Hair Blogs


How common is hair loss after bariatric surgery?

Bariatric surgery: Loss of hair is common

I've seen dozens and dozens of patients these past few months experiencing hair loss after bariatric surgery. This hair loss is mostly of the telogen effluvium kind and a large proportion of the hairs are expected to grow back. A proportion of people don't quite regain the same density as they once had -  a phenomenon whereby hair shedding episodes are said to accelerate the development of androgenetic alopecia. 

 

How common is hair shedding after bariatric surgery?

I enjoyed reading a new study from Brazil which showed that quality of life is enhanced greatly following the weight loss from bariatric surgery. In the study, hair loss was common following the surgery and occurred in nearly 70 % of those that have surgery. 

 

 

REFERENCE

Silva PR et al. Nutritional status and life quality in patients undergoing bariatric surgery. Arq Bras Cir Dig. 2014;27 Suppl 1:35-8.

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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'Metabolic syndrome' and why it matters for those with genetic hair loss?

 

What is metabolic syndrome?

Metabolic syndrome refers to a cluster of medical issues such as high blood pressure, high cholesterol, diabetes, and excess fat around the waist. Essentially many of the factors that are known to increase the risk of heart attacks and stroke.

It's been known for a while that individuals with androgenetic alopecia "AGA"  (also called male pattern balding and female pattern hair loss) are at increased risk to develop metabolic syndrome.  Researchers from China recently reviewed all of the studies relating to the issue. They identified four case-control studies and 2 cross-sectional studies including 950 AGA subjects and 3056 control subjects.

What were the results of the study?

The study showed that taken all together, AGA was significantly correlated with developing metabolic syndrome - in fact the risk was raised about three times.

 

Conclusion 

The medical field has not yet embraced this concept and we have a lot of work left to do. There is good evidence now that men and women with AGA (especially early AGA are at risk to develop metabolic syndrome.  We urgently need to protocols ways to screen patients and identify those at highest risk. 

 

Reference

Wu Dx et al. [Association between androgenetic alopecia and metabolic syndrome: a meta-analysis]. 2014 Sep 25;43(5):597-601.

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Is FUE better than strip surgery?

Many patients wonder if FUE is better than strip? FUE is not necessarily better technique - it's just different. It's critical that patients considering hair transplant surgery understand the unique differences in these two procedures.

With FUE (follicular unit extraction) there is no 'linear scar'  but contrary to popular belief there is a scar! However, it's just a tiny tiny circular "microscar". It's hard to see and that's the great thing about FUE. But it is a scar nevertheless. Because the area heals with a microscar, it is often possible for one to wear their hair very very short. The International Society of Hair Restoration Surgery has cracked down on clinics choosing advertising scarless surgery. 

What are the downsides of FUE? 

There are some important considerations with FUE. For example, if an individual is likely to go on to develop more significant balding in advanced ages, then it's possible that with FUE surgery will involve taking hairs from an area in the donor region that might not truly be permanent hairs. 

Take two men at age 29 with thinning in the front of the scalp. Both are destined to go on to develop a Norwood VI pattern without surgery. One gets 2500 grafts with strip and one gets 2500 grafts with FUE. Both look great one year after their surgery and both look good 10 years after. But do both look good 30 years after their surgery? There is a slightly greater chance that the man who had strip will have "fuller" hair at age 57. 

It's important for all men consider hair transplant to understand this concept. There are benefits to both strip and FUE. 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Should you get a blood test for DHT ?

Measuring DHT not useful for most men and women 

 Androgenetic alopecia is one of the most common types of hair loss. In men, it is known as male pattern balding and in women it is known as female pattern hair loss.

The exact cause remains to be worked out but it is thought that in those affected genetic factors make the hair follicles more sensitive to the hormone dihydrotestosterone. Such sensitivity causes those hair follicles to get skinnier and skinnier with time - a phenomenon which is called 'miniaturization'

 

Measuring DHT : A good idea or not?

