Hair Blogs


Hair Transplant Day 1

What does a hair transplant look like on day 1?

 

After 1 day, the new grafts are adapting to their new "homes." Grafts are visible 1 mm or so above the level of the skin. 

 It is easy to dislodge a graft in the early stages and doing this causes it to bleed. After about 5 days, hair follicles are rooted in the scalp and hard to dislodge.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Hair Transplantation into Scars

Hair Transplantation into Scars

It is sometimes possible to transplant hairs into a scar

Scars on the scalp are common. Most people have tiny scars from bumping or injuring their scalp. Some people have linear scars from hair transplant surgery done via follicular unit strip surgery (FUSS). For those with scars from FUSS, it is possible to transplant hairs from an area containing thick hairs into that scar. Thin scars uptake hair better than thick scars and the graft survival is greater.

This picture shows an close up image of a patient with a successful hair transplant whereby hairs were placed into his donor scar.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Cutis Verticis Gyrata (CVG)

Ridges and Folds

CVG is a condition where extreme scalp ridging occurs. The cause of this is still unknown. Although the majority of individuals with CVG are healthy, a small proportion have neurological and hormonal issues.

Treatment is difficult, although surgical excision of the furrow has been reported to be successful. Placement of a filler (like poly-L--lactic acid) may also help. 


Reference
Al-Malaq A, et al. Surgical correction of primary cutis vertices gyrata. Ann Plast Surg. 2002.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Finasteride for Women

Celebrating 10 years of Iorizzo study

This is the 10 year anniversary since Iorizzo and colleagues from Bologna, Italy published a study which renewed interest in the use of finasteride for the treatment of female pattern hair loss.

Iorizzo and colleagues looked at the benefit of finasteride at a dose of 2.5 mg in 37 women diagnosed with female pattern hair loss. All women in the study were also using a birth control pill.

After 12 months of follow up, 62 % of women using finasteride had an improvement in hair density. 13 patients (30 %) hair loss had stabilized,  it did not get worse but  did not improve. Only 1 of 37 patients experienced a worsening of their hair density.

This was an important study. The 2000 study was Price and colleagues (see next blog) really called into question whether finasteride helped at all for women with female pattern (genetic) hair loss. 


This study suggested that finasteride could help with 62 % getting some improvement (30 % getting a fairly nice improvement). More studies are needed to understand who responds and who doesn't and how all the antiandrogens rank (finasteride, spironolactone, dutasteride, flutamide, cyproterone acetate).

Reference
Iorizzo M1, Vincenzi C, Voudouris S, Piraccini BM, Tosti A. Finasteride treatment of female pattern hair loss.
Iorizzo M, et al. Arch Dermatol. 2006.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Finasteride for Women

A look at the early days (2000-2002)

Finasteride is FDA approved for men with a type of hair loss known as "androgenetic alopecia" (male pattern balding). It is not FDA approved for women but physicians may use off label if they feel if could help their patient. 

So does it help women with genetic hair loss?

Early studies suggested "no". A study by Vera Price and colleagues in 2000 suggested a 1 mg dose in post menopausal women did not help. The study had some limitations in that some women in the study may not have had androgenetic alopecia. But nevertheless, these early studies suggested maybe it does not help women.

But 2 years later in 2002 when Shum and colleagues presented 4 women (2 pre and 2 post menopausal) who responded to a higher dose of finasteride - 2.5 mg finasteride. All 4 women had hyperandrogenism (one or more of elevated hormones, hair on the face, infertility issues). This refueled interest in the role of finasteride for women. We'll discuss additional studies this week.

Finasteride must never be used by women who are trying to become pregnant or who are pregnant as is can harm a developing baby. Other side effects can include mood changes, decreased libido, breast tenderness, breast enlargement and fatigue. It is more commonly used in post menopausal women because of the concerns about pregnancy. 


Reference
Shum et al. Hair loss in women with hyperandrogenism: Four cases responding to finasteride. Journal of the American Academy of Dermatology 2002; 47: 733-9


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Do grey hairs grow faster?

Do grey hairs grow faster?

Although there many myths surrounding grey hair, this answer seems to be yes!

Dr Van Neste examined 3343 hairs from 24 women. Grey hairs not only seemed to grow faster, but were also thicker than standard pigmented hair. Thicker hairs were thought to be due to the more developed central layer of the hair known as the medulla.

Reference
Van Neste D. Thickness, medullation and growth rate of female scalp hair are subject to significant variation according to pigmentation and scalp location during ageing. Eur J Dermatol 2004; 14; 28-32.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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How "perfect" is the balding process

A closer look at temple recession

It should come as no surprise that humans aren't perfect - and not perfectly symmetrical either. One foot is often bigger than the other, one leg longer than the other and one eye is often higher than the other.

