums, radiation, stabilized alopecia areata, surgery defects, traction
alopecia, lupus and other abnormalities of the hair and scalp.
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