Hair Blogs


How do I diagnose hair loss?

Diagnosis comes from listening and looking

I'm often asked how I diagnose hair loss. Sometimes it's easy and sometimes it's challenging. What steps are taken? What is the basic approach?

This short clip provides a brief overview of the key steps of first listening to the patient's story of their hair loss and then examining the scalp up close.

Hope you enjoy

 

Jeff


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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Health, Obesity and Hair Loss:

Does unhealthy eating contribute to hair loss?

I'm often asked if healthy eating helps slow genetic hair loss. In other words, does an apple a day keep the hair doctor away? We don’t really  know how healthy eating slows hair low. However, what we do know is that unhealthy eating that leads to obesity does seem to accelerate hair loss.

 

Two studies support a relationship between obesity and hair loss

A 2011 study looked at the risk factors for male balding in policeman in Taiwan. Interestingly, young male policemen who were obese had much higher rates of male balding than thinner policemen.

In 2014, researchers from Taiwan explored whether there was a relationship between obesity the severity of male balding. They studied 142 men (average at 31 years) with male balding who were not using medicines for hair loss.   The study showed that men with more severe  hair loss tended to be more overweight than men with less severe hair loss.  In fact, men who were overweight or obese had an approximately 3.5 fold greater risk for severe hair loss than men with more normal weights. In addition, young overweight or obese men had a nearly 5 fold increased risk of severe hair loss.

 

Does an apple a day keep the hair doctor away?

We don't really know the role of healthy eating - does it slow hair loss? That's unknown. What we do know is that the flip side appears true - that extremes of unhealthy eating leading to obesity do seem to be associated with accelerated hair loss. Overall, these two studies mentioned above do support the notion that being overweight might contribute in a negative manner to balding in men. 

Further studies are needed to determine whether encouraging weight loss in obese patients could impact the rate of balding or the effectiveness of treatments for male balding.

 

 

Reference

 

Chao-Chun Y et al. Higher body mass index is associated with greater severity of alopecia in men with male-pattern androgenetic alopecia in Taiwan: A cross-sectional study.  J Am Acad Dermatol 2014; 70; 297-302.

Su LH et al. Androgenetic alopecia in policemen: higher prevalence and different risk factors relative to the general population (KCIS no. 23). Arch Dermatol Res. 2011 Dec;303(10):753-61

 

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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.
Androgenetic Alopecia, Health Assocations
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Cholesterol Lowering Drugs for Treating Alopecia Areata? A New Study says Yes

STATIN DRUGS FOR HAIR LOSS? 

Alopecia areata is considered an autoimmune condition. Medications that reduce or modify the effects of the immune system are traditionally used to treat alopecia areata. You may be familiar with treatments such as steroid injections, topical steroids, diphencyprone (DPCP), anthralin, or  immunosuppressive pills such as methotrexate, sulfasalazine and prednisone.  These all affect the immune system in some way or another.

New research now suggests that cholesterol lowering medications may also be helpful. Interestingly, in addition to the ability of these medications to lower cholesterol levels, these drugs also reduce inflammation. The reduction of inflammation is a key step in treating alopecia areata.

 

What are statins?

The ‘statins’ are a well-known group of medications used to treat high cholesterol.  In fact,  it is estimated that about 3 millions Canadians and 30 millions Americans use statins to control their cholesterol.  Ezetimibe is a second type of cholesterol lowering medication and works by blocking the absorption of cholesterol.

 

In a new study, 19 patients with advanced alopecia areata were treated with two cholesterol medications – simvastatin and ezetimibe for 24 weeks.  Remarkably, after 24 weeks, 14 of 19 patients (nearly 75% of patients) were found to regrow hair so some extent. The majority of those who continued the drug after then 24 week period maintained their hair and the majority of stopped the drug after then 24 week period lost their hair again.

 

Comment

 

This is a tremendously exciting study, opening the doors to even larger studies of the use of these cholesterol lowering drugs in the treatment of alopecia areata. These drugs are well known in the population as cholesterol lowering drugs and so we have many years of experience with these drugs. Although side effects such as muscle pains, muscle damage, diarrhea, irritation of the liver, and a rise in blood sugars can occur with these medications – these are relatively infrequent. 

