The Classification of Hair Loss

Hair transplant surgeons describe hair loss in patients using classification systems. Classification systems can provide several advantages. They can help to determine what therapies or surgical procedures to use and help to standardize hair loss terminology, enabling better communication between hair transplant surgeons. Some systems are more comprehensive than others and the majority of systems are gender specific^1–4. The most common classification system used to describe hair loss in men is the Hamilton-Norwood system and in women, the Ludwig system is typically used⁵.

In the 1950s, Hamilton categorized hair loss into eight types (I-VIII). Non-balding men were categorized as type I to III and balding men were categorized as type IV to VIII^2,5. Hamilton based these categories on frontal hair recession and thinning patterns that were observed in over 300 men who were experiencing hair loss⁵. In 1975, Norwood revised this system based on where hair thinning starts such as in the temple and crown areas and then progresses along the top of the scalp^4,5. The main hair loss classification system used in women, the Ludwig system, was developed in 1977 by Ludwig³. Women's hair loss was classified into three different grades (I-III). A grade 1 women typically experienced thinning along the crown region and a grade 3 women experienced complete baldness³. Other classification systems that focus on hair loss in women include a five-stage classification system developed by Ebling and Rock, an eight stage system developed by Savin (nicknamed the Savin scale), and a self-reporting photographic based scale developed by Sinclair^5,6.

If you are curious about what class your hair loss might be considered be sure to ask your hair transplant surgeon at your next consultation.

Article by: Sarah Versteeg MSc, Mediprobe Research Inc. 

1. Koo SH, Chung HS, Yoon ES, Park SH. A new classification of male pattern baldness and a clinical study of the anterior hairline. Aesthetic Plast Surg. 2000 Feb;24(1):46–51.


2. Hamilton JB. Patterned loss of hair in man; types and incidence. Ann N Y Acad Sci. 1951 Mar;53(3):708–28.


3. Ludwig E. Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br J Dermatol. 1977 Sep;97(3):247–54.


4. Norwood OT. Male pattern baldness: classification and incidence. South Med J. 1975 Nov;68(11):1359–65.


5. Gupta M, Mysore V. Classifications of Patterned Hair Loss: A Review. J Cutan Aesthetic Surg. 2016 Mar;9(1):3–12.


6. Sinclair R, Jolley D, Mallari R, Magee J. The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women. J Am Acad Dermatol. 2004 Aug;51(2):189–99.

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Free PRP & Laser Hair Therapy For New Hair Transplant Patients

For a limited time Sure Hair International is offering FREE Platelet Rich Plasma therapy and 3 months of laser hair therapy.

• 1 Platelet Rich Plasma Treatment (Valued at $1,500)


• 3 Months of Laser Hair Therapy (Valued at $1,500)

This promotion will be available for transplants performed until the end of November, 2016. Check out the following blog posts for more information on the benefits of laser hair therapy and platelet rich plasma therapy.

Advanced Laser Hair Therapy – 90% Effective Regrowth Treatment

The Vampire Treatment

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Ruxolitinib – A Treatment for Alopecia Areata

Hair loss can be caused by many different conditions such as chemotherapy-induced alopecia, androgenetic alopecia (male pattern baldness) and alopecia areata (spot baldness). Alopecia areata  or 'spot baldness' is an autoimmune disease where actively growing hair follicles are attacked by the body's own immune system¹. This condition can lead to total scalp hair loss (alopecia totalis) or total scalp and body hair loss (alopecia universalis)². Alopecia areata is a relatively common form of hair loss, second to androgenetic alopecia³.

As alopecia areata can impact the quality of life, potential treatments for this hair disorder have been examined⁴. For instance, ruxolitinib has been recently evaluated⁵. Ruxolitinib is currently approved to treat disease of the bone marrow (e.g., myelogibrosis)⁶. In a recent open-label clinical trial, 12 moderate to severe alopecia areata patients were given 20 mg of ruxolitinib, twice a day for 3 to 6 months⁵. At least 50% hair regrowth occurred in 9 of these patients by week 12 and 7 of these patients obtained over 95% regrowth by the end of treatment⁵.  Bacterial skin infection, upper respiratory tract infection, and urinary tract infection are some of the adverse effects reported in this study⁵.

Ruxolitinib is just an example of the many off label emerging therapies being developed. Other off-label therapies for alopecia areata include topical or systemic steroids, and topical immunotherapies⁷. Talk to your doctor if you are interested in finding out more information on hair loss treatments.