If DHT is so important, a common question is whether doing a blood test for DHT has any value in the evaluation and management of androgenetic alopecia. 

 

A recent study set out to evaluate the usefulness of DHT level in patients with androgenetic alopecia. The study comprised 49 individuals, including 9 men and 19 women with androgenetic alopecia. The control group consisted of 17 healthy women and 4 men without hair loss.

 

What were the results of the study?

All in all, increased serum concentrations of DHT were observed in both patients with androgenetic alopecia and in those without. More importantly, the differences in mean values of DHT were not significant according to two groups and increased serum concentrations of DHT were not correlated more severe hair loss.

 

What are the conclusion of this study?

Although DHT plays an important role in the pathogenesis of of androgenetic alopecia, asking patients to do a blood test is not useful for most patients.

 

Reference

 

Urysiak-Czubatka I et al. Assessment of the usefulness of dihydrotestosterone in the diagnostics of patients with androgenetic alopecia. Postepy Dermatol Alergol. 2014 Aug;31(4):207-15. doi: 10.5114/pdia.2014.40925. Epub 2014 Sep 8.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Platelet Rich Plasma for Men and Women: Results of the Largest Study to Date

PRP requires a small amount of blood to be obtained. The blood is then separated to obtain platelet rich plasma or "PRP" that is then injected into the scalp

PRP requires a small amount of blood to be obtained. The blood is then separated to obtain platelet rich plasma or "PRP" that is then injected into the scalp

PRP FOR HAIR LOSS

Platelet rich plasma remains an area of active interest for the treatment of androgenetic alopecia (AGA).  A number of growth factors present in the PRP are known to stimulate hair growth and stimulate activation of dermal papilla cells. A handful of studies to date support a role for PRP in treating AGA.

 

New study supports a benefit of PRP

In a new study, US and Italian researchers designed a study investigating the role of PRP in men and women with AGA.  PRP concentrations 3.5 to 4 times above baseline were used in the study. A 1mm deep Scalproller was used to further induce cutaneous inflammation.  Injections were repeated at a 3 month time point and clinical evaluation was performed at the 3 month and 6 month interval. 2 investigators assessed the response of patients via before and after photographs.

64 patients enrolled in the study, including 42 men and 22 women. The median age of males was 28 and 32 in the female group. None of the patients were allowed to start new therapies other than the PRP.

 

What were the results of the study?

Overall, results favored the use of PRP for treating AGA. One investigator deemed 62/64 patients to have improved and the second investigator felt 64/64 improved.  Investigator 1 deemed 40.6 % to have a clinically important difference and investigator 2 felt 54.7 % had a clinically important difference. There was no difference in responses according to gender, age, number of platelets or the degree of hair loss at baseline.  Interestingly, a greater degree of improvement was found in those with a more severe hair loss.  There were no adverse effects noted such as allergic reactions pain, fever or prolonged redness. Post operative telogen effluvium was not noted.

 

Conclusion:

This is an exciting study which further supports a role for PRP in the treatment of androgenetic alopecia.  Like other studies, this study supports the notion that PRP concentrations should be 3-5 times above baseline in order to stimulate improvement. There are numerous PRP machine on the market and numerous distinct techniques. Further research is needed to understand which components and modifications are most important.

 

 

Reference

Schiavone et al. Platelet-Rich Plasma for Androgenetic Alopecia: A Pilot Study. Dermatol Surg; 2014; 40:1010-1019.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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What is pressure alopecia?

Hair loss from pressure?

or.jpg

Pressure alopecia doesn't refer to hair loss caused by stress! Rather if refers to hair loss from prolonged positioning on one's back, usually during prolonged surgeries (cardiovascular surgery, gynaecological surgery, abdominal surgery.)

