Hair Loss: An Insider Guide to Hair Restoration and Replacement

Hair Loss: An Insider Guide to Hair Restoration and Replacement November 2013 Why you may want more hair. Typically, people don t realize their hair is thinning until they ve lost 50% of it.

By age 35, two-thirds of American men will have some degree of appreciable hair loss. Why You May Want More Hair Typically, people don t realize their hair is thinning until they ve lost 50% of it. People lose their hair for many reasons, and the incidence of hair loss itself often brings up a lot of emotional issues. Studies reported by the American Hair Loss Association found that the majority of men who suffer from hair loss rate themselves as extremely unhappy about their situation. The most common reasons given are: Belief that hair loss negatively affects interpersonal relationships. Feeling that hair loss negatively affects their professional life. Loss of self-confidence. Belief that hair loss harms the first impression they make. In some ways, the situation is even worse for women. Some people can embrace a Bald is Beautiful position for men, but women rarely go completely bald. Approximately 30% of women experience thinning hair throughout their lives that s over 40 million women in the United States alone. With a woman s feelings of femininity often linked to her hair, the psychological impact of hair loss can be severe. In fact, according to a new online survey conducted by the International Society of Hair Restoration Surgery, nearly 60% of people asked whether they would rather have more hair, more money or more friends chose more hair. Chances are, you re probably reading this because you ve suffered some form of hair loss. And you re probably wondering what you can do about it. Unfortunately there is no one-size-fits-all answer. However, the information you ll find here will help you understand more about the condition of your hair and your options. Hair restoration is a billion dollar industry, and that means it attracts honest physicians who provide serious hair restoration solutions as well as opportunists with worthless products and empty promises. There are complex factors involved in hair loss, including age, gender, ethnicity and even genetic predisposition factors that you can t do anything to change. What you can do, is become better informed, and reading the information here is the first step in doing so. We want you to understand why you ve lost your hair, how serious the loss might become and what solution is the best fit for you. You may notice as you read this guide, that we recommend no product or service over another. We don t push you towards buying anything. Our goal is to give you the objective, unbiased information you need to begin making a plan. 3

1 The Anagen Phase This is also called the active growth phase. This phase continues anywhere from 2 to 6 years with the average hair growing for 1,000 days - about 3 years. The longer the hair stays in this phase, the longer it grows. Anything short of 2 years results in balding. Approximately 80-85% of all hairs are in the Anagen Phase at any given time. How Does Hair Grow? In order to understand the reasons you may be losing your hair, it s important to understand the process of hair growth. Our hair is formed at the base of a hair follicle. Hair grows differently from person to person, 2 The Catagen Phase This is the regressive or transitional phase. It lasts for a period of 2 to 3 weeks, during which the hair stops growing but is not yet shed. Between 3 and 4% of our hair is in this phase at any given time. The follicle is an actual structure that looks like a pouch and is located below the skin. A strand of hair technically, the hair shaft is nothing more than hardened keratinized tissue that grows from a follicle. This is where hair growth is initiated. A typical head contains approximately 100,000 hair follicles, although not all of them are active at the depending on a variety of factors, including age, weight, metabolism, hormones, ethnicity, and medications. However, everyone s hair growth goes through three distinct phases: The Anagen Phase. This is also called the active growth phase. The longer the hair stays in this phase, the longer it grows. same time. Usually about 20% are dormant. When our inactive or dormant hair follicles start working again, they push out an old hair while producing a new one. This is called the hair growth cycle. Our hair grows at an average rate of one-half inch every month and a single strand grows for years. The Catagen Phase. This is the regressive or transitional phase, during which the hair stops growing but is not yet shed. The Telogen Phase. This resting phase, at the end of which the hair falls out and a new hair begins to take shape. 3 The Telogen Phase This resting phase continues for approximately 100 days (3-4 months), at the end of which the hair falls out and a new hair begins to take shape. About 10-13% of our hair is in this phase at any given time. When more hair than that enters and remains in this phase, the result is After that, a resting phase sets in. Then, the hair falls out. We might lose 50 to 100 hairs on a given day and some of us lose even more. Once a hair falls out, it can take up to 3 months for a new hair to grows in its place and sometimes it doesn t grow back at all. This is all a natural part of the cycle. extensive hair loss. If, over a long period of time, hair cannot regrow as fast as it is being lost, it s time to consider hair growth remedies. 5