Study: Lattouf C and colleagues. Treatment of alopecia areata with simvastatin/ezetimibe. J Am Acad Dermatol 2015; 72: 359


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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Capturing the very earliest changes of Genetic Hair Loss

Recognizing genetic hair loss in the earliest stages

Genetic hair loss is common. By age 50, about 60 % of men and 35 % of women will develop genetic hair loss.  Hair loss typically starts in certain areas of the scalp - such as the temples and crown in men and central scalp in women.

 

 

Alteration in follicular counts may precede miniaturization 

Miniaturization refers to the progressive reduction in hair follicle diameter during the course of genetic hair loss. In other words, hair follicles get skinnier and skinnier over time. This is a very typical feature of genetic hair loss. One other feature that is frequently seen is the alteration of hair follicle counts. Rather than hair follicles appearing in bundles of two hairs or three hairs, they are frequently seen as single isolated hairs. 

The photo above nicely illustrates this concept. Both photos were taken from the same patient. The photo on the left shows hair follicles grouped together in groups of two three and even four hairs. This area of the scalp is unaffected by genetic hair changes. The photo on the right shows very typical genetic hair loss. Hair follicles are still similar in size (thickness), but what is seen is mostly single hairs - the groupings of two and three hair bundles are no longer present. This is very typical of the earliest features of genetic hair loss. 

 


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 transplantation in black men: Can we do FUE?

Choosing between FUE and FUSS in hair transplant surgery

There are two ways that a hair transplant can be done nowadays: FUSS and FUE. With FUSS (follicular unit strip surgery), a strip of skin is removed from the back of the scalp and then the area is stitched up. The result is a linear scar or line. With FUE, the back of the scalp is shaved and hairs are removed from the area "one by one." The results is small tiny circular 'microscars in the area where the hairs were taken. the advantage with FUE is patients can wear their hair short in the future without worrying about seeing the scar.

FUE in black men: What the are the main considerations?

Most of my male patients with afro-textured hair want to wear their hair very short. Having a linear scar is not practical. Therefore, the decision on having FUE rather than FUSS is very important. 

Performing FUE on afro-textured hair requires much more skill than caucasian hair. The photo in the top panel on the right shows the typical curved hair follicles in afro textured hair and the photo on the bottom shows the relatively straight hair from a caucasian patient. It's easy to see why removing these hairs with a small punch would be more difficult in the top panel. 

Ensuring healthy grafts: how do I perform FUE in afro-textured hair?

In performing FUE, I focus on being flexible in the instruments I use. I don't start the day thinking that I'm going to use one sized punch over another, or do the procedure one way instead of another. One must be flexible. I generally start with a 1.17 mm punch and then move to 1 mm and then 1.3 mm and see what produced the best grafts. I move from manual punches (that I direct myself) to 'motorized' punches that drill with the help of a motor.  I go from minimal depth punches to deeper punches into the skin. All while looking at the grafts that are coming out to ensure they are healthy. 

Our hair transplant program for afro-textured is consistently able to offer FUE as a good option for hair transplantation. In fact, for most of my black male patients we are nearly routinely doing FUE rather than FUSS - a big change from just 3-4 years ago.

 

 

 

 

 


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 transplantation for central centrifugal cicatricial alopecia (CCCA)

Scarring Hair Loss Conditions in Black Women : Is hair transplantation an option?

**CLICK TO ENLARGE ** Photo of top of scalp in woman with CCCA

Diagnosing hair loss in women with afro-textured hair requires special expertise. Many hair loss conditions are possible and they tend to look similar. Central centrifugal cicatricial alopecia (CCCA) can look similar to genetic hair loss and so can some types of traction alopecia. Our program for women with afro-textured hair addresses some of the unique aspects of hair loss and hair care in black women. 

Hair transplantation in CCCA

Central centrifugal cicatricial alopecia (or "CCCA" for short) is a type of scarring hair loss condition in black women. Hair loss starts in the centre of the scalp and spreads outwards over time. If treated early, the condition may be halted - at least for some women. Hair transplants are possible in CCCA once the condition becomes quiet. Usually this means no further hair loss for a period of 1-2 years. 


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 happens during genetic hair loss anyways?

Genetic hair loss : Miniaturization then Loss

**CLICK TO ENLARGE ** A magnified view of genetic hair loss. 

Photo showing a magnified view of genetic hair loss. Two important findings are shown here:

1. The very tiny 3-4 mm hair in the circle is called a "vellus-like hair."

2. The thick hair next to it (in the circle) nicely demonstrates the original size of the hair.

3. The arrow points to thin hairs called "miniaturized hairs" which likely will progress on to become a "vellus-like hair" (unless treatment is started) until the hair is ultimately lost and baldness in the area occurs.


