Callender Dermatology and Cosmetic Center | Glenn Dale MD

Hair Loss & Transplantation

.Valerie D. Callender MD | Callender Dermatology & Cosmetic Center | Glenn Dale, MD
Women instinctively associate lush hair with feminine beauty. It can be frightening to notice shedding that seems to be more substantial than normal. We all shed nearly 100 hairs a day. More than this could signify the need for a medical consultation and examination.

Female pattern hair loss affects more women than many people imagine. In some practices, more than 25% of hair restoration patients are women. The reason for seeking treatment may differ as it relates to the pattern of hair loss. For example, some women wish to lower their hairline or to increase the density of hair around their face while others seek treatment that will add thickness to their part line or crown of the head. What most patients have in common is that they want to achieve the profound cosmetic improvement that comes from appropriate hair restoration treatment.


Hair Loss And Hair Transplantation in Women of Color

Hair Transplant | Callender

There are several causes of hair loss in women – hereditary causes, crash dieting (inadequate protein), childbirth, birth control pills, medications, medical illnesses (thyroid disease, anemia), surgery, cancer treatments and improper hair care. The most common type of hair loss in all women, regardless of race, is female pattern hair loss (FPHL) or hereditary thinning. It occurs in approximately 30 million women in the United States. Younger and older women alike can be affected, but the typical patient is between 50-60 years od age.

Although, not surprising, that the younger the women is with hair loss, the more devastating it can be to her. Studies have shown that hair loss in women can negatively impact their self-esteem and social interactions. FPHL presents as a diffuse thinning of hair at the top of the head (crown) and may extend to the front of the scalp. Medical treatment with topical Minoxidil 2% (Rogaine) is available over-the-counter, but must be used continuously in order to maintain the new growth.

Two of the most common types of hair loss in black women, both which are associated with hair grooming practices, include traction alopecia and central centrifugal cicatricial alopecia (CCCA). These conditions can lead to permanent hair loss and hair restoration is the only answer.


How do I know if I am losing too much hair due to a medical condition?

Hair loss may not happen quickly. Because hair grows in cycles, it can take up to 3 months for hair to fall out after exposure to a given trigger. If excessive shedding continues for 3 months or longer, consult with a board-certified doctor who is familiar with the hair growth cycles, potential reasons for hair loss, and treatment options that may promote healthier hair growth.

A thorough consultation, medical history, and examination can help us determine if a medical condition is the root issue that is triggering hair loss. The good news is that most of the medical reasons for hair loss can be addressed with medication or lifestyle changes. For example, some women lose too much hair as a result of a hormone imbalance or iron deficiency. Thyroid dysfunction may also lead to hair loss, as may extreme weight loss or body weight that is too low.

Together, you and your doctor can uncover the possible reasons you are losing too much hair.


Traction Alopecia

Traction alopecia occurs in both children and adult women. It results from various hairstyles and hair grooming practices that are unique to women of color. These include pony tails, braids, weaves, locs and hair rollers that pull the hair tight and eventually, hair loss develops. The areas of hair loss are usually symmetrical and occur along the temples and the above the ears. If caught early on, medical treatment and changing the damaging hairstyle can stop this condition from becoming permanent.


Central Centrifugal Cicatricial Alopecia (CCCA)

Callender Skin | Hair Restoration

CCCA, or formally known as hot comb alopecia and follicular degeneration syndrome, is an inflammatory scarring form of hair loss that is becoming an epidemic in the black female population. The cause of this condition is unknown; however, many of the women have a history of chronic use of hair chemicals (relaxers, jheri curl, texturizers, and bonding glue used for hair weaving) or heat (hot comb or hot curler use).

CCCA is a progressive and destructive scalp condition that commonly goes unnoticed. It usually begins at the top of the scalp (crown or vertex).  The most common early signs are hair breakage, itching, scalp tenderness in the affected area.

Again, if addressed early, medical treatment along with changing the current hair grooming methods can stop the progression of the hair loss and in some cases, hair regrowth can occur.

Unfortunately, most women seek treatment too late and the hair loss becomes permanent.<


Treatments for Hair Loss

At Callender Dermatology and Cosmetic Center, patients have options for hair restoration treatments. In some cases, hair transplantation surgery is the best choice. Patients may also benefit from non-surgical treatment using PRP injections into the scalp.

