Hair Blogs


Hair transplants and scarring alopecia

Can hair transplants be performed for patients with scarring alopecia?

Scarring alopecia refers to a group of hair loss conditions that cause scarring in the skin and around the hair follicles. They lead to permanent hair loss. Examples of these conditions include conditions such as lichen planopilaris, frontal fibrosing alopecia, pseudopelade and folliculitis decalvans. 

A hair transplant can be performed in these conditions provided the condition is "quiet" or "inactive." By quiet or inactive, I am referring to three conditions that need to be met.

 

CRITERIA FOR TRANSPLANTATION IN SCARRING ALOPECIA

1) The patient has had no further hair loss for 1 year 

2) There are no further scalp symptoms, including itching, burning and pain

3) The patient has adequate amount of donor hair to move from one area of the body into another area

In the properly selected patient, hair transplants can work very well in patients with scarring alopecia.  It is important to understand that these conditions can rarely 're-activate' after the transplant but this is not common. Nevertheless, patients must be followed regularly to evaluation for activation.

 


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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Minoxidil foam - a once daily application for women

MINOXIDIL FOAM ARRIVES IN CANADA

Minoxidil is the first and still the only formally FDA approved treatment for genetic hair loss in women.  Until recently, only the 2% strength received formal approval as a treatment for women. 

Now the 5 % foam has received FDA approval as well as approval by Health Canada for distribution and sale. We know the 5 % foam is just as effective as the 2 % solution (not better) but has the advantage of being used once a day rather than twice per day. Studies have consistently shown that many women prefer the foam formulation over the liquid formulation. 

The product will be over the counter (no prescription). It's not yet widely available in stores, but soon will be. 


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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"Rabbit syndrome" An uncommon side effect from Minoxidil

MOUTH/LIP TREMORS FROM HIGH DOSES OF MINOXIDIL

Topical minoxidil is FDA approved for the treatment of androgenetic hair loss at concentrations of 2% and 5 %. Common side effects including shedding in the first month of use, hair growth on the face, dizziness, rare heart palpitations. Other less common side effects are sporadically reported. 

Dermatologists from India described a new side effect from minoxidil. 2 patients using 10 % minoxidil (higher than the FDA approved dose) developed a vibration-like sensation/tremor over the lips and around the lips. The tongue was not involved.  This  tremor was rhythmic and regular and lasted up to 40 minutes after application. Given the similar to a rabbit, the findings have been previously referred to as  "Rabbit syndrome."

Interestingly, when the patients reduced the minoxidil to a lower dose of the standard concentration, the side effects ceased. 

Conclusion/Comments

Minoxidil is commonly used as a treatment for male and female patterned hair loss. It can be used alone or in combination with other treatments including hair transplantation. The safety profile is good and many countries make it available to the public as an over the counter product. It appears that the "rabbit syndrome" from minoxidil is rare. However, physicians and the public need to be aware of side effects of this over the counter medication, particularly in patients who use greater than the recommended amount. 

 

REFERENCE

Nagar R. Rabbit syndrome because of topical minoxidil foam. Dermatol Ther. 2015 Mar 26. doi: 10.1111/dth.12227. [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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Topical finasteride for men with hair loss

Topical finasteride: how effective? how safe? how smart?

We have recently entered a whole new era of what I call the Era of Finasteride Frenzy.  Anecdotal reports of possible persistent side effects have caused many physicians and patients to change their views on the drugs and some to even abandon it.  The FDA and Health Canada has modified its labelling of the drug to convey the uncertainties to the public. 

Some of these issues have been discussed in other blogs of mine. Today I'll talk about the solution some have taken to overcome or get around the issues of oral finasteride side effects - a move to topical finasteride

Topical Finasteride: Is it safe? effective?


First off, topical finasteride is not FDA approved for hair loss in men. Any use of topical finasteride in men is "off label". I'm going to limit all discussions here to men as use in women is not FDA  approved for the oral form. 