Article by: Sarah Versteeg MSc, Mediprobe Research Inc. 

1. Paus R, Slominski A, Czarnetzki BM. Is alopecia areata an autoimmune-response against melanogenesis-related proteins, exposed by abnormal MHC class I expression in the anagen hair bulb? Yale J Biol Med. 1993 Dec;66(6):541–54.


2. Islam N, Leung PSC, Huntley AC, Gershwin ME. The autoimmune basis of alopecia areata: a comprehensive review. Autoimmun Rev. 2015 Feb;14(2):81–9.


3. Alkhalifah A, Alsantali A, Wang E, McElwee KJ, Shapiro J. Alopecia areata update: part II. Treatment. J Am Acad Dermatol. 2010 Feb;62(2):191–202, quiz 203–4.


4. Masmoudi J, Sellami R, Ouali U, Mnif L, Feki I, Amouri M, et al. Quality of life in alopecia areata: a sample of tunisian patients. Dermatol Res Pract. 2013;2013:983804.


5. Mackay-Wiggan J, Jabbari A, Nquyen N, Cerise J, Clark C, Ulerio G, et al. Oral ruxolitinib induces hair regrowth in patients with moderate-to-severe alopecia areata. JCI Insight. 2016 Sep 22;1(15):e89790.


6. Jakafi (ruxolitinib) tablets, for oral use [Internet]. U.S. Food and Drug Administration. 2016 [cited 2016 Oct 10]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/202192s012lbl.pdf


7. Delamere FM, Sladden MM, Dobbins HM, Leonardi-Bee J. Interventions for alopecia areata. Cochrane Database Syst Rev. 2008;(2):CD004413.

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Are Robots Taking Over Hair Transplants?

Hate waiting for lines at the bank? How about waiting in line at the theatre? Debit machines and movie ticket kiosks are what I gravitate towards when I'm at the bank or seeing a movie as they dramatically shorten wait times. These technology based shortcuts can also be used in hair transplants.

Follicular unit extraction (FUE) is a donor harvesting technique that removes hair follicles from a donor region without creating the need for linear incisions (1). FUE can be quite time consuming as only one follicular family (a group of 1 – 4 hair follicles) is removed at a time (2). The amount of time required to remove hair follicles from a donor region is decreased when adding robotic technology and automation to FUE (2).

Robotic FUE systems are made up of three major components. The first is a robotic arm that contains two different types of punches; a sharp punch and a blunt punch. The sharp punch makes a superficial 1 mm incision around the hair follicle and the blunt punch then creates follicle detachment through a second deeper incision (2). The next major component is the suction system. Suction is used to help move the hair follicle above the skin surface to allow for easier extraction (2). Cameras are also a major component of robotic FUE systems. These cameras are equipped with processing software that helps direct punch incision, ensuring punches are correctly placed at the right angle for effective extraction (2). This imaging software can also prevent overharvesting; only allowing follicles to be extracted when they are 1.6 mm apart from each other (2).

There are several different robotic and automated devices on the market today such as the NeoGraft automated hair transplant system, the surgically advanced follicular extraction (SAFE) system and the ARTAS Robotic System (Restoration Robotics Inc., San Jose, CA) (3-6). Be sure to speak with your hair transplant surgeon if you are interested to learn about robotic or automated devices in your upcoming hair transplant consultation.

Article by: Sarah Versteeg MSc, Mediprobe Research Inc. 

1. Rassman WR, Bernstein RM, McClellan R, Jones R, et al. Follicular unit extraction: minimally invasive surgery for hair transplantation. Dermatol Surg 2002;28:720-8.


2. Avram MR, Watkins SA. Robotic Follicular Unit Extraction in Hair Transplantation. Dermatol Surg 2014;40(12):1319-26.


3. NeoGraft web site. Available from: http://neograft.com/. Accessed July 14, 2014.


4. Rose PT. The latest innovations in hair transplantation. Facial Plast Surg 2011;27:366-77.


5. Gupta A. Microrefined microfollicular hair transplant: a new modification in hair transplant. Ann Plast Surg 2014;73:257-65.


6. Harris JA. New methodology and instrumentation for follicular unit extraction: lower follicle transection rates and expanded patient candidacy. Dermatol Surg 2006;32:56-61; discussion 2.

