Hair Loss and Hair Restoration

Normal hair growth occurs in cycles as individual hairs go through a growth phase and a resting phase before falling out. The lost hair is replaced by a new hair growing the same follicle. starting the cycle again. It’s normal to lose between 50 to 100 hairs each day. Excessive hair loss that causing thinning or bald spots can be troubling, but dermatologists can help determine if the loss is permanent or temporary and recommend treatment options to restore hair for many patients.

Causes of Hair Loss

There are many possible causes of hair loss and thinning.

Improper Use of Chemical Treatments

Treatments such as dyes, tints, bleaches, straighteners or permanent waves can cause hair to become weak and break if the chemicals are used too often. In most cases, hair grows back out when the patient stops using the chemical treatment.

Hereditary Thinning or Balding

The most common cause of hair loss is a genetic trait for baldness inherited from either parent called androgenetic alopecia. Both men and women can be affected, but women usually get thinning hair without becoming fully bald. Hereditary hair loss can start as early as the teens.

There is no cure, but medical treatments that may help some patients include:

  • Minoxidil – a lotion that’s applied to the scalp twice a day, which both men and women can use.
  • Finasteride – an oral medicine for men only, which blocks the formation of a male hormone in the hair follicle.

Alopecia Areata

This less common type of hair loss can affect both children and adults of any age. Recent research has identified genes that play a part in alopecia areata.

Usually starting with smooth round patches of hair loss, alopecia areata can result in the loss of all scalp hair and sometimes all body hair. Hair can regrow with time and treatment is focused on making hair regrow faster.

Treatments include:

  • Cortisone injections are the site of hair loss
  • Topical medications applied to bald spots

Learn more about Alopecia Areata.

Telogen Effluvium

Illness, stress and other events can cause excessive hair loss, most often resulting in thinning rather than bald patches. In many cases, telogen effluvium goes away in a few months without treatment.

Causes can include:

  • High fever, serious infection or the flu
  • Major surgery or long-term (chronic) illness
  • Untreated thyroid disease
  • Insufficient protein in the diet
  • Low iron or low blood cell counts
  • Birth control pills and other medicines
  • Childbirth
  • Cancer treatments

Tinea Capitis (Scalp Ringworm)

A highly contagious fungus causes scalp ringworm, a condition that is most common in children. With scalp ringworm, scaly patches appear on the scalp which may be accompanied by broken hair, redness, swelling and oozing. Dermatologists prescribe oral medication to cure scalp ringworm.

Hair Pulling

In children, hair pulling and twirling that can cause thinning is a habit that often goes away as the child gets older. Hair pulling in teens or adults may be a sign of an obsessive-compulsive disorder (OCD) known as trichotillomania, which may require treatment.

Cicatricial (Scarring) Alopecia

This rare illness can cause patchy hair loss with itching and or pain. Inflammation around the hair follicle causes damage, scarring and lasting hair loss. The cause of cicatricial alopecia is unknown, and treatment is provided to stop the spread of inflammation.

Genetic Disorders

Some genetic disorders can cause hair to become fragile and break. 

Hair Restoration Procedures

Dermatologists and dermatologic surgeons often perform hair restoration procedures in their offices using local anesthesia. With today’s more advanced techniques, patients can expect more natural-looking results and faster recovery times.  Depending on the patient, two types of procedures may be recommended:

Hair Transplants

A hair transplant uses your own hair taken from a donor region (donor strip) to fill in bald spots. Unlike the unnatural “plug” transplants of the past, today’s dermatologists transplant hair using small grafts of only one to three hairs each for more natural results. Your dermatologist will determine whether you are a good candidate for hair transplants based on the amount and health of your remaining hair. The number of grafts and the number of office visits needed depends of the extent of your hair loss. Three to six months after the procedure, the transplanted hair starts to grow in and grows in fully in about one year.

Scalp Reduction

With advances in hair transplants, scalp reductions are becoming less common, but may be recommended for patients with large bald areas. During a scalp reduction, the surgeon removes a few inches of bald skin and sutures (sews) the areas with hair on both sides of the bald spot together. This procedure, which may be recommended alone or along with hair transplants, can decrease the size of a bald spot or eliminate it completely.

Your dermatologist at Dermatology and Skin Surgery will give you instructions for post-operative care of the treated area. Most patients can resume normal activities in a few days. The dermatologist will also discuss the risk associated with these procedures, which are rare and tend to be minor.