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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Scalp Folliculitis - not a single entity

Scalp Folliculitis: what is it? what causes it?

Scalp folliculitis refers to conditions having inflammation within the hair follicle opening.  This is a very common condition in the population and there many causes of scalp folliculitis, including bacterial, viral, fungal causes, overuse of hair products, irritants, heat, ingrown hairs.

Treatments are targeted towards addressing the cause. Both bacterial causes, antibacterial washes and topical antibiotics may be used. Reducing occlusive hair products is helpful for those with folliculitis from overuse of greasy products. I especially like my patients with folliculitis to treat their folliculitis before getting a hair transplant.


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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Graft quality in FUE hair transplant procedures

3 haired FUE graft

3 haired FUE graft

FUE graft quality

topic that isn't discussed enough in the hair transplant world, is whether graft obtained during FUE hair transplant procedures are of the same quality and have the save survival rate as the graft quality in strip procedures. With strip procedures, hair is taken from the back of the scalp and hairs are processed under the microscope into individual units. With FUE procedures, follicular units are taken 'at the site.' 

The photo on the right shows a nice three haired graft obtained by follicular unit extraction (FUE). Certainly, it's possible to obtain terrific grafts by FUE, but is the proportion of healthy grafts the same in FUE as in strip procedures? Is the rate of graft survival the same? Modern hair restoration does not know that answer yet. More studies are needed to convincingly determine that the rate of graft survival in FUE is the same as strip. In all likelihood it probably similar given that patients with FUE have nice results. But we really don't know for sure as of yet whether the rate of graft survival in FUE is the same as strip.


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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Exercise after a hair transplant - when and how much?

Hitting the gym after your hair transplant

After a hair transplant, many of my patients want to get back to exercise, back to the gym and back to weights. So when is it safe?

During the first week post op, the main issues with regard to exercise is preventing sudden changes in blood pressure that could affect the grafts. During the second week the main issue is tension and stress on the donor area that could affect the healing of the donor area. 

FOLLICULAR UNIT EXTRACTION (FUE) SURGERY

For patients who had follicular unit extraction procedures (FUE), I advise return to light cardiovascular activity at day 8 and light weights at day 11. Heavy weights at day 14.

FOLLICULAR UNIT STRIP SURGERY (FUSS) SURGERY

For patients who had strip surgery (FUSS), I advise return to lightcardiovascular activity at day 12 and light weights at day 15. Heavy weights at day 21. The main issue with FUSS type procedures is proper healing of the donor site


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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Genetic hair loss (androgenetic alopecia): Hair colour changes

Does hair change colour during genetic hair loss?

Genetic hair loss (also called androgenetic alopecia). Hair not only becomes thinner during the course of genetic hair loss - but often becomes lighter in color too.

The photo on the right shows dark coloured hairs surrounding by numerous lighter coloured hairs. This can sometimes be seen through the course of hereditary thinning. 

*CLICK TO ENLARGE* Changes in hair colour during genetic hair loss.


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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Daily Hair Loss: What is normal?

photo 2-4.PNG

Assessing daily hair loss

Ah, the drain catcher. To fully understand hair loss problems, one must be able to interpret what patients explain about their hair loss in the shower. Normally, we lose 50-65 hairs per day. But what if it's 88? What does it mean? What if they are mostly short hairs? mostly long hairs? Hairs with a white bulb? What if the patients shampoos weekly not daily? I pay particular attention to changes in the daily rate of hair loss. If a patient normally loses 50 hairs per day, but now is losing 100, this may be abnormal. If a person's normal rate of loss is 35 hairs per day but now loses 85, this may be abnormal.  Changes in the daily shedding rate are important 


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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Using Minoxidil Concentrations above 5 % : Is it worth it?

Minoxidil Concentrations beyond 5 %

Everyday, patients come into my hair transplant office with all sorts of minoxidil compounded solutions other than the standard 2 % and 5% concentrations that are FDA approved. Some ordered online, some from their home countries.  You name it, and I've seen it!

But is it safe?

