What are the causes of excessive hair loss?

It is normal to shed some hair each day as part of this cycle. The average scalp contains about 1,00,000 hairs. On average a person loses about 100 hairs per day. However, some people may experience excessive (more than normal) hair loss. Hair loss of this type can affect men, women and children. Balding is a natural phenomenon. Men and women undergo thinning of hair and loss of hair as they age. This is mainly related to ageing, hereditary factors and testosterone. About 25% of the men start balding by the time they are 30 yrs old.

Many people suffer from hair loss due to various factors like:

• Stress
• Prolonged illness
• After undergoing a major surgery
• Nutritional deficiency, Crash diets that lack sufficient protein, Iron and Vitamins
• Hormonal imbalance – post delivery or thyroid gland problems (either overactive or under active)
• Chemical and Physical stress to the hair shaft from Hair Coloring, Perming, Permanent straightening or lengthening.
• Infection of the scalp – Fungal infections
• Medications, Post Chemotherapy, excess Vitamin A

Can improper care of my hair cause hair loss?

Yes. If you use tight hair rollers, the pull on your hair can cause a type of hair loss called traction alopecia. If the pulling is stopped before scarring of the scalp develops, your hair will grow back normally. However, scarring can cause permanent hair loss.

Hot oil hair treatments or chemicals used in permanents (also called "perms") may cause inflammation of the hair follicle, which can result in scarring and hair loss.

Common hair loss patterns:

There are 2 common patterns:

• Male pattern baldness: This involves a receding hairline with thinning around the crown with eventual bald spots. This has been attributed to genetics and testosterone influence
• Female pattern baldness: This involves thinning on the scalp with an intact hairline. It is attributes to genetics, testosterone imbalance and age.

When to seek Medical Help?

• You are losing hair in an unusual pattern
• You are losing hair rapidly or at an early age (for example, in your teens or twenties)
• You have any pain or itching with the hair loss
• The skin on your scalp under the involved area is red, scaly, or otherwise abnormal
• You have acne, facial hair, or an abnormal menstrual cycle
• You are a woman and have male pattern baldness
• You have bald spots on your beard or eyebrows
• You have been gaining weight or have muscle weakness, intolerance to cold temperatures, or fatigue

What are the treatment options?

There are various treatment options available.

• Minoxidil
• Finasteride
• Low level Laser therapy
• Dermaroller
• Mesotherapy
• Hair weaving
• Hair Transplantation
• Stem cell therapy
• Nutritional supplements
• Diode Laser for Hair

What diet should be followed to get good and strong hair?

Just like your skin and body, your hair also needs a balanced diet to stay healthy. By including sources for essential fatty acids in your diet, you can give your hair back its strength and lustre. Foods such as tuna, sardines and such oily fish, and nuts, olives and avocados are rich in essential fatty acids. Sprinkling flaxseed and pumpkin seeds over your salad is also another great way to get these Essential fatty acids in your diet.

To keep your hair well hydrated, be sure to drink 6-8 glasses of water everyday. Also try to include foods which contain silica such as rice, oats, lettuce, parsnips, asparagus, onion, strawberry, cabbage, cucumber, celery, cauliflower and green leafy vegetables. Silica is vital to the strength of hair, and can stop hair breakage. Although the link between premature graying and diet hasn’t been established, evidence does suggest that the aminoacids tyrosine – which acts as a precursor to color producing pigments in the hair and skin – can help!Thinning hair or hair loss may be a sign of iron deficiency. Be sure to eat plenty of iron rich foods, such as red meat, eggs, legumes, whole grain cereals, dried fruits and green leafy vegetables. Since hair is composed mostly of protein, your hair will most likely respond well to the addition of high protein foods such as meats, eggs, cheese, seeds and nuts. These foods can help reinforce the hair follicles and prevents the hair from falling out.

At Dr. Umashankar's Dermavision® we use Dermaroller 1.5/2. K-FDA approved Microneedling technique to increase the vascularity of the scalp thereby increasing the clinical outcome and give better results in patients who are taking medical management for hair loss. It is important to select a treatment that will address your particular needs directly and provide an effective solution.