Nowadays, it's pretty standard in the operating room for someone to be in charge of making sure the patient's head is turned frequently during surgery. If not, the tiny blood vessels get occluded and skin ulceration and hair loss can occur.

 

Hair loss on post op day 7

Hair loss occurring a 7-14 days after the surgery from the middle back of the scalp usually indicates pressure alopecia. Patients may develop tenderness and crusting a few days before the hair loss. Fortunately for most - the hair loss is temporary and grows back in 1-2 months. However, for a small number of individuals the hair loss is permanent. Hair transplantation provides an option to restore density. 

 

Reference

Davies and Yesudian. Pressure alopecia. Int J Trichol 2012; 4(2): 64-68

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Welcome October! Do you know about pumpkin seed oil?

Pumpkins and Hair Loss: 

Reflections on pumpkin seed oil for hair loss during my recent visit to the pumpkin patch

Reflections on pumpkin seed oil for hair loss during my recent visit to the pumpkin patch

As October rolls in, it seems appropriate to discuss pumpkins and one of the oils from the seeds - pumpkin seed oil (PSO). 

Surprisingly, pumpkin seed oil (PSO) has been shown in previous studies to block the action of the enzymes 5-alpha reductase and to have antiandrogenic effects on rats.

Korean researchers undertook a randomized, placebo-controlled, double-blind study was designed to evaluate the efficacy and tolerability of PSO for treating male patients with mild to moderate androgenetic alopecia (AGA).

 

How was the study designed?

76 men with AGA received 400 mg of PSO per day or a placebo for 24 weeks. Four outcomes were closely followed in the study: assessment of standardized clinical photographs by a blinded investigator; patient self-assessment scores; scalp hair thickness; and scalp hair counts. Reports of adverse events were collected throughout the study.

 

What were the results?

At the end of the 24 week treatment, self-rated improvement score and self-rated satisfaction scores in the pumpkin seed oil-treated group were higher than in the placebo group (P = 0.013, 0.003). The PSO-treated group had more hair after treatment than at baseline, compared to the placebo group (P < 0.001). Mean hair count increases of 40% were observed in PSO-treated men at 24 weeks, whereas increases of 10% were observed in placebo-treated men (P < 0.001). Adverse effects were not different between the two groups.

 

Comments

Further studies are needed to understand the benefits of pumpkin seed oil in promoting hair growth. These results are encouraging, especially in light of their relative safety.

 

Reference

 

Cho YH et al. Effect of pumpkin seed oil on hair growth in men with androgenetic alopecia: a randomized, double-blind, placebo-controlled trial. Evid Based Complement Alternat Med. 2014;2014:549721. doi: 10.1155/2014/549721. Epub 2014 Apr 23.

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Traction alopecia & Greenland

Beautiful view of Greenland from my seat, where traction alopecia first got its name in 1907

Beautiful view of Greenland from my seat, where traction alopecia first got its name in 1907

Traction alopecia refers to a type of hair loss due to pulling forces. Women who wear their hair back tightly in pony tails or those using braids weaves or cornrows are also susceptible to traction alopecia.

Some men are also susceptible to traction alopecia, such as Sikh men who use turbans. 

 

1907: Traction Alopecia introduced to scientific literature

Traction alopecia has probably been seen for thousands of years, but it was first described in 1907 in West Greenland. Hair styles at the time in Greenland resembled the modern 'pony tail' and lead to hair loss.  It was termed "Alopecia Groenlandica" by an Austrian dermatologist. 

Traction alopecia has many different appearances but often appears as an area of hair loss along the frontal scalp.

In the early stages of traction alopecia, hair can regrow to some degree if the hairstyling practices are stopped (pony tails, braids, weaves). If left, and the traction alopecia is present for many years, hair regrowth is not possible with medications. 

 

 

Hair transplantation for traction alopecia

Restoration of the frontal hairline in a woman with traction alopecia. Photo: 12 months post op.

Restoration of the frontal hairline in a woman with traction alopecia. Photo: 12 months post op.

