Articles

Hair Restoration in the Scarred Scalp

Our head is one part of the body most vulnerable to injury, leaving injured sites often bald after healing. This results due to the destruction of hair follicles in injured areas. The most common cause of scalp injury is physical trauma. There are many other causes of scalp injuries including burns (fire, hot substances), chemical burns (corrosive substances such as acids or alkaline), radiation burns (excessive amounts of ionizing radiation x-rays or gamma rays), inflammatory diseases, surgery(s), and self inflicted injury.

Where hair follicles are destroyed, hair will not grow in that area. If scalp scars are small they may not cause any significant cosmetic problems. However, size and placement of some scars may make it impossible to disguise. An option to resolve this problem could be to consider hair restoration, usually through the method of hair transplantation. Sometimes, if suitable, the scarred area can be reduced in size by surgical excision and repair, leaving a smaller area requiring hair transplantation.

Hair transplantation in the scarred scalp is not undertaken lightly. It requires careful examination and consideration of numerous factors, including;
• Underlying chronic inflammatory diseases.
• Scalp blood supply in scarred area. Hair follicles need a good blood supply in order to survive and function, otherwise the transplanted hair follicles will die or be unable to function adequately.
• Scalp thickness of surgical hair restoration recipient site. Very thick scar tissue may limit accessibility to blood vessels, while very thin areas may be unable to hold transplanted follicles.
• Underlying surgical repair. Someone who has had surgical repair of head injury, or repair after neurosurgery, may have a metal plate underlying the scar tissue compromising hair restoration surgery or become the focus for postoperative infection. It may not necessarily rule out surgical hair restoration, however, it is a potential complication that must be assessed.

Utilising the latest hair transplantation technology and the knowledge of factors leading to higher graft survival rate, the result of hair transplantation into scar tissue today is very satisfactory. Although not all, a significant number of patients suffering from scalp scarring can now benefit from this form of treatment.

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Factors affecting Hair Restoration Surgery

Smoking, alcoholic beverages, and medications do you consume these things? And if so how much do you consume? What about herbal health food products? These things should be considered before undergoing hair restoration surgery. You may ask, what is the connection between smoking, drinking, medications, herbal products or vitamins have to do with surgery? All these things have the potential to contribute to excessive bleeding or ‘oozing’ during and after the operation.

The surgeon needs to have honest answers, not to change or judge the patient’s lifestyle, but to assess the potential for excessive bleeding from wounds during and after the surgery. The presence of a risk factor for excessive bleeding may be an indication to delay surgery until the risk factor has been reduced. An example is, a period of ‘no smoking’ and ‘no drinking’ prior to surgery. The risk of bleeding for hair transplantation patients is largely for oozing; it may extend the time needed for implantation of hair grafts and pose a potential threat for loss of some grafts after surgery.

General List of Risk Factors:

Tobacco Smoking

Smoking (especially long term and heavy smokers) has numerous harmful effects on the body. There are the increased risks for lung cancer, chronic obstructive pulmonary disease, heart disease and systemic circulatory disease. The nicotine and other chemicals in smoked tobacco can cause or contribute to disorders of blood circulation, causing increased risk for excessive bleeding. The reduction of elasticity in small blood vessels in the skin, can decreases the blood supply to hair transplants, causing increased risk for transplant failure. Also people with long term exposure to second hand tobacco smoke may be affected with decreased blood supply to the skin.

Alcohol Consumption

Alcohol containing ethanol disturbs the ability for healthy blood clotting as it causes blood to be ‘thinner’. Consumption of a single drink of alcohol has been shown to increase risk for bleeding with one to two hours.

Recreational Drugs

Drugs such as cocaine can have interactions with medications that can cause unforeseen side effects and complications.

Prescription Medications

Many prescription medications are known to increase risk for bleeding. They may have cross-reactivity with other medications and herbal products; they can increase or decrease the effects of the drug and blood clotting.

Vitamin Supplements

Vitamin E, especially in large doses, has been reported to increase risk for bleeding by its effects on blood platelets and other blood clotting factors.

Over the Counter Medications

Widely used over the counter medications, such as Aspirin and non-steroidal anti-inflammatory drugs may increase bleeding risk at higher doses or with frequent use. As these medications are not prescribed, patients may not disclose their use in pre-surgical examination.

Herbal Products

Many herbal products are known to have cross-reactivity with prescribed drugs that can increase risk for excessive bleeding.

Patient – Physician Communication

Patients should tell their physicians about all medications they take, whether it is prescribed or over the counter. Physicians should explain why this information is important in pre-surgical assessment.