 Does it get absorbed?


Yes, it gets absorbed into the blood. Any discussion that topical finasteride is too big of a molecular to get into the skin is wrong. Topical finasteride enters into the blood. And yes - it lowers DHT levels. 

But any discussion of topical finasteride must focus on the dose. 2  % finasteride topical solution is going to have different effects than an 10 % solution.  0.25 % finasteride is going to be different yet! If I were to make up 0.0000000001% finasteride topical solution, it would likely be quite safe with little if an absorption. However, it probably wouldn't do anything for patients with hair loss. So it comes down to dose. Plain and simple. One should not talk about topical finasteride unless they are prepared to talk about the dose


Studies of topical finasteride: Important Lessons


A recent study of 0.25 % topical finasteride showed that it reduced DHT levels to the same amount as standard 1 mg finasteride pills. We don't yet have any data to know if this translates into topical finasteride working just as good or being just as effective, worse or better. 
 

What about side effects?


We don't yet understand the side effects of topical finasteride. It's likely that 10 % topical finasteride is going to have more side effects than 1 % topical finasteride. But those studies need to be done and confirmed. If sexual performance and mood levels are related to DHT in the blood,  then it's pretty likely that lots of men using topical finasteride would be expected to have side effects too. These studies have not been done and so we don't know. 

For hair loss in men, it appears that getting a good benefit from finasteride ultimately comes down to inhibiting DHT. Inhibit it more and you'll get a better outcome for hair loss. You'll get more side effects too.


Conclusion

Topical finasteride doesn't just stay in the scalp. It gets into the blood and inhibits DHT. Side effects are possible with topical finasteride. We need to be very careful assuming topical means safer. The scalp is a wonderful way to get drugs into the body. 



Reference


A novel finasteride 0.25% topical solution for androgenetic alopecia: pharmacokinetics and effects on plasma androgen levels in healthy male volunteers.Caserini M, et al. Int J Clin Pharmacol Ther. 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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How do you want to receive news of your biopsy results?

Phone call or office visit: How would you want to be given biopsy results?

I do a lot of scalp biopsies to pin point the precise cause of a patient's hair loss. When the results of the biopsy land back on my desk - I often say to myself - if i were this patient would I want the results over the phone or given in person here at the office. A new study suggests many people consider a phone call to be just fine. 

A US study asked this very question to 301 individuals who receiving a skin biopsy. Although these were not biopsies for hair loss, the same general principles can likely be extracted. Interestingly most of the patients (67.1%) preferred to speak directly with their doctor by phone to receive their skin biopsy results. Being notified at an in person  clinic visit as a distant second place.  

What matters most to patients?

Based on the study, it seems that what matters most is that patients is speedy delivery of information and an ability to get questions answered. 51.7% wanted a method that was rapid, and 7.8% preferred a method that was not only speedy but also allowed them an opportunity to ask questions.

 


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 routine blood tests needed for Spiro?

Starting spiro for female genetic hair loss? Study suggests routine blood tests for potassium might not be necessary! http://ow.ly/3xxo3O


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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To Poo or Not to Poo: A closer look at the “no poo” (no shampoo) movement

Should you give up shampoos?

If you’re like most people, you have a bottle or two of shampoo in your shower and you use it to clean your scalp and hair. Perhaps you’re a daily user, perhaps you use shampoos a few times week. If you have coarse and curly hair, you might use shampoo even less frequently.   But you use it. If my own practice is representative of the world out there I know some of you even change your shampoo brands frequently.

However, a small number of women (and an even smaller number of men) have decided to forgo shampooing the scalp altogether. This defines the so called “no poo” movement (i.e. ‘poo’ is short for shampoo)   

 1. We are a shampoo loving society

As a society, we have grown to love shampoo and love shampooing. Walk into any drug store and you’ll see just how much real estate is devoted to shampoos. We love the smells of shampoos and the feel of shampoos. We love the look and feel of shampoo bottles. We like the shampoo aisles, shampoo ads and shampoo commercials.  We are a shampoo loving society.