Do men with frontal balding have equal recessions on both sides as the hairline moves back or does one side often recede quicker than the other?

A new study of 41 men with early frontal balding showed that the right side was more recessed on average than the left. Overall, the right side had a 23 % larger area of recession compared to the left side.

In conclusion male balding is not symmetrical. Right sided recessions are more rapid.

Reference
Asymmetry of the Receding Hairline in Men With Early Androgenetic Alopecia.
Azar RP, et al. J Cutan Med Surg. 2016.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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How does hair get it's colour?

How does hair get it's colour

We have cells in the hair follicle known as "follicular melanocytes".

Melanocytes are our pigment producing cells. They are found in the skin and hair. Melanocytes make granules known as "melanin" and then transfer these to hair follicle keratinocytes. Pigment then accumulates in the growing hair shaft.

Melanocytes don't just make pigment whenever they want to. There is a complex communication between the cells of the bulb (the lower part of the follicle). Dermal papilla cells, melanocytes and keratinocytes all have a vote. Pigment is only produced in the anagen phase (growing phase) of the hair cycle.

When inflammation is present in the bulb, as in alopecia areata for example, the hair follicle does not always get properly pigmented. That is why patients with alopecia areata often regrow white hair.

By age 50, about 50% of us will notice that at least 50 % of our hair is grey. This appears to be due to a depletion of melanocyte stem cells that lead to fewer and fewer melanocytes being produced.

how does hair get its colour.png

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Scalp Camouflaging Agents

Keratin Fibers

A number of companies manufacture "keratin fibers." These fibers can be used to hide hair loss and create the appearance that a patient has more hair density than he or she really does. They are sprinkled onto the scalp and the fibers bind immediately by electostatic forces to the hair. Some also sit on the scalp. Hair spray can be used if a patient wishes.

Topical treatments such as Rogaine, minoxidil topical steroids, etc must be applied to the scalp first before hair fibers are applied.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Monitoring Hair Loss & Growth

Convenience of a Nearby Mole

In the early stages monitoring hair regrowth can be challenging - especially when the degree of hair regrowth is not enough to be noticeable by the patient. 
In these situations it can be very helpful to compare the changes that have occurred at a fixed location of the scalp. During clinical trials, a small circular dot is often tattooed on the scalp so that the clinician can compare that exact same spot over time. 
In daily practice we don't tattoo the scalp. However, if a patient has a mole, pigmented spot, or blood vessel this can be used as an easy frame of reference to compare how hair density in the area changes over time.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Telogen Hair=Club Hair

Telogen Hair= Club Hair

Hair grows and hair sheds in 3 phases: anagen, catagen and telogen.

Telogen hairs are hairs that typically fall out of the scalp, accumulate in our brushes and combs and flow down the sink and drains.

About 50-60 hairs each day loosen up from the scalp and are officially done their cycle. It's normal to lose more on a "shampooing day" (ie 100-120) because these hairs are more readily loosened from the scalp.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Female "androgenetic" alopecia

Do all women have a family history?

Female androgenetic alopecia also known as female pattern hair loss. Some people refer to it as the female equivalent of male balding.

Androgen hormones and genetics have a very clear role in men. For women, it is not as clear. Not all women improve their female pattern hair loss with antiandrogen medications - and not all have a clear genetics.

Between 15 to 30 % of women with female pattern hair loss do not have a strong family history of balding.

We still have a ways to go in understanding the role of hormones and genetics in female hair thinning.

Reference
Siah et al.
Int J Trichology. 2016 Apr-Jun;8(2):57-61.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Scalp Eccrine Glands

What do they do?

Eccrine glands are sweat glands. They are found in high density on the palms and soles. The third highest density goes to the scalp.

Eccrine glands secrete sweat (mostly made of salt water) but also potassium and bicarbonate.

Eccrine glands play a key role in "thermoregulation" - they help us stay cool and warm. By secreting salt water on the surface, heat from the body gets used up to evaporate the water and the surface cools down.

Eccrine glands also get activated after emotional stress (fear, pain, anxiety provoking situations). It's easier to see scalp sweating in a bald individual but really anyone can feel the increased moisture on the scalp after high physical activity, stress or emotions.

It is easier to see eccrine gland openings in patients with darker skin (as shown here).


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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Thinning hair at 21

Here is an answer to a new question posted on realself.com

Any advice?


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299
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