Eyebrow Loss

EYEBROWS:

I have had a spate of requests and consultations for eyebrow replacement lately so I thought I’d send out a little blog about it. Eyebrow hair loss is something most people think of in the context of a fraternity prank. However it is more problematic and common than that. To begin with, it affects both men and women and many cases are related to an underlying medical problem. For instance, loss of the outer 1/3rd of the eyebrow may be a symptom of low thyroid (hypothyroidism) – a serious medical condition. Eating disorders and rapid weight gain and weight loss are also associated with brow (and scalp) hair loss. There is a psychiatric condition that may affect the brows called Trichotillomania which is a compulsion to pull out one’s hair. It is predominantly a disorder of women (~93% female) and eyelashes and eyebrows are very often affected, I suspect since they are within easy reach! These are just a few of the possibilities for eyebrow loss and if you have eyebrow loss, you should schedule an appointment with your physician or hair doc like myself to get fully evaluated just because there are so many possible diagnoses.

Additionally, eyebrow hair loss is emotionally wrenching no matter who you are or how you got it. Not only is it immediately apparent to whoever meets you, it changes how you view yourself. I have had many patients tell me that their own reflection appears foreign, which explains why so many turn to permanent make-up (a form of tattooing) or “drawing/penciling-in” as a solution to the cosmetic part of the problem. For those who have been a victim of a drive-by shaving, especially of a single brow, it is an even more frustrating event since that hair has about a 1:3 chance (some even say 1:2) of NOT growing back! That sort of cosmetic imbalance can be devastating and affect all parts of a person’s life (imagine going to a job interview or your wedding day like that!) so please do not prank anyone in this way.

There is hope, though. If the eyebrow loss is caused by a medical diagnosis, treating the underlying problem should correct the loss even though it may take some time. I give it up to a year to work with my patients. There are patient reports that a small amount of minoxidil/Rogaine (http://www.rogaine.com) or Jan Marini’s Age Intervention Eyelash (http://www.janmarini.com/prod_ageintervention.php) applied only to that area (like with a cotton tipped applicator) will improve eyebrow growth - although note that neither product is explicitly approved for that purpose.

Treatments for loss due to scars (like from a car accident or burn) or plucking (as long as the plucking is no longer occurring) involves hair transplant to the brows. Although it can never replicate nature exactly, hair restoration surgery does replace the hair and look natural. I imagine some of the starlets from the 30s and 40s wished this option was available when they needed it for their pencil-thin brows. Once the hair is transplanted, it is permanent so extreme care must be taken since the patient will have to live with the good and the bad results. Again, because this is such a delicate and visible area, evaluation by a hair surgeon and/or medical doctor like myself is absolutely necessary before a treatment/surgical plan can be developed or initiated – this is not a problem to fool around with on one’s own!

Hope that helps!

Cheers!
Sara Wasserbauer, MD
drwasserbauer@californiahairsurgeon.com
www.californiahairsurgeon.com
1-877-8 HAIR MD

The Eyebrow Gamble

PATIENT QUESTION:
Sent on September 14, 2006 at 2:20 PM

i fell asleep at a frreinds and woke up with 1 of my eyebrows shaved off.how long will it take to grow back fully

ANSWER:
I have good and bad news for you; your eyebrow hair should grow back within a year but you have a 1/3 chance of not having it grow back at all. This is why surgeons who do facial plastics no longer shave the brows before surgery - they ended up with too many unhappy patients who never had their brows grow back! Incidentally, I know of no other hair on the body that has this tendency, either (although if you pluck/pull hair enough it may slow or stop growing anywhere).

This is all academic for you, though, since you are the one who has to suffer with the single eyebrow and the "unibrow" jokes. So practically speaking, if after a year the hair does not grow back or grows back insufficiently, you may consider a surgical brow restoration procedure which can give very nice results. Keeping one's natural brows intact is always the best solution cosmetically, though so I hope they grow back for you. Let me know if they do not and I'll have you come in for a consultation. Good luck!

Best,
Sara Wasserbauer, MD
drwasserbauer@californiahairsurgeon.com
www.californiahairsurgeon.com
Walnut Creek, CA
1-877-8 HAIR MD

Are balding hairs genetically programmed for "suicide?"

PATIENT QUESTION:
On Sep 6, 2006, at 5:33 PM, [edited out] wrote:

Greetings,

I looked over the description of male pattern baldness on your website and it implicates genetic factors as the cause. So I'm wondering if there's something different genetically about the hair follicles that stop producing hair, or is there loss of blood circulation or some other factor (also possibly genetically caused) that would cause hair to fall out in the MPB areas of the scalp?

Are the transplanted follicles then subject to the same genetic factors that caused the original follicles to quit? Or were the MPB follicles "suicide" follicles based on their genetics?

What percentage of your patients have to take medications to keep the transplanted follicles alive?

ANSWER:

In short order, the answers to your questions are; "Yes," "No," "That is one way to put it," and "Zero."

For reasons medical science doesn't know, the hair follicles at the back of your head are genetically immune to the effects of DHT (the hormone that is implicated in the vast majority of male pattern hair loss cases). The hair follicles at the top and front of your head are susceptible to DHT and that is why they are lost over time. No matter where you put those hairs from the back of your head, they will be immune to the effects of DHT and will therefore grow permanently. This is what makes hair transplant surgery even possible - it takes genetic susceptibility (what you termed "suicide follicles") plus the hormone DHT to equal hair loss.