What Causes Hair Loss? There are a number of reasons a person may lose his or her hair, the primary one being heredity. Androgenetic Alopecia is the most common form of alopecia (hair loss) and simply refers to the fact that the cause is a combination of hormones and heredity. Androgenetic Alopecia can be inherited either from the mother or the father. Also referred to as male pattern or common baldness, this form of hair loss is caused by the effects of the male hormone DHT (dihydrotestosterone) on genetically susceptible scalp hair follicles. This sensitivity to DHT is present mainly in hair follicles that reside in the front, top, and crown of the scalp (not the back and sides). Androgentic Alopecia produces the easily identifiable patterns described in the Norwood Classification. This type of hair loss is caused by three interdependent factors: genes, hormones and age. Genes - Understanding genetics is not always simple, and such is the case with balding. The presence or absence of balding in one s parents or grandparents (either maternal or paternal) is not necessarily predictive of one s likelihood of balding. That said, common baldness cannot occur without the presence of specific inherited genes. And contrary to popular belief, those genes can be passed on by either parent. The ability of a gene to affect one s characteristics (i.e., be visible in a particular individual) is called expressivity. Gene expression is related to a number of factors, the major ones being hormones and age although other factors, including stress, can also play a role. If you want to find out if you re likely to have Androgenetic Alopecia, there s a simple test that can predict your level of risk for thinning or balding. A DNA cheek swab provides early diagnosis and allows for early intervention - both of which can increase the likelihood of successful treatment. The test is called HairDx and is an example of the ongoing advancements in hair loss medicine. If you are interested, you should ask your physician about this test. Hormones - Hormones are biochemical substances that are produced in various glands in the body. Your glands secrete these chemicals directly into the bloodstream so that they can be spread throughout the body. Hormones are very powerful; very small amounts can have profound effects on our system. As we all know, hormones are, in part, responsible for many of the differences between genders. What some people don t realize is that all normal men and women produce both male and female hormones, but they occur in different concentrations. The most common of the male hormones are testosterone, androsteinedione, and dihydrotestosterone (DHT) and they are, obviously, much more prevalent in men. Over a period of time, the exposure of the hair follicles to DHT in a genetically susceptible person leads to Androgenetic Alopecia, or male and female pattern baldness. Some research suggests that the way in which this exposure occurs is an important component in determining the basis of future medical treatments. In certain cells of the hair follicle, as well as in the sebaceous glands, there are high levels of an enzyme called 5-alpha-reductase. What this enzyme does is to convert testosterone, which is delivered through the blood, into DHT. Consequently, if you limit the activity of the the 5-alpha-reductase enzyme, it would result in less conversion of testosterone to DHT. Age - The presence of the necessary genes and hormones alone are not sufficient to cause baldness. Even after a person has reached puberty, susceptible hair follicles must continually be exposed to DHT over a period of time for hair loss to occur. The age that these effects finally manifest themselves varies from person to person and is related to one s genetic composition as well as the levels of testosterone in the bloodstream. There is no set age at which balding occurs. It is a process, and this is a simple, but often - ignored fact. Like any process, it can be rapid or slow, it can begin toward the end of life or in one s late teens, and it can progress in a seemingly relentless fashion, or it can stop and start, appearing to stabilize and then beginning again. 7