Shampoos were first synthesized in the 1930s, as an alternative to bar types soaps which left a heavy film or “soap scum” on the hair.  Such deposition leaves the hair dull and more difficult to manage.  In years gone by, women  would shampoo their hair at the salon and then have it set. Shampooing every 2-4 weeks was normal. Shampooing wasn’t typically a home-based procedure. It wasn’t until the 1970s and 1980s that shampoos became standard for household daily use. In North America, many women have changed to shampoo their hair very frequently. Moreover, we seem to enjoy squeezing our shampoo bottles and in general use far too much shampoo with each use than we really need to. It’s not really harmful to do so – except to our bank. It’s too often forgotten, that shampoos are meant for cleaning the scalp and conditioners are meant for the hair. A small dab of shampoo is usually sufficient to clean the scalp.


2. If people don’t poo (shampoo), what do they do?

For those who are participants in the ‘no poo” movement and don’t use shampoos, common substitutes include simply using water alone, using apple cider vinegar, baby powder, dry shampoos or using baking soda.  I believe that many of such practices are well tolerated for most people. However, those with color treated or relaxed hair may find that that high pH of baking soda (up to 10-12) to be particular harsh on their hair and increase the chance of damage and hair breakage.  


3. Does frequent shampooing trigger your scalp to make more oil?

It’s true that the use of shampoo removes oils from the scalp. These oils are helpful to condition the hair – and might be regarded as nature’s best conditioners. At present, however, there is no scientific proof that the scalp compensates for frequent shampooing by in turn producing more oil. The amount of oil that our scalp produces is genetically determined, and to a much lesser degree by the foods we eat, hormones, seasons and the environment. Changing your shampoo practices won’t reset your oil production. That factory is deep under the scalp (in glands known as sebaceous glands) and not influenced by how you shampoo. It would be nice to think otherwise – but there’s simply no proof.


4. How often should you shampoo?

There is no magic number for how often we should shampoo. In fact, the number is different for everyone.  Those with fine, oily hair are going to benefit from daily shampooing as the oils tend to weigh down the hair. Those with coarse and curly hair can go much longer as the hair will actually look better when not washed so often.   The same is true for those with color treated or relaxed hair – washing less frequently is preferred to further limit damage to already slightly damaged treated hair.  Once or twice a week is likely just fine. Although we certainly shampoo our hair too often, washing the scalp daily is unlikely to cause harm. Furthermore, there is no evidence that avoiding shampoo altogether offers a health benefit. In other words, the no poo movement is a personal choice, not a health choice.

 

5. Are there any adverse effects of not shampooing ?

Individuals with existing scalp problems could develop a ‘flare’ of their scalp disease with cessation of shampooing. For example, I’ve seen many patients who forgo shampoos that develop worsening dandruff and seborrheic dermatitis ( which is a close cousin of dandruff). It’s usually mild and tolerable. To understand why this occurs, it’s important to understand that dandruff and seborrheic dermatitis are caused by yeast that lives on our scalps.  These yeast feed off scalp oils. Excessive oiliness from not shampooing provides this yeast with an abundance of food and in turn further exacerbates the patient’s scalp problem.  The no poo decision might not be for everyone.


6. If you’re going to shampoo, should you go sulfate free?

For those who decide that the no poo movement might not be for them, a common question then arises – what about joining the sulfate free movement? Certainly, sulfate free shampoos are popular. If you’ve used a sulfate free shampoo you immediately notice they don’t lather up quite as well as a shampoo containing sodium lauryl sulfate or ‘SLS‘. The main downside of these shampoos is not their lathering ability but the fact that SLS shampoos are a bit more drying and are more likely to lift the cuticle and cause damage for those with color treated or relaxed hair. The can also cause irritation for those with scalp problems, including eczema.  The vast majority of people in the popular will notice little difference to their hair from using a sulfate free or SLS containing shampoo.  Decisions on whether to use SLS shampoos for other reasons (including environmental) are still being researched. However, from the perspective of the hair – the vast majority of people will not achieve better hair care from sulfate free shampoos.