Hair transplantation can be a very good option for treating traction alopecia - provided the pulling forces have been stopped.

The photos on the right show typical before and after photos following hair transplantation. Most patients achieve final results by 12 months following their procedure.






Reference

Hjorth N. Traumatic marginal alopecia; a special type: alopecia groenlandica. Br J Dermatol 1957. 1957; 69: 319-22



Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Thinking about starting a treatment for hair loss? My Rules of Safety

Doc, have you ever heard of this treatment?

There are literately thousands of treatments available for hair loss and hair care and literately thousands of them of have no clear benefit or have marginal benefit only.   Suppose you are sitting at a restaurant and you overhear someone comment at the next table comment that rinsing of the hair twice daily with the extract of 4 specific vegetables has done wonders for the hair.

Should you try it out?

At first thought you might think... 'It probably can't hurt... and if it helps... great!" But what if I told you that I've seen over 150 patients in the last 2 years alone with hair loss that never recovered because of treatments they thought "couldn't hurt."

When it comes to deciding on hair loss treatments, I generally advise my own patients and the public to think in terms of these principles.  I call them my Rules of Safety.

 

Rules of Safety

 

If the treatment has been reported in the medical literature to have clear benefit in more than 1500 patients, AND has more than 10 scientific publications to back up the claim that it “works”, AND has been around more than 5 years AND has FDA approval

 

 ask your general physician, dermatologist or hair specialist about whether you should use it. I like to call it a group A treatment.

 

 

If the treatment has been reported in the medical literature to have clear benefit in more than 75 patients, AND has more than 4 independent scientific publications to back up the claim that it “works”, AND has been around more than 5 years

 

ask your dermatologist or hair restoration specialist whether you should use it as an ‘off label' treatment.  I like to call it a group B treatment.

 

 

If the treatment has been reported in the medical literature to have benefit in less than 75 patients, AND has less than 3 independent scientific publications to back up the claim that it works,   

 

ask your dermatologist or hair restoration specialist whether there are clinical trials or clinical studies available for you to participate in. I like to call it a group C treatment.

 

 

If the treatment has never been reported in the medical literature to have benefit and there are no independent scientific publications to back up the claim that it "works"   

 

ask yourself… “Why am I doing this?”

I like to call it a group D treatment as a reminder - don't  !

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Lattise for Eyebrows: Does it help?

Eyebrow Loss: Latisse can help many

Latisse (generic name: bimatoprost) is FDA approved for eyelash growth. Anytime a physician prescribes a medication outside of it's intended use, it's called an 'off label' use.

Latisse for the eyebrows is an "off label" use of the drug. 

That said, Latisse can certainly work well to stimulate eyebrow growth in some patients. It has helped hundreds of my own patients improve their eyebrow density. Even in small amounts (i.e. whatever small amount is left over after applying to the eyelid) can help. It appears that Latisse works better for hereditary or age related thinning than for traumatic related loss (such as from over plucking, tweezing or trichotillomania).

 

Other options for Brow Loss: Minoxidil and Hair Transplants

Other options for eyebrow loss include minoxidil (Rogaine) and hair restoration. Not everyone is a candidate for these treatments.


More studies of Latisse needed

Formal studies are needed but for now Latisse is a good option for eyebrow thinning. There is no formally approved treatment on the planet for eyebrows  - but there needs to be ..... as eyebrow thinning is a common and distressing problem. 
 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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No such thing as scarless hair transplant surgery - International Society issues Alert

 ISHRS clamps down on false advertising

In an effort to stop false advertising in the field of hair restoration, the world's largest hair restoration society - The International Society of Hair Restoration Surgery (ISHRS) - has issued clear guidance to the public on the topic of scarless surgery:

"THE FACT IS THAT ANY INCISION WHETHER BY MACHINE OR HAND THAT ENTERS THE SKIN BEYOND THE MOST SUPERFICIAL OF DEPTHS CAUSES A SCAR TO FORM"

(ISHRS website, Sept 2014)

 

Interested to read more?