Of all women who suffer from hair loss, 70% have no apparent cause other than heredity. Hair Loss In Women The causes of hair loss in women are much more varied than in men. When a woman first comes to a physician about hair loss, a careful history must be obtained in order to determine the pattern. Is the hair thinning all over? Is it a widening of the part? Or is it a typical male pattern of hairline recession? This information lets the physician know where to direct the exam and if laboratory studies are indicated. Although women can also experience the Norwood pattern so common in men, the more typical female classification is called the Ludwig Pattern, in which the hairline is retained, but the thinning hair on top of the scalp becomes more pronounced over time. There are 3 stages: mild, moderate and extensive. Once a pattern is determined, we look at progression. Did the loss begin suddenly, and was a rapid shedding noticed? Or, has there instead been a slow, steady loss over time? Depending on the pattern and progression, the doctor may decide to do microscopic hair exams together with hair pull or pluck tests, or order various lab studies. Common systemic conditions that can cause hair loss include anemia, thyroid disease, excess androgens, autoimmune disorders, crash dieting, as well as many causes of acute stress, including surgery, childbirth, fever, severe illness, and extreme psychological trauma. Mild Hair Loss. Moderate Hair Loss. Extensive Hair Loss. 9

The Norwood Scale Tips for Taking Care of the Hair You Have Even though hair loss is partly linked to genetics, age and hormones, professional stylists offer many tips for slowing down the process. Dry gently - After washing, pat your hair dry with a Keep it loose - Styles that put a lot of strain on Norwood Scale 1. 0% rate of recession Norwood Scale 5. 80% rate of recession soft towel. Rough treatment can break off hair just as it s emerging. hair, such as tight ponytails, can make strands fall out faster. Get the right brush - Choose one with soft bristles Eating and drinking healthy - Foods like fish and and brush gently, especially when your hair is wet fresh fruits and veggies help nourish hair. And and most fragile. drinking plenty of water helps carry important Get the right shampoo - Pick a mild product that has as few chemicals as possible. In addition, rub nutrients throughout the body, including to the skin follicles that hold the roots of hair. your scalp gently to stimulate blood circulation. Don t panic - It s normal to shed a good amount of Norwood Scale 2. 20% rate of recession Norwood Scale 6. 89% rate of recession Use a detangler - A cream rinse can spare you from having to comb or brush through tangles. hair - some stylists say 50 to 100 strands daily. Consult a doctor - Proper diagnosis of the cause of Avoid hair dryers - Hot air can damage proteins in hair and make it more likely to break. If you do use a dryer, keep it on the lowest setting. your hair loss and early intervention are both key in slowing loss, saving the hair you have and having a successful hair restoration outcome. Norwood Scale 3. 45% rate of recession Norwood Scale 7. 99% rate of recession Norwood Scale 4. 70% rate of recession 11

What Are Your Hair Restoration Options? Here is a broad overview of hair restoration options, with certain choices being better suited to certain individuals based on their particular circumstances. A 5-year study shows Propecia to be an effective treatment, as it stabilizes hair loss in 90% of men. This makes it the current gold standard for non-surgical hair restoration. However, it has not been shown to be effective in women and is, in fact, dangerous for women who are or may be pregnant. (While pregnant women should not take this drug or even touch broken tablets there is no risk to a fetus if the father is taking Propecia.) Viviscal Pro is a specially formulated 100% natural food supplement that specifically targets and nourishes thinning hair caused by breakage and shedding of follicles, while simultaneously promoting the growth of existing hair. 3. Medical Devices Low-level laser therapy (LLLT) is sometimes referred to as low-power laser, soft laser, or therapeutic laser therapy. LLLT administered to the scalp has been shown to improve the health of existing hair, stimulate new hair growth and stop hair loss. LLLT is available as weekly 20-minute treatment sessions sitting under a laser hood in a clinic or as 2. Oral and Topical Treatments an at-home therapy with a small handheld device This category includes products that are designed like the HairMax Lasercomb. In either case, the to slow or stop hair loss and/or promote hair hair follicles absorb the laser light in the form of We recommend consulting with a professional to get a more detailed account of your particular situation and making a choice only after you have thoroughly weighed the pros and cons of all options. growth. Many people claim to experience new hair growth from a host