I am recovering from trichtilomania and the hairs that are gone that place stopped growing hair all together and you can see the scalp, I was wondering if there is a miracle to help me regrow or start regrowing my hair…my currant shampoo is nioxin and nizorel…

Patients who’ve suffered from trichotillomania for awhile may damage or even remove the hair roots by excessive pulling, making non-surgical hair regrowth next to impossible.
Hair transplants will restore the hair, but it is very common for those with trichotillomania to resume pulling out the hair after the transplants begin to grow.
First strp will be to address the trichotillomania from a medical/psychiatric medication or therapy approach and solve the underlying problem. Once the patient knows that the cause of the trichotillomania has been fully addressed (fo a long period of time, then the reward can be a hair transplant to put their hair back.

Dr. Cole has already setup a clinic that offers CIT (Cole Isolation Technique) in Korea.  The purpose of offering CIT in Asia is to educate other hair transplant doctors to produce excellent results with the minimally invasive procedure.  Our operation in Korea is a part of our efforts to provide quality hair transplant surgery to all individuals in Asia.  The most recent technology in CIT hair transplant surgery is created at the main office located in Atlanta, Georgia. The Cole Hair Transplant Group offices all have the same common goal of satisfying each patient and making their visit a wonderful experience.

For additional information on low-cost CIT in Korea & China, contact The Cole group: Contact Form.  The Cole Hair Transplant Group offers free in-person consultations with Dr. Cole.  The Cole Hair Transplant Group o

ffers 18+ years of hair transplant experience and provides high-quality hair transplant procedures.  It also specializes in the non-strip scar method of hair transplant and reconstructive hair transplants.

This news originally posted on forhair.com in the following URL:
CIT in Asia news in forhair.com

I am a 36 year old American Indian female with very long black hair. I have noticed that i have been losing my hair on top by my center part. I have bi-polar disorder, i have been on the same prescription for two years. I have always had extremely thick hair and now it feels so thin. What do you think could be causing this and what can i do to get my hair back to it’s normal fullness? I do not get periods anymore, i had a uterin embolisation three yrs ago. I am very vain about my waist length hair. Please help me.

There are many medications that can cause hair loss. It would be helpful to know what medications you are on.

With women hair loss can begin in your 30s, 40s, or 50s due to normal female pattern hair loss. The cause of this form of hair loss is not as well understood as male pattern hair loss. It will generally leave an intact frontal hair line with loss beginning just behind this. Over time it continues into the top and the very back of the top scalp. It can also involve the sides and back of the scalp in some women. All women with hair loss should rule out hormonal diseases including hyperthyroidism, hypothyroidism, and an elevated level of male hormones. You should also be checked for iron deficiency anemia that can come from heavy periods though this does not seem possible in your case. Laboratory testing includes a T4, TSH, FSH, LH, DHEA, CBC, Ferritin level. Some connective tissue diseases such as lupus can cause hair loss so you might check a WESR and an ANA. If you are having joint problems such as arthritis, this might point to a connective tissue disease.

If all these tests are normal, consider two 4mm biopsies of the affected area that should be read by someone who is a dermatopathologist experienced in reading hair biopsies. It is important to obtain intact hair follicles when taking these biopsies and they must be taken from where you are having hair loss. These can often identify the cause also tell us if you have a more difficult form of hair loss to treat such as a scarring alopecia such as lichen planopilaris.

Someone experienced in evaluating hair loss might be able to help evaluate possible cause of your condition by performing an examination of the hair shaft diameters and a hair pull test.

I heard the tern “Donor Recharging”, what does it means?

CIT donor recharging is a method of preparation where each extracted scalp follicular unit is replaced with a body hair follicular unit. The exchange of these grafts isn’t always one for one but the purpose of CIT donor recharging is to replete the donor area and help the donor area from being too thinned from harvesting with hair transplant. CIT donor recharging also stimulates the production of melanin, a pigment in the donor area. Donor recharging allows patients with higher degrees of hair loss to maximize their scalp hair donor supply and fill-in the absence of extracted follicular units. The results with donor recharging are subject to the same limitations as BHT and results cannot be guaranteed. CIT donor recharging results vary from patient to patient and the appearance of the results is unpredictable.

Resources:

Click here to read more about donor recharging

Rechargeable donor area ?

Donor After 6,000g Harvested with donor Recharging

If I’m not totally sure to have a hair transplant, what are some good resources to help understand the process?

Understanding the process is of the utmost importance when considering hair transplant surgery. Many men have wound up with less than desirable results due to lack of information and/or the sales techniques of unscrupulous clinics.
The forhair.com website is a good place to start. There is a voluminous amount of information there with which a person may educated themselves about hair transplantation, the various methods of “harvesting” the hairs for transplant, and also about expectations and outcomes of the procedure.
The non-surgical treatments for hair loss are also discussed at length; this website has more written information that most potential candidates could read in many weeks. The information is truthful, in depth and free from the slick marketing techniques of many clinics.

Check these Hair transplant information and resources:
Forhair.com–Hair Transplant Information
Forhair Hair Transplant Forum
Hair Transplant Guide
IAHRS.ORG
Hair Transplant Information on this site:
Hair Transplant On Hair Loss Press

Are many hairs transected as the surgeon makes extractions on the donor during hair transplantation?

Good question. The answer is that it varies wildly from surgeon to surgeon and clinic to clinic. We take great pride in having achieved some of the lowest transection rates in the hair transplant world.

Our transection rates with CIT are averaging less than 3% which is very low compared to the industry as a whole. Some published papers on FUE and other single graft harvesting techniques cite transection rates as high as 50 to 70% from their own clinics! This is a travesty, and should be mentioned only to be condemned. .