 

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A Hair Transplant for a Younger, More Attractive, More Successful, More Approachable Appearance

Hair loss is a common phenomenon which will affect most of us, especially men, as we age. There are a few treatment options, particularly in the early stages. Medications such as finasteride¹ and minoxidil² can help to prevent any future hair loss. Aesthetic camouflages such as thickeners, specialized tattooing³, scalp micropigmentation, and hair systems are also available. Finally, there is hair transplant surgery.

Among men, one of the most common cosmetic surgeries is a hair transplant. Accordingly, a team of researchers from Johns Hopkins University has recently released a report which investigated some of the benefits received from investing in a hair transplant⁴.

The research team recruited 122 participants online to rate age, attractiveness, successfulness and approachability in men. The participants were shown 13 sets of photographs. Each set was composed of two images of the same man. In half of the sets, the photographs were before and after shots of a man who had received a hair transplant. The other set of photographs included two images of the same man who had not had a hair transplant. The participants who performed the rating were roughly half women and half men, between the ages of 18 – 52 years, with the majority being Caucasian with some post-secondary education.

After analyzing all of the ratings, the study authors concluded that a hair transplant could improve a man's general perception in all four categories (age, attractiveness, successfulness and approachability). Therefore this study seems to suggest that a hair transplant can deliver some very effective results. There are a few points to consider however. This was a small study, with only 13 men rated. Also important, the photographs that were used were not standardized for characteristics such as lighting and background. For instance in the example shown in the report, it is difficult to see the eyes in the pre-transplant image as the man appears to be squinting; however, they are open wide in the post-transplant image. Moreover none of the images included a man's smile as all images were of a neutral face. All of these variables could have affected the results of the study, although the authors are confident in their conclusions.

Overall, there are multiple treatments for hair loss. Hair transplant surgery probably requires one of the biggest investments but it can also be one of the more effective.

Article by: Dr. J.L. Carviel, PhD, Mediprobe Research Inc.

References

1. Gupta AK, Charrette A. The efficacy and safety of 5α-reductase inhibitors in androgenetic alopecia: a network meta-analysis and benefit-risk assessment of finasteride and dutasteride. J Dermatol Treat. 2014 Apr;25(2):156–61.


2. Gupta AK, Charrette A. Topical Minoxidil: Systematic Review and Meta-Analysis of Its Efficacy in Androgenetic Alopecia. Skinmed. 2015 Jun;13(3):185–9.


3. Rassman WR, Pak JP, Kim J, Estrin NF. Scalp micropigmentation: a concealer for hair and scalp deformities. J Clin Aesthetic Dermatol. 2015 Mar;8(3):35–42.


4. Bater KL, Ishii M, Joseph A, Su P, Nellis J, Ishii LE. Perception of Hair Transplant for Androgenetic Alopecia. JAMA Facial Plast Surg. 2016 Aug 25;

The post A Hair Transplant for a Younger, More Attractive, More Successful, More Approachable Appearance appeared first on Sure Hair International | Toronto.

Tools of the Trade

A wide range of tools, instruments and devices are used during a hair transplant. These instruments can include punches, robotic devices, suction-assisted devices and implanters.

Punches have been used in hair transplants since the 1930s. These instruments allow hair follicles to be released from their surrounding tissues. Punches can have a wide range of characteristics (e.g., shape, sharpness and size) that can influence their capabilities. Sharp punches, for example, can be inserted along the hair follicle, cutting the connecting tissues that hold the follicle in place. Unsharpened punches can help prevent trauma or deformation of surrounding follicles during harvesting¹. Excessive laxity (looseness) and the need for specific angles (e.g., curly hair) can increase the difficulty of punch extraction².

Robotic devices can also be used in hair transplant procedures. These devices contain sharp punches that cut around the follicle, making graft removal easy and fast³. Using robotic technology specific characteristics (e.g., follicle density, hair angle etc.) can be controlled by the physician⁴.This can help create high quality grafts and limit the time required for harvesting⁴. The ARTAS system is an example of such a device and is in use all over the world.

Suction-assisted devices can also assist a surgeon during a transplant. These devices are commonly used during follicular unit extraction (FUE) to partially or fully remove a hair follicle. Suction-assisted devices give physicians better control during harvesting, allowing punch penetration to be deep without increasing the risk of hair follicle injury⁵.

Implanters are also used during hair transplants. As the name suggests they are used to help implant harvested grafts. Sharp or dull implanters can be used in hair restoration procedures such as eyebrow and scalp restorations⁶.

If you have any questions about what type of instruments will be used during your procedure ask your hair transplant surgeon during your consultation.