of products. There are many products on the market that have not undergone clinical trials and others simply don t work either because they are outright scams or because they are not the right match for a person s needs. Rogaine (minoxidil) doesn t stop the cause of hair loss, but instead helps stimulate hair growth when energy, which stimulates cell metabolism, eliminates free radicals and improves blood flow. This results in thicker, healthier looking hair and, in many, actual regrowth. LLLT is often used to stop hair loss in conjunction with hair restoration surgery and also as a healing method because of its skin In general, hair restoration options can be Two medical therapies that should be considered, applied topically twice a day. Studies show that at repairing properties. separated into four categories: 1. Hair Replacement Systems 2. Oral and Topical Treatments 3. Medical Devices 4. Hair Restoration Surgery... however, are Propecia (men only) and Rogaine. 48 weeks of use, Rogaine hair loss medication stabilizes hair loss in over 70% of men and approximately 80% of women. Generic minoxidil is available in a 2% and 5% solution, but name brand Rogaine makes a 5% foam, which seems to be less drying and irritating to the scalp as well as easier and less messy to apply. This treatment option has three primary benefits: it s non invasive (the laser doesn t break the skin), it s painless and it has FDA clearance for hair regrowth. LLLT is most effective when there is some existing hair in the treatment zone, even if the hair has decreased in length and thickness (i.e., miniaturized). All laser therapy should be medically supervised. Even if you are only considering non-surgical treatment options, it s best to consult your 1. Hair Replacement Systems A hair replacement system is simply that - replacing your lost hair with something else. This option includes hairpieces, toupees and wigs. One drawback to this option is that a hairpiece may limit your choice of activities. Another is that over time, it can become costly with monthly Propecia (finasteride) is a pill that is taken daily. This drug works to halt the various forms of alopecia that occur in men by inhibiting Type II 5-alpha reductase, the enzyme that converts testosterone to DHT. This reduces the levels of personal physician or a hair loss expert who can make proper recommendations for the best treatment options for you as well as explain how to apply and use the oral and topical treatments. It should be noted that both Propecia and Rogaine may be used in combination and in conjunction with hair transplant surgery to treat hair loss. maintenance fees. Some people consider this DHT in the scalp, which can shorten the hair Viviscal Professional - Although not a medication, solution socially awkward, but for others, it may be growth cycle and allow hair to revert back to a one oral therapy that seems to get good results is a perfect solution. normal growth cycle. Viviscal Professional. 13

Because it is used to create the look of thicker or - A thin strip of donor hair is harvested from the There are 3 approaches that are often used to denser hair, it is an excellent way to blend scars, donor area, which is the region of hair on the back make these extractions the SAFE System, the treat hypogonadism or partial alopecia, or fill in of the head where hair is genetically programmed NeoGraft device and the ARTAS robotic system. Laser Therapy LaserCap. Using the same science as LLLT, the LaserCap is one of the newest breakthroughs in non-surgical solutions for treating hair loss. A LaserCap treats your entire scalp at once with 224 low-level lasers each with the same wavelength and intensity of a laser hood. Aside from providing a greater concentration of therapy, a LaserCap offers the convenience of being able to use it on the go. It can be worn alone or under a hat and can be used anywhere (in the car, for example). The main benefit of the LaserCap is that the total output is much greater. With a regular regimen of 30 minutes per day, 3 times per week, patients usually notice a difference in their thinning hair within 60 days. For even better results, many patients use the LaserCap in conjunction with other non-surgical hair loss treatments like Rogaine and Propecia. Scalp Micropigmentation is a tattooing technique in which tiny, metabolically inert pigment granules are implanted below the skin s surface. The artistic strokes mimic the look of a closely shaved scalp. This is an ancient Asian beautification practice that has gained popularity around the world. Scalp Micropigmentation can create a natural look when used to enhance hair transplants, for hair transplant repair procedures, to camouflage linear scars or, in some cases, as an alternative to hair thinning areas around your natural hair. Another plus is that if a patient decides to pursue other treatment techniques, the SMP performed earlier does not cause any constraints. SMP is bio-absorbable by the immune system in approximately two years. Over time, the pigment will disperse more deeply into the skin and may look different than it did originally. 