Single blade strip surgery has average initial transection rates (in our hands) of about 2%; again, it is all over the map depending upon the experience and expertise of the surgeon, and at least for strip, upon the experience and expertise of the surgical staff. One of the most important variables is the surgical technician staff; after the strip is harvested, the tissue is processed by these technicians. Their transection rates can range from 5% up to as much as 50% of the grafts, and is dependent on their training and skill. This is why quality control in a hair transplant practice is so very important (but unfortunately is not the norm by any means). In our practice, CIT has a lower transection rate <3% than strip; in strip cases, our technicians’ transection rates, plus the transection during harvest, averages 5%. So for us, even this relatively low strip transection exceeds our even lower CIT transection!
Remember that the training and expertise of hair transplant surgeons runs the gamut, from beginners with virtually no experience to speak of, to veterans with thousands of cases and thousands of quality results under their belts. However, there is one other factor that comes into play, which is standards. A physician may have years of experience, but set the standards in his practice very low. In this situation, sloppy work and poor technique, combined with minimal staff oversight and quality control, may produce high transection rates and other conditions that lead to mediocre results at best, and cosmetic disasters at worst.

We are proud of the high quality and dedication to excellence that we are known for!

I have heard that it is possible through gene therapy and biological methods to make straight here permanent curly. Do you know if this is on the market yet for cosmetic purposes and if so please can you provide contact details of the clinics.

There are many potential gene therapies being investigated now. One company in San Diego (which researchers do not name) is supposedly working on a cream to help regrow hair using gene therapy. They evidently are also working on one to turn grey hair back to its dark original color, and one to cause a “permanent permanent” (straight hair turned curly). These are a ways off from being released to the public, if they even prove to be effective.
If they do work, at least partially, they would then have to go through FDA approval, which may take years and cost tens of millions of dollars (although there would certainly be plenty of investors in a product that would cure baldness, for example).
Also, there are many ethical questions that are only now being raised regarding gene therapy. Some have to do with creating “cosmetic or aesthetic perfection” for those who can afford it, and creating an underclass of “cosmetically challenged” humans, who cannot.

Certainly no one is going to forbid someone from marketing a cure for baldness, or a “genetic permanent”; however, these possibilities are at this point just that: possibilities. The press tends to take these things and run with them, but they are often exaggerated and made to seem closer to mass consumption than they really are.

Can beard hair be removed through hair transplantation?

There are two ways to remove hair from the donor area. One is by strip method. The other is by removal of individual follicular units. The strip method is not acceptable because it will leave a permanent linear scar. Individual follicular unit removal is acceptable and does work. In fact we often employ this for transplant of beard hair to the scalp. We also use this method to remove unwanted facial hair. This can occur with some forms of face lifting where the hair from the beard is relocated behind the ear. This can be a very difficult and unnatural place to get a razor to shave the beard. We have also used this method to relocate eyebrow hair from a location well above the eyebrow and re-implant the hair into the thinner medial aspect of the eyebrow to create a natural eyebrow transplant.

You should first consider laser hair removal for unwanted facial hair. This may require more than one procedure to remove all the hair. Laser hair removal is only indicated when you have pigmented hair. If there is no pigment in the hair or the hair has turned “grey”, you laser hair removal will not work. Removal of facial hair by CIT or FIT may require more than one pass, as well, to remove all the hair.

I’m a woman over 40 and was diagnosed with androgenetic alopecia ten years ago. My 16 year old is losing her hair. I took her to the derm and was told that it is stress related. The doctor said that she did not see the genetic pattern. My daughter is losing her hair on the sides above the temple and also in her part. Isn’t this genetic pattern? I don’t know if I buy the whole stress theory. The doctor spent 5 minutes with us and ran her fingers through my daughters hair. Can stress hair loss mimic androgenetic?

There might be a stress component, but it is not a common cause of hair loss except with alopecia areata, which tends to be well circumscribed and circular in shape. There are different kinds of stress. There is mental stress and there is physical stress such as a severe illness or significant trauma. Physical stress can produce a global form of hair loss.
The fact that mom has the diagnosis of AA increases the chance of the daughter having a similar problem, however at 16, she is a bit young for that. Other possibilities are polycystic ovary syndrome; one would expect other signs of androgen excess with this (facial hair, acne, increased body hair, etc). The sides of the scalp are not a common area for androgen excess to present itself. Female pattern loss can involve the sides of the scalp however.
I am unsure what is meant by “above the ear”. If the loss is in the fronto-temporal recess, it could be androgenetic alopecia; if it is on the sides (parietal), that is unlikely and it may be a diffuse patterned or unpatterned alopecia.
The loss through the area of the “part” may indicate a Ludwig pattern of AA, which is a more typical “female” pattern, as opposed to the “male” pattern of temporal recession and loss of the hairline.
A thorough workup with a physician specializing in hair loss would be your best option at this point. You should look for any changes in density or hair diameter. You could follow this up with a biopsy properly performed. Make certain to perform some lab tests to look for anemia, androgen excess, iron deficiency, or a thyroid dysfunction.

I am 27 and first noticed that i had hair loss about 24..My dad also has hair loss so its should be caused by genetic. About 1 year ago,i already had very little hair . I have been using Minoxidil 5 %, and Propecia, and it helps to control the hair loss but recently i realize that there is excessive hair loss even though i use it faithfully. I tried other ways of different treatment but i dun see any results. I recently saw this product “provillus’,its main ingredient is saw palmetto. It is said that it is similar to propecia but it doesn’t affect your sex drive ,Is this true? Can you please advise me on what other methods can i try,i recently just bought a laser set,do you think it will be useful?

Hair Loss is a multi-factorial problem. This is probably why some people respond well to DHT inhibitors such as Propecia and why others do not respond as well. Some people respond well to Minoxidil or Rogaine, while others do not. We recommend treating your hair loss with as many options as possible to cover as many potential causes of hair loss as possible.

You can purchase saw palmetto over the counter in a health food store and take the pills each day. Saw palmetto is a DHT blocker. We recommend you use this.

We also recommend you shampoo with Nizoral Shampoo at least once a week. Leave the product on for 5 minutes prior to rinsing. The product is a topical agent so it needs skin contact to do its job. We also recommend Hair Cycle shampoo and conditioner 4 to 5 times per week. Again, leave this product on 5 minutes prior to rinsing. Hair Cycle is an anagen stimulator so it will help you keep the hair in the growing phase longer. This should help you prolong the life of your hair. Hair Cycle is also healthier for your scalp since it lacks sodium laurel sulfate, which is the agent creating lather in most shampoos. This lather is the equivalent to engine degreaser and it is not healthy.

