ProHAIR Transplant Clinic

Are you concerned about baldness or hair loss or thinning hair?
Your hair is a vital part of how you feel .....

The ProHAIR Transplant Clinic is the only national, organization dedicated to educating the public, healthcare professionals, main stream media and legislators about the emotionally devastating disease of alopecia (hair loss) and baldness.

The ProHAIR Transplant Clinic is

• Committed to the prevention and treatment of hair loss.
• Recognizes that hair loss of any kind is a seriously life altering disorder and understands just how crippling this disease of the spirit can be to many who suffer with it.
• Guided by its Board of Directors and Medical Advisory Board.

Through various activities, the ProHAIR Transplant Clinic aims to:

• Treat individuals with hair loss and balding with hair transplantation.
• Promote professional and public awareness of hair transplantation.
• Encourage the advancement of scientific research in the field of baldness, hair loss and hair transplantation.
• Eliminate the stigma surrounding baldness, hair loss and hair transplantation.

The ProHAIR Transplant Clinic is the authoritative source of information for people with hair loss and for the health care professionals who care for them. The ProHAIR Transplant Clinic is an active and prominent educator in the field of hair transplantation, baldness and hair loss.

At ProHAIR Transplant Clinic we focus on the needs of our staff as well as the patient to ensure that the best-trained staff in the world is always operating at peak performance.

Please Click Here to request more information from ProHair Transplant Clinic.

WHAT IS FOLLICULAR UNIT TRANSPLANTATION?
Follicular Unit Transplantation (FUT) is a technique, in which hair is transplanted from the permanent zone in the back of the scalp into areas affected by genetic balding, using only the naturally occurring, individual follicular units. In order to remove follicular units from the back of the scalp without damaging them, the donor tissue is removed in one piece. This technique, called Single Strip Harvesting, is an essential component of follicular unit transplantation as it not only preserves the follicular units, but it prevents damage (transection) to the individual hair follicles. It differs dramatically from the Mini-Micrografting technique of using a multi-bladed knife that breaks up follicular units and causes unacceptable levels of transection of hair follicles. The other harvesting technique, Follicular Unit Extraction (FUE), allows the surgeon to remove individual follicular units without a linear donor incision. The most essential component of Follicular Unit Transplantation is Stereo-Microscopic Dissection. In this technique all of the follicular units are removed from the donor tissue under microscopic control to avoid damage.

HOW IS FOLLICULAR UNIT TRANSPLANTATION DIFFERENT FROM MINI-MICROGRAFTING?
In contrast to Follicular Unit Transplantation, where the graft sizes are determined by nature, in Mini-Micrografting the graft sizes are arbitrarily determined by the assistants who cut the donor tissue into the size pieces that they need. Another name for this technique is Mini-Micrografts cut to size. In mini-micrografting, neither preserving follicular units nor even keeping hair follicles intact are felt to be that important.

YOUR PROCEDURE
When you arrive for your hair transplant, the ProHAIR Transplant Clinic staff will begin by going over the activities for the surgery. Your ProHAIR Transplant Clinic doctor will review the goals that have been established and will answer any last minute question that you might have. The doctor will take the time to be sure that there are no outstanding issues, areas of confusion or concerns. The surgical consent form that is signed followed by the taking of pre-surgical photographs. Mild medication is given to relax you and to make you more comfortable. We also give routine antibiotics before and after the procedure.

LENGTH OF THE PROCEDURE
Your Follicular Unit Transplant may require many hours of work by a team of professionals. Some of the longest procedures (between 2000-2500+ grafts) may take hours of surgery and during that time, many highly trained nurses will participate in the process. The work must be organized efficiently so that the total length of the procedure for the patient will be minimized. On average, a procedure of 1000 grafts would last about 6 hours.

THE SURGICAL EXPERIENCE
The procedure may be long, but for the patient the time goes by quickly. You are lightly sedated so that you can sleep if you desire. Most patients choose to watch TV or movies for at least part of the time. We try to make your experience enjoyable so that the actual time the surgery takes is transparent.

A relaxed and informal atmosphere is encouraged so that the day stands out as one of the better, more pleasurable experiences ever encountered.

THE SURGICAL TEAM
The team  prepares the grafts according to the surgeon's exacting specifications. The preparation of 2,000 or more grafts and placing them into the recipient area may take a team hours of intensive, concentrated work. Care is taken to keep the surgical team free of stress. Just as the patient needs a break, so do team members. At ProHAIR Transplant Clinic we focus on the needs of our staff as well as the patient to ensure that the best-trained staff in the world is always operating at peak performance.