It's true a small number of patients swear by it. That going form 5 % to 10 % really helped a lot. But the reality is that increasing the concentration significantly increased the chance of side effects. These include:

1. headaches

2. dizziness and blood pressure instability

3. heart palpitations

4. swelling in the face

5. pins and needles

6. hair growth in unwanted places

 

FDA: Cracking down on higher minoxidil concentrations

The US Food and Drug Administration (FDA) is now cracking down on companies selling the higher concentrations of minoxidil - out of simple recognition that they are not safe for some people. 

All in all,  for those considering minoxidil,  sticking with 5 % minoxidil concentration is not only  the safest option at present, but also the best option at present. 


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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Are women good candidates for FUE hair transplant procedures, including ARTAS?

FUE or FUSS: What's the best type of hair transplant procedure for women?

Nowadays, there are two common methods of performing a hair transplant: Follicular unit strip surgery (FUSS) and Follicular unit extraction (FUE).

Which is better for women? Does one clearly win out over another?

 

Well let's review, and you'll see why I nearly always recommend FUSS for women - and avoidance of FUE.

 

 

 

1. Follicular unit strip surgery (FUSS). 

With FUSS, the hairs in a small region in the middle of the back of the scalp are trimmed and those hairs and the accompanying skin are removed. Removal of that piece of skin requires placement of stitches or sutures. A small scar (about the thickness of the lifelines in one's palm) will ultimately form as the area heals. However, as soon as the patient walks out the door on day 1 - nobody can tell there has been a surgery in the back of the scalp. The stitches are completely hidden. 

 

SUMMARY of FUSS METHOD

- NO SHAVING of SCALP IS REQUIRED

- STITCHES ARE REQUIRED

 

 

 

 

2. Follicular unit extraction (FUE)

With FUE, the back of the scalp is shaved and follicular units are removed from the back of the scalp 'one by one.' These tiny circles heal on their own and stitches are not required.  Contrary to what is often (unfortunately) advertised, FUE is not a scarless procedure - the areas simply heal with tiny circular microscars that soon get covered as the hair grows out.  It takes about 10 days for the hair to grow back to cover the scars but it takes 1 month for the hair to grow 1 cm. For women with 30 cm hair, it takes about a 2 years for the hair to grow back to that length. 

 

SUMMARY of FUE METHOD

- SHAVING of SCALP IS REQUIRED

- STITCHES ARE NOT REQUIRED

 

Summary: FUE is not the ideal hair transplant technique for women

Based on current technology, I don't believe FUE is the best technique for women. I don't recommend Neograft, I don't recommend ARTAS, and I don't recommend manual or motorized FUE for women considering hair transplants. I do not recommend FUE. 

I have yet to meet a female patient who prefers to shave their head over a small scar which is hidden within their hair.  

For man who normally wear their hair very short, FUE can still be a good technique - and certainly a large proportion of our cases are FUE. But 99.5 % of our female hair transplant patients undergoing moderate sized hair transplant cases prefer strip surgery (FUSS) with placement of stitches.


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 ACell/Matristem available in Canada yet?

ACell/Matristem in Canada: What's the status?

I've received many inquiries directed to our Platelet Rich Plasma (PRP) Program about the use of a product called "Matristem" sometimes also called "ACell". In this week's blog, I'll discuss Matristem, a unique product from the company ACell  - and it's current status in Canada

ACell is a US based company that creates products for regenerative medicine. One of these products is Matristem. Matristem is a  “porcine urinary bladder matrix,” (essentially a purified product from from pig bladder cells). The Matristem product is helpful in wound healing and is used by wound care specialists. Given the close relationship between wound healing and hair growth, many physicians have been exploring whether Matristem can be combined with platelet rich plasma to enhance results.

Matristem/ACell: Still not allowed to be used in Canada!

Despite it's FDA approval in the United States, ACell/Matristem is not available in Canada and I'm unable to offer it to Canadian patients. I've had numerous discussions with Health Canada and physicians in Canada are not allowed to use the product. Unfortunately there are no exceptions to extend to my patients!  I'll continue my discussions with ACell and Health Canada in the months ahead.

Overall, I'm not too concerned about these restrictions as there has yet to be good comparative studies of Matristem/PRP vs PRP alone. So it remains anyone's guess whether ACell really adds benefit to PRP for hair loss. These studies need to be done, need to be published and need to be verified. 

