Facial Hair Restoration Surgery

There is a growing demand for hair restoration surgery in recipient areas other than the scalp.  According to the 2011 ISHRS practice census, 93% of  the recipient regions where new hair was transplanted into were the scalp; and  7% of procedures had non-scalp recipient sites. The non-scalp recipient sites are:

• Eyebrows (4.4% in 2010 vs. 3% in 2004)
• Beard/Moustache (1.5% in 2010 vs. 1% in 2004)
• Eyelashes (0.6% in 2010 vs. 0.35% in 2004)

Slowly becoming more popular are procedures involving surgical hair restoration of the beard and mustache.   Beard growth typically occurs dramatically during puberty and continues to increase in density until the mid-thirties. The common causes for decreased follicular density in the beard and mustache areas include:

• Surgical or trauma scars/burns
• Congenital absence of hair
• Cleft reparation
• Scarring alopecia
• Folliculitis

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HOW IS THE PROCEDURE PERFORMED & WHAT ARE THE RESULTS?

Surgical facial hair restoration procedures are performed under local anesthesia with an oral sedative if desired by the patient. The procedure roughly takes 2 to 5 hours depending on the number of grafts harvested. For the first 5 days after the procedure, tiny crusts form around each transplanted hair, and careful attention the transplanted area must be given. By the second day, patients are able to travel home and resume non-strenuous activities. The transplanted hairs will begin to fall out at around 4 weeks, and then start to regrow at 3-4 months.

WHAT ARE THE RISKS WITH FACIAL HAIR TRANSPLANTATION?

There are few risks or adverse events associated with these procedures.  Complications are few and excellent cosmetic outcomes are the usual results once the hair regrows. There are two surgical techniques used to remove the donor hair from the back of the scalp.  The most common hair surgical procedure excises a linear  strip from the back of the head. The second most common technique is Follicular Unit Extraction (FUE) where individual hair units are removed “one-follicle-at-a-time.” Both techniques are safe with excellent results, but a hair surgeon must be able to give you an opinion as to which technique may be better suited for you.

Hollywood’s Recession: Before They Were Bald

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The Difference Between Male & Female Hair Loss

Many people believe female pattern hair loss is the same disease as male pattern hair loss, and  the hair loss pattern just looks different in women. In the last decades, though, the discussion between hair restoration surgeons in the International Society of Hair Restoration Surgery (ISHRS) has focused on the reality these two separate diseases or problems exists. Today many ISHRS physicians hypothesize  there are two different disease entities because their natural history (epidemiology) is so different.Many hair restoration surgery specialists think Female Androgenetic Alopecia is a misnomer and prefer the term Congenital Female Pattern Hair

PROMOTING PUBLIC AWARENESS-CARLOS PUIG

Promoting public awareness of female hair loss to the lay pubic and medical doctors is no easy matter. One particular physician, though, leading the effort is Carlos Puig , of Houston, Texas.  His tireless efforts to bring public attention to this medical condition is applauded and deeply appreciated. He is the founding member and current President of the ISHRS.  He is a world-renowned hair  restoration surgeon and probably the most knowledgeable hair specialist on female hair loss.

On a regular basis he leads an international effort to teach physicians about female hair loss and surgical restoration.  His hair restoration course, “Cowgirl Hair Loss Workshop,”  is an excellent compilation of his knowledge as well as featured hair surgeons from around the globe.   His below referenced chart comparison illustrates the differences between hair loss in men and women. We commend Dr. Puig for his efforts to bring hair surgical and medical restoration options to female hair loss suffers.

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**Chart adopted from Dr. Puig’s web site: www.hairrestorationhouston.com

HORMONE, STRESS, GENETICS ?

In some women with a genetic predisposition to hair loss, a group of hormones called androgens interferes with the growth cycle of the hair. These androgen hormones-testosterone, Androsteinedione, and Dihydrotestosterone (DHT)- are dominant hormones in men, but are present in women to a much lesser degree. In some women, hair loss may be due to the action of androgens on the hair follicles.

Hair grows at one-half inch per month and the growth phase can lasts two to six years. With yet-to-be discovered physiologic signals, the hair goes into a resting phase for a period of time, then the hair follicle falls out and a new follicle starts the process all over again.

In women who are genetically susceptible, when the testosterone comes in contact with enzymes residing in the hair cell, it is converted into the more potent androgen DHT, which then binds with receptors deep within the hair follicle. Over time, DHT in the hair follicle alters the natural resting and growth phases of the hair. Some of the hair follicles eventually die, while others stop continuing healthy hair growth.