DONOR SCALP
The area from where the donor strip is removed is sutured closed. This usually leaves a very fine scar that heals in a week or two with the sutures being removed in that time frame. Ideally, the scar may heal well enough that it is almost undetectable even when the hair is combed back by a barber or hairdresser. After the tissue has been harvested, the individual follicular units (each containing from 1 to 4 hairs) are meticulously dissected out in their naturally occurring groups under strict stereo-microscopic control. The grafts are trimmed of extraneous fatty tissue and the bald intervening skin between the groups is discarded. The isolation of individual, naturally occurring follicular units, that were obtained from the donor area as a single strip, and then carefully dissected under microscopic control, is an essential part of Follicular Unit Transplantation. If this step is not done correctly the follicles can be injured and growth impaired. It is important that these steps be carried out only by a highly experienced surgical team.

LENGTH OF TIME THE GRAFTS ARE AWAY FROM THEIR BLOOD SUPPLY
A number of hours may pass between the time the donor grafts are removed from the back of the scalp to the time they are placed into the recipient area. Care must be taken to preserve the viability of the grafts during this process. The procedure starts with the removal of a strip of scalp from the donor area. Once the strip is removed, it is immediately immersed into a cold bath of Lactated Ringer's saline to lower its temperature. Once the individual follicular unit grafts are prepared, they are cooled to 3.8-4.0C and kept at this temperature while awaiting placement.

BLEEDING
Many people have the impression that hair transplantation is a "bloody procedure." In our hands it is not. At ProHAIR Transplant Clinic, we have developed surgical techniques that greatly minimize the amount of bleeding in all aspects of the procedure..

MAKING THE RECIPIENT SITES
It may be the one part of the procedure where your ProHAIR Transplant Clinic physician is silent as he concentrates on making recipient sites. Don't be concerned if he isn't chatty during this time. Your ProHAIR Transplant Clinic physician is accustomed to working in, and around, existing hair so you need not cut your hair short for the procedure. Your existing hair may help to cover any traces of the transplant.

PLACEMENT OF NEW GRAFTS
Placing is the longest part of the procedure. The placement process is exacting and during this time you will be asked to keep your head relatively still. Watching TV, looking at movies or even sleeping will make the time go quickly. You can take breaks as needed, to eat and use the bathroom. When placing is complete, post-op instructions are given to you verbally and in writing. A bandage is placed around your head and is worn home.

AFTER YOUR PROCEDURE
The night of the surgery, and for the next few nights afterwards, you are encouraged to sleep with your head elevated on pillows. You will be given medication to help you sleep if needed. The next day after the surgery, you will come back for removal of the bandage and you will be instructed how to shower and gently clean the transplanted area. The follicular unit grafts are made to fit snugly in the recipient site and will not be dislodged in the shower provided you follow the instruction given to you. If the post-operative instructions are followed carefully, in most patients the transplant is barely detectable after a few days and practically undetectable after the first week. We will give you medication for swelling, but in spite of this, some patients experience swelling of the forehead that settles around the bridge of the nose over the course of the next several days. If this occurs, it is almost always gone in the 5th day after the surgery and should not be a cause for concern. Frequently, the newly transplanted grafts can be made less noticeable by minor changes in hair style to cover the area. Makeup consultants in large drug stores and department stores can help you choose the appropriate shade and type of makeup. Any problem of visibility can also be minimized by altering the appearance of your face. If you do not shave for a while, most people will focus upon your new beard, not on your head. If you have a mustache or a beard, consider taking it off for the first few weeks and then letting it grow back.

Please Click Here to request more information from ProHair Transplant Clinic.

For Men

MALE PATTERN BALDNESS
Androgenetic alopecia or common male pattern baldness (MPB) accounts for more than 95% of hair loss in men. By the age of thirty-five, 35% of all Hungarian men will experience some degree of appreciable hair loss and by the age of 50 approximately 50% of men have significantly thinning hair. Approximately twenty five percent of men who suffer with male pattern baldness begin the painful process before they reach the age of twenty-one. Contrary to societal belief most men who suffer from male pattern baldness are extremely unhappy with their situation and would do anything to change it. Hair loss affects every aspect of the hair loss sufferer’s life. It affects interpersonal relationships as well as the professional lives of those suffering. It is not uncommon for men to change their career paths because of their hair loss.

CAUSES OF HAIR LOSS
Androgenic alopecia or male pattern baldness (MPB) is responsible for the vast majority of hair loss in men. While there are many possible reasons people lose hair including serious disease, reaction to certain medications and in rare cases extremely stressful events, most hair loss is men can be blamed on heredity testosterone and age. What male pattern baldness sufferers are actually inheriting are hair follicles with a genetic sensitivity to Dihydrotestosterone (DHT). Hair follicles that are sensitive to DHT begin to miniaturize, shortening the lifespan of each hair follicle affected. Eventually, these affected follicles stop producing cosmetically acceptable hair. This process of „Miniaturization” causes the terminal follicles to produce „Vellus” or baby hairs, that are fine, short and nonpigmented. Male pattern baldness is generally characterized with the onset of a receding hairline and thinning crown. Hair in these areas including the temples and mid-anterior scalp appear to be the most sensitive to DHT. This pattern eventually progresses into more apparent baldness throughout the entire top of the scalp, leaving only a rim or "horseshoe" pattern of hair remaining in the more advanced stages of MPB.