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New Drug for Medical Treatment of Androgenetic Alopecia or Male Pattern Hair Loss

Drug used today

Up until today, doctors have 2 medical treatment options to offer our patients who are suffering from hair loss:
Minoxidil (commonly known as Rogaine) and
Finasteride (Propecia and Proscar)

For more information on these drugs please click on the following link -

http://www.hairtransplantinstitute.com.au/management.html

These drugs have extensive researches done under the strictest protocols and finally proven by Food and Drug Administration of U.S. – FDA to treat hair loss. Because it has been available in the market for over 10 years, doctors have a lot of information regarding the efficacy and side effects and even long term effects on the body. Hence, to suitable candidates, it is very safe to use under the guidance of a qualified doctor who has experience with these drugs.

Dutasteride

This is a drug with very similar characteristic with Finasteride. It has been used by some doctors in the past 2 years as ‘Off Label’ treatment for hair loss. ‘Off Label’ is a short hand term for using a drug for a use not approved by the FDA. It is used only with caution and after complete assessment by an experienced doctor.
More and more is now known about this drug, and it is now approved by FDA for the treatment of patient with a condition called – Benign Prostate Hypertrophy (BPH).
This drug blocks both type 1 and type 2 5-alpha reductase (5-αR), which is an enzyme needed to convert testosterone to 5-alpha dihydrotestosterone (DHT). Finasteride only blocks type 2 5-αR. DHT is the chemical responsible for the damage to the hair follicles.
Clinical trials of dutasteride as a treatment for Androgenetic Alopecia or Male Pattern Hair Loss are currently underway in the U.S., and investigators have reported successful outcomes.
For more information, please click on the following links –

http://www.ishrs.org/articles/dutasteride-trials.htm

http://www.dutasteride.com/

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Female Pattern Hair Loss and Baldness

Female pattern hair loss is not as recognizable as those in men as it occurs in more than one pattern. In some cases, it can be effectively treated. Females can begin to lose hair at any age, and may not have any obvious hereditary association or recognizable ‘female pattern alopecia’. Female pattern hair loss can begin as early as their 20’s, especially for those who experienced early puberty. Stressful events such as pregnancy or illness can also be associated with temporary hair thinning.
If you are concerned about your hair loss, consulting a hair restoration specialist or tricologist for an evaluation and diagnosis is undoubtedly the best way to figure out your situation. Self diagnosis is often ineffective, as women tend not to have obvious patterns of hair loss - compared to men. Hence once again, you should always consult a trained and experienced physician for a correct diagnosis.
The most likely cause of scalp hair loss is androgenetic alopecia, which is an inherited sensitivity to the effects of androgens (testosterone, dihydrotestosterone) on scalp hair follicles. Luckily with women, hair loss due to this cause usually does not develop true baldness like that seen in men. For example, in men, we often see a ‘cue-ball’ appearance due to androgenetic alopecia.
In women, the thinning of scalp hair due to androgenetic alopecia, miniaturization (hair follicles getting smaller in diameter) tends to be found over all the affected areas of the scalp. Miniaturizing hairs are an aspect of androgenetic alopecia, but may also be associated with other causes and is not in itself a diagnostic feature of androgenetic alopecia. An example can be seen in menopausal women, hair may begin to miniaturize and become difficult to style. Accurate diagnosis should be made by a hair restoration specialist. If left untreated, hair loss can progress to more advanced loss of hair.

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Male Hair Loss before 21

Hair loss is commonly seen as an issue dealt in older men; however hair loss can begin as young as 15 years of age. This is usually unexpected and an extreme shock to a person aged 21 and younger to discover that he is losing hair around the frontal hairline and above the eyebrows on either side of the “widow’s peak”. This would result in the appearance of a high forehead. Young men may also notice excessive shedding when he combs, brushes and showers his hair.

If the young man’s father, mother, uncles or brothers have male pattern hair loss, he may not be as shocked to discover that he has the “baldness trait”, but nonetheless, hair loss before the age of 21 can be a disturbing situation to undergo because it can affect him psychologically and emotionally, leaving him feeling disfigured and less attractive.

What should a young man do if he is experiencing hair loss?

A consultation with a physician who specialises in hair restoration who is a member of the International Society of Hair Restoration Surgery (ISHRS), such as Dr Johnathan Chan, is the best first step for a solution to hair loss. These specialists are not only skilled and experienced, but most importantly, they follow ethical guidelines which are particularly important for patients who aren’t yet adults. Minors shouldn’t be ‘pushed’ into any decision regarding restoration solutions, which is why a parent or guardian should be present during the decision-making. During the consultation, assessments will be made to determine the cause of hair loss before any decision on treatment is made.

