The following are excerpts from the Question and Answer segments of Dr. Bernstein’s Open House Seminars. |
HAIR TRANSPLANT SEMINAR: PART 6
Hair Loss Treatments and Products
Attendee: In terms of lightening hair, as opposed to dying it, is it that the difference in color between the scalp and the hair is less so the hair doesn’t look as thin or does lightening it actually make the hair thicker than dying it?
Dr. Bernstein: Lightening the hair does two things. It decreases the contrast between the skin and hair for those with light skin. And it acts as filler, filling in the spaces between the hairs.
The other thing that it does is it reflects more light so that it looks fuller.
Did everyone understand that? Okay, then I am going to ask the group a question. In a black person, does lightening their hair give the appearance of more hair or less hair? Any ideas?
Attendee: Less?
Dr. Bernstein: It makes it look like less hair, because it increases the contrast with the dark skin. However, the light hair would also reflect more light! So then the question is, which is more important, the contrast or the fact that it reflects more light? Actually both of these factors are important so it would depend upon the individual situation.
Attendee: Doesn’t lightening your hair cause you to lose more hair?
Why should lightening your hair cause you to lose more hair? Hair grows from the root, from the follicle that sits below the surface of the skin. Although, lightening the hair may damage the hair shaft and make it appear more brittle, it does not effect the root – it will not effect the growth of new hair. That is of course unless the scalp itself is burned from overzealous treatments.
On the other side of the coin, many people use hair conditioners, hair treatments, all those things and they think will help you grow more hair. Actually, they don’t. Hair is dead, so treating the hair doesn’t affect growth. Treatments may make the hair silky and keep it from breaking, but it won’t affect growth.
It’s the same thing with hair treatments, whether you use a conditioner to keep your hair from breaking, it can make your hair look more full, but actually the growth center below the follicle – you know, below the surface of the skin in the follicle is not affected by things you do to your hair. Otherwise, cutting the hair would be bad for it. And certainly cutting is more traumatic than bleaching it or dying it.
So as long as you’re not burning the roots, as long as you’re just doing it to the hair, then it will be no problem.
Attendee: Could you tell me some products that you can put on your head to make the hair appear thicker?
Dr. Bernstein: Yes. Go to our website and look under Medical Treatments, which is on the left navigation. When you click on Medical Treatments, there’s going to be a number of buttons on top of the page. One says Camouflage Agents. When you click on that, there is a list of products with their descriptions, the companies that make them and telephone numbers where you can get them. There are five main product types and they’re all very different – there are powders, creams, and sprays and they come in a wide variety of colors to match your hair or scalp. You have to get a few and see which ones you like.
Hats and Hair Loss
Attendee: Does wearing a hat cause hair loss?
Dr. Bernstein: I find it fascinating that this is such a frequently asked question. The answer is “obviously not.” Think about it for a moment. A hat generally touches the sides of the head, not the top where you lose the hair – so it can’t be from pressure. And it certainly doesn’t cause hair loss by depriving the head of oxygen. Hair, like everything in the body, gets its oxygen through the blood stream, not by the surrounding air. Does wearing shoes and socks prevent ones toenails from growing?
Diagnosing Androgenetic Alopecia
Attendee: “My son has started to – I think he may be thinning and we’re concerned about putting him on Propecia for life.” So the question is how can you tell, when someone is young, whether they’re actually balding or not? How do you tell if an eighteen-year-old kid is balding?
Dr. Bernstein: There are actually a number of things that we can look at that can make the hair loss diagnosis pretty clear-cut. Some things are soft findings and some things are hard – more reliable. The first soft thing is family history. If someone has a family history where people are bald, then obviously it increases their chances of becoming bald. Particularly, if someone has a family history where some in the family says, “oh, when I was eighteen I started losing my hair and then I became bald over the next five years”. If another family member started to thin at 18, then this is obviously not a good sign. So the family history is important particularly if there is a family member that is older but had a similar pattern of loss as the person in question.
The second thing is the person's own sense of his hair loss. Although this is a soft finding, I think that this is extremely important. If an eighteen-year-old - I’m saying eighteen just as an example - an eighteen-year-old comes into my office and says, “I put my comb through my hair and it seems like it is getting thinner. I used to go to the barber and they used to use these thinning shears. They don't have to do that anymore.” That’s very, very important to me. Even though he looks like he has a full head of hair to me, it doesn’t matter. If the person is complaining of decreased hair volume, that's a sign that he may be losing his hair. So that’s another soft finding, but very important.
The next thing is if the hairline is changing. I often hear “my hairline used to be flat, straight across, and now it's kind of going up in the corners.” This may also indicate that someone is thinning. Some people's corners go up, but they actually never go bald. They go from an adolescent hairline to an adult hairline, which is normal. It doesn't mean you're balding. However, a changing hairline can indicate that someone is actually going bald. So it's a soft sign.
If someone is receding in the temples but also their crown is starting to thin, then that is definitely a sign that they are going to eventually lose their hair and go bald, especially in a young person. So temple recession plus crown thinning is a clear sign of genetic hair loss.
The next thing is if one thins beyond the hairline. And the way you can tell is to look at their scalp and you see miniaturization. This is accomplished with an instrument called the densitometer. It has a strong light with magnification and this magnifies the scalp thirty times, so that you can clearly see the different populations of hair – hair with different shaft diameters. If you see thick terminal hair interspersed with very fine hair, that means that the hair is not stable, is becoming miniaturized, and that person is balding. This is a hard finding.
So when you put soft findings of family history and the sense of decreased hair volume and changing hair line, together with the hard findings of patterned hair loss and the presence of miniaturization, then the diagnosis of hair loss, of androgenetic hair loss, is pretty secure. And those are the people that we put on Propecia. And you want to put the hair loss patients on earlier rather than later. If a patient only has soft findings, it is more of a judgment call, but with several soft findings, I will place younger patients on the medication as well.
The most important thing when evaluating a young person with hair loss is to look at their donor area. Because if the hair in ones donor area, the back and sides of the scalp, are also miniaturizing, this is a condition called diffuse unpatterned hair loss. In these men the hair is thinning diffusely all over and these people are not candidates for a hair transplant surgery. And they are also at risk of balding very, very rapidly very early.
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