Dermaroller in hair loss

How does it feel during the treatment

A topical anaesthetic is used to numb the treatment area before performing the Dermaroller. Most patients describe the discomfort as moderate and acceptable with slight pain during the procedure but persistantpain were never experienced by the patient.

What should I expect after the treatment?

There will be slight pain with edema which resolves completely in 10 minutes. The results will be seen after the 3rd or 4th treatment with appearance of new hair from the follicles along with conversion of thin hair into thick hair.

How many treatments are necessary?

Treatment is conducted every 3-4 weeks until a satisfactory result is obtained. The number of treatments required varies, usually 8 -10 treatments are required for maximum result.

Side effects?

The skin can become red immediately after treatment with slight edema which resolves in 10 to 15 minutes. No permanent side effect is seen.

Time taken for each treatment?

Treatment can take from 15 - 30 minutes , depending on which area is being treated.

It works by supplying energy to our hair follicles using low photons of light. Laser using low power can easily penetrate into our skin without the feeling of heat. The Laser rays are directly applied on the scalp so that the supply of red blood cells is stimulated, which in turn provides more nutrients and oxygen to the scalp. Additionally, with the increased red blood cells, blood circulation is improved allowing your hair to grow well.

Who are the ideal patients who benefit from Low level Laser therapy?

People who will benefit from Low Level Laser therapy includes those that have:

• Hair loss not exceeding five years
• Bald spot not exceeding four inches across the head
• Genetic hair loss
• Currently using other hair loss therapy or treatment
• Undergoing Chemotherapy or experienced hair loss after an illness
• Dry scalp
• Experienced hair loss after giving birth (post-partum)

What results can you expect from Low Level Laser?

You will notice the following effects:

• Hair becomes beautiful because it is fuller, shinier and more manageable
• Hair Loss slows down or even stops
• Hair Follicle has improved for re growth
• Scalp dryness or irritation decreases or stops
• Hair cuticles are closed leading to improved results for hair procedures such as Color, Perms, Henna etc
• Better hair shaft by increasing its volume.

How long does the treatment take?

Each session takes about 20 minutes. Treatment protocols used in our centre generally involves 2-3 treatments per week for 6 weeks followed by once a week session for the next 3 - 5 months, depending on the hair condition.

When can I see the results?

The results are visible by the second to third month after starting with the prescribed regimen.

Info on laser hair reduction

Dr. Umashankar's Dermavision® uses the best in laser technology approved by the Food and Drug Administration (FDA) for permanent hair reduction.

How does laser treatment work?

Hair reducing lasers work by interacting with the pigment in the hair to produce heat. A very intense beam of light is passed through the skin at the hair root. The dark hair becomes very hot and destroys the cells that produce the hair. If the light is intense enough, the hair follicle is damaged to an extent where it can no longer produce hair at all.

Is the treatment safe?

The treatment is approved by the FDA, who has deemed it safe. Each centre is medically supervised at all times. The light produced by the laser is in the infrared end of the light spectrum as opposed to the ultraviolet end. This type of light is non-carcinogenic (non-cancer causing).

Lasers have been used in the medical profession for over 15 years and no long-term side effects have been reported.

Does the treatment hurt?

Everyone’s pain threshold is different. As treatment settings vary according to individual skin and hair types, so do the levels of discomfort. We provide the option of a topical anaesthetic and also our patented inbuilt cooling system allows us to specially cool the treatment area, hence reducing the discomfort level. This will be discussed at your initial consultation.

The test patch performed at the consultation will give you an idea as to the discomfort level.

Who carries out the treatment?

All of our treatments are carried out by fully qualified doctors who have undergone the core of Knowledge training which focuses on Health and Safety issues.

What does the consultation and test patch involve?

The consultation involves a discussion with the laser practitioner who will examine your skin and hair type for suitability. A test patch is carried out to determine the best treatment settings and to avoid overdosing the skin. If any adverse effects are experienced on the test patch area, we may need to re-assess your treatment programme. A test patch is mandatory for each area to be treated.

How many treatments will I need?

During your consultation we will assess the skin and hair and plan a tailor-made programme that will offer you the best results to suit your needs. On average we recommend a course of 6 sessions. However, some clients do not need to return after 3 treatments. Hence we recommend that you pay per treatment, instead of paying for a course. The sessions are typically spaced 4 – 6 weeks apart.