The term ‘androgenic alopecia’ in women is often referred to “female pattern hair loss.” It is a broader term that encompasses many possible causes of hair loss in women. Androgenic alopecia is caused by factors related to the actions of hormones, e.g., ovarian cysts, use of high androgen index birth control pills, pregnancy, and menopause. Just like in men, DHT and heredity plays a role in this disease.

In men, the pattern of hair loss is distinct whereas, women have a diffuse thinning of their hair. Female pattern balding affects circumferentially the whole top of the head with preservation of the frontal hairline. Men rarely have diffuse thinning and the frontal hair line is usually  loss to balding.

The science of female balding remains not entirely  understood.  Genetic codes and other factors plays a role in hair loss in women and remains a challenge to doctors and patients alike.

ISHRS Annual Meeting: Course Faculty

At the annual scientific meeting held in the in the Bahamas, the International Society of Hair Restoration Surgery (ISHRS) held their twentieth year of education, research, and collegiality at the Atlantis Resort on Paradise island.  The event was attended by almost one thousand physicians and associated professionals in the hair restoration field.

The annual meeting included didactical and hands-on courses, live surgery workshops, seminars, scientific sessions, and poster presentations.  The meeting was highlighted by lectures by Dr. Ralf Paus from the University of Manchester who spoke on “emerging therapies and strategies to induce hair growth,” and Dr. Bruce Morgan from Harvard University who discussed hair morphogenesis and follicular regeneration.

A workshop and hands-on course teaching Follicular Unit Extraction (FUE) to new physicians was given by hair transplant surgeons teaching both manual and motorized FUE techniques.   The course faculty was composed of international surgeons such as Dr Alex Ginsburg of Israel; Jose Lorenzo of Spain; Jean Devroye of Belgium; and  U.S. trained hair transplant surgeons such as Dr. Ken Williams of Irvine, California; James Harris, of Denver, Colorado; John Cole, of Atlanta, Georgia; William Rassman, of Los Angeles, California; and Sanusi Umer, of Torrance, California.

Automated FUE Hair Restoration: Patient Results

36 year-old male came into The Irvine Institute of Medicine & Cosmetic Surgery concerned about hair loss in his frontal hairline.  2000 grafts using Automated FUE technology were recommended to recreate and lower the frontal hairline.  2021 grafts were harvested from the donor site and transplanted to the frontal hairline.  The pictures above show the dramatic difference at only 7 months post op, with final surgical results at 12 to 18 months.

Emma Stone is Blonde Again: The Science of Hair Dyes

Earlier this month, 23-year-old actress Emma Stone changed her look from sassy redhead to bombshell blonde, surprisingly her natural color.  Emma began the process of lightening her famously fiery red hair in March when she went strawberry blonde.  She has since completed the peroxide process with a return to near-platinum locks.

In previous posts we have discussed that excess hair coloring can cause hair loss, but in this post we will discuss how lightening your hair can cause necrosis (death) of the scalp.

What Exactly Is Hair?

Typical mammalian hair consists of the shaft, protruding above the skin, and the root, which is sunk in a follicle, or pit, beneath the skin surface. Except for a few growing cells at the base of the root, the hair is a unique tissue composed of keratin and related proteins. The hair follicle is a tubelike pocket of the epidermis, that encloses a small section of the dermis at its base. Human hair is formed by rapid divisions of cells at the base of the follicle. As the cells are pushed upward from the follicle’s base, they harden and undergo pigmentation.

The hair on our scalps and in our eyebrows and eyelashes are different from other bodily hairs. The hair on our heads grows a healthy .5 inch per month, and long scalp hairs have an average life of 3 to 5 years. Most of us have between 100,000 and 150,000 hairs on our heads!

There are two kinds of melanin found in the hair: eumelanin (the most common and responsible for hair shades from brown to black) and phaeomelanin (responsible for yellowish-blond, ginger and red colors). Absence of pigment produces white/gray hair. Before any permanent color can be deposited into the hair shaft, the cuticle, or outer layer, must be opened. The insoluble formula then reacts with the cortex to deposit or remove the color

Coloring/Tinting/Dyeing the hair is a chemical process of adding color to the hair shafts. Until the early 1900s, hair coloring was made from a wide range of herbal and natural dyes. Flying in the face of other chemists who found the development of hair coloring trivial and unworthy of their time, French chemist Eugene Schueller created the first safe commercial hair coloring in 1907. His invention was based on a new chemical, paraphenylenediamine, and provided the foundation of his company, the French Harmless Hair Dye Company. A year later, the name was changed to one that is more familiar today –L’Oreal. L’Oreal, one of the hair product giants, has grown steadily over the years; the company credits advanced and applied research of new product development and expansion into markets around the world with its global success.