Surgical hair transplant involves direct harvesting of tissue from one part of the scalp to another. After removing a predetermined piece of tissue (6 to 8 inches by 1 inch or slightly larger), the doctor dissects the strip into follicular units containing 1 to 3 strands of hair. This technique, referred to as follicular unit transplantation or FUT, may achieve excellent results for women with female pattern hair loss or traction alopecia.

PRP hair restoration may also help women with female pattern hair loss or traction alopecia regain fuller, thicker hair. This technique works by stimulating more activity within the hair follicles. Injections of PRP, or platelet-rich plasma, increase blood circulation through the scalp and hair follicles. This treatment also introduces various growth factors that support tissue regeneration over time.

Each method of hair restoration offers unique benefits which we can discuss during your consultation.


Hair Transplantation

Hair transplantation or hair restoration is a popular cosmetic procedure that is commonly performed in Caucasian men with male pattern baldness. According to the American Academy of Cosmetic Surgery, hair transplantation was the most popular cosmetic surgery among men, with 177,998 procedures performed in the year 2000. Most of us have seen the late night infomercials, highlighting the fabulous results of hair transplanting in men, restoring their youth and good looks.

However, women of color are never seen in these advertisements, as if this surgical procedure is not indicated for their hair loss. With the increasing incidence of hair loss in black women, the surgical correction of hair loss is an important and necessary component to the overall treatment regimen for this emotionally devastating condition.


What is Hair Transplantation?

Hair Loss | Callender Skin

Hair transplantation involves removing healthy hair or grafts from the back of the scalp (donor site). We then transplant them into the area of hair loss (recipient site). It is an in-office surgical procedure that is performed under local anesthesia and minimal sedation; so hospitalization is not required. We use various techniques to remove the hairs from the donor site.

The most common technique involves removing a strip of hair bearing scalp (6-8 inches long x 1 inch wide) and then dissecting it into follicular units (1-3 hairs). We call this procedure follicular unit transplantation (FUT) and produces a natural appearing hairline. This technique is extremely important in patients with traction alopecia and female pattern hair loss.

In contrast, women of color with CCCA have better results with transplanting larger grafts, rather than follicular units. Because the area of hair loss occurs on the crown and not the hairline, larger grafts are used to provide better coverage and create an illusion of density.


Is hair transplantation painful?

Both hair transplant surgery and PRP hair restoration are performed using a local anesthetic. Before commencing with tissue grafting in hair transplantation, the doctor injects a numbing medication just beneath the skin on the scalp. This desensitizes pain receptors. Patients are awake during treatment and may feel sensations such as tugging or pressing, neither of which should be painful.

After hair transplant treatment, the scalp may feel tender in some places and sore in others. Comfort is typically manageable with either over-the-counter or prescription pain medication.


How many treatments will I need to restore my hair?

The need for multiple hair transplant procedures varies significantly from one person to another. The need for additional sessions may arise if hair loss is severe or if the patient desires more thickness and fullness. During an in-person consultation, your doctor can estimate the number of treatments it may take to give you the results you desire.


Is hair transplantation a permanent solution to hair loss?

Years of clinical practice suggest that hair transplant surgery can achieve permanent results in a large percentage of patients. However, some people seek touch-up treatments sometime after their initial results are achieved.


Are there any risks to hair transplantation?

Hair transplant surgery carries a slight risk of bleeding and infection. These are uncommon complications from treatment. More probable complications include scarring and patchy-looking results. Working with an experienced hair transplant surgeon, these risks are reduced significantly.


Racial Differences in Hair Restoration

Hair Loss | Dr. Callender

There are several racial differences in hair transplant surgery. These include (1) reason for the procedure; (2) the shape of the hair; and (3) risk of keloid formation. Most women of color seek hair restoration for the treatment of traction alopecia and CCCA.  However, male pattern baldness in men and FPHL in women is the reason in Caucasians. Black hair is curly with a curved hair follicle and removing donor hairs can be very difficult and extremely challenging.

Transection of the hair follicle is a constant problem even for the best hair transplant surgeon or surgical assistant. This makes finding a hair transplant surgeon with experience in black hair, such as Dr. Callender, particularly important. There is an increased risk of keloid formation in the black population. Therefore the risk of developing a keloid from hair transplant surgery is a possibility. We will not perform the  procedure if there is a history or keloids. If a keloid scar develops at the surgery site a topical corticosteroids or cortisone injections can flatten the scar.


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