How long does each treatment take?

This depends on the size of the area you are having treated and you will be advised during your consultation. We use a variable spot size from 3 to 10mm. This enables us to clear an area very quickly, which also reflects in the price. For example, a bikini and underarm together takes about 30 minutes, an upper lip takes 10 mins.

Does the laser treat blond / Grey hair / Very fine?

Very blond / grey / very fine hair are not suitable for laser treatment, on one hand because of insufficient heat being generated in the hair and on the other because too much heat is being generated in the skin.

Can I remove the hair between treatments?

The hair is not to be removed from your skin during treatment as the old, dead hair (the hair cast) has to work its way out. The hair cast often appears to be growing hair for up to two weeks after treatment, after which it will fall out. You can remove the hair cast by shaving, trimming or depilatory cream. Waxing and plucking are not acceptable methods of removing the hair between treatments.

Is there anything I should avoid before and during my treatment course?

Do your best to minimize a suntan to the area being treated as a suntan can put your skin at risk as the increased skin pigment will absorb some of the laser heat. Do not apply irritant creams like Glycolic Acid (AHA creams) and Retinoic acid to the skin before or during the course of treatment. Also be sure to tell us if you have been taking any tablets for acne such as isotretinor if you are taking any herbal medications as these can make your skin sensitive to laser.

48 hours after treatment

• Some redness and swelling is expected in the area for a few hours post treatment
• Use a non-perfumed aftercare product such as Tea-tree body lotion or Aloe Vera gel which can be purchased at the centre
• Avoid perfume, body lotions, after-shave, make-up and deodorant on the treated area.
• Avoid heat treatments such as hot baths or showers, saunas and steam rooms.
• Avoid restrictive clothing or excess friction on the area
• Avoid cardiovascular exercise and swimming as the chemicals in the water may cause irritation
• Avoid facial and body treatments until the skin has returned to normal
• Do not hesitate to call us if you have any doubts or questions

Recent technology for the treatment of Alopecia (Baldness) ie. male pattern hair loss, female pattern hair loss & hair loss associated with various disorders. It is a revolutionary treatment for hair fall. The stem cells promote new hair growth within 3 to 4 weeks of treatment. The hair density increases by 30 to 40% by three sessions of treatment. On an average six sessions are required once in a week to 10 days along with which supplements are given. Stem cells activate the dead hair follicles and convert them into growing healthy new hair follicles.

Over the last decade hair transplantation surgery has undergone significant changes.

Hair transplantation today is often performed in a single “megasession”, or in multiple sessions over a period of weeks or months. A megasession completes the entire procedure—harvest of hair follicles from a donor site at the back of the patient’s scalp and placement of harvested follicles in a recipient site on the scalp—in a single session lasting several hours. Multiple sessions may be a better choice for some patients, based on a patient’s wishes and factors such as medical conditions.

Over the ensuing 3 to 6 months after transplantation, most transplanted follicles will thrive and produce hair at their new site. Some transplanted follicles will fail to thrive in their new environment.

Worried about..

• Corn field’ appearance from large grafts??

Microsurgery (1-2 hair) - has largely avoided ‘corn field’

• Time needed for surgery and number of sittings??

Use of lasers in preparing the receptor sites has reduced the time needed for surgery and has also greatly reduced the number of sittings

Latest in hair transplantation - "Follicular Unit Transplantation"

As these act as a distinct anatomic and physiologic unit, they give better results with good cosmesis.

Introduction: Platelet-Rich Plasma (PRP)

Search for a way to enhance survival of transplanted hair follicles and promote healing with minimal scarring after transplantation led to trials of PRP. A growing literature already existed on use of PRP in sports medicine, orthopedic surgery and dental surgery and a number of other medical and surgical specialties to enhance tissue repair and healing after surgical procedures or injury.

What Are Platelets?

Platelets are biological constituents of blood, along with red and white blood cells. Unlike red and white blood cells, platelets do not have a nucleus and therefore do not qualify to be called “cells”. They are somewhat smaller than red and white blood cells.