A CLOSER LOOK AT DHT
Dihydrotestosterone (DHT) is a derivative or by-product of testosterone. Testosterone converts to DHT with the aid of the enzyme Type II 5-alpha-reductace, which is held in the hair follicle’s oil glands. While the entire genetic process of male pattern baldness is not completely understood scientists do know that DHT shrinks hair follicles, and that when DHT is suppressed, hair follicles continue to thrive. Hair follicles that are sensitive to DHT must be exposed to the hormone for a prolonged period of time in order for the effected follicle to complete the miniaturization process.

DIAGNOSIS
Typical male pattern baldness is usually diagnosed based on the appearance and pattern of the hair loss along with a detailed medical history, including questions about the prevalence of hair loss in the family. At ProHAIR Transplant Clinic, an experienced doctor examines the scalp under magnification with a device called a ‘Densitometer’, in order to assess the degree of miniaturization of the hair follicles. This assessment is very important when recommending the proper course of treatment. Some advertised "clinics" might recommend a costly hair analysis or a scalp biopsy to properly diagnose your hair loss. The only reason to have a hair analysis is to assess the possibility of poison induced hair loss. A hair analysis may reveal substances such as arsenic or lead, however, hair loss caused by poising does not present itself in a typical male pattern. You should avoid these clinics and seek the advice of a doctor from ProHAIR Transplant Clinic, who can properly examine you and help you treat your hair loss. When considering treatment for your hair loss, it is important to understand just how far your hair loss has progressed. There will be times when you will have to relay this information via telephone or the internet to physicians or practitioners you may be trying to receive information from. It is also important to guard yourself against misdiagnoses of your condition.

DIFFUSE PATTERNED ALOPECIA AND DIFFUSE UNPATTERNED ALOPECIA
Two other types of genetic hair loss in men, as well as women, not often considered by doctors are, "Diffuse Patterned Alopecia" and "Diffuse Unpatterned Alopecia," as they pose a significant challenge both in diagnosis and in patient management. Understanding these conditions is crucial to the evaluation of hair loss in both women and men, particularly those that are young when the diagnoses may be easily missed, as they may indicate that a patient is not a candidate for hair transplant surgery.

Diffuse Patterned Alopecia (DPA) is an androgenetic alopecia manifested as diffuse thinning in the front, top and crown, with a stable permanent zone on the sides and in the back . In DPA, the entire top of the scalp gradually miniaturizes (thins) without passing through the typical Norwood stages.

Diffuse Unpatterned Alopecia (DUPA) is also androgenetic, but lacks a stable permanent zone and affects men much less often than DPA. DUPA, found more in women then men, tends to advance faster than DPA and ends up in a horseshoe pattern resembling the Norwood class VII. However, unlike the Norwood VII, the DUPA horseshoe can look almost transparent due to the low density of the back and sides. Differentiating between DPA and DUPA is very important because DPA patients often make good hair transplant candidates, whereas DUPA patients almost never do, as they eventually have extensive hair loss without a stable zone for harvesting.

The progression of male hair loss in Diffuse Patterned Alopecia (DPA) and Diffuse Unpatterned Alopecia (DUPA). In DUPA, the sides thin significantly as well.

For Women

INTRODUCTION
Mistakenly thought to be a strictly male disease, women actually make up forty percent of hair loss sufferers. Hair loss in women can be absolutely devastating for the sufferer’s self image and emotional well being. Unfortunately, society has forced women to suffer in silence. It is considered far more acceptable for men to go through the same hair loss process. Even more unfortunately, the medical community also treats the issue of women’s hair loss as if it were nonexistent. Since hair loss doesn’t appear to be life threatening, most physicians pay little attention to women’s complaints about hair loss and essentially tell their patients that it’s no big deal, and that you’ll just have to live with it. Of course what these physicians don’t seem to realize is that the psychological damage caused by hair loss and feeling unattractive can be just as devastating as any serious disease, and in fact, can take an emotional toll that directly affects physical health.