Other products you might consider include topical spironolactone.

The laser comb is expensive, but should help. We are working on a less expensive model.

You might find that decreasing the dosage of your Propecia to three times a week on Monday, Wednesday, and Friday has less of an affect on your sex drive.

Please note that Rogaine Foam is a new version of topical minoxidil and seems to produce less skin irritation. It also is better absorbed and does not leave your hair oily or greasy the way most minoxidil solutions do.

I am now 19 months post surgery from a body hair transplant with you. I noted significant improvement at the 9 month mark, but minimal since then. Can I expect more growth and more density from the body hair transplant I had with you 19 months ago. I live in Spain.

It’s always difficult to say if hair always grows. It really does not matter if it is head hair to body hair. It’s a bit easier when you place head hair on a bald scalp, however. The same is true for body hair. With body hair we’ve learned a few things. One is that lower densities can produce better yields than higher densities. What does this mean? Well, sometimes a yield of 60% to 70% is the best you will see with body hair and it could be 30 to 40%. With head hair on the other hand, the yield is always 90% or less. Usually the lowest you will see is around 70%. Again high densities seem to play a role in lower density with head hair. I’ve seen body hair results that surely look like 90% yields however. We also know that anagen hairs produce a higher yield than telogen hairs. I’m not certain why.

You have to understand the dynamics. Head hair is 80 to 90% in anagen. Body hair is 40 to 60% in anagen. Therefore, in reality, the best you should see from a head hair transplant is 80 to 90% and the best you should ever see is 40 to 60% from body hair. That does not mean that 10% of head hair and 40 to 60% of body hair died. It means that those percentages should always be resting or in telogen. As one hair cycles out, another cycles in and begins to grow. That’s the dynamics.

I think that most body hair transplant results to date seem to follow scalp hair in terms of growth, though we did recently get a 4 year photo of a patient that certainly seemed much better than his 14 month photo. What this means is that at about 8 to 12 months, the result probably peaked with minimal improvement thereafter.

Your comments about hair length are very important. One thing I’ve found with body hair is that while it does grow longer than on the body, it does not seem to grow more than twice the length it grew on the body. It also grows slower than scalp hair, but faster than body hair. Body hair grows about 0.2 mm per day while scalp hair grows about .44 mm per day. The same body hair transferred to the scalp grows about .34 mm per day. This is important in that it shows body hair does indeed begin to take on more of a scalp hair character when moved to the scalp. Since it will not grow as long as scalp hair, a shorter hair style should ultimately be preferred. This is what we have found. Individuals with significant loss such as yourself note better coverage with longer hair because they need the longer hair to cover all the bald surface area. Ultimately, however, you have a comb over appearance. With the addition of body hair density, you are able to groom your hair shorter, yet still have a better overall appearance without the comb over affect. The shorter hair style will generally make you appear younger as you mature and certainly looks more professional than the longer comb over hair style.

I have a seemingly strange question. Has anyone tried taking advantage of medical donors with hair transplant procedure?

That’s a good question and one that we’ve thought about previously. I suspect one of the big concerns with this would be trying to match the donors. With life and death situation such as kidney and liver transplants, medical insurance will take care of the testing. With hair transplants, the procedure is not medically necessary so most insurance companies shy away from paying for hair transplant surgery. When someone dies, they check their organ donor status. If they are a donor, they are tested. If there is a suitable match in another state, the organs are air lifted to the patient. Such protocol for hair would be extremely expensive. Also, one often has immunosuppressive medications to prevent organ rejection. This would be quite expensive to the cosmetic surgery patient, as well since insurance companies would not pay the fee for on going immunosuppressant treatment.

My reason for writing to you is over the past 8 to 9 months I have noticed an “excessive thinning” of my hair. My hair has also been dried out and brittle. I am a natural dark haired individual and do bleach my hair. I have been doing so for over 20 years with no negative affect.
I moved to south Georgia in September - into an older home, which has well water. I immediately noticed the texture of my hair changing. It became much drier and hard to style. I was told it might be because of the well water and the pH of the water.
What is your opinion? Are there any tests I can do on the well water? Would that cause hair loss? Is there any other tests to perform that might indicate something bad or missing in the water that would be so negative on my hair.

There multiple reasons people loose their hair. With female hair loss the causes may include hormonal problems. One should consider a thyroid problem. This could be due to an elevated thyroid or a low thyroid function. A change in medications might stimulate hair loss in women with female pattern loss and this should be considered too. One would generally see female pattern loss prior to age 62 if this were the cause.

I think you should consider the well water as a possible cause. There are numerous heavy metals present in well water and you can absorb heavy metals through the skin or through ingestion. There would include thallium, arsenic, mercury, copper, cadmium, or bismuth. A half gram of bundled hairs kept in their normal orientation (tops toward the top) sent to the National Medical Services in Willow Grove, PA can evaluate your hair for arsenic.
A low pH can sometimes cause copper in the pipes to precipitate out into the water and this can result in an accumulation of toxic levels of copper in your system.

You could have your physician work you up for heavy metal exposure. Blood levels, urine levels, and hair levels will generally tell you if you have been exposed to heavy metals. Often times you will have neurological findings or symptoms with heavy metal exposure.

Lab tests in addition to a heavy metal analysis include thyroid function tests, a CBC and ferritin level to evaluate you for iron deficient anemia, a dihydroepiandrosterone level to check you for elevated male hormones, a testosterone level, a FSH and LH. If the work up comes back negative, you could consider a properly performed biopsy. The dermatology department at the Medical College of Georgia in Augusta could perform most of this work up.

Heavy metal poisoning produces a characteristic form of anagen hair loss. A dermatologist should be able to assess you for any particular hair shaft abnormalities. Heavy metals were often found in pesticides and herbicides that could have found their way to your well water.

Of course hair coloring can make your hair brittle and cause breakage. This could be a factor currently and might result from a change in salons who use different chemicals or leave the agents on for a long period of time.