Platelets are probably best known as components of the blood clotting system. When injury disrupts a blood vessel and causes bleeding, platelets are quickly activated and contribute to formation of a clot that stems the flow of blood. Platelets contribute to clot formation by (1) participating in release of a cascade of chemical factors essential to the clot-forming process, and (2) changing shape and interlocking with one another to plug the bleeding site by forming a physical barrier to blood flow. This physical barrier consists of interlocked platelets and strands of hemostatic fibers called fibrin.

But platelets are more than just first-line responders to bleeding injury. Every platelet is also a biochemical storehouse of regulatory, signaling and growth-factor molecules that participate in recovery and healing of tissue as well as emergency response to injury. Growth-factor molecules associated with platelets include:

• Platelet-derived growth factor (PDGF)—promotes blood vessel growth, cell replication, skin formation;
• Transforming growth-factor-beta (TGF-b)—promotes growth of matrix between cells, bone metabolism;
• Vascular endothelial growth factor (VEGF)—promotes blood vessel formation;
• Epidermal growth factor (EGF)—promotes cell growth and differentiation , blood vessel formation, collagen formation;
• Fibroblast growth factor-2 (FGF-2)—promotes growth of specialized cells and blood vessel formation; and,
• Insulin-like growth factor (IGF)—a regulator of normal physiology in nearly every type of cell in the body.

All of these growth factors initiate and enhance physiologic processes that contribute to tissue recovery and health after injury. The growth factors are also involved in normal physiologic processes such as blood vessel formation.

The rationale for use of PRP in surgery is to artificially increase the number of platelets at a site where the storehouse of growth factors in the platelets can be put to use in enhancing tissue recovery, repair and health.

What is PRP?

PRP is blood plasma containing a concentration of platelets many times greater than occurs normally in blood. PRP is “autologous”, meaning that it comes from the patient’s own body. This is similar to the practice of having a patient donate his/her own blood before a surgical procedure, to be used in preference to blood from the hospital blood bank should a transfusion be needed. Another example is the removal and transplantation of a patient’s own skin for a plastic surgery procedure. Because PRP is autologous, it has no potential for causing a foreign-body immunologic reaction. PRP is immunologically neutral.

PRP in Historical Perspective

Techniques for producing platelet-rich plasma (PRP) and using it to promote and enhance healing after tissue injury have been known for more than 30 years. For most of that period, uses of PRP were in hospitalized surgical patients. Few comparative studies of significant size or good design were carried out. Use of PRP was limited by technical difficulties of producing PRP preparations of adequate potency.

Advances in technology have made the preparation of PRP faster and more efficient, and increasing uses of PRP began to be found in surgical specialties. Surgical hair restoration was one of the specialty areas in which PRP began to be used.

How PRP is made?

Platelets for PRP are derived from a patient’s own blood:

• Blood is withdrawn from a patient’s arm by syringe, as it would be for any laboratory procedure.
• The tubes containing withdrawn blood are placed in a centrifuge and spun for a period of time.
• The centrifuging “spins down” the red and white blood cells and platelets and concentrates them at various levels in the tubes. Blood plasma that is rich in platelets is drawn off from the appropriate level. Plasma defined as platelet-rich plasma contains 4 to 8 times the number of platelets per cubic centimeter found in normal plasma. With a little additional preparation the PRP is ready for application.

PRP in Hair Transplantation

The potential for using PRP to promote healing and hair growth after hair transplantation is centered in three functional applications:

1. To preserve and enhance hair follicle viability during and after hair transplantation;
2. To promote and enhance tissue repair and healing after hair transplantation; and,
3. To reinvigorate dormant hair follicles and stimulate new hair growth.

To Preserve and Enhance Hair Follicle Viability

Between the time that hair follicles are removed from a donor area of the scalp and transplanted into a recipient area, they are subject to damage from several causes:

• Dehydration if the donor follicles are inadequately moistened between the times of removal and transplantation;
• Oxygen and nutrient starvation due to being removed from blood supply during the harvest-to-transplantation time period;
• Temperature and acid/alkaline changes in the follicle environment; and,
• Revascularization injury when the donor follicles are transplanted to the recipient site and must re-adapt to having a blood supply.

A common approach to maintaining donor hair follicle viability during the transition period is to keep them in a storage solution that provides a protective environment of appropriate temperature, chemical balance and nutrient supply. Recent research has indicated that addition of PRP to the storage solution improves follicle viability during and after transplantation, enhances post-transplantation tissue healing and promotes hair growth in transplanted follicles. An approach advocated by some investigators is to bathe the donor hair follicles in activated PRP just prior to transplantation.