 

Conclusion: Are you giving up shampoo?

Hair is personal. Hair helps define who it is we are and how we present ourselves to the world. Our hair is central to our self identify. If you don’t want to shampoo your hair – don’t shampoo your hair. There are a small number (but manageable number) of risks. Similarly if you want to shampoo your hair frequently, shampoo it. Change up your brands.  Enjoy all that shampoos offer in further defining what is personal, individualistic and what defines our feelings of self identity and self-expression.  There are risks to many things and it simply comes down to being well informed.  Humans quickly learn what shampooing frequency is right for them.


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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The No Poo movement - Dr. Donovan interviewed on CHCH News

More Women going without shampoos

The 'no-poo' movement refers to a trend whereby shampoos are not used. Instead various non shampoo alternatives are used (water, apple cider vinegar, baking soda).

Dr. Donovan was recently interviewed on CHCH News 

See the interview here:

http://www.chch.com/the-no-poo-movement/


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's new in male balding research?

NEW DRUGS MAY BE IN THE PIPELINE FOR MALE BALDING

 

According to a news release, Kythera Holdings has acquired licensing rights to setipiprant - potential drug for hair loss. Setipiprant is a selective oral antagonist to the prostaglandin D(PGD2) receptor.  

 

Why is blocking the PGD2 pathway important?

About three years ago, I shared a blog 

Breakthrough in Baldness? Blocking the Prostaglandin D2 Pathway May be the Answer 

In that blog, I described research showing that PGD2 levels were higher in bald areas of the scalp than non bald areas. Theoretically, blocking this pathway could have important roles for baldness. 

And so here we are three years later. Kythera Holdings, a subsidiary of Kythera Pharmaceuticals, announced that it has acquired  licensing rights to setipiprant, in the agreement with Actelion. Apparently, human studies are next for the company. What is so interesting about this drug is that it's already been studied for other uses. Setipiprant has previously been studied as a type of alley treatment, including a phase 3 study in patients with seasonal allergic rhinitis and a phase 2 study in patients with asthma. There were no serious side effects in these studies and treatment was well tolerated. According to the news release, Actelion suspended the development of setipiprant due to lack of efficacy seen in the allergy and asthma studies. So we haven't heard more about the drug. 

READ MORE  


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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New Roles for the Hair Loss Drug Finasteride: Treating Heart Failure

A Drug for Hair Loss, Prostate Enlargement ... and Maybe Heart Failure!
 

It is well known that androgen hormones like dihydrotestosterone (DHT) have an important role in hair loss in those who are genetically predisposed. Recent scientific evidence also indicates that androgen hormones like testosterone or the more potent dihydrotestosterone (DHT) contribute to the development of heart failure. About 700,000 individuals die of heart disease in the USA and Canada every year.

Does blocking male hormones help improve heart failure?

Researchers from Germany recently set out to design a study to determine whether anti-androgenic therapy with the drug finasteride improves the ability of the heart to function under states of heart failure. Instead of studying humans, the researchers studied mice with heart failure.

What did the researchers find?

The researchers found the heart function was markedly improved in response to treatment with finasteride in mice. In addition, finasteride treatment also allowed mice with heart failure to live longer.  

Final Conclusions

The researchers concluded that finasteride has the potential to reverse heart failure in mice and could be a potential therapy for human trials in the future 

 

Reference

Zwadio C et al. Anti-Androgenic Therapy with Finasteride Attenuates Cardiac Hypertrophy and Left Ventricular Dysfunction. Circulation. 2015 Jan 28. 

 


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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Diabetes and Hair Transplantation: Can patients with diabetes have a hair transplant?

A blog on important considerations for individuals with diabetes consideration hair transplantation

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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.
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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

 


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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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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