Click here


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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International Society Issues Hair Transplant Consumer Alert

Hair Transplant Consumer Alert

Many hair transplant surgeons, including myself, are members of the International Society of Hair Restoration Surgery (ISHRS). It is the largest international body of hair transplant surgeons in the world. Our society is extremely concerned about the growing risk to patients of unlicensed technicians performing substantial aspects of hair restoration surgery. 

The ISHRS has recently issued a consumer alert to warn patients of potential harm that can come about when unlicensed technicians perform critical parts of the pre op or the surgery or the post op. 

In a new statement, the ISHRS has stated quite clearly that it "believes the following aspects of hair restoration surgery should only be performed by a licensed physician or licensed allied health professional practicing within the scope of his or her license:                                                                                                                                  

1. Preoperative diagnostic evaluation and consultation           

2. Surgery planning

3. Surgery execution including:

  • Donor hair harvesting
  • Hairline design
  • Recipient site creation

4. Management of other patient medical issues and possible adverse reactions

 

What to read the full consumer alert?

Please click here to read the full consumer alert


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Can we pre-determine who minoxidil is going to help?

Will minoxidil help?

Minoxidil is FDA approved for the treatment of androgenetic alopecia. In fact, it was the first treatment formally approved by the FDA for hair loss. The drug does not help everyone with hair loss. In fact, studies suggest it helps only 30 % - 40% of users.

 

Is it possible to predict if minoxidil will help me?

At present, the only way to determine if minoxidil will help is to try it out. And that phase of "trying it" phase needs to last about 6 months in order to determine if minoxidil will help or not.


The sulfotransferase enzyme

Recent research has turned to focusing on whether the activity of an enzyme in hair follicles called the sulfotransferase enzyme can predict who minoxidil will and will not help. Two studies have previously reported that sulfotransferase enzyme activity in plucked hair follicles predicts a patient's response to topical minoxidil therapy. In a new study, researchers confirmed the clinical utility of a sulfotransferase enzyme test in successfully ruling out 95.9% of nonresponders to topical minoxidil for the treatment of AGA.

 

Comments

This is a powerful step in the right direct for a safe and somewhat effective medication. I've seen countless numbers of patients helped by minoxidil, and countless more who have not been helped.  If we can now figure out who shouldn't use mionxidil - this is a huge step in the right direction. I'm excited to follow where this sulfotransferase enzyme testing will lead- I am confident we'll hear more soon. This is good science put to good work. 

 

Reference

Goren et al. Clinical utility and validity of minoxidil response testing in androgenetic alopecia. Dermatol Ther. 2014 Aug 12. doi: 10.1111/dth.12164. [Epub ahead of print]

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Eyebrow transplantation: Deceivingly Simple?

Eyebrow Transplantation: Cautionary Tales

Eyebrow hair transplants are popular, especially among women.  A few weeks ago, the Toronto star had a great article on eyebrow transplants that further caught the attention of many. In parallel to the increasing number of women having eyebrow transplants there is has been an increase in the number of women having transplants who shouldn't be.

 

Taking a step back before having eyebrow transplant.

Many women are good candidates for eyebrow transplants - but a small proportion are definitely not. This week alone I saw 6 patients who had eyebrow transplants sometime in the past a various centers around the world- who came into my office with one question - "why didn't it grow out like I imagined it would?"

 

Here's a few cautions for anyone considering eyebrow transplants. If these statements sound like you, step back and pause.

 

1. I have complete eyebrow loss 

Women with complete eyebrow loss "might' be a candidate for a transplant but absolutely need to see a dermatologist first.  Alopecia areata and frontal fibrosing alopecia are two conditions that can lead to eyebrow hair loss - and don't respond very well to hair transplants.  Hair loss from these conditions can sometimes look similar to age related thinning.  Simple rule: if you have complete eyebrow loss, get a proper diagnosis. Don't assume you've over tweezed, or that your thyroid abnormality caused the loss - just assume you need to see a dermatologist. 