I usually see progressive female pattern loss begin after pregnancy or in the 40s to 50s. I do not see it begin in 62 year old women typically. Often times there is a family history, which means your mother would have exhibited these symptoms. Medications high in progesterone can stimulate hair loss in women prone to this form of hair loss. Any therapy would be directed at the cause. Therefore, it is best to determine the cause first. I think most of this work up can be done closer to your home. If it comes down to a biopsy, it probably is better for me to take, but I’d get the lab work up first.

When and how does the new hair grow in after my hair transplant ?

Many people ask this question during and after their hair transplant; some actually think the hair will all continue to grow and they will have their “new head of hair” immediately. Unfortunately, most individuals have to accept delayed gratification as part of the transplant experience!

When the grafts are placed in the balding areas, they indeed may continue to grow for a few weeks. However, by about three weeks, the hairs begin to rapidly shed and soon most all of them are gone. The good news is that the follicle cells, the ones that make the new hair shaft that grows up and out, are still lying dormant under the skin.

At about three to four months, the first hairs begin to sprout through the scalp. At first, all new hairs will be finer, and slightly less pigmented than they will eventually be after some growth time. It is important to note that the grafted hairs do not all begin to come in simultaneously; they generally sprout in a “staggered” fashion, which means that each month some new sprouts will be noticed emerging from the scalp, until they all have grown in! Full growth will have occurred, on average, after about 10 to 12 months; full ingrowth may sometimes take a little longer on second and subsequent procedures.

Of course, the full cosmetic effect may not be apparent right away. This is because length and caliber of hair, as well as density, contribute to coverage. Once the hair has grown long enough and each shaft has become thick enough, then the full coverage will be apparent and the welcome decrease in the appearance of thinning and baldness will be noticeable.

What is the importance of hair characteristics in hair transplant surgery?

These characteristics are significant in that they determine to a great degree how much coverage of the scalp there is, in order to block light. When light is not blocked and penetrates through to the scalp, the appearance is of thinning or balding.

The other big factor here is the density, which is another topic unto itself. The density is the number of hairs or follicular units per unit area (square centimeters or square inches or whatever unit you prefer; the centimeter is the standard for physicians). Although this density usually gets most of the attention when discussing hair loss, hair characteristics are equally, if not more, important.

First let’s look at color. At first, one might think that the darker the hair, the better the coverage. This is generally not correct. Lighter hair usually goes with lighter skin, and the tow together tend to mask thinning very well. Darker hair can cover well, but in the case of poor hair transplant work (pluggy looking, or larger graft on frontal hairline) they may stand out much worse than lighter hair. We will discuss color in more detail when we discuss contrast.

Curl is another very important factor in coverage. Generally speaking, curly hair provides coverage in proportion to the degree of curl (i.e., wavy hair gives better coverage than straight hair, curly hair better than wavy, very curly better than slightly curly, etc.). This has to do with light blockage as well. The curlier the hair is, the more it creates a meshwork of sorts (kind of like a thatched roof) which “stands up” a little bit off the scalp and keeps the light from penetrating to the scalp.

Contrast has to do with the difference between hair color and skin color. The closer to each other the hair and scalp are, the better the coverage. In a way, this “fools” the eye of the observer into not noticing the decrease in density. If a person with blonde hair and light skin loses 50% or his or her density, they may appear much less affected than a person with equally light skin and jet black hair. In this case the dark hairs of the second example are highlighted against the light skin and it shows the sparseness of the hair. The person with the blonde hair reveals very little difference between the hair and scalp, in other words, the observer cannot detect where the hair leaves off and the scalp begins.

Last, let’s consider caliber. Thicker strands of hair provide more “hair mass”, which is a term doctors use to describe the total effect of length times caliber. The more hair mass in a given area, the better the coverage. This makes intuitive sense. Imagine covering a hut with logs. If you place 20 logs as a roof, which will give better coverage, skinny logs or big round ones with large diameters? Of course, the bigger ones, so the thicker hairs do the same over the scalp. And remember, what appears as thinning or balding is simply the appearance of light shining through to the scalp.

I’m told by various strip physicians that the strip scar is a thin as a pencil mark. Is this true?

This is completely dishonest. The average strip scar is 2 to 3 mm wide and it can stretch from ear to ear. If you plan to cut your hair short, this can be a problem for you as it is obviously a man made scar. It is an obvious sign that you had a hair transplant. No one wants anyone to know they’ve had a hair transplant, however. No one wants anyone to know they had hair loss or that they ever considered hair restoration surgery. Even shorter hair styles can expose the strip hair transplant scar. Frequently we are told that a hair cut of a number 3 or shorter exposes the strip scar form a strip hair transplant.

There is a new fallacy you are hearing from strip surgeons, as well. They claim that their new trichophytic closure technique produces pencil thin scars that are invisible. We’ve seen 5mm wide scars produced by this technique. Five millimeters is ¼ inch wide. It is a huge gap with no hair in it. When the trichophytic closure works, it rarely works in the rear of the scalp. You will not see an advantage along the sides of the scalp usually. Furthermore, the tighter you make the scalp by performing successive strip procedures, the more likely it is that your scar will widen and stretch out. Furthermore, these strip scars can turn whiter than the surrounding skin or bright pink. This produces further contrast to the scars should they be exposed by a short hair cut or by a medical illness that causes thinning or loss of your hair.

One other problem you will never hear about from your strip surgeon is that strip procedure causes irreversible changes in your donor area hair growth angles. A strip is nothing more than a scalp reduction in the donor area. It alters hair growth angles for the rest of your life.

There is no reason to have a strip procedure. It really is up to the patient to demand the alternative, which is far better. Patients should begin to demand CIT, which is an advancement over our older FIT procedure. There is CIT and no quite CIT. Many physicians will tell you they perform FUE. This FUE procedure does not meet the quality of CIT. CIT is a proprietary procedure with quality instrumentation. Only CIT has proven results day in and day out with all types of hair including wiry, kinky hair seen in men of African decent.

With all the disadvantages of a strip procedure for hair loss you might ask yourself why all physicians don’t make the switch to CIT. The answer is very simple. They don’t want to work that hard. CIT is a far more complex procedure that requires the physician to learn new skills. Strip hair transplant surgeons are used to their strips and the ease with which they are performed. Don’t expect them to change. The only thing that will cause surgeons to modify form their scar forming strip procedures is for patients to begin demanding the less invasive CIT procedure.