TYPES OF WOMEN HAIR LOSS
Hair loss can be temporary or long lasting. Temporary hair loss can be easy to fix when its cause is identified and dealt with or difficult when it is not immediately clear what the cause is. Hair loss that could have been merely temporary may become long lasting as a result of an incorrect diagnosis. The potential for such misdiagnoses is perhaps the most frustrating aspect of hair loss for women. The information in this section will help you identify the cause of your hair loss. Alopecia is the medical term for excessive or abnormal hair loss. There are different kinds of alopecia. What all hair loss have in common, whether it’s in women or men, that it is always a symptom of something else that’s gone wrong in your body. Your hair will remain on your head where it belongs if hormone imbalance, disease, or some other condition is not occurring. That condition may be as simple as having a gene that makes you susceptible to male or female pattern baldness or one of the forms of alopecia areata, or it may be as complex as a whole host of diseases. Fortunately, hair shedding may also be a symptom of a short-term event such as stress, pregnancy, and the taking of certain medications. In these situations, hair will grow back when the event has passed. Substances (including hormones), medications, and diseases can cause a change in the hair growth and shedding phases and in their durations. When this happens, synchronous growth and shedding occur. Once the cause is dealt with, hairs go back to their normal pattern of growth and shedding, and your hair loss problem stops.

FEMALE PATTERN BALDNESS
Dihydrotestosterone (DHT), a derivative of the male hormone testosterone, is the enemy of hair follicles on your head. Simply put, under certain conditions DHT wants those follicles dead. This simple action is at the root of many kinds of hair loss, so we’ll address it first. Androgenetic alopecia, commonly called male or female pattern baldness, was only partially understood until the last few decades. For many years, scientists thought that androgenetic alopecia was caused by the predominance of the male sex hormone, testosterone, which women also have in trace amounts under normal conditions. While testosterone is at the core of the balding process, DHT is thought to be the main culprit. Testosterone converts to DHT with the aid of the enzyme Type II 5-alpha reductase, which is held in a hair follicle’s oil glands. Scientists now believe that it’s not the amount of circulating testosterone that’s the problem but the level of DHT binding to receptors in scalp follicles. DHT shrinks hair follicles, making it impossible for healthy hair to survive.

The hormonal process of testosterone converting to DHT, which then harms hair follicles, happens in both men and women. Under normal conditions, women have a minute fraction of the level of testosterone that men have, but even a lower level can cause DHT- triggered hair loss in women. And certainly when those levels rise, DHT is even more of a problem. Those levels can rise and still be within what doctors consider "normal" on a blood test, even though they are high enough to cause a problem. The levels may not rise at all and still be a problem if you have the kind of body chemistry that is overly sensitive to even its regular levels of chemicals, including hormones. Since hormones operate in the healthiest manner when they are in a delicate balance, the androgens, as male hormones are called, do not need to be raised to trigger a problem. Their counterpart female hormones, when lowered, give an edge to these androgens, such as DHT. Such an imbalance can also cause problems, including hair loss. Hormones are cyclical. Testosterone levels in some men drop by 10 percent each decade after thirty. Women’s hormone levels decline as menopause approaches and drop sharply during menopause and beyond. The cyclic nature of both our hair and hormones is one reason hair loss can increase in the short term even when you are experiencing a long-term slowdown of hair loss (and a long-term increase in hair growth) while on a treatment that controls hair loss. The majority of women with androgenic alopecia have diffuse thinning on all areas of the scalp. Men on the other hand, rarely have diffuse thinning but instead have more distinct patterns of baldness. Some women may have a combination of two pattern types. Androgenic alopecia in women is due to the action of androgens, male hormones that are typically present in only small amounts. Hair loss can be caused by a variety of factors tied to the actions of hormones, including, ovarian cysts, the taking of high androgen index birth control pills, pregnancy, and menopause. Just like in men the hormone DHT appears to be at least partially to blame for the miniaturization of hair follicles in women suffering with female pattern baldness. Heredity plays a major factor in the disease.

Types of Hairloss

INTRODUCTION
The word alopecia is the medical term for baldness or hair loss. Alopecia does not refer to one specific hair loss disease -- any form of hair loss is an alopecia. The word alopecia is Latin, but can be traced to the Greek alopekia which itself comes from alopek, meaning fox. Literally translated, the word alopecia (alopekia) is the term for mange in foxes. Hair loss can be caused by any number of conditions, reflected in a specific diagnosis. Some diagnoses have alopecia in their title, such as alopecia areata or scarring alopecia, but many do not, such as telogen effluvium. Alopecia can be caused by many factors from genetics to the environment. While androgenetic alopecia (male or female pattern baldness, AGA for short) is by far the most common form of hair loss, ProHAIR Transplant Clinic Transplant Clinic doctors, also see many people with other forms of alopecia. Several hundred diseases have hair loss as a primary symptom. The most common non-AGA alopecias that doctors at ProHAIR Transplant Clinic Transplant Clinic see are telogen effluvium, alopecia areata, ringworm, and scarring alopecia. Other, more rare forms of hair loss may be difficult to diagnose, and some patients may wait months, even years for a correct diagnosis and undergo consultation with numerous doctors until they find one at ProHAIR Transplant Clinic Transplant Clinic with knowledge of their condition. Plus, with rare diseases, there is little motivation for research to be conducted and for treatments to be developed. Often, even when a correct diagnosis is made, doctors can offer no known treatment for the condition. Research into hair biology and hair diseases is a very small field, and even research on androgenetic alopecia is quite limited. Perhaps 20 years ago there were fewer than 100 people worldwide who studied hair research in a major way. In recent years, there may be five times as many. This is still a small number compared to, say, diabetes research, but the expanding numbers of researchers investigating hair biology is positive, and eventually should lead to a better understanding and more help for those with rare alopecias.

