Facts, Figures and Definitions About Hair Loss
A.G.A – AndroGenetic Alopecia, also known simply as “pattern balding”, is the most common cause of hair loss in both men and women. DHT (Dihydrotestosterone) kills hair follicle and stops hair growth in particular areas. Some 70% of men and 40% of women are affected by A.G.A. to some degree and at some point.
Aggravated Female AndroGenetic Alopecia – In women, AndroGenetic Alopecia is associated with medical conditions such as Polycystic Ovary Syndrome (PCOS), which involves a hormonal imbalance. This imbalance may cause irregular menstruation, acne outbreaks, weight gain, excess body hair (hirsutism) as well as thinning of hair loss.
Aggravated Male AndroGenetic Alopecia – Male AndroGenetic Alopecia is indeed genetic but it is also associated with numerous contributing medical conditions such as coronary heart disease, prostate enlargement, insulin production disorders and hypertension (high blood pressure).
Alopecia – The scientific term for hair loss, or baldness. It may refer to either hair loss from head or body.
Alopecia Areata – Patchy baldness that typically begins with rapid hair loss on discrete areas of the scalp and sometimes progresses to complete baldness and even loss of body hair. The characteristic diagnostic finding is short, broken hairs called ‘exclamation point’ hairs. Alopecia areata affects both males and females and, most often, children and young adults. It seems to be caused by an autoimmune mechanism, wherein the body’s own immune system attacks the hair follicles and disrupts normal hair formation. Alopecia areata is sometimes associated with allergic disorders, thyroid disease, vitiligo, lupus, rheumatoid arthritis, ulcerative colitis, and other conditions, and some forms may be inherited. Hair can sometimes regrow within a year without treatment. The longer the period of time of hair loss, the less chance that the hair will regrow.
Anagen Effluvium – The word effluvium means an outflow. Anagen effluvium is a condition in which people have their hair falling out during the anagen or growing phase of the hair growth cycle. The hair loss pattern is just like that of telogen effluvium in that the hair loss tends to be in a diffuse manner. At any given point, people should have 80-90% of their hair in the anagen phase, so if someone is suffering from anagen effluvium, they will suffer from a rapid type of hair loss since so many hairs will be affected. Anagen effluvium is usually caused by chemotherapy or radiation therapy.
Central Cicatricial Centrifugal Alopecia (CCCA) – a form of scarring alopecia on the scalp that results in permanent hair loss. It is the most common form of scarring hair loss seen in black women. However, it may be seen in men and among persons of all races and hair color (though rarely). Middle-aged women are most commonly affected.
Crown Area – The area in the top/back portion of the head which contains a swirl or spiral pattern of hair growth. Also called the ‘vertex,’ it may be the first area where male pattern baldness is noticed.
Crown balding – Hair loss on the crown starts around the whorl (at the back of the head), and spreads outward to produce a circular baldness.
DHT – Dihydrotestosterone (the male hormone also found, in trace levels, in women) interacts with the 5-alpha reductase enzyme found in the hair follicle’s oil glands and is converted to DHT. The DHT then causes hair follicles to shrink and then renders them incapable of growing healthy hair.
Donor Dominance – The concept that hair follicles transplanted from the donor area will continue to grow in the recipient area.
Donor Site (Area) – The area of the scalp (generally the back and sides) where hair-bearing skin is removed during a strip surgical hair restoration procedure. For hair transplants to be effective, the hair in this area must be permanent, i.e. not subject to the effects of DHT. The NeoGraft Automated Hair Transplantation system restores the hairline using the Follicular Unit Extraction (FUE) method to gently remove the individual follicles from the back of the head (the “donor area”) in their naturally occurring groupings of about 1-4 hairs. With NeoGraft (FUE) the donor site does not include excision of a strip of scalp.
Enzyme – A protein molecule in the body which acts as a catalyst in a specific reaction. In this case, the enzyme 5-alpha reductase acts as a catalyst on testosterone to produce the derivative dihydrotestosterone (DHT). This is an important factor in male pattern baldness.
F.A.G.A. – Female AndroGenetic Alopecia. With women this type of balding usually causes thinning of the hair over the entire head rather than in a defined pattern common to hair loss in men.
Female Pattern Alopecia – the most common type of hair loss for women. In women, androgenetic alopecia begins with gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head.
Female Pattern Baldness – A hereditary pattern of baldness found in women typically characterized by a diffuse thinning of hair and/or hair loss at the front portion of the scalp behind the frontal hairline. Also called “Female Hereditary Hair Thinning.”
Finasteride (Propecia, Proscar) – Finasteride is a type of steroid reductase inhibitor. It works by reducing the amount of the hormone dihydrotestosterone (DHT) in the body.
Follicular Unit Graft – A graft consisting of a single follicular unit. In appropriate patients, artistic planning – in addition to the correct angulation, orientation, and positioning of follicular unit grafts – can yield an exceptionally “natural” appearance of the transplanted hair.
Follicular Unit Micrografting – A method by which large numbers of follicular units are harvested from the donor site (usually in a long strip or ellipse) and then microscopically dissected into grafts containing single follicular units.
Follicular Unit or FU – is a term that describes how scalp hair normally grows. Scalp hair is not evenly distributed across the scalp like corn in a cornfield. It grows in clusters of follicles, little islands of one to four follicles. Each FU has a distinct anatomic and physiologic identity, and a micro-environment of cells, nerves and blood vessels.
FUE – (Follicular Unit Extraction), removes one follicle or follicular unit at a time, targeting the FUs that appear most likely to thrive and produce hair in a transplant recipient site.
Grafting – A variety of procedures