What is Maximum Medical therapy for hair loss?

People with hair loss, and certainly anyone even CONSIDERING hair transplant, may want to use a regimen of maximum medical therapy. This just means using a number of different medications that have different mechanisms of action to try to “cover all the bases”, so to speak. Attacking hair loss by targeting different aspects of the process is a way of using the synergy between various agents to maximize the effects.

Finasteride (Propecia and Proscar) is an agent that blocks the formation of dihydrotestosterone (DHT), a hormone that has been implicated in male pattern baldness (androgenic alopecia). This is a first line drug for men with thinning hair or balding. It is not beneficial for women; in fact, it can cause birth defects if a woman is exposed to the drug and gets pregnant. It has few side effects in men and has been used for about 25 years with a good safety record.

Minoxidil (Rogaine and many generic versions) is topical, or placed directly on the scalp. Side effects are few, and it has a synergy when used with finasteride. This may be used in men and women, and is considered by many to be the drug of choice in women with hair loss.

There is some evidence that an anti-fungal shampoo containing ketoconozol (Nizoral) may help slow hair loss. It can be used twice a week and has the added effect of decreasing dandruff and itching of the scalp. There are also a variety of over the counter preparations (Hair Cycle products) and internet-marketed preparations that are available. Many of these contain minoxidil and other ingredients. Some of these are topical androgen (male hormone) blockers; there is little scientific proof of their effectiveness, but many men swear by them, and they may work for some.

The most important thing one can do with these latter agents is read and read some more. Information from sources other than the manufacturers is likely to be more objective and may help one with informed decisions.

This video demonstration was taken during live hair transplant surgery with one of Dr. Cole’s patients.  With strip harvesting or traditional FUE, the patients are very limited in their personal appearance and have difficulties getting back to normal daily activities because they are asked to shave their head.
Shaving the head allows the physician to have high visibility of the donor area which is necessary for donor hair extraction. With the new C2G technique, the patients are able to keep their normal hair style before and after the CIT technique!
Now patients can have the best of both worlds. They no longer have to put up with the pain associated with strip scars and they can still maintain their normal hair style.

It is really unknown what causes shock loss.  Shock loss is hair loss resulting from a hair transplant procedure.  There are many theories, however.  Shock loss most likely is due to an inflammatory response as a result of physical trauma.  It is really quite uncommon in the donor area.  It is more common in the recipient area.  The density of incision sites may play a role as high density incision sites tend to produce shock loss more commonly.  Shock loss will occur only in the area where the incisions are made.  It will not occur in adjacent regions.

Shock loss begins about 2 to 3 weeks after a procedure and it will continue over a period of a few weeks.  If you experience hair loss months after a procedure, it is not due to shock loss, but rather due to progression of hair loss or some other factor unrelated to the hair transplant procedure.

Some feel it is due to the injection of epinephrine, which is commonly added to the anesthetic.  This is most likely untrue as you will not see shock loss in areas where anesthesia is given, but rather only in areas where the incision sites were made.  You also more commonly see it in the recipient area while epinephrine is also given in the anesthetic given in the donor area during a hair transplant surgery.  Even though the same anesthetic with epinephrine is given in the donor area, you do not see shock loss in the donor area when it occurs in the recipient area.

The inflammation might result from physical trauma, but it also might be due to the free radicals that accumulate in tissue that continues to metabolize outside the body in an anaerobic state.  Free radical scavengers in the storage fluid along with cooling of the tissue outside the body might help reduce the amount of free radicals produced by the grafts.  One might also limit the free radical load by limiting the recipient area density during a hair transplant.

Shock loss is uncommon in the donor area with both strip harvesting and with FUE or FIT.

When shock loss occurs, the hair will generally begin to grow back after a hiatus of 3 months.  It is only the fine wispy baby like hair that seems most prone to remain dormant following shock loss.  This sort of baby fine, short, lightly pigmented hair produces the least amount of coverage, however, so it will not be missed as coarser, darker, longer terminal hairs will take their place when the hair transplantation produces new hair growth beginning three months after the hair transplant.

What are the ways to camouflage strip hair restoration scars?

Camouflaging Strip Scars

Scars in the donor area from strip harvests may be problematic for many men. They may be short or run from ear to ear. Sometimes they widen over time, occasionally to more than two centimeters, which is deforming. This is usually due to an overly tight scalp, too low a placement, or poor surgical technique. They also change the direction of hair growth below the scar, relative to above the scar, which may cause a “shadow” of the linear scar to be evident even with the hair grown out somewhat.

IN order to minimize the appearance of scars, several strategies are available. There are cosmetics such as Dermatch, which may help disguise the scar. The hair may also be grown out fairly long to attempt coverage. This, of course, may not be an option for those with an over harvested donor region.

Surgical scar revision may be attempted, often without success. This consists of excising the scar and them suturing up the wound, hoping that the resultant scar will look better than the original one. This can work in some instances; however, if the condition that led to the scarring is not remedied, then even the best revision may fail.

Grafting into the scar is another option. Because yields tend to be lower in scars, this may take more than one surgical procedure over many months to have a significant cosmetic effect. Either body or scalp hair may be used; scalp hair is generally a better choice if it is available.

Do you recommend Zinc to treat hair loss

is a Zinc whitish metal that acts as an essential nutrient in humans. Its deficiency leads to a number of biochemical and physiological problems; it is required for hundreds of different biochemical reactions, so not having enough can affect many different systems in the body. Zinc helps the immune system stay strong so we can fight infection; it helps with growth and healing, and keeps our senses of smell and taste intact!

Some of the causes of zinc deficiency include chromic alcoholism, malnutrition, malabsorption (problems absorbing nutrients from the gut), vegetarianism (because plants provide much less zinc than animal products like meats), high intake of iron, and diarrhea. Dietary sources of zinc include meats, some seafood, dairy products, and nuts; people with meat/seafood in their diets absorb more zinc than people with largely plant proteins. Oysters have the highest zinc content of any food. Since zinc is known to have an effect on sexual function and fertility, perhaps this is where the age-old reputation oysters have as an aphrodisiac!

