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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Eyebrows

The eyebrows are one of the most important features on the face. They create the frame of the face. It is very important to have the right shape of the eyebrows. 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. This shape will open up your face and give you a brighter look!!!

The main function of the eyebrow is to prevent moisture, mostly salty sweat and rain, from flowing into the eye. The eyebrows also shade the eyes from sunlight, prevents dandruff and other small objects from falling into the eyes, as well as acting as sensor for detecting objects being near the eye, such as small insects.
The eyebrows also have an important facilitative function in communication especially in strengthening expressions, such as surprise or anger. Many make-up artists view eyebrows as a major feature in defining the face. Depending on the shape of the eyebrows, it sometimes can cause what is known as a ‘false facial expression’ (such as a person’s eyebrows shaped to seem as if the person was angry or scary but really isn’t).

The shape of eyebrows we can adjust depending on our face shape. The best way to tell what kind of face shape we exactly have, we should pull all our hair back from the face and look closely in the mirror.

There are Six Basic Face Shapes

Perfect Eyebrows

Oval Face Shape
The perfect brow shape is generally considered to be the soft angled shape. This is in fact the most popular stencil shape, and works beautifully with an oval face shape.
Heart Face Shape
A low arched-round brow creates a natural look. A high arch round brow adds (possibly needed) length to a shorter heart face shape.
Long Face Shape
A flat brow shape accomplishes this. It’s horizontal shape makes the face appear shorter.
Round Face Shape
A high arched brow accomplishes this. Look for a brow shape that follows a straight line to the peak of the brow, and creates more vertical lines. Stay away from a rounded brow shape. This makes a round face shape look very round.
Square Face Shape
Angled brows create this balance. Also consider the curved brow shape, suggested for diamond face shapes. The curves soften stronger features.
Diamond Face Shape
The curved brow shape does this. Notice that many beautiful celebrities that have a diamond face shape also have curved brows.

• Measure the length of your face with a ruler. (In this case the total length of face is 8inches)
• Divide the total length by 3. (8 ÷ 3 = 22/3 or 2.67)
• Measure the length from the bottom of your nose to the bottom of your chin. (In this case 21/3)
• If the length of nose-chin (21/3) is longer than the length of overall 1/3 length (22/3), chances are you have a long face.
• If the length of nose-chin is less than the length of overall 1/3 length, chances are you have a round face.
• If the length of nose-chin is equal to the overall 1/3 length, chances are you have an oval face.

Knowing your face shape is the first step to creating your most beautiful look!!!

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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.