The two main chemical ingredients involved in any coloring process that lasts longer than 12 shampoos are:

• Hydrogen peroxide (also known as the developer or oxidizing agent) — This ingredient, in varying forms and strengths, helps start the color-forming process and creates longer-lasting color. The larger the volume of the developer, the greater the amount of sulfur is removed from the hair. Loss of sulfur causes hair to harden and lose weight. This is why, for the majority of hair coloring, the developer is maintained at 30% volume or less.
• Ammonia — This alkaline allows for lightening by acting as a catalyst when the permanent hair color comes together with the peroxide. Like all alkalines, ammonia tends to separate the cuticle and allow the hair color to penetrate the cortex of the hair.

In addition, various types of alcohols, which can also dry the hair, are present in most hair color. The hydrogen peroxide is the main culprit for initiating inflammatory skin reactions on the scalp.

Megan Fox’s Eyebrows: Full Eyebrows Are In

The eyebrow is an important part of facial symmetry and contributes to the aesthetic appearance of men and women. Eyebrows frame the eyes and are one of the primary anatomical facial structures we see when looking at people.

Celebrities often set the trends and fashion. Notice at how different Megan Fox’s eyebrows are from 2003 to today.  Megan Fox’s eyebrows are thicker and shaped to frame her beautiful face which brings out her blue eyes even more. Her thinner brows (picture left) were set high above her eyes and showed so much space that gave the appearance her face was wider than it really is.

Eyebrows lose their natural full appearance by:

• Congenital Causes
• Trauma-burns, auto accident, surgery, ect.
• Radiation or Chemotherapy
• Medical, Autoimmune, or Systemic Disease (Lichen Planus or Alopecia Areata)
• Obsessive Compulsive Disorder (Trichotillomania)
• Over grooming or management
• Normal Aging Process

For patients desiring a denser and fuller appearance of their eyebrows, Eyebrow transplantation surgery can restore eyebrows to their natural youthful appearance. Hair transplant surgeon of Irvine, California, Dr. Ken Williams adds, “Eyebrow hair transplantation is a safe and an aesthetically elegant procedure.  A common history in women with decrease eyebrow density  is typically a history of overplucking and over grooming.”  He adds, “Hypotrichosis (eyebrow hair loss) is a condition that can be easily treated with surgery by an experienced hair trasnplant surgeon.”

Before undergoing this type of hair restoration, patients should be aware that the hair transplanted to eyebrows will continue to grow in length and will need to be periodically trimmed. For surgeons performing this procedure, Williams adds, “The greatest challenge is knowing during the healing process that the new eyebrow hair follicle inserted into the recipient site may change its orientation and exit angle. This will cause a slight change to the transplanted hair’s orientation and result in an eyebrow hair that may be slightly elevated or improperly angled. The hair restoration surgeon must create the recipient sites so the new hair follicle grows parallel with the existing eyebrow hairs.”

The appearance of an eyebrow transplant will mature and soften over the course of a year, during which time the eyebrows can be groomed- tweezed, waxed, or shaped as desired. After the one year mark, a second eyebrow hair transplant procedure may be considered if patients would like to add density to the eyebrows.

Heidi Klum & Seal Headed For Divorce?: Lupus Causes Hair Loss

On Sunday, January 22, 2012 Heidi Klum and Seal announced they are filing for divorce. The two wed on May 10, 2005 and have 3 children together.  Heidi’s statement to the press on what led to split, via her rep, was relatable and gracious.  “While we have enjoyed seven very loving, loyal and happy years of marriage, after much soul-searching we have decided to separate,” the duo says in a joint statement. “We have had the deepest respect for one another throughout our relationship and continue to love each other very much, but we have grown apart. This is an amicable process and protecting the well-being of our children remains our top priority, especially during this time of transition. We thank our family, friends, and fans for their kind words of support. And for our children’s sake, we appreciate you respecting our privacy.”

Jet magazine reported on June 10, 1996 that at age 23 Seal was diagnosed with Discoid Lupus Erythematosus (DLE). DLE is a rare form of Lupus causing scars of the face, ears, and scalp.  A majority of people with lupus experience some hair loss whether they have a form of lupus that affects several organs or a form that mainly affects the skin. Most of the time, though, lupus is unlikely to cause complete or permanent hair loss.

“Hair loss can be an early sign of lupus,before the disease is actually  diagnosed. Lupus causes widespread inflammation, almost always involving the skin, particularly, on the face and scalp“, says Irvine hair transplant surgeon Dr. Ken Williams.  He adds,  “inflammation and other systemic medical factors, can cause the hair on the scalp to gradually thin out.  Patients may even lose their hair in clumps. or eyebrows, eyelashes, beard, and body hair is also possible.