4. Hair Restoration Surgery The hair in your scalp grows in groupings. These groupings, called follicular units, typically certain cells of the hair follicle. In hair restoration, single-hair follicular units are transplanted in irregular patterns along the hairline, to mimic the original hairline. Multiple-hair follicular units are used in the interior to provide density and fullness. In this way, these transplanted hair that grows back looks completely natural. Surgical hair restoration is the only permanent solution for restoring your hair. This is a field of medicine that is constantly evolving, as physicians are constantly trying to meet the needs of their patients. Finding the right doctor and educating yourself on hair restoration are the first steps in getting the most out of surgical hair replacement. You should know both the surgeon s qualifications and level of expertise. Many find it helpful to speak with some of the surgeon s past patients, something you should feel perfectly comfortable in asking. Here are some of the options in this area and the various ways they re implemented: FUT Hair Transplant is the most common hair transplant surgical technique. This procedure is performed under local anesthesia. not to fall out. - Using microscopes, the donor strip is dissected into grafts of individual follicle units of 1 to 4 hairs each. This harvest must be precise in order to gain the best yield from your donor area. - These grafts are placed in cold storage until they are meticulously placed in the recipient sites created by your surgeon. These transplanted hairs are permanent. With today s advanced surgical techniques and technology, a very natural looking result can be achieved. Follicular Unit Extraction (FUE) is a method of obtaining donor hair for FUT procedures. It s been developed as an alternative harvesting technique for patients who need an option other than the traditional single strip method. These could be patients who are concerned about having a linear scar, who want to wear their hair very short or whose scalp is too tight for strip harvesting. Unlike the strip method in which only the precise donor strip is harvested, FUE requires that the entire donor zone be shaved and the follicular units extracted directly from the scalp. The follicular units are removed one at a time, which is a timeconsuming and labor-intensive process. They are taken from the donor area with a microscopic punch, which makes a circular incision around the follicular unit and removes it. Then, similar to any other transplant procedure, the surgeon creates recipient sites and technicians place the grafts in the proper angle and direction. Due to the time required to properly extract the follicular units, the surgeon often has less time to focus on the design of graft placement (the artistic component) unless sessions are kept small or are done over several successive days. SAFE System is a hand-held, motorized punch that is used for manual FUE procedures. This device isolates the follicle units from the surrounding scalp area and there is minimal damage to the follicles during harvesting. The process is slow. NeoGraft. is a semi-automated, hand-held dermal punch that was designed to make extraction more efficient. This device allows the surgeon to extract the hair follicle units with a suction system, like a vacuum. Although the FUE process may go a bit faster, it is not highly sophisticated and does not provide any additional information during either harvesting. Also, the suction system can occasionally result in damaged grafts. ARTAS System is the most sophisticated method of hair restoration available today. This computer system provides the surgeon with 3-D images of the scalp, which are constantly updated to guide the practitioner to the best areas for harvesting hair follicles, giving the surgeon more time to create a new, natural hairline. This precision technology includes digital mapping so the doctor can make the most accurate plan for both the harvest site and the recipient site. The system extracts intact follicular units in a random fashion so those areas continue to maintain their natural appearance. This methodology also guarantees that the hair remains healthy and protected during the transplant procedure. transplant surgery. 15

