Dermatology Center of Northwest Houston Dermatology Center of Northwest Houston - Lisa D Hitchins MD : (281) 256-2000
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Modernizing MedicineEMA dermatology

Patient Info

Hair Loss

Hair loss or alopecia is a common phenomenon of the hair growth cycle. Most hair on the scalp, about 90%, is in a growing phase while about 10% of hair is in its resting phase. Resting hairs fall out after a period of 3-4 months and new hairs grow in. It is normal to lose some hair as a part of normal hair growth, but when the hair loss is severe it is considered a disorder.


Hair loss can happen in the following patterns:

  • Traction Alopecia - This occurs when you tie ponytails very tight causing stress on the hair follicles and eventually hair loss
  • Cicatricial Alopecia - Also referred to as scarring alopecia, this is seen in conditions such as lichen planus and discoid lupus erythematosus. The inflammation destroys the hair follicles
  • Androgenic Alopecia - This type of hair loss is a characteristic male-pattern or female-pattern baldness. In this condition, the growth phase of the normal hair is short and they fall off easily
  • Trichotillomania - It is a mental condition in which the person develops an urge to pull out his own hair causing patchy areas of baldness
  • Telogen Effluvium - This may be caused as a result of shock, either emotional or physical


Common causes for hair loss are:

  • Chronic illness or major surgery: You may lose large amounts of hair due to stress caused by illness or surgery
  • Hormonal imbalances: Imbalance in male and female hormone levels and thyroid gland secretions can cause hair loss
  • Medicines such as anticoagulants, birth control pills and antidepressants can cause hair loss as an adverse effect
  • Fungal infections of the scalp
  • Poor nutrition
  • Underlying Disease: Hair loss appears as an early symptom of some underlying diseases


Your doctor may prescribe medicines that help slow the loss of hair or prevent baldness. They include:

  • Corticosteroids -anti-inflammatory drugs which are used to treat hair loss are available in the form of injections, oral preparations or skin creams
    • Local Injections - The medicine is directly injected into the hairless patches on the scalp. New hair grows in the region in about 4 weeks
    • Oral Corticosteroids - Oral medicines are prescribed for short periods if the hair loss is due to autoimmune disorders
    • Topical Ointments - Steroid ointments or creams are applied directly to the affected area
  • Minoxidil (5%) - Promotes hair growth. Minoxidil is a FDA-approved drug for treating male and female pattern hair loss. The solution is applied twice daily to the scalp. It can also be used in the eyebrow and beard areas. New hair grows in about 12 weeks
  • Anthralin - This is a tar-like substance often recommended for use in combination with other treatments
  • Topical sensitizers are medicines which produce an allergic reaction when applied to the scalp causing itching, scaling, and eventually hair growth. These include squaric acid dibutyl ester (SADBE) and diphenylcyclopropenone (DPCP)
  • Photochemotherapy - A light-sensitive drug called psoralen is given either orally or topically and then exposed to an ultraviolet light source
  • Alternative Therapies-These include acupuncture, aroma therapy, zinc and vitamin supplements
  • Hair Loss Surgery
    • Hair Transplant is a procedure in which plugs of hair are taken from areas of the scalp where hair is thick and placed where there is hair loss
    • Follicular transplants: In this procedure single hair follicle is removed and placed where there is no hair follicles
    • Scalp rotation: In this procedure, an area of your scalp with good hair is taken and placed in the area of poor hair growth
  • Hair loss can be prevented by maintaining good hair hygiene and eating foods rich in iron and vitamin B

Hair Transplantation

Hair loss is a normal process of aging but severe hair loss at a younger age is a cause for concern. Hair loss is common among both men and women. Excessive hair loss can lead to a thinning hair line and areas of baldness. Hair loss treatments are recommended based on several factors, including the type of hair loss, degree of hair loss and your personal preferences. Although hair loss is not a serious medical condition, it is the cause of emotional disturbances for many.

Hair Transplantation

Hair transplantation technique is a solution for male and female pattern baldness when other treatments are a failure. It is a surgical procedure where individual hair follicles from densely grown areas are transferred to bald areas.