Article by: Sarah Versteeg MSc, Mediprobe Research Inc. 

1. Devroye J. Powered FU Extraction with the Short-Arc-Oscillation Flat Punch FUE System (SFFS). Hair Transpl Forum Int. 2016;26(4):129, 134–6.


2. Poswal A. Expanding needle concept for better extraction of body hair grafts. Indian J Dermatol. 2013;58(3):240.


3. Bernstein R. Integrating robotic FUE into a hair transplant practice. Hair Transpl Forum Int. 2012;22(6):228–9.


4. Harber R. Notes from the Editor Emeritus. Hair Transpl Forum Int. 2013;23(4):121.


5. Trivellini R. An Innovation in Suction Assisted FUE. Hair Transpl Forum Int. 2016;26(2):58–9.


6. Elliott V. Commentary on “FUE Graft Placement.” Hair Transpl Forum Int. 2016;26(2):56.

 

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Hair Transplant Terminology Cheat Sheet

To help you prepare for your upcoming hair transplant consultation, here is a cheat sheet of hair transplant options and techniques your hair transplant surgeon might suggest.

Follicular unit. Scalp hair grows in groups, with up to 4 hairs per group¹. These groups are referred to as follicular units. These follicular units contain more than just hair follicles but also contain nerves, blood vessels, collagen and muscle (erector pilorum)¹. Since these follicular units contain all the required material for survival and growth a fully intact transplanted follicular unit should flourish after being implanted.

Strip. Strip is a harvesting method that will likely be one of the first hair transplant options brought up by your surgeon. Strip is a term used to describe the removal of hair bearing skin from the back of the scalp. Follicular units are then removed from this strip through the use of a microscope and then implanted into the desired areas². You should be aware that a linear scar will be created if this method is used.

FUE. FUE stands for follicular unit extraction. It's a term that describes a harvesting technique that removes hair follicles directly from the scalp³. FUE can be used to transplant hair follicles into thinning areas as well as camouflage previous hair transplant scars^4,5.

The untouched strip. The untouched strip technique, a combination of strip and FUE, could be another option suggested by your surgeon⁶. This technique is quite an attractive option as you don't need your hair to be shaven to 1 mm in length to undergo this type of hair transplant. The strip part of this technique is very similar to the normal strip harvesting however FUE is additionally used above and below the strip border⁶. This can allow for better coverage and greater density⁶.

Non-shaven FUE. The non-shaven follicular unit extraction technique (NSFUE) may not be offered at all hair transplant clinics. In this technique the donor hair is cut short and hair follicles removed⁷. Hair follicles are then implanted in a similar fashion as the traditional FUE method.

SMP. Scalp micropigmentation (SMP) is not a hair transplant technique but it may come up as an option for those who may not meet hair transplant criteria. It's a tattoo technique that can give the impression of hair^8,9. SMP can help with camouflaging scarring and thinning areas^8,9.

Article by: Sarah Versteeg MSc, Mediprobe Research Inc. 

1. Bernstein RM, Rassman WR. Follicular unit transplantation: 2005. Dermatol Clin. 2005 Jul;23(3):393–414, v.


2. Avram M, Rogers N. Contemporary hair transplantation. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2009 Nov;35(11):1705–19.


3. Dua A, Dua K. Follicular unit extraction hair transplant. J Cutan Aesthetic Surg. 2010 May;3(2):76–81.


4. Avram MR, Rogers N, Watkins S. Side-effects from follicular unit extraction in hair transplantation. J Cutan Aesthetic Surg. 2014 Jul;7(3):177–9.


5. Gho CG, Martino Neumann HA. Donor hair follicle preservation by partial follicular unit extraction. A method to optimize hair transplantation. J Dermatol Treat. 2010 Nov;21(6):337–49.


6. Crisostomo M. The Combined Technique (FUE + FUT) Without Fully Shaving Hair: Executive Untouched Strip. Hair Transpl Forum Int. 24(3):90–1.


7. Park J. Direct Non-shaven FUE Technique. Hair Transpl Forum Int. 2014;24(May/Jun):103–4.


8. Rassman WR, Pak JP, Kim J, Estrin NF. Scalp micropigmentation: a concealer for hair and scalp deformities. J Clin Aesthetic Dermatol. 2015 Mar;8(3):35–42.


9. Rose PT. Hair restoration surgery: challenges and solutions. Clin Cosmet Investig Dermatol. 2015;8:361–70.

 

 

 

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