As for medications, Propecia and Rogaine have scientifically proven effectiveness to stop or slow hair loss even though they work in different ways. Neither of them is necessary to keep transplanted follicles alive, though. I will often recommend that my hair restoration patients begin one or both of these medications to preserve what they have and therefore maintain the best cosmetic result, but neither is necessary for the continued and permanent growth of the transplanted hair.

I hope that helps! Let me know when you have any further questions.

Cheers!
Sara Wasserbauer, MD
drwasserbauer@californiahairsurgeon.com
www.californiahairsurgeon.com
Walnut Creek, CA
1-877-8 HAIR MD

Alopecia Areata

PATIENT QUESTION:
What is Alopecia Areata exactly? [from a patient consultation 8/5/6]

ANSWER:
Alopecia Areata is thought to be an “autoimmune disease” where the body’s own immune system forms antibodies to normal tissue and attacks itself (in this case, the hair follicles in a small area on the scalp). This diagnosis does not mean one will lose one's hair in the future. In fact, it is difficult to tell whether those hairs may grow back or not, whether other new areas of hair loss will show up or not, or even what causes individual spots to appear. I find that most patients report a history of acute stress which precipitated the condition.

Since medical science is not certain what causes this condition (www.naaf.org is an excellent source of additional information), different treatments are available but no single definitive treatment exists. Among the treatments one could try would be:
steroid injections,
topical minoxidil,
topical steroids,
PUVA,
other medications, and
surgical hair replacement.

Note that I placed surgical hair replacement last on this list. Patients are only considered candidates for surgical hair replacement after two to three years with a STABLE area of alopecia areata - otherwise the same autoimmune process will destroy the grafts! If it is a small area, I often recommend topical minoxidil therapy (5%) as a low-cost initial treatment since it is available at your local pharmacy over the counter, followed by steroids but you should definitely be seen by a hair specialist and use photos to document your progress. It is important to be patient, since hair has its own schedule and will take time to grow even if the therapy is working - up to a year. When talking with patients, I also discuss Toppik as a useful camouflaging agent, and B Vitamin and Iron as useful supplements for general hair health.

Hope that helps!

Best,
Sara Wasserbauer, MD
drwasserbauer@californiahairsurgeon.com
www.californiahairsurgeon.com
Walnut Creek, CA
1-877-8 HAIR MD

Cheap Hair Transplants

PATIENT QUESTION:
On Sep 15, 2006, at 1:34 AM, [edited out] wrote:

How much is it for 2000 grafts? Can you price match
$2.5.graft? Is there any misc fees?


ANSWER:
Thanks for taking the time to write. Your question is a good one and actually gave me a little laugh this morning. The answer is that I used to charge $2.50/graft, but that was when I was in training and had no experience! I also see a lot of patients who paid a low fee ($4 or less per graft) for their initial surgery since I do a lot of corrective work. It is for that reason I have to give you the old "caveat emptor" ("buyer beware") because in this business you definitely get what you pay for. Let me give you an example:

One of my former patients had a transplant on the East coast for $1/graft. He ended up coming to me with a 7mm wide scar since to make enough money to cover the overhead and make a profit the surgeon took more tissue than he should have and could not close the wound. With the additional medical bills it ended up costing the patient more and he got a poorer result than if he had come to a reputable, experienced surgeon in the first place. He also had a knee replacement and told me when he left after his last visit that he has since learned never to stint on a "cheap pair of shoes or cheap medical care" again because it ends up costing more in the long run.

If you cannot afford a good surgeon, you might consider waiting until you can since hair transplant cannot be undone. You are intent on getting a good deal, and I applaud that. I would emphasize researching the doctor involved, their training, their staff, their area of expertise (brows, scars, etc.), and to meet patients who have also had surgery from them at that price to see what you get.

Good luck and I'd be happy to meet with you and show you examples of surgery if you have any further questions.


Best,
Sara Wasserbauer, MD
drwasserbauer@californiahairsurgeon.com
www.californiahairsurgeon.com
Walnut Creek, CA
1-877-8 HAIR MD

Hair Replacement Treatments

Welcome Stranger!

My name is Sara Wasserbauer and (in the interests of a full disclaimer) I am a doctor who, among other things, counsels and treats patients with hair loss. I get asked questions all the time about the different and new tonics, shampoos, salves, pills, vitamins, and every other treatment for alopecia (hair loss) you can think of. I just want to clear up a few misconceptions about hair loss and what does or does not work to replace or regrow hair.

There are only three treatments that work: Finasteride (Propecia), Minoxidil (Rogaine), and Hair Transplant Surgery. Propecia is a pill that you take daily which stops the hormone that causes most forms of hair loss and prostate cancer. Minoxidil is a topical solution which causes hair to grow stronger and increases blood flow to the hair follicle. Hair transplant surgery moves hair from the permanent area at the back of your head (think Jean-Luc Picard of StarTrek fame) to the areas where you have lost it (crown, hairline, etc.)

Propecia and Rogaine are temporary - effects stop when you stop using the medication but long term side effects are rare. Hair transplant is permanent but needs to be done perfectly to look natural. Any of those late night hair loss remedies probably owe their efficacy to minoxidil. Since is came off-patent a few years ago, it can be used in unregulated formulations (up to a certain percentage) as their active ingredient in a proprietary (and EXPENSIVE) formulation made by a cosmeceutical company. You can save a lot of money by buying it over the counter at a drugstore (the generic brand at a large warehouse store is the easiest and cheapest) so that is what I usually recommend.

Save your money. Don't be duped by slick advertising. Until something scientifically proven comes along, these treatments are your best bet.

Cheers!
Sara Wasserbauer, MD
www.californiahairsurgeon.com