EFFLUVIUM
Some hair loss conditions go by the name Effluvium which means an outflow. Effluviums characteristically affect different phases of the hair growth cycle. Hair follicles on the scalp do not continuously produce hair. They cycle through a growth stage that can last two or more years, then regress to a resting stage for up to two months before starting to grow a new hair fiber again. At any time on a healthy human scalp, about 90% of the hair follicles are growing hair. These active follicles are in what is called the Anagen Phase. That leaves up to 10% percent of scalp hair follicles in a resting state called Telogen Phase, when they don’t produce any hair fiber.

TELOGEN EFFLUVIUM
Telogen Effluvium (TE) is probably the second most common form of hair loss, doctors at ProHAIR Transplant Clinic Transplant Clinic see. It is a poorly defined condition; very little research has been done to understand TE. In essence though, TE happens when there is a change in the number of hair follicles growing hair. If the number of hair follicles producing hair drops significantly for any reason during the resting, or telogen phase, there will be a significant increase in dormant, telogen stage hair follicles. The result is shedding, or TE hair loss. TE appears as a diffuse thinning of hair on the scalp, which may not be even all over. It can be a bit more severe in some areas of the scalp than others. Most often, the hair on top of the scalp thins more than it does at the sides and back of the scalp. There is usually no hair line recession, except in a few rare chronic cases. The shed hairs are typically telogen hairs, which can be recognized by a small bulb of keratin on the root end. Whether the keratinized lump is pigmented or unpigmented makes no difference; the hair fibers are still typical telogen hairs. People with TE never completely lose all their scalp hair, but the hair can be noticeably thin in severe cases. While TE is often limited to the scalp, in more serious cases TE can affect other areas, like the eyebrows or pubic region. Whatever form of hair loss TE takes, it is fully reversible. The hair follicles are not permanently or irreversibly affected; there are just more hair follicles in a resting state than there should normally be.

THERE are THREE BASIC WAYS TE can DEVELOP:
There might be an environmental insult that shocks the growing hair follicles so much that they decide to go into a resting state for a while. This results in an increase in hair shedding and a diffuse thinning of hair on the scalp. This form of TE can develop rapidly and may be noticeable one or two months after receiving the shock. If the trigger is short lived, then the hair follicles will return to their growing state and start producing new hair fibers pretty quickly. This form of TE usually lasts less than six months and the affected individual has a normal scalp hair density again within a year.

The second form of TE develops more slowly and persists longer. The hair follicles may not all suddenly shed their hair fibers and enter a resting telogen state. Rather, the follicles may enter a resting state as they normally would, but instead of returning to a new anagen hair growing state after a month or two, they stay in their telogen state for a prolonged period of time. This results in a gradual accumulation of hair follicles in a telogen state and progressively fewer and fewer anagen hai follicles are left growing hair. In this form of TE, there may not be much noticeable hair shedding, but there will be a slow thinning of the scalp hair. This form of TE is more likely to occur in response to a persistent trigger factor.

In a third type of TE, the hair follicles do not stay in a resting state but rather cycle through truncated growth cycles. When this happens, the individual experiences thin scalp hair and persistent shedding of short, thin hair fibers.

CAUSES OF TELOGEN EFFLUVIUM: STRESS AND DIET
What are the trigger factors for TE? The short answer is many and varied. Classic short-term TE often happens to women soon after giving birth. Called postpartum alopecia, the sudden change in hormone levels at birth is such a shock to the hair follicles that they shut down for a while. There may be some significant hair shedding, but most women regrow their hair quickly. Similarly, vaccinations, crash dieting, physical trauma such as being in a car crash, and having surgery can sometimes be a shock to the system and a proportion of scalp hair follicles go into hibernation. As the environmental insult passes and the body recovers, the TE subsides and there is new hair growth. Some drugs may also induce TE, especially antidepressants. Often a switch to a different drug resolves the issue. More persistent insults can result in more persistent TE. For example, a chronic illness may lead to TE. Arguably, the two most common problems are Chronic Stress and Diet Deficiency. Many dermatologists, including doctors at ProHAIR Transplant Clinic Transplant Clinic, believe chronic stress can gradually exert a negative effect on hair growth and lead to persistent TE. Research with animal models has provided evidence to back up this claim. There does indeed seem to be a link between stress, a change in hair follicle biochemistry, and more hair follicles entering a telogen resting state. Whether dietary problems are causing TE in North America is hotly argued among dermatologists. A lack of a mineral, vitamin, or essential amino acid can certainly cause TE, such as with people in third world countries where diets can be completely deficient in one or more nutrients. Animal experiments also provide supporting evidence. In first world countries the average diet is rarely completely deficient in a particular vitamin or mineral. However, some dermatologists claim that with a reduction in red meat intake and a preference for vegetarian diets, some individuals are not getting a balanced intake of all the nutrients required for good hair and overall body growth. In particular, there are claims that women may be deficient in their iron intake. Why women specifically? Because women lose iron at regular intervals as a result of menstruation. Some dermatologists believe that as we now eat less red meat, a key source of iron, some people are not eating enough iron and TE is the result. Other potential deficiencies of the modern North American diet -- such as a lack of zinc, amino acid L-lysine, or vitamins B6 and B12 -- have also been suggested to contribute to TE.