The goal of the consultation is to educate patients about the cause, progression, long-term ramifications and the treatment for hair loss. A simple consultation with the physician may be cheaper than ‘miracle treatments’ that are advertised in the media.

What treatment will the physician recommend?

Most physician hair restoration specialists do not usually recommend hair transplantation surgery to men under 21, however for individuals with a certain patient characteristic; hair transplantation can be an option.

Hair transplantation may not be a good restoration option for young men because:
• The pattern and progression of hair loss has, in most cases, not been fully revealed.
• Hair transplantation performed at such an early age may be less desirable later in life when the pattern is fully revealed.
• It is difficult to design a hairline that will look natural for the rest of the patient’s life.
• Once the transplantation is complete, future surgeries would be needed to maintain a natural look. Unfortunate results of the transplantation being performed too early may require future surgeries to correct.

With surgery not being the best option, there are still non-surgical options that the physician may recommend such as the use of the drugs Minoxidil (commercially known as Rogaine®), and Finasteride (commercially known as Propecia®). These drugs have not only been scientifically proven to treat hair loss, but are also the only drugs to be approved by the U.S. Food and Drug Administration (FDA). If a young man decides to take these drugs while they are still young (after a consultation with the physician), it will not only slow down the hair loss but improve the chances of success for hair transplantation later in life.

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Grooming of Men's Eyebrow

How to groom men’s eyebrows?

Well, it doesn’t mean to remove a lot of hair and shape them like women, creating high or dramatic arches. A simple tune-up will make them look more groomed. Sometimes, all it takes is trimming the brows or taking a couple hairs here and there. Different rules apply for men than women when taming the brows.

Eyebrow Waxing

Unless you have very sensitive skin, waxing is a quick and relatively easy alternative to plucking your eyebrows and it can last weeks. Although it is generally best to get eyebrows waxed professionally, it can be expensive – up to around $ 15 as a general rule, although salons do differ.

Eyebrow Threading

In Great Britain men now make up 40% of the visitors to its brow bars, double the proportion of a year ago. They are going for a treatment called ‘threading’, an ancient method of hair removal which originated in India in which a thin twine of cotton thread is rolled over the offending area, plucking the hair from the follicle level. Unlike plucking, threading removes an entire row of hair at a time so is quicker, more accurate and less painful. British men come for threading either in a bid to look good for a job interview, or to make happy their fiancées, as part of the wedding preparations.

Eyebrow volumizer

Any volume we add to our hair can make it look thicker. For hair on our head we add gel or mousse to help add body. Coating brow hair makes it look up to 1 ½ times thicker. This in turn makes you look like you have a lot more volume. A liquid can shine, go on in “globs” or smudge. A very fine dry powder with a high colour payout coats hairs individually. It does not glisten, run or smudge, not even in the rain or swimming.

 The common men’s eyebrow shapes:

Grooming by beeswax

When our brows are not doing what we want and it’s making us mad, one of the products we can use, is old-fashioned moustache wax which we can buy at the chemist. The main ingredient is beeswax. It’s cheap and will hold brows all day, though it’s dense, so we can only use a trace and we have to brush through it.

Eyebrow Mascara

You may have well-defined lashes, but bad brows can ruin your entire look. Brow problems can range from thin or bushy brows to more pronounced ones like uneven colour, uneven arch, or even a complete lack of brows. Most problems can be corrected with an eyebrow pencil, but if you want really convincing results, eyebrow mascara is necessary to have!

What is eyebrow mascara?

An eyebrow mascara helps enhance the shape, colour, and texture of your eyebrows; it works much like a lash mascara, except that an eyebrow mascara is thicker and heavier to prevent dripping. Some eyebrow mascaras come in the same tube and wand containers, but comb applicators are becoming more common because they are easier to use.

What's the difference in using eyebrow mascara?

While some mascara can be used on both brows and lashes, there are some subtle differences between the two. Colour is more important in an eyebrow mascara, whereas a lash mascara is designed more for enhancement and shape. An eyebrow mascara can also be used to draw the brows themselves, so they are more fade-resistant. Eyebrow mascaras also rarely has gloss since gloss doesn't necessarily make brows more attractive.

Who needs eyebrow mascara?

Some people have naturally thin eyebrows and need an eyebrow mascara to make them look thicker. Others have cut-off or nonexistent brows due to accidents or medical conditions. In this case, an eyebrow mascara can be used to draw or extend the brows themselves. For most people, however, an eyebrow mascara is mostly for enhancing the brow colour and shape and, using the comb applicator, for arranging the strands for a neater and cleaner look around the eye areas.

