Hair Loss

what causes it?

Cultures and societies worldwide associate luxurious hair with youth, beauty, and good health. Hair has always been one of the most important aspects of a person’s aesthetics and personality. People express themselves through hairstyles of all sorts and for many, their hair is what makes them feel beautiful.

To many people, the mention of hair conjures up images of ladies with magnificent, flowing locks. Many women associate their hair with their sexuality, sensuality, and beauty and may feel that they are no longer attractive due to hair loss or thinning hair

Hair has also been associated with power since biblical times. To men, their hair is a key part of the male psyche that represents their virility, and hair loss, a bald spot, or thinning hair may lead them to feel less manly or attractive.

Usually thought of as something men start worrying about as they get older, hair loss (often extensive and sudden) can impact on anyone – male or female – at any time. Hair thinning or baldness are serious concerns and can be devastating to self-esteem.

Types of hair loss or alopecia

Involutional alopecia: hair gradually thins with age, more hair follicles go into the resting phase, and the remaining hairs become shorter and fewer in number.
Alopecia areata: patchy hair loss in children and young adults that often starts suddenly and may result in complete baldness (alopecia totalis)
Alopecia universalis: loss of all body hair including eyebrows, eyelashes, and pubic hair
Trichotillomania: a psychological disorder seen most frequently in children in which a person pulls out one's own hair.
Telogen effluvium: temporary hair thinning over the scalp that occurs because of changes in the growth cycle of hair in which many hairs enter the resting phase at the same time, causing hair shedding
Scarring alopecias: Inflammatory skin conditions (cellulitis, folliculitis, acne), and other skin disorders (such as some forms of lupus and lichen planus) can result in scars that destroy the ability of the hair to regenerate, resulting in permanent hair loss. Hot combs and hair too tightly woven and pulled can also result in permanent hair loss.
Androgenic alopecia: a genetic condition that can affect both men and women
- male pattern baldness: characterized by an M shaped receding hairline and the gradual disappearance of hair from the crown and frontal scalp, hair loss can begin as early as teens or early 20s
- female pattern baldness: general hair thinning over the entire scalp, with the most extensive hair loss at the crown, with noticeable thinning during the 40s or later

Causes of hair loss or alopecia

Hormones: abnormal levels of DHT (an androgen normally produced by both men and women)
Genes: from male or female parents may influence predisposition to male or female pattern baldness
Stress such as illness, childbirth: temporary hair loss
Fungal infection
Drugs: chemotherapy, blood thinners, blood pressure medication, birth control pills
Burns, injuries, and X-rays
Autoimmune disease: immune system attacks the hair follicles, may cause alopecia areata
Cosmetic procedures: excessive shampooing, perms, bleaching, and dyeing, tight braiding, using rollers or hot curlers, and running hair picks through tight curls contribute to overall hair thinning by making hair weak and brittle. can also damage and break hair. However, these procedures don't cause baldness. In most instances, hair grows back normally if the source of the problem is removed. Still, severe damage to the hair or scalp sometimes causes permanent bald patches.
Medical conditions: Thyroid disease, lupus, diabetes, iron deficiency anaemia, eating disorders, and anaemia can cause hair loss. Hair loss may be permanent if scarring occurs, such as in some forms of lupus, lichen planus or follicular disorders.
Diet: A low-protein or severely calorie-restricted diet can also cause temporary hair loss.

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Medication for Hair Loss

Topical Vasodilators: Applied to the scalp, causes blood vessels to dilate, allows more oxygen, blood, and nutrients to the follicles, not considered effective in extensive baldness
Hormone blockers
- For Men: 5-alpha reductase blockers - originally used in higher doses for the treatment of prostate problems, reduce the formation of the male hormones
- For Women: Anti-androgens - reduce adrenal androgen production and exerts competitive blockade on androgen receptors
Corticosteroids: Suppress the overactive immune system in alopecia areata. Can be administered by application, injection or orally
Prostaglandin F2α (PGF2α) analogues: Originally used for glaucoma but found to be effective in reduced eyelash and eyebrow growth (hypotrichosis) or loss of eyebrows or eyelashes (madarosis).