When dietary deficiencies are suspected, supplements may be taken. However, supplements themselves can cause problems. Our bodies can only process so much iron each day. At high doses, iron is toxic and this can itself cause hair loss. At really high doses, iron supplements will cause death. Vitamin A supplements can also cause a TE reaction in some individuals, as excessive vitamin A can also be toxic. TE can occur on its own or as part of another disease. The early stages of androgenetic alopecia (male or female pattern baldness, AGA for short) are effectively TE. Early AGA is characterized by an increase in resting telogen hair follicles. Someone in the early stages of AGA may have up to 40% of their scalp hair follicles in telogen. TE can also be a symptom of other conditions, such as inflammatory conditions like Alopecia Areata. Hair follicles are particularly sensitive to thyroid hormones and about one third of individuals with a thyroid disorder have TE. Exposure to toxins can also cause TE as one of many symptoms.

TREATMENTS FOR TELOGEN EFFLUVIUM
How TE is treated depends on what has activated it. For short-term TE that can be linked to a trigger like hair transplant surgery. When this happens, it is called Surgical Effluvium and the best response is to sit tight and wait for the follicles to recover of their own accord. This is a normal outcome after hair transplantation and usually happens when hair follicles are transplanted to areas of thinning not complete baldness. Mostly found in women hair transplants, this complete recovery can take up to 18 months to 24 months. For persistent TE, if the causal factor can be isolated, then the best method is to remove it. For example, if stress is the problem, stress reduction is the long-term answer. If a dietary deficiency appears on a blood test, then supplements can work. A deficiency in thyroid hormones can be treated with hormone supplements. However, often a specific causal factor cannot be identified. If this is the case, there are few treatment options. Most hair transplant surgeons, including those at ProHAIR Transplant Clinic Transplant Clinic resort to prescribing Minoxidil, a direct hair growth stimulator. Minoxidil can work well for some individuals with TE, but if the underlying cause is still present, then Minoxidil must be continued to block redevelopment of TE. With removal of the trigger, Minoxidil use can be stopped. More explanations of this and other drugs during the FREE CONSULTATION at ProHAIR Transplant Clinic Transplant Clinic. Before leaving the subject of TE, here are a few words about natural hair shedding. Everyone sheds hair and you may see more hair shed at certain times of the year. Studies show that humans, at least in Northern Europe away from the equator, shed more hair in the fall and to a lesser extent in the spring. This temporary increase in the number of telogen hair follicles and shed hair is probably due to changes in hormones in response to changes in daylight exposure. Studies in mink and other mammals show that daylight exposure significantly alters prolactin levels and that prolactin has a significant effect on molting. As with mink and other mammals, humans probably have much the same molting response. Such hair loss should be temporary.