How To Avoid Deceptive Marketing There are literally thousands of products claiming to be a miracle cure for baldness. Billions of dollars are spent on these cures with little or no results. It s easy to fall prey to lofty promises and sometimes it s hard to separate fact from fiction. A Dozen Don ts Hair loss is not only a physical event, it s an emotional one. We ve found it helpful to remind our clients of a few rules of thumb so they can create a plan for themselves armed with solid information and clarity. Before experimenting and wasting money on Research any hair loss treatment you 1. Do not believe you can recover all of your 9. Do not assume that natural products are safer potentially fraudulent products, call or email the parent company, and request copies of their research, evidence of success, and the credentials of the firm testing the hair loss product. Also remember that FDA approval does not mean a company must back up their claims of effectiveness, only that the product or technique is relatively safe. We suggest properly evaluating each product with a sound mind rather than emotion. Some things to remember There is no miracle Hair Regrowth Therapy. Though this may sound like common sense, late night infomercials may try to convince you otherwise. Keep this truth in the back of your mind and save money and hair! If it sounds too good to be true, it probably is. This old adage holds as true for hair loss products as anything else and probably more so in this industry where people are willing to spend almost anything to have the head of hair they want. are considering. The Internet is a great resource to research any product you are considering using. Evaluate each ingredient and, moreover, research whether there have been any third-party unbiased clinical efficacy studies. Make informed decisions instead of buying on emotion. While advertisements usually won t blatantly lie, they will stretch every truth imaginable to lure your business. Make decisions based on evidence from your research, not promises and money-back guarantees. Verify that patient photos and testimonials are real. Don t rely on company website testimonials try and meet or speak with real patients to learn how successful they were with the specific product or service. lost hair. Have realistic expectations. Good treatment enables you to maintain the hair you have remaining. At best, you may be able to regain the hair you ve lost in the last 3 years. 2. Do not wait too long. The later you start treating the baldness, the less successful your treatment will be. 3. Do not begin your treatment with unproven remedies. Start with clinically proven medicinal and/or laser treatments under the care of a physician. 4. Do not rush to try the latest unique products. Wait for independent product reviews. Be skeptical of secret proprietary formulas and products with too many active substances. 5. Do not trust the before and after pictures on product websites. They are easy to enhance. For the most part, reading the testimonials of delighted customers is a waste of your time. 6. Do not believe that an extra intake of vitamins, minerals and nutritional supplements or a change in your diet can increase your hair density. They can, however, improve the quality of your hair. than proven medicine. Very few of them have ever been subject to rigorous clinical testing and often their side effects are unknown. 10. Do not try to speed up the process by overdoing it. Be consistent and patient. You will not see any positive results earlier than 4 months after starting a new treatment. Unless you are suffering from side effects, you should stick with a treatment for at least 8 to 12 months before evaluating. 11. Do not tell everybody you know that you re beginning to treat your baldness. Tell only the people you live with. This is not the type of process that needs to be overseen by your peers. If your treatment is successful, people will notice and comment. That feedback can be extremely motivating. 12. Do not become overwhelmed or disheartened by managing adjunctive therapies. All the work you re putting in is worth it. Add-on non-surgical therapies can continue to help your condition. Liken it to brushing your teeth you don t stop just because you get a cavity filled. Prevention and maintenance are at the core of any health or beauty routine. 7. Do not let others discourage you. If someone offers negative feedback about a proven treatment, find out whether he or she really suffers from male or female pattern baldness; find out if they were applying the treatment correctly. 17

Why you may want more hair. Whatever your goals for hair restoration, the best way to get there and enjoy it once you ve arrived is with a focused, Typically, people don t realize their hair is thoughtful plan. The information presented in this guide is designed to provide general information about hair loss and thinning until they ve lost 50% of it. restoration, and is not intended to specifically recommend any product or service. We make no promises or guarantees of any kind for any product or service you elect to use. While every care has been taken in the preparation of this guide, it remains your responsibility to insure that information is accurate and timely. NOVEMBER 2013