ACell's Matristem is a unique product and I look forward to it someday being available in Canada for me to use. Right now, we're constantly modifying our own PRP technique to optimize results for men and women with hair loss.

Check on the status:

Interested individuals can check on the status of Matristem anytime, by entering Matristem into the search criteria of the Health Canada guide:

http://webprod5.hc-sc.gc.ca/dpd-bdpp/index-eng.jsp

It doesn't come up now - but when it does, I'll look forward to reviewing the evidence as to whether it helps or not before offering it to my patients.


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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Switching from Minoxidil to Finasteride

Minoxidil and Finasteride are both FDA approved for treating androgenetic alopecia (male pattern hair loss) in men.  In general, those individuals who get an improvement with minoxidil and then stop - all the newly acquired hairs will be lost.

Can adding finasteride now prevent this loss? 

And the answer is that it can for some men - but not all. In fact, a 2003 study confirmed that adding finasteride does not always block the hair loss that comes with stopping finasteride

In short, a given individual will know in 4-6 months if they are one of the individuals that finasteride can block the hair loss after stopping minoxidil - or not. I often advise my own patients to simply overlap the two treatments (Finasteride and minoxidil together) for 4 months and then stop minoxidil.

 

Reference
Tosti et al. Finasteride treatment may not prevent telogen effluvium after minoxidil withdrawal. Arch Dermatol. 2003 Sep;139(9):1221-2.


 


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 my treatment working?: The Power of the 1 cm Rule

How do I know if my treatment is working ?

So you've started a new treatment and you're wondering if it's helping your hair. How do you know?

Well, it's important first figure out the answer the following questions:

What type of hair loss do I have? Am I supposed to get more hair with my treatment? ....or is the purpose of the treatment to STOP further loss?

For many types of hair loss, the goal of treatment is to stimulate new hair growth. Because hair only can grow about 1 cm per month maximum - one would expect a number of 1 cm hairs after the first month of treatment and a number of 2 cm hairs after two months. Generally when I invite patients to meet with me at 6 months - I expect to see a number of 6 cm hairs.  I like to call this the "1 cm rule of hair regrowth"

However, sometimes treatment is designed to thicken existing hairs and improve quality rather than trigger new sprouts of hair. So the main factor to assess in this case is hair density - and improvement in overall scalp coverage. Careful assessment for 1 cm, 2 cm and 6 cm hairs is less important in these cases.

For some types of hair loss, particularly the group of conditions known as scarring hair loss conditions, the primary goal of treatment is to stop the hair loss - not to regrow hair. Therefore, if a patient looks the exact same in 6 months, the treatment is rated as a success.

 

 

 


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 I get FUE or strip hair transplant surgery ?

FUE is not always a good idea

There is a wave of excitement in the world with hair transplant surgery done via follicular extraction or "FUE." I'm excited too - I enjoy doing FUE and a great deal of our procedures are FUE. In fact, about one-half of our procedures this coming week will be FUE and one half will be strip procedures (FUSS).

 

But FUE always a good idea? No !

Not at all. The main concern about FUE is that it frequently involves removal of hairs from regions in the back of the scalp that might thin out in the future. For some patients FUE and strip are equally good - the patient can go ahead and choose!!! For other patients, FUE is an inferior method - strip is the only method I'll do! For other patients, strip is inferior method and FUE is the only method I'll do! 

 

In many cases, the decision as to whether to have a hair transplant done via the FUE method or via the strip method is not left up to the patient to decide, nor is it left up to the hair transplant surgeon to decide. It is a complex decision that involves discussion of numerous factors.

 

For 20 % of patients who walk in the door, strip is the only option. For 20 % of patients, FUE is the only option based on the information they provide during the interview. For 60 % of patients, it's up to them!

As an example, let's consider two 29 year old identical twins (TWIN 1, TWIN2) with the same amount of hair loss. These 29 year old male twins have a lot of hair loss at the front of the scalp. I estimate they needs 3000 grafts for a nice result.  They have some thinning in the top of the scalp too. They do not want to use minoxidil or finasteride. The  dad is fairly bald, and the grandparents are bald. The twins other older brother just had a hair transplant at age 42. Let's pretend for the sake of discussion that we did a hair transplant via FUE for one of the twins and a hair transplant via strip method for the other twin- now let's fast forward from age 29 to age 55 and see how each twin is doing. 