ANAGEN EFFLUVIUM
Anagen effluvium is a diffuse hair loss like telogen effluvium, but it develops much more quickly and can cause individuals to lose all their hair. Anagen effluvium is most frequently seen in people taking cytostatic drugs for cancer or those who have ingested toxic products like rat poison. Substances of this type inhibit rapid cell proliferation. This is a desirable factor if you are trying to block the development of a cancer, but the cells of hair follicles are some of the most rapidly proliferating, noncancerous cells the body has. Hair fiber from scalp hair follicles grows at up to 0.4mm a day and that rate of growth requires a lot of cell proliferation. Cytostatic cancer drugs and various toxins and poisons inhibit rapid cell growth, including the proliferation of cells in the hair follicles. The result is a sudden shut down of hair fiber production. The onset of anagen effluvium is very rapid. Some individuals who start taking anti-cancer drugs can literally pull their hair out in clumps within the first two weeks. Because these drugs act so quickly and are so potent, the hair follicles have no time to enter into a telogen resting state, as with telogen effluvium, a response to a more moderate environmental challenge. Instead, in anagen effluvium the hair follicles enter a state of suspended animation, frozen in time. The hair fibers fall out quickly, but instead of looking like typical telogen hairs with little bulbs of keratin on the root end, the hairs that fall out are mostly dystrophic anagen hairs with a tapered or sometimes feathered root end. With cytostatic anti-cancer drugs, the degree of hair loss varies from person to person. Some people may have a mixture of anagen effluvium and telogen effluvium and have more limited hair loss. Some cancer treatment centers try to block the hair loss using a cold therapy. More popular in Europe than North America, cold therapy involves covering the scalp with ice packs or using a special hood filled with cold water while the anti-cancer drugs are given. The cold sends the hair follicles into suspended animation prior to contact with the drug. This stops the hair follicle cells from taking up the drug and being damaged by it. The result is much less drug-induced hair loss. However, doctors worry that any cancer cells in the skin may also avoid the anti-cancer drugs if cold therapy is given during drug treatment. Some experimental drugs to block drug induced hair loss are under development, but the same fear applies. The treatments to stop hair loss may also protect any cancer cells in the skin. While, the development of anagen effluvium is rapid, the recovery is also equally rapid. Because the follicles are just frozen in time, they are ready to grow once the factor causing the anagen effluvium has been removed. On completion of an anti-cancer drug treatment course, a person may start to see new hair growth within a month. The hair follicles are not destroyed, so there should be a normal hair growth density. However, some people notice a change in the nature of the hair fiber produced. Some people find their hair changes from straight to curly or vice versa, or sometimes there is a change in hair color. These changes may be permanent.

ALOPECIA AREATA
Alopecia Areata (AA) is probably the third most common form of hair loss doctors at ProHAIR Transplant Clinic Transplant Clinic see, after androgenetic alopecia and telogen effluvium. The lifetime risk for AA is nearly 2%, or two in every 100 people will get AA at some point in their lives. It is not contagious; you can’t catch AA from someone who has it. Researchers believe AA is an autoimmune disease such as rheumatoid arthritis, but in this case the individual’s own immune system attacks hair follicles instead of bone joints. Just why or how AA develops is not clear. For whatever reason, the immune system is inappropriately activated and attacks hair follicles. Research using several disease models shows certain types of lymphocytes play a primary role in the hair loss. They seem to attack the hair follicles, mistakenly thinking that somehow they are a threat to the rest of the body. AA can affect men, women, and children. It often appears as well-defined circular bald patches on the scalp. Many people will get just one or two patches, but for some the hair loss can be extensive. Unfortunately, children who develop AA before puberty are most likely to develop more extensive and persistent hair loss. Hair loss that spreads to cover the entire scalp is called Alopecia Totalis. If it spreads over the entire body, affecting scalp, eyebrows, lashes, beard, pubic hair, and everything else, then the condition is called Alopecia Universalis. If the alopecia is just limited to the beard area in men, it is called Alopecia Barbae. The inflammation involved in AA focuses on the roots of hair follicles deep in the skin. As a result there is very little visible at the skin surface. There is no redness and often no pain, although a few people do find their skin itchy or painful to touch in the very early stages of AA development. Usually, though, there is no sensation -- just a patchy shedding of hair. The hair loss can be quite sudden, developing in a matter of a few days and it may happen anywhere on the scalp. The patch is usually smooth bald skin with nothing obvious to see beyond the absence of hair. Unlike other autoimmune diseases, the target of the inflammatory response in AA, the hair follicles, are not completely destroyed and can re-grow if the inflammation subsides. People with just one or two patches of AA often have a full and spontaneous recovery within two years whether or not they receive treatment. However, about 30% of individuals find the condition persists and becomes more extensive, or they have repeated cycles of hair loss and re-growth. Traditionally, AA has been regarded as a stress-induced disease. Unfortunately that view persists today, even among some dermatologists, even though very little scientific evidence supports the view. AA is much more complicated. Extreme stress might trigger AA in some people, but recent research shows that genes can also be involved. There are probably several genes that can make an individual more susceptible to developing AA. The more of these genes a person has, the more likely they will develop AA. Some researchers believe there are a wide range of contributing factors that make someone more susceptible to developing AA. Hormones, allergies, viruses, and even toxins might contribute. Probably several factors combined are involved in the activation of AA in any one individual.