What makes a good eyebrow mascara?

Eyebrow mascara should always be evenly coloured and drip-proof. For a more natural look, make sure the colour matches the shade of your hair. If you have sensitive skin or hair, choose hypoallergenic eyebrow mascaras to avoid any adverse reactions. There are existing also colourless mascaras which are good just for keeping the brows in wanted shape. We can buy them in the cosmetics area of any department store.

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Hair under the Microscope

Over the last 50 years, hair restoration has progressed to improve the surgical techniques and refine hair transplantation as a whole. This is due to the scientific research conducted, looking through the physical and chemical properties of hair.

Using the most advanced technology in microscopes, scientists are discovering a detailed look into the complex structure of hair and the properties that separate hair into three “ethnic” categories; African, Asian and Caucasian. The ethnic category of your hair can be considered in hair transplantation.

Under a low-powered microscope, a piece of human hair is shown to have an outer layer of flat scales which point outwards from root to tip. These scales are called cuticles and are made up of keratin, a form of protein which can be found in the skin, fingernails and toenails. The major function of the cuticle is to protect the inner tissue called the cortex, where hair growth occurs.

Ethnic differences in hair can also be seen through a low-powered microscope. From a cross-section view of hair in their ethnic category, we can see that Asian hair is more circular in diameter, while African hair is more oval in shape. Caucasian hair appears as an intermediate between the other two categories.

In terms of shape, lengthwise, African hair is irregular in curling and twisting of the hair which is the complete opposite of Asian Hair which is straight and have no irregularities. The irregularities of African hair can have positive and negative implications for hair restoration surgery because African hair emerges from the scalp in different angles and directions. This curling of the hair allows more coverage of the scalp using fewer hair follicles, however extracting African hair is more difficult for a specialist to harvest. Caucasian hair tends to generally be straight with some irregularities.

A microscopic view inside the hair shaft.

The cuticle layer of hair acts to protect the cortex layer underneath. It is the cortex layer that gives hair fibre its shape, resilience and cosmetic attributes.
A microscopic view of the cortex, lengthwise, shows that the cortex is packed together with cortical cells from root to tip. A microscopic view of the cortex in a cross-section examination is like looking at an electric cable with hundreds of wires packed closely together. The cortical cells are packed with fine macro- and micro fibrils. The way that cortical cells are packed is a major contribution to the shape of “ethnic” hair.

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Should Males Trim their Eyebrows?

Often we look at celebrities and idolise the way they look, but in the celebrity world, a new appearance has emerge among male stars. They are trimming their eyebrows, making them appear more slick and well-groom, something of which women appeal. This leads the average man to ask himself, “should I trim my eyebrows?”
In Japan, it is considered ignorant to not pluck your eyebrows as Japanese people place strong attention on appearance. Having a person who does not groom himself is seen as bad-mannered to a degree.
At AHTI, we agree that men should trim their eyebrows as, if done properly, eyebrow trimming can widen the eyes and make men look more alive and sharp. The problem with trimming is that there are boundaries to how far a man should trim their eyebrows. There is a huge difference between a well-groomed man and a feminine looking male. The trimming shouldn’t be too obvious or prominent. Eyebrows that are trimmed too much can make a man look fierce which is not too charming.

Some men do not need to trim their eyebrows because they have a fine brow already, which means they only need to remove excess brow growth. Men with thick, bushy eyebrows however, are recommended to go for an eyebrow trimming session.

For first timers, here are some facts and advice:
1. For first timers especially, leave it to the professionals. Nowadays, there mare many eyebrow spa/salon available.
2. They often say: “with pain comes beauty” and with eyebrow trimming, there is no exception, although the pain of the plucking only feels like a quick ant bite. If your trimmer plucks the hairs in the same angle and direction that the hair grows, then there should be less pain.
3. When you go to visit the hair dressers, you would tell them what kind of hair style that you want. This is the same as with trimming your eyebrows. You must tell the trimmer about how much hair you would like trimmed and express concern for over trimming.
4. Eyebrows that are shaved or trimmed will grow back continuously because the hair was not removed by the root. Plucking and tweezing the brows removes the hair by the root, which means that the hairs take longer to grow back, meaning that you will not need to have your eyebrows trimmed as often as you think.
5. Men’s eyebrows should not arch too much because the arched eyebrow shape is ideally for women. The most aesthetically appealing appearance of the brow is when the shape, starting from the middle of the face arches up 2/3 to the peak, and then slightly comes back down 1/3 to the side.

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