Supplementation of zinc may be necessary in some people prone to low zinc levels. Some people believe that in modern times our foods are so low in nutrients, that supplementing is always needed (although this is not the opinion of the scientific community as a whole). The recommended daily allowance (RDA) of zinc is around 10 mg per day for healthy adults. The upper limit considered safe is 40 mg per day for healthy adults. High intake of zinc (150 to 450 mg per day or more) may cause a number of health problems. Among these are low levels of copper, depressed immune system function with increased susceptibility to infection, retarded growth in children, loss of appetite, sexual dysfunction with erectile dysfunction in males, hair loss, diarrhea, delayed wound healing, slowed mental function, and altered taste and smell.

What scientific evidence is there for treating problems with zinc? There is strong evidence for using it to treat children in developing countries that have severe diarrhea, for treatment of stomach ulcers, and in the blood disease sickle cell anemia. There is good, but less strong evidence for the following:

• Acne

• ADHD (attention-deficit hyperactivity disorder)

• Down’s syndrome associated problems

• Fungus infections of the scalp

• Herpes virus infections

• High cholesterol

• Immune system boosting

• Plaque on teeth and gingivitis of the gums

Wilson’s disease, which causes abnormally high copper levels (remember how we said that too much zinc lowered copper levels in the body?)

There is possible evidence for zinc improving hair loss, but more high quality studies are needed to find out the truth about this issue. We do know, however, that a deficiency of zinc can definitely cause hair loss, among other physical problems. It is just not clear yet (because of a lack of scientific studies) that supplementing zinc in people with normal or abnormal levels will delay or stop hair loss and/or stimulate the growth of hair. This does not mean that zinc will not improve hair loss; it just means that there is not enough definitive evidence from valid studies to recommend its use without reservation.
Despite this lack of evidence, many books and websites recommend various dosages of zinc, in addition to selenium and other trace elements, as well as vitamins and other supplements. It is necessary to evaluate these recommendations in terms of whether the supplementation is beneficial to the body as a whole, and whether there is any risk of toxicity at the doses recommended. Then informed decisions can be made.

My mother had esophageal band surgery a couple of years ago due to her excessive weight problem. Following this she has noted progressive hair loss and a change in her personality. I’ve read that band surgery and stomach stapling can cause hair loss. Is this true?

Bariatric (Weight Loss) Surgery: Metabolic, nutritional, psychological and physiological Consequences Bariatric or weight loss surgeries have become commonplace in the USA and in other countries, in part due to an ever increasing incidence of obesity in the context of a societal standard of beauty that emphasizes a thin, shapely physique. Lobbying by various organizations, as well as medical studies detailing the present and future consequences of untreated obesity, has led to insurance coverage for these surgeries, which were previously deemed “cosmetic”. This article will detail some of the physical and mental aspects of the often rapid weight loss which occurs after bariatric surgery.
The bariatric surgery community utilizes a number of procedures to promote rapid and hopefully permanent weight loss. Some of the earlier methods have been abandoned or modified due to unacceptable morbidity in the post-operative period, both immediate and long-term. Currently used techniques most often decrease absorption of calories or promote early satiety (feeling of fullness), or some combination of the two.

Unfortunately, the decreased absorption of calories is accompanied by decreased absorption of macro- and micro-nutrients. This often leads to nutritional deficiencies of varying degrees of severity. Sometimes these deficiencies may go undetected for some time, until they have had a profound effect on the patient. Many of these deficiencies can be very difficult to treat (refractory) once established. They may cause significant derangement in the patient’s physical, mental and emotional health.

Nutritional deficiencies associated with bariatric surgery:
Multiple vitamin deficiencies: D, A, B12, B1
Multiple mineral deficiencies: iron, magnesium, calcium, zinc
Macronutrient deficiencies: protein, fatty acid, caloric
The endocrine system may also be deranged; hyperparathyroidism may occur, secondary to vitamin deficiencies, and this condition may cause multiple physical and mental/emotional disorders. This may lead to new micro nutrient disorders, or exacerbate those which have already resulted form the surgery. All of these factors together may set the stage for multiple, interrelated metabolic conditions that may have an overwhelming effect on the patient after bariatric surgery.
In addition to the physiological issues detailed above, mental and emotional distress or overt illness may also occur subsequent to these procedures. This may range from mild depression to full-blown psychosis. The etiology of these symptoms is only partially clear. Some may be due to radical, sudden changes in body image. Others manifestations may be due to metabolic derangements such as magnesium deficiency, hyperparathyroidism, and/or various B vitamin deficiencies. Unfortunately, authorities say that the psychological effects of bariatric surgery have yet to be as fully elucidated at the physiological ones have been.
Another major issue in the post-operative period has to do with the cause of the obesity itself. It is widely believed that many overeaters use food for “self-soothing”, in other words, it calms their anxieties, cures boredom, temporarily alleviates depression (but worsens it in the long run), may act as a substitute for caring relationships and love interests, and generally supports the individual emotionally. When the ability to eat is radically curtailed, this whole quasi-“relationship” the person has with foods is interrupted, sometimes with disastrous consequences. This is one of the many reasons that bariatric surgeons must screen the population of patients so strictly, and this is also one of the reasons that psychotherapy before and after such procedures is seen as mandatory. It is of interest that current studies reveal a substantial percentage of these patients eventually regain much or all of the weight they initially lost, despite the “permanent” nature of the surgery.
Hair loss is another very common consequence of bariatric surgery, and of course can exacerbate the psychological problems the patient may develop. The germinal cells found in the bulb at the base of the hair follicle are among the most rapidly dividing cells in the body. This is one reason that hair is so sensitive to any stressors experienced by the human organism.
It is well known that people may experience an effluvium, or shedding, under the influence of myriad stressors. These can be physiological or psychological, and the hair loss may be permanent or temporary. Bariatric surgery may be an overwhelming stressor, and even in the most optimal cases, it is a major perturbation to the body as well as the mind.

I had hair transplant procedure a week ago and I’ve note that the hair is still growing in the grafts. Does this mean the hair has been accepted and that it will continue to grow?