These topical medications promote increased growth of healthy eyelashes, eyebrows and adnexal hairs.

Interact with hair follicle prostanoid receptors, stimulating resting follicles (telogen phase) to transition to growing follicles (anagen phase).

Prolong the anagen phase of eyelashes, leading to an increase of eyelash length.

Has also been studied in alopecia such as alopecia areata and androgenic alopecia.

Low-Level Light Therapy for Hair Loss

The efficacy of low-level light/laser therapy (LLLT) was discovered by chance when mice irradiated with a low fluence red laser had increased hair growth. The exact mechanism is still unknown but LLLT may increase anagen hairs through the release of nitric oxide and reduced inflammation.

Fractional Infrared Lasers

Fractional laser resurfacing involves the deposition of a pixelated pattern of microscopic laser wounds surrounded by healthy tissue resulting in both greater efficacy and shorter downtime compared to non-fractionated treatments. Fractional lasers induce hair growth by efficiently penetrating the scalp and upregulating the Wnt/β-catenin pathways.

Fractional laser therapy may not only treats alopecia but may also prevent recurrent hair loss. Trauma stimulated wound healing likely plays a role. Hair follicle stem cells provide progeny that migrate to the epidermal defect and promote re-epithelialization. This cutaneous wound healing process increases tremendously during the anagen stage of the hair cycle, and additional hair follicles regrow after wounding.

Regenera Activa

Regenera Activa is a medical device that processes tiny samples of scalp skin to extract hair follicle progenitor cells, separating them into smaller, more absorbable autologous micrografts. The cell suspension is then infiltrated into areas of hair loss to help damaged hair follicles regenerate.

Regenera Activa has been studied to improve hair density, hair counts and scalp coverage in patients with androgenic alopecia. Reduction of hair loss is first witnessed, usually after 1 to 3 months, followed by the improved thickness and density of existing hair and growth of new hair over the next 6 months. Results may last from 1 to 3 years.

Hair transplantation

Hair transplantation involves the relocation of skin plugs with healthy hair follicles to bald areas. Depending on the area of hair loss, several hundred to thousand plugs may be required

Follicular unit hair transplants: transplant one to four hair follicles per plug for a more natural look
Follicular unit extraction (FUE): transplant individual follicle units for less scarring
Robotic assistance such as ARTAS may improve the ease of hair transplantation but tend to cost more

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1Aesthetics's View on Hair Loss

dr wan's perspective

In Dr Wan’s view, it is important to first assess the patient in detail to arrive at an accurate diagnosis, looking out in particular for medical conditions that could be causing hair loss.

Medications should be started to arrest the progression of hair loss. Hair loss supplements such as marine protein have shown positive effects in promoting hair growth in some clinical studies.
Low-level light therapy is a safe non-invasive way to stimulate hair regrowth and should be added wherever possible to enhance the results of other treatments.
Fractional lasers can be helpful in stimulating hair regrowth through harnessing the skin’s natural healing process.
Regenera Activa is suitable for mild to moderate androgenic alopecia.
For severe cases of androgenic alopecia, a hair transplant can be performed.

While non-invasive treatments such as medications and LLLT may be slow to show effect, patients may not be ready to undergo costly hair transplants that may not always be successful. Hair biology is complex and hair loss is a complicated multifactorial condition. In Dr Wan’s opinion a multimodal approach should be instituted to tackle the hair loss process from all angles, thus he usually uses combination treatment for a synergistic effect. For example:

In alopecia areata, he may utilize a course of intralesional steroid injections combined with fractional laser and LLLT.
In mild to moderate androgenic alopecia, oral treatment with fractional laser, Regenera Activa and LLLT

Dr Wan Chee Kwang

FOUNDER / MEDICAL DIRECTOR

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