Investigators have reported that PRP promotes hair growth from follicles by the action of platelet growth factors on hair follicle stem cells. The platelet growth factors induce follicle stem cells to shift from a dormant state to an active state that starts the process of hair production. While investigators have reported such activity, no advertised claims of PRP efficacy in promoting hair growth can be made because there has been no FDA approval that would allow such claims to be made.

To Promote and Enhance Tissue Repair and Healing

In activity promoting tissue repair and healing after injury of surgery, the growth factors stored in platelets are released at a site of tissue injury, promoting tissue repair and healing. Individual growth factors such as PDGF have been used by surgeons to promote wound healing in hospitalized surgical patients. The rationale for using PRP in outpatient surgical hair restoration is to use the full array of platelet-associated growth factors to promote healing and minimize scar formation, as well as to promote maximum hair growth in transplanted follicles.

A described method of applying PRP to scalp incisions is by injection of a PRP gel into the wounds at the time of wound closure. Clinicians and investigators using this procedure have described enhanced healing at the transplant site. These reports are usually of individual cases or of a small number of cases. Such reports do not meet definitions of clinical trials that would, for example, be required in the United States for seeking FDA approval of PRP use specifically in hair transplantation with claims of efficacy and safety. Some investigators suggest that PRP should not be used routinely in hair transplantation to promote healing, but might be of use in patients who have had previous injury or scarring at a transplant site. Investigators who oppose routine use of PRP in hair transplantation cite the need for additional data from well-designed clinical trials.

To Reinvigorate Dormant Hair Follicles

After noting enhanced hair growth of transplanted hair after use of PRP, investigators conducted a small study of PRP effect on dormant non-transplanted hair follicles. The study hypothesized that platelet growth factors can “wake up” dormant hair follicles and begin the production of new hair. PRP was applied after scalp skin was slightly injured to induce platelets to release growth factors at the injury site. Enhanced hair growth and hair diameter was noted over the next 4 months, with a fall-off in enhanced hair growth after 4 months. This use of PRP is still regarded as experimental, with need for further study.

Safety, Complications, Contraindications to Use of PRP

PRP is immunologically neutral and poses no danger of allergic, hypersensitivity or foreign-body reactions.Sterile technique must be used at every stage of PRP preparation and application. Sterile technique is especially important if a patient has an underlying medical condition that predisposes to infection.

A brief period of inflammation at wound sites may be experienced by a patient after application of a PRP gel. Inflammation may be associated with release of platelet-associated factors at the wound site.

Some medical conditions may be a contraindication to use of PRP. Many of these are not absolute contraindications because the conditions vary from patient to patient. It is wise to raise the question with a physician hair restoration specialist if and when the use of PRP is discussed.

Is PRP Approved by the United States FDA?

The use of PRP in the United States as part of the clinical process of hair transplantation does not require FDA approval, just as the use of blood transfusion during or after surgery does not require FDA approval. Use of PRP as part of the surgical treatment is defined as a procedure and is not subject to FDA regulation.

However:

• In the United States, the device used to prepare PRP must have FDA approval. Centrifuges that separate PRP from whole blood for a medical purpose (e.g., to assist tissue healing) are medical devices covered by the Federal Food, Drug and Cosmetics Act. Federal law requires that manufacturers of medical devices must obtain clearance or approval for the products before offering them for sale. Failure to have premarket approval or clearance for such devices is a violation of U.S. law. Premarket approval requires data showing that a device is safe and effective.
• The FDA has not approved PRP as a medication specifically for use in hair transplantation. FDA approval would be based on objective evidence of efficacy (e.g., promoting healing, promoting hair growth) and safety. Claims that PRP is “FDA approved” for use in hair transplantation are incorrect. Advertised claims of PRP efficacy in promoting hair growth may be a violation of FDA protocol regarding medical claims.

The use of PRP specifically in hair transplantation to promote healing and hair growth could be considered when, for example:

• Clinical trials of appropriate size and design are approved by the FDA, and
• Results from the clinical trials convincingly demonstrate that end-point goals of efficacy and safety have been met.