Following hair transplantation hair in the grafts will continue to elongate for about 10 days. Some of this may be continued hair growth, but it also reflects a move toward anagen effluvium. In anagen effluvium the dermal sheath begins to contract and move toward the surface of the skin much like an accordion. This shortening of the dermal sheath will push the bulb of the hair shaft toward the surface of the skin. Therefore, some of the elongation of the hairs is not due to growing, but rather due to a contraction of the dermal sheath toward the skin surface.

Once the dermal sheath contracts, the hairs will either begin to shed on their own beginning in two to three weeks after the transplant. Some of the hairs will continue to rest on the surface of the skin for a prolonged period of time. Eventually the scalp skin will either begin to form a wall around the resting, non-growing hair, or the scalp will form a pustule or pimple like reaction that will eventually burst and the non-growing hair will exit the skin with the exudate from the pimple or cyst like structure.

It is probably a good idea to minimize the number of the cyst like structures that you get because they represent unnecessary inflammation. Inflammation may not always be a good thing. In theory inflammation might sometimes lead to an autoimmune response toward one’s own hair and this in turn may compromise future graft growth.

In order to minimize inflammation, we generally recommend that patients begin removing non-growing hair fragments beginning three weeks after the hair restoration procedure. The best way to manage this is to aggressively wash the scalp with soap and a wash cloth. Non-growing hair will come out easily like removing a pin from a soft stick of butter. Growing hairs on the other hand must be plucked and it takes a good bit of force to accomplish this.

Sometimes hairs do continue to grow following a hair transplant without ever going into the resting phase, but it is unlikely that you will see more than 10% go into the resting phase. It is far more likely that the hairs will shed. Occasionally hairs almost shed, but then continue to grow. We can easily recognize these hairs because they have a dark tip that is coarse followed by a narrow constriction that is of lighter color. This is followed by a gradual darkening of the hair shaft and increase in hair diameter once again. We call these hairs that exhibit signs of this trauma pol pinkus hairs and they are a sure sign of recently transplanted hairs that have continued to grow.

Now that there is a genetic test to predict your hair loss, is it possible to simply wipe out this gene and thus put a halt to hair loss?

The genetic test is a test for a marker on the X chromosome that predicts hair loss. We do not know if this gene has anything to do with the cause of hair loss. Hair loss is multifactorial. This is probably why you see a few people who respond favorably to certain topical or oral medications while others don’t seem to respond at all. It is more probable that hair loss results from the interaction of multiple genes. It remain unknown what would happen should we alter a single gene. The consequences might actually be negative.

I see on your website that you offer a Hairdx test, what is it and how is it helpful to prevent hair loss?

Hairdx is a genetic marker test to determine your risk for hair loss and to determine whether you might not loose your hair. The test evaluates a specific marker on the X chromosome. As you know, the X chromosome arises from the mother of the male. The marker is on the androgen receptor gene located on the X chromosome. Men who carry this gene variant are at a 60% risk of loosing their hair by age 40. Men with the less common genetic variant have a greater than 85% probability of not going bald before age 40. Ninety-five percent of bald men have the high risk androgen receptor variant.

It is known, however that androgenetic hair loss is polygenic in inheritance. One receives genes from both the mother and the father and it is felt that hair loss is not sex linked. This means that you can receive the risk for hair loss from either the mother or the father, but the specifics are still poorly understood. To date there are 4 major genes that determine your risk for hair loss, age of onset, eventual hair loss pattern, and rate of hair loss progression.

This test is only a prediction of future hair loss. It does not rule in or rule out the probability of future hair loss entirely. If you test positive, you should be evaluated for other signs of hair loss. These include miniaturization of the hair follicles and loss of hair shaft pigment. If you show signs at any point after testing positive for the marker, you might want to consider medical therapy such as Propecia or Minoxidil. You might also want to begin using Haircycle shampoo and conditioner to prolong the anagen duration, which is known to slow down the rate of hair loss progression. Instituting medical therapy at an earlier stage in life may limit the rate of your progression and the ultimate degree of loss you will suffer from.

We are happy to send a test kit to you if you like. The cost of the test is 149.00. This is the first diagnostic test to help you determine if hair loss may be in your future.

Dr. Cole, what is the C2G stand for?

C2G stands for the Cole Isolation technique to go or CIT to go. CIT is a proprietary method of harvesting individual follicular units one at a time such that there is no need for a strip harvest. Strip harvests leave linear scars and no one can predict how wide the scar will be or whether it will be pale white in color or red in color. Either way the strip harvest leaves you will a linear scar that obviates your capacity to wear your hair short and leaves you vulnerable to others suspecting you’ve had a hair transplant previously. Often patients are so concerned about their strip scar that they cease going to a barber or hair stylist for fear of exposure.

In an effort to overcome this social stigma we developed the CIT procedure. The single negative to this procedure has been the requirement for patients to shave the donor area. This can result in problems blending back into society or into one’s work place. The goal of C2G was to develop a procedure that allows patients to keep their hair long so that they can return to their normal social environment within a few days.

C2G is a procedure where only individual follicular units are trimmed and the resulting individual follicular units are then transferred to the top of the scalp after harvesting them via CIT. Only the individual follicular units are trimmed so that you have a normal appearing donor area from day one and you also have the advantage of avoiding the strip scar altogether. Now there is no reason to avoid taking advantage of all the long term benefits of CIT. This includes no linear strip scar, no prolonged strip scar pain, no prolonged strip scar tightness or numbness in the donor area, more hair per graft (more bang for you buck), and a lower follicular injury rate (transaction rate).

There was once a draw back to CIT. Now there is none. C2G is the future of hair restoration surgery.

What are the common used hair transplant techniques and how are they different from CIT?