This technique is primarily used to treat male pattern hair loss and less often female pattern hair loss. It is also used to restore eyebrows and eyelashes, and to fill the scars caused by accidents or surgery such as face-lifts. Norman Orentreich MD, a dermatologist, introduced the technique of hair transplantation in the United States over 40 years ago and it is accepted by the medical and surgical community.


In Hair Transplantation procedure hair follicles are harvested from the donor site and transplanted into the recipient site. The recipient and the donor areas will be numbed with local anaesthesia. The surgery may last for approximately 4 hours and the scalp is treated with certain antibacterial chemicals and shampooed to prevent infection.

Donor hair can be harvested in 3different ways:

Punch Harvesting - This was the most commonly used method from the late 1980’s to early 1990’s. In this technique a small hand held machine with a 2 to 6 mm spinning punch was used that presses into the donor scalp parallel to the hair to minimize transaction of any hair follicles. The punched grafts may be lifted gently, using forceps or a sterile needle and cut free using scissors. Donor sites were closed by suturing or skin staples or left to heal by secondary intention. Grafts obtained by punch harvesting may be transplanted directly or cut into smaller grafts.

Excision - The donor site is excised (cut out) as an elongated strip using a scalpel blade. Donor sites are closed using sutures or skin staples. The donor tissue is dissected into grafts ready for transplantation. Scars formed in this method were minimal.

Strip Harvesting - The donor site is excised as a strip using a scalpel containing 2 or more scalpel blades mounted parallel to one another. The special scalpel facilitates the dissection of the donor scalp into minigrafts and micrografts.

After harvesting the follicles, recipient site is to be prepared. Several techniques are used to prepare and create the recipient sites.

Single Hair and Slit Grafting - Using a scalpel blade or needle, slits are made in the scalp in which grafts are placed. This method is most often used to recreate the frontal hairline.

Dilation (Modified Slit Grafting) - Sharp dilators are inserted directly into the scalp, pushing the scalp aside to allow insertion of mini-grafts or micro-grafts. Dilators may be used to provide hemostasis, clot formation to stop bleeding.

Punch Grafting - Using 1-4 mm diameter punches a defect is created at the recipient site where the graft is to be inserted.

Laser Assisted Grafting - In this method carbon dioxide laser will be used to create recipient sites.

Once the sites are created and prepared, small forceps or needles are used to grasp the graft and gently insert it into place.

While providing beautiful fuller head of hair, the surgery can have some complications and side effects.

Side effects

  • Mild pain and discomfort
  • Swelling
  • Formation of scabs over the grafts
  • Headaches due to tugging and manipulation of the scalp
  • Numbness or scalp tenderness
  • Temporary thinning of pre-existing hair
  • Itchy scalp


The possible complications include the following:

  • Bleeding, but this is easily controlled by pressure
  • Swelling around the forehead and the eye area
  • Scaring
  • Infections (occur rarely)
  • Recipient site can develop small cysts


  • The most common indication of hair transplantation is male- and female- pattern baldness. It is a progressive, diffuse and symmetric loss of hair
  • Male pattern alopecia
  • Cicatricial alopecia- Irreversible loss of hair on the scalp associated with scarring
  • Traumatic alopecia- It is hair loss caused by injury to the scalp
  • Traction alopecia-It is type of hair loss caused when excessive force is applied on hair during hair style or a mental condition (trichotillomania; patient is urged to pull out the hairs)
  • Patients with hair loss from lupus erythematosus
  • Reconstruction of eyebrows


  • Contraindicated in patients with unrealistic expectations
  • Patients taking blood thinners

Precautions before and after surgery

Before surgery

  • Preliminary blood tests should be undertaken 2 weeks prior to procedure
  • If allergic to any medications, inform your dermatologist
  • Pre-operative antibiotics are prescribed to prevent infection
  • On the day of surgery you will be instructed to wash hair with antibiotic shampoo
  • No medicine other than the antibiotics prescribed by the surgeon should be taken
  • The patient should stay off alcohol for certain period before surgery

After surgery

  • Operated area must not be shampooed for some days
  • Operated area must not be exposed to sunlight for some days
  • Hard combing of the area of transplant should be avoided
  • Prescribed medication should be taken
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