What I hope you'll come to understand is that the twin who had a hair transplant via strip method looks similar at age 30 but much, much better age age 55. The twin who had FUE at age 55 likely lost a good proportion of the grafts that were transplanted

 

TWIN NUMBER. 1: HAIR TRANSPLANT VIA FUE

Fast forwarding 25 years, twin 1 is disappointed. Hair looked good at one year following his transplant and even looked good at 5 years following the transplant. But now 25 years after his transplant, he's disappointed that his brother looks better! Many of the hairs that were transplanted back age age 29 have thinned out- they were taken from areas of the back of the scalp that were destined to undergo balding.

TWIN NUMBER 2 : HAIR TRANSPLANT VIA "STRIP SURGERY"

Fast forwarding 25 years, twin 2 is happy. Hair looked good at one year following his transplant and even looked good at 5 years following the transplant. And now 25 years after his transplant, he's quite tickled that he has better hair than his brother ! TWIN 1 attributes the better hair of TWIN 2 to less stress and a healthier diet - but in reality that has little to do with what we're seeing. The reasons is simple. Twin 2 has better hair because were taken from areas of the back of the scalp that was quite unlikely to undergo balding.

FUE is a wonderful technique. It's just not for everyone. 

 

 


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 DUPA (Diffuse Unpatterned Alopecia)?

DUPA: Why it matters?

DUPA is the short form for the term 'diffuse unpatterned alopecia.' This is a subtype of hereditary hair loss, or androgenetic alopecia. DUPA can affect both men and women.  Today, we'll focus on DUPA in men and why it is critically important to identify men with DUPA and to separate this pattern of hair loss from all others.  In order to understand DUPA, it is important to understand the normal pattern of hair loss in men. 

 

The Hamilton Norwood Scale

Hair loss in many men follows the so called Hamilton Norwood scale whereby men first lose hair in the temples and/or crown. The seven stages of the Hamilton Norwood scale is shown in the diagram on the right. Over time, some men will develop hair loss over the the entire frontal, mid-scalp and crown  - this defines the Advanced Hamilton Norwood Stages (Hamilton Norwood scale VI or VII).

Not all men with hair loss follow the Hamilton Norwood scale. 

 

 

DIffuse Patterned Alopecia (DPA)

In diffuse patterned loss, patients thin across the entire frontal scalp from front to crown. All of these hairs undergo miniaturization. The back and sides however - are spared. Treatment for diffuse patterned alopecia includes both medical and surgical treatments. Because the back of the scalp is unaffected in diffuse patterned alopecia, and therefore rich in good hairs hair transplantation is a good option.  Finasteride, minoxidil, low level laser and platelet rich plasma may also be good options.

 

Diffuse Unpatterned Alopecia (DUPA)

With this basis, we can begin now to understand a relatively uncommon pattern of hair loss in men called Diffuse Unpatterned Alopecia or "DUPA". About 2-6 % of men have this pattern of hair loss, so it is relatively uncommon.  Patients with DUPA develop hair thinning not only in the front and top of the scalp, but also in the sides and back. In men with DUPA, the majority of hairs on the scalp are undergoing miniaturization or will at some point undergo miniaturization. The importance of recognizing DUPA is the fact that hair transplantation is not an option. Hairs at the back are not of good quality to move as they are (or will someday become) miniaturized.  If a hair transplant is attempted in a patient with DUPA, it may look good for a few years, but the transplanted hairs are at very high risk to thin out and be lost over time. The only treatment for patients with DUPA is medical treatment - minoxidil, finasteride, low level laser and platelet rich plasma.

 

 


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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How do women's eyelashes change with Age?

 

How do eyelashes change with age?

Have you ever wondered what happens to eyelashes with age. Well, a recent study set out to examine changes in eyelashes among 179 Asian, Hispanic, White, East Indian and Black women women between ages 22 and 65.  

Key points of the study:

The authors found that THREE parameters DECREASE with age:

1) eyelash length

2) eyelash thickness

3) eyelash darkness  

 

 Comment

This simple yet well helpful study confirms what women tell us: their eyelashes change with age. Cosmetic product such as bimatoprost (Latisse) can enhance eyelash length and thickness and sometimes darkness as well. 

 

Reference

Glaser et al. Epidemiologic Analysis of Change in Eyelash Characteristics with Increasing Age in a Population of Healthy Women. Dermatol Surg 2014; 40: 1208-13


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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