SCARRING (CICATRICIAL) ALOPECIA

Scarring Alopecia

Trichotillomania is a condition where a person experiences an urge to pull out his or her own hair from the scalp, eyebrows, eyelashes, or body, oftentimes creating unusual patterns of hair loss. If the hair plucking continues long term, permanent damage to the hair follicles occurs, leading to permanent hair loss (scarring alopecia). Plano, TX hair restoration surgeon, Dr. Joseph Yaker, can treat hair loss that results from this disorder, but the patient must be fully cured first from the psychological disorder. If caught early enough, hair will likely grow back. If hair does not regrow, hair transplantation would be the treatment of choice.

CAUSES OF TRICHOTILLMANIA

The causes of trichotillomania can be quite complicated. It is often seen more in women and mainly occurs around puberty and even menopausal age. In many cases, the urge to pull out hair is unintentional and patients don’t realize that they are doing it. Others may have underlying stress, anxiety or depression and pluck their hair out as a coping mechanism. As a result, they find that pulling out hair feels gratifying. Many people with this disorder are so embarrassed by their actions that they deny having this compulsive habit, so they don’t seek help. The diagnosis is made following a thorough medical history and scalp and hair examination. Prolonged trichotillomania will leave hair in short, uneven broken hairs in the area of hair loss. The bald patches tend to be worse on the side of the person’s dominant hand.

TREATMENT

Once diagnosed, cognitive behavior therapy (CBT) and certain medications may help treat trichotillomania. CBT includes techniques that can help a person recognize and change their thoughts, feelings, or behaviors. There are also numerous support groups available. Unfortunately, it is impossible to predict how long someone may suffer from this disease or if and when it will return. Without treatment, trichotillomania tends to be a persistent condition that may wax and wane in severity throughout a lifetime. Psychological treatment must be completed first so that once the hair is restored, the patient does not repeat the behavior of pulling it out again.

Nonsurgical Treatment

For patients who have been cured of trichotillomania for at least one year and their hair follicles are still alive, Dr. Yaker offers numerous nonsurgical options to help the hair regrow. Minoxidil (brand name: Rogaine®), platelet rich plasma (PRP) with placenta-derived extracellular matrix therapy and low level laser therapy may be used to help strengthen and restore hair. Dr. Yaker’s HairScan Plan will help track the progress of hair growth every 90 days after starting any form of nonsurgical therapy.

Surgical Treatment

Once a patient has undergone full treatment for trichotillomania, and it has been confirmed that there has been no relapses for a period of at least one year, Dr. Yaker will discuss hair transplant surgery has an option to restore the lost hair. Hair transplant surgery will involve either Follicular Unit Transplantation (FUT), known as the “strip method”, or Follicular Unit Extraction (FUE). Both of these surgeries take hair from the back of the scalp and transplant it into the balding areas. The only difference is in the way the hair is removed from the back of the scalp. Dr. Yaker will have a thorough consultation with the patient to ensure the pulling habits no longer exist so that a successful outcome can be had and maintained after surgery.

Patients who wish to have their hair restored with transplantation surgery must meet the following criteria:

  • They must complete a psychological evaluation and seek therapy to break the pulling habit and compulsion to pull their hair.
  • The patient has not pulled their hair, nor had the urge to pull hair for at least a full year.
  • There are no scalp irritations or ongoing symptoms such as tingling or itching.
  • The hair loss has not progressed.
  • There is enough donor hair to use for hair transplantation.

TRACTION ALOPECIA (LATE STAGE)

Traction alopecia is a type of hair loss caused by self-inflicted pressure and pulling on the hair follicles. Traction alopecia usually starts at the hairline and temples and can progress if the stress on the hair follicles continues. Hair loss from traction alopecia can be stopped and reversed if the cause is found and stopped early. If the hair loss continues, it may become permanent and could require hair transplantation if the patient desires new hair. Plano, TX hair restoration surgeon, Dr. Joseph Yaker, will assess the amount of damage and recommend a course of treatment to restore the lost hair.

CAUSES OF TRACTION ALOPECIA

Traction alopecia is caused by continuous, long-term tension and pulling on hair follicles. It is commonly associated with certain hairstyles (braids, weaves, extensions, cornrows, ponytails) but can also be associated with harsh chemicals (dyes, bleaches, straighteners) and straightening irons. Hair damage can be so severe that the hair root is pulled out completely or destroyed to the point where the hair falls out.

TREATMENT

If the cause of the stress on the hair is stopped soon after hair loss begins, the hair should recover and re-grow on its own. If the stress continues, the hair loss will continue and may become permanent. Some people will simply need to loosen their hairstyles or limit the amount of time they wear a tight hairstyle. Others will need to avoid any causes of traction alopecia completely.

Nonsurgical Treatment

If hair loss from traction alopecia is minimal and caught early, non-surgical treatments such as Minoxidil (brand name: Rogaine®), platelet rich plasma (PRP) with placenta-derived extracellular matrix therapy and low-level laser therapy may be used to help strengthen and regrow hair. If the loss is permanent, this will lead to scarring alopecia, and hair transplantation would be the only treatment option. Dr. Yaker’s HairScan Plan will help track the progress of hair growth every 90 days after starting any form of nonsurgical therapy.

Surgical Treatment

If there is permanent hair loss from traction alopecia, Dr. Yaker can perform Follicular Unit Extraction (FUE) or Follicle Unit Transplantation (FUT), which extracts healthy hair follicles from the back of the scalp and then transplants these follicles to the areas affected by hair loss. Both FUE and FUT use advanced technology and surgical artistry to create fuller hair with a natural look. FUE and FUT provide similar results, the difference is in the way the hair is removed from the back of the scalp.