Hair transplant surgery can be done using several different techniques, including old-style plugs, strip harvest, The Cole Isolation technique (CIT), and body hair transplantation (BHT). Plug harvesting is only mentioned for historical reasons; it is a very poor technique and should not be used in the modern era. Strip harvest using only two incisions became popular during the 1990’s, and is still widely used today. CIT is very new, having been used only the past 5 or 6 years, but is beginning to challenge strip surgery in some areas as a procedure with much less scarring. BHT is used mostly for adding hair to scalp hair surgeries, and in patients who have had much of their scalp donor hair removed. Scalp hair is always better, and BHT is seen as a complement to scalp hair.
Hair grows on the scalp in separate units, which are known as follicular groups or follicular units. They contain 1, 2, 3, 4, or rarely 5 or more hairs. During the CIT procedure, a special tool is used to take these hair groups out one at a time. The advantage is that no long incision or wound is made in the scalp, and therefore no long scar results. Also, there is very little pain after the surgery, and the hair grafts come out ready to place in the balding areas, with no trimming needed. Sometimes there are tiny white dots left where the hair s were taken out; these are very small and if the hair is more than ¼ inch long or so, the dots are invisible.
These hair grafts are then placed into tiny slits or holes made by the surgeon into the balding or thinning hair areas; in about 3 or 4 months the first of the “new” hairs begin to sprout and by the end of a year, the full result of the transplant will be seen!

I would like to know what is the CIT hair transplant? why is it better then the strip?

CIT or “The Cole Isolation Technique” (former known as FIT) is a hair transplant harvesting technique developed by Dr. John P. Cole in the early years of this century. It is similar, but not identical to, FUE, or follicular unit extraction. CIT uses proprietary technology and instruments to harvest intact follicular groups ranging from 1 to as many as 6 or more individual hairs along with their intact dermal elements. It must be stressed that these dermal elements are essential for the growth of new hairs in the recipient areas (these are the areas of thinning or balding that are being transplanted). Extracting hairs without the dermal elements is easy, but amounts to nothing more than a “pluck”; these hairs will not grow.
As with any other harvesting method, the hair transplant surgeon will first outline the donor areas to be harvested, as well as the areas which will be receiving the harvested grafts later on. Then, local anesthetic is infiltrated into the donor area to render the skin and deeper structures numb and insensitive to pain. Then, just before harvesting begins, the area is injected with a “tumescent” fluid consisting of saline, and often medications to minimize bleeding. This tumescent technique is fairly common in a number of cosmetic procedures. It is beneficial in a number of ways; it helps decrease bleeding with medications and also by virtue of the pressure of the fluid on blood vessels in the tissue; it brings the skin up and away from deeper structures; it provides a taut, firm surface on which to score the skin, and it slightly separates the follicular groups from each other so that they may be more easily isolated from one another.
Then, the skin around the follicular groups is scored with the special instruments; the surrounding tissues are teased away from the follicles and then the entire unit, that is, the hair shafts, the dermal elements surrounding the shafts, the sebaceous glands and a tiny ring of skin at the top is gently pulled out. The graft is perfect, and ready for placement in the recipient area. No trimming or preparation is generally needed. This is one of many benefits of CIT compared with the older style strip harvest method, which requires microscopic dissecting of all grafts prior to placement, necessitating a large team using stereo microscopes.
Healing of the tiny sites from which the grafts are pulled commences almost immediately. Usually by the second or third day, the tissue has grown in to cover the hole and there remains only a pale pink dot at the site. In some individuals, this may eventually appear as a slight “white dotting”, which is not strictly speaking a scar, but rather an area of hypopigmentation. This just means that the cells within the follicles that produce the dark pigment called melanin are gone, and the skin here is a slightly lighter shade than the adjacent skin. This phenomenon is relatively unpredictable; it is most common in darker complexioned people, but may manifest in pale-skinned folks. Likewise, it may occur after CIT with very small instruments, and not at all with larger-sized extractors (or vice versa!)
We feel that, compared to a linear, ear-to-ear strip scar, these tiny white dots have minimal negative cosmetic impact. With the hair only a few millimeters long, these dots are undetectable. A strip scar, on the other hand, may be visible with the hair considerably longer, and it may widen, sometimes for no apparent reason. In addition, the strip scar changes the direction of hair growth below it, relative to the direction above it. Unless a person desires to wet shave their hair down to the skin, these white dots, if they do occur, are invisible to the casual observer.
Now, once the grafts are extracted and ready for implantation, the process is quite similar to strip harvest hair transplant surgery. Tiny jeweler’s forceps are used to very gently grasp the hair-bearing grafts and place them into miniscule recipient sites. These sites are created by the hair transplant surgeon using various blades or needles; each site is made carefully and with a deliberately natural pattern. The angle relative to the axis of the head is extremely important, because the hair normally grows in specific patterns. These patterns have a general similarity in all people, but there are specific ways in which these patterns diverge in individuals. A “cowlick” at the frontal hairline is a good example, as is a unique “whorl” at the vertex or crown. It is often appropriate to closely mimic the existing pattern to obtain the most natural effect.
The so-called angle of emergence is of utmost importance as well. This is the angle at which the hair emerges from the scalp. This angle may be quite acute, that is, the hair may lie down very close to the plane of the scalp. If an inexperienced or minimally gifted surgeon makes these angles too high, then the look will be peculiar and unnatural. We have seen many cases such as this, and it is especially noticeable at the leading edge of the frontal hairline; follicles growing on the hairline at or close to a 90 degree angle are an aesthetic and cosmetic disaster.
Regional placement of various graft sizes is another challenge for inexperienced surgeons. One hair grafts ONLY should be placed at the leading edge of the hairline. Two hair grafts are then placed behind these “singles”; the “full-sized” three, four, or larger grafts are only placed further back behind the soft, feathered hairline. We commonly see repair cases with two, three, and even four hair grafts all over the frontal hairline! Fortunately, we can now remove these unsightly, inappropriately-placed grafts with the CIT technique and redistribute them further back where they rightly belong.
As with all hair transplants, the hair shafts themselves, which are essentially dead protein, will begin to shed at about 2 to 3 weeks. However, the follicular germinal elements are safely lying dormant beneath the skin. Usually at about 3 to 4 months, the first “new” hairs will begin to emerge. There will continue to be further growth for up to a year or more, but usually the full cosmetic effect will be evident at about 12 months.

Between early 2004 and late 2005, he had three smaller procedures, which together accounted for approx.4800 grafts, all via FIT/CIT technique. During his history of loss subsequent to his priors, he experienced additional loss therefore we transplanted on top once he came in during March of this year. In this year’s session, we transplanted approx 1200 grafts which include several hundred FIT farmed grafts to his donor.