TREATMENTS FOR ALOPECIA AREATA
There are a range of treatments for AA, but none are effective for everyone and some people with AA don’t respond to any treatment. Because some of the available treatments have a high risk of side effects, they are often not used for children. The most common AA treatment involves the use of corticosteroids. Corticosteroid creams applied to the bald patches are popular with the average dermatologist, although this treatment approach is only successful for the very mildest cases. A more potent approach is to inject corticosteroid solutions into the bald patches. This can work well for some people, but close monitoring is required to ensure that side effects, such as skin thinning at the site of injection, do not occur.In extensive cases, systemic corticosteroids (those taken in pill or other form to affect your body) are used, though not continuously since they can cause significant side effects like bone thinning. But short-term „pulse therapy” often has good results.More specialized treatment approaches involve the application of contact sensitizing chemicals to the skin. These cause an allergic reaction that can help promote hair growth. That may sound counterintuitive but it seems to work. A variety of experimental approaches are currently in laboratory and clinical trials. One group of drugs being tested are „biologics” which have bits of protein that interfere in a very specific way with the activity of immune cells. Biologics are injected systemically to damp down the immune activity and allow hair to regrow. The results of these trials are awaited with much interest.Unfortunately, people with more extensive, long-term AA find the treatments currently available do not work well. For these individuals the only practical answer is a wig and lots of emotional support. It can be depressing not to have hair, especially for children, who don’t want to be different from their classmates at school, and women. Hair Transplantation is absolutely not recommended in these patients, because transplanted hair to these sites will not grow.

Densitometry
Densitometry is a technique that analyzes the scalp under high-power magnification to give information on hair density, follicular unit composition, hair scalp diameter and degree of miniaturization of scalp hairs during the consultation at ProHAIR Transplant Clinic. It can be used to help evaluate a patient’s candidacy for hair transplantation and help predict future hair loss. Multiple measurements taken from different parts of the scalp are often helpful, particularly if there is significant variability from one location to another.

The widespread adoption of Follicular Unit Transplantation (FUT), with its ability to allow for large numbers of grafts to be safely transplanted in one session, dramatically changed the way modern hair transplantation could be performed. The procedure enabled thousands of follicular unit grafts to be transplanted in one session and complete hair restorations to be accomplished in just a few procedures.
In order to identify which candidates are suitable for surgery, which may respond best with medications alone, and who can be expected to have more stable hair loss – or become extensively bald – a careful history and physical examination should be performed. This evaluation should not be taken lightly, nor passed off to non-physicians, as the decision to proceed with a surgical solution for hair loss can have a profound impact on a person for the rest of his or her life. With its ability to offer more objective hair measurements, densitometry can play a useful role in this evaluation.

Information provided by densitometry are: 1) Hair density -the # of hairs per unit area, 2) Follicular unit density -the # of follicular units per unit area, 3) Hairs per follicular unit – both the range (observed) and the average (calculated), 4) Presence of miniaturization, 5) Hair shaft diameter, 6) Degree of miniaturization, 7) Response to medication and 8) Growth after a hair transplant.

Densitometry showing the natural follicular groupings in the scalp in a person with low density (left), average density (middle), and very high density (right). Note, that as the hair density increases, the average hair count in the follicular unit increases, but the density of follicular units remain relatively constant.

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Dr. Ignacz Zsuzsa
Plastic Surgeon

Dr Mantse TamasHair Transplant Doctor

PLACES OF EMPLOYMENT

• 2001-2007 Atlantik International Hair Transplant Clinic, Budapest, Founding Member and Medical Director
• From 2007 ProHAIR Transplant Clinic, Budapest, Founding Member and Medical Director

MEMBERSHIP OF SOCIETIES

• American Academy of Cosmetic Surgery 
• European Society of Hair Restoration Surgery (ESHRS) 
• International Society of Hair Restoration Surgery (ISHRS) 
• Hungarian Dermatological Society 
• Hungarian Medical Society

PROFESSIONAL TRAINING

• 1993 Assists in the first Hair Transplantation, Ottawa, Canada
• 2001 International Society of Hair Restoration Surgery, Live Surgery Workshop, Orlando, USA
• 2002 Dr. Pierre Bedard, Montreal, Canada, Hair Transplant specialist
  Dr. Thomas Kohn, Montreal, Canada, Dermatologist and Hair Transplant specialist 
• 2003 Dr. Theodore Sutnik, Los Angeles, USA, Dermatologist
• 2003 World Hair Society, Live Surgery Workshop, New York, USA
• 2003 Dr. Marc Avram, New York, USA, Dermatologist and Hair Transplant specialist 
• 2004 Dr. Theodore Sutnik, Los Angeles, USA, Dermatologist
• 2005 Dr. Pierre Bedard, Montreal, Canada, Hair Transplant specialist
• 2006 Dr. Damkerng Pathomvanich, Bankok, Thailand, Hair Transplant specialist 
• 2007 Dr. Mark McKenzie, Toronto, Canada, Hair Transplant specialist
  Dr. Walter Unger, Toronto, Canada, Dermatologist and Hair Transplant specialist
  Dr. Marla Rosenberg, Toronto, Canada, Dermatologist and Hair Transplant specialist
  Dr. Pierre Bedard, Montreal, Canada, Hair Transplant specialist
  Dr. Paul C. Cotterill, Toronto, Canada, Hair Transplant specialist 

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