Although lupus-related hair loss can be shocking, the hair will most likely grow back once the lupus is medically treated and controlled by a specialist, such as a rheumatologist. The signs and symptoms of lupus often go into remission for long periods of time, but the disease tends to flare back up unpredictably. If a lupus flare occurs the hair loss may start again.

If your hair is falling out, consult a hair loss specialist to find out why. Unless you’re already being treated for lupus or you have other signs and symptoms of the disease, your hair loss is probably caused by something else. Among the possibilities are genetics, medications, hormonal changes, thyroid disorders, nutritional deficiencies, and stress.

For more information on Lupus please visit the Lupus Foundation of America.

Saints defeat Lions, but Drew Brees is losing fight against hair loss

On Saturday, January 7, 2012 the New Orleans Saints defeated the Detroit Lions with a 45-28 NFC wild-card victory.  Drew Brees led an unstoppable offense by throwing for 466 yards, the most yards in a regulation playoff game.  “We were pulling out all the stops,” Brees said.  “We play aggressive. We’re not going to apologize for that. That gives guys in the huddle a lot of confidence. We’re not going to pull the reins back. It’s pedal to the metal.” That type of aggression has led to many victories for the New Orleans Saints, and if Brees would show that type of aggression with his hair he may have preserved his frontal hairline and overall hair density.

It is normal to shed hair everyday and the truth is we lose between 100-125 hairs on any given day.  However, some individuals may experience higher amounts of hairs being shed each day. Once a hair reaches the end of its growth cycle it will then shed from the scalp. At any given time 10% of our hair is in a “resting phase” and after 2-3 months resting, hair falls out and new hair grows in its place.

As we age, both men and women will experience some hair loss. This is a normal part of the aging process. Androgenetic Alopecia (AGA) accounts for 95% of hair loss, and it often times runs in families. In men this condition is usually referred to as Male Pattern Baldness (MPB). MPB is characterized by a receding hair-line and baldness on the top of head.  Women, on the other hand, don’t go entirely bald even if their hair loss is severe. Instead, hair loss is spread out evenly over their entire scalp while maintaining the frontal hairline.

Hair restoration surgeon, Dr. Ken Williams of the Irvine Institute of Medicine and Cosmetic Surgery adds, “Drew is one of the truly amazing football players in the NFL. But if he continues to lose hair, he will look much older than his chronological age if he does not intervene at this time in his life.  His hair loss is quite noticeable and I don’t want to see him lose any more.”

Hormones play a dominant role when talking about AGA. Simply put, both men and women produce testosterone and this testosterone is converted to dihydrotestosterone (DHT) with the aid of the enzyme 5-alpha-reductase. DHT miniaturizes the hair follicles causing the membranes in the scalp hair density to decrease.

Men naturally produce more testosterone than women and therefore men experience more hair loss. Both male and female AGA is very common and easily treated medicallyand surgically. For medical treatment,  minoxidil is recommended for both men and women to apply topically twice a day. For men, taking the oral medication finasteride, DHT blocker, is strongly recommended. Male and female AGA responds well to low-level laser therapy, and platelet rich plasma therapy is a therapy with a potential future as well.  For surgical treatment there is the older and more invasive linear strip method, or the latest FDA approved hair surgery called Automated FUE.

Bon Jovi Death Hoax & Hair Loss

Jon Bon Jovi is the latest celebrity victim of the infamous “celebrity death hoax.”  Yesterday afternoon Jon quickly went to Facebook to set the record straight stating “heaven look a lot like New Jersey.”

In the early days of his career, Jon sported the infamous long big hair of the 1980s. Over the years his hair has been de-poofed and cut shorter to reveal significant hair thinning and hair loss of the frontal hairline. On February 20, 2009 Starpulse.com quoted Bon Jovi “Oh, let me tell you, I am so worried (about my hair). I look at guys like Sting and think, ‘Well, he’s cool about it,’ but I’m already losing it a bit and I’m so aware of it. Someone told me that you have to regularly massage your scalp, so I do that all the time. You look like a jerk, but it’s got to be worth a shot, right?” At the end of 2009 Jon spoke with The Times, he said when his wife threw him a 40th birthday party he jokingly told her to take lots of photos because it would be “the last pretty birthday”. Jon Bovi reveals, “I ain’t gonna do no shots, no Botox, no hair plugs, anything. I’m comfortable enough in my skin to know that such is life. I’d rather age gracefully.”

Hair transplant surgeon Dr. Ken Williams, of OC Hair Restoration Center located in Irvine, California, advises patients to be proactive about their hair loss and diligent about their daily treatment program.  “Daily treatment is key,” says Dr Williams, “the use of a DHT blocker like Propecia, and topical application of minoxidil will stop further loss and maintain the current hair density.”