 

2. I lost my eyebrow quickly and need a quick solution

The ideal candidate for eyebrow transplants is someone who lost their eyebrows slowly - through years of over tweezing or slow age related thinning. Individuals who lose their eyebrows over a 6 month to 12 month period are usually not good candidates - they need to see a dermatologist to figure out what is going on.

 

3.  I am looking for a single procedure only. 

An eyebrow restoration is a delicate process. Transplants of the scalp can often be accomplished with one procedure - but such a statement is inaccurate for the eyebrows. There are few areas of the face so important as a properly designed eyebrow. One must expect to have at least two procedures to make the eyebrows look amazing. The first procedure is designed to build the density and create the basic framework. I nearly always recommend a small touch up to finalize the brow. 

 

4. I want my eyebrows to look like Cara Delevingne

I encourage patients to bring in photos of individuals whose brows they admire. This is helpful to understand the features they are looking, the density, the shape.  The most popular photo to be brought in, by far,  is that of British model Cara Delevigne.  Together with my patients, we've studied all the angles, directions and positioning of the estimated 1000 eyebrows that make up Cara's 2 eyebrows.  But is this shape and density appropriate for everyone? Not at all. The appropriate shape and structure of the eyebrow depends on an array of factors including the patients eye structure & surrounding orbital bones, their facial symmetries, their cheek bones, nose, forehead and chin. I encourage patients to bring in many photos - but the most important photo of all - is a photo from their own past.

 

Conclusion

Eyebrow restoration is delicate work. The first step for anyone deciding whether to have a transplant is figuring out if they are a candidate a not. 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Finasteride and Dutasteride: No Risk of Breast Cancer

New Study Suggests no Risk

 

The 5α-reductase inhibitors (5-ARI) finasteride and dutasteride are used to treat male pattern hair loss. These medications an be used alone or combined with hair transplant surgery. One of the rare risks of these drugs is enlargement of breast tissue in men - a phenomenon called gynecomastia. There has been some question in the past as to whether there could be an increased risk breast cancer in men. Recent evidence has suggested that there is no such increased risk and a new study supports this notion as well.

 

A new study suggests no risk

A UK study of  men aged 45 years and older was done to retrospectively evaluate men with breast cancer compared to men without breast cancer over the 20 year period 1992 to 2011. 398 cases were identified and matched to 3,930 controls. In this study, there was no evidence of an association between short-term or long-term use of finasteride or dutasteride and the risk for breast cancer in men.

 

Comment:

Last year, I wrote a blog describing a study from the Journal of Urology which suggested that there was no increased risk of breast cancer. This study is in line with these previous studies. Overall, the overwhelming data to date suggest that use of these medications for hair loss does not increase the risk of breast cancer.

 

Reference

Duijnhoven et al. Long-term use of 5α-reductase inhibitors and the risk of male breast cancer.

Cancer Causes Control. 2014 Aug 19.  

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Eyebrow Transplants: The Latest Trend in Hair Restoration

Eyebrow Transplants:  Interview in Toronto Star

Today, I was interviewed in the Toronto Star about a trend we're seeing in hair transplantation: eyebrow transplants.

For a full link to the article click here.

Eyebrows have an extremely important role in facial aesthetics. They frame the face. They draw attention to (or away) from the eyes.

 

What is an eyebrow transplant?

An eyebrow transplant is a short (3-4 hour) cosmetic procedure whereby hair follicles are removed from the back of the scalp and moved into the eyebrow. 

Briefly, hairs are generally chosen from the back of the scalp just behind the ears because these hairs are the "finest" calibre hairs and most closely match the hairs of the eyebrow. Hairs can also be taken from the nape of the neck in some patients as well as leg and arm. The choice of hair depends on the patient's hair characteristics.  99 % of the time it comes from the back of the scalp. 

In order to take hairs from the back of the scalp, the area must first be frozen with "freezing medications" like lidocaine. These are usually the same freezing medications as a dentist might use to freeze a tooth. Once the area is frozen, hairs can be removed as a large piece of skin (called strip excision) or one by one (called follicular unit extraction).  There are distinct advantages of each.

Once hairs are obtained from the back, they are prepared for placement into the eyebrow. In order to do this, the eyebrow is frozen with the same freezing medications and then tiny tiny incisions (tunnels) are made in the eyebrow at very precise angles and directions.  Once the incisions are made, the new tiny hairs from the back of the scalp are placed down into those holes.  

It is critical that patients are aware of what to expect next - I.e. the so called "post-op" period.  This must be thoroughly discussed with the physician who plans to do the procedure.  In general, a partial list of side effects include swelling and redness and crusting for a few days. Redness may persist in some patients many weeks. However, fortunately not all.  The area must be bathed twice daily as the area at the back of the scalp must also be kept meticulously clean. 

Eyebrows, once they grow out in 2-3 months must be trimmed regularly.  These hairs grow like the hairs did when they were located in the back of the scalp - i.e. they grow long.  It takes 7-12 months to see results. 
 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Cancer Drug May Offer new Treatment for Alopecia Areata

Preliminary Study in 3 Patients

Alopecia areata is an autoimmune hair loss condition that affects about 2% of the population. Treatments include a variety of immunosuppressive treatments. Hair transplantation is not an option for this type of hair loss condition.

Researchers from Columbia University in New York have uncovered a potentially new treatment for alopecia areata: an oral cancer drug known as ruxolitinib.

In a well designed study, the investigators first showed first that the drug was effective in a mouse model of alopecia areata. After showing it worked it mice, the researchers then tested the drug in three patients with alopecia areata.  All three patients experienced hair growth in just a matter of a few months. Although the study was performed in only a small number of patients, it opens the door for further study of this medication.

 

What is Ruxolitinib?

Ruxolitib is a type of cancer drug. It is not a new drug and in fact is already on the market to treat an uncommon bone marrow cancer called myelofibrosis as well as a few other conditions. The drug belongs to a group of medications that inhibits signals within immune cells called the JAK kinase.

Ruxolitinib is currently prescribed by cancer physicians and patients who use the drug need to be carefully monitored. It can cause a drop in blood counts, and can increase the chance of bleeding and bruising. Some patients are more prone to infections while on the medication. Rarely other side effects such as irritation of the heart and liver, weight gain and elevated cholesterol levels can occur.

 

Conclusion

Further studies are needed to determine if the cancer drug ruxolitinib is safe and effective for patients with alopecia areata before determining if it should or should not be prescribed to larger numbers of patients. Certainly, results from the first three patients are encouraging.  

 

Reference

 Study article: Xing et al. Alopecia areata is driven by cytotoxic T lymphocytes and is reversed by JAK inhibition. Nature Medicine. Published online Aug 17 2014


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Control of Graft Depth Essential in Hair Transplantation

Many factors to create natural looking hair transplant results 

How does one great natural looking results in hair transplantation? Well there are many ways, including paying careful attention to the angle and direction that new hairs are put into the area of hair loss, controlling the density or spacing of the hairs, controlling the calibre of hairs and controlling the depth that hairs are placed.

Going deeper: Understanding Depth Control

Hair transplantation essentially involves taking follicles from the back of the scalp and moving them into areas that are thinning or bald. Small "holes" "tunnels" or incisions are created in the bald area to accommodate the new hairs. 

Creating these incisions is meticulous work. They have to be perfect. Tunnels that are too deep will cause the new hairs to sink into them creating unsightly 'pitting' (little indents around the hairs). Tunnels that are not deep enough may lead to hairs falling out or the hairs may heal as tiny mounds raise above the surface of the skin. 

 

Ensuring Proper Depth in Hair Transplant

The photo to the right shows how I ensure proper depth of a patient's grafts. The instrument on the far right is a needle attached to a blade holder. The needle must be adjusted so that it is the appropriate size.

 

Conclusion

A number of factors, including graft depth,  are important to ensuring natural looking results

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Breast Cancer Patients on Aromatase Inhibitors: Risk of Hair loss Increased

Risk of hair loss increased two fold

Aromatase inhibitors are a group of medications used to treat breast and ovarian cancer. Common names of these drugs include Anastrozole (Arimidex), Letrozole (Femara), Exemestane (Aromasin), Vorozole (Rivizor), Formestane (Lentaron), Fadrozole (Afema). Over the past few years we've come to realize that these medications can cause hair loss in some women.

 

How do these medications cause hair loss?

Aromatase inhibitors cause hair loss because they reduce the levels of estrogen and increase the levels of testosterone. Both of these can contribute to hair loss.

 

New study quantifies risk of hair loss

A new study published in the journal Breast Cancer Research and Treatment  examined the association between aromatase inhibitor treatment and hair loss or hair thinning among female breast cancer survivors. Records were analyzed from 851 female breast cancer survivors. The results showed that 22.4 % of the breast cancer survivors reported hair loss and 31.8 % reported hair thinning. In addition,  breast cancer survivors who were within 2 years of starting aromatase inhibitor treatment at the time of survey completion were approximately two and a half times more likely to report reporting hair loss  or hair thinning  within the past 4 weeks compared to those who were never treated with these drugs. 

 This study adds to a growing body of literature showing that aromatase inhibitor use is associated with an increased risk of hair loss and hair thinning

 

Treatment Options: Minoxidil and Hair Transplantation.

Few studies have been done examining the optimal treatment plan. However, I have used minoxidil and hair transplantation to restore density in many patients with aromatase inhibitor induced hair loss. More studies are needed 

 

Reference

Gallicchio L et al. Aromatase inhibitor therapy and hair loss among breast cancer survivors. Breast Cancer Res Treat. 2013 Nov;142(2):435-43.  

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Hair loss after brow lifts: Hair transplantation sometimes an option

Brow lifts may cause hair loss in some women

Brow lifts may cause hair loss in some women

The brow lift

In this week's blog I'd like to discuss a cosmetic procedure called the "brow lift." It's not a cosmetic procedure that I do, but a cosmetic procedure that I've come to understand. I've been performing an increasing number of hair restoration procedures on for women who developed hair loss after facial plastic surgery, including brow lifts.

A browlift (also called a forehead lift) is a cosmetic surgery procedure to help minimize the sagging or drooping of the skin around the eyebrows and above the nose. According to the American Society for Aesthetic Plastic Surgery about 70,000 people have brow lifts each year.  Patients often have a brow lift to restore the appearance of a droopy eyebrow which may give the appearance of being sad, angry or tired. 

A number of surgical technique are available nowadays for performing a brow lift including endoscopic procedure and open procedures.  Some of these procedures involve incisions placed in the eyebrow, some in the forehead and some well into the hairline.

Hair loss after brow lift

Hair loss is one of the top side effects of brow lifts done by both open and endoscopic procedures. It may occur in up to 10 % of patients undergoing these procedures.  Hair loss is often temporary but may be permanent in a very small proportion. Patients with permanent hair loss from cosmetic facial plastic surgery may be candidates for hair transplant surgery.

It is important for patients undergoing cosmetic facial procedures including brow lifts to understand the potential risks of hair loss and discuss these risks with their surgeons.

 

Reference

Stephanie Byun et al. Complications of Browlift Techniques: A Systematic Review.  Aesthetic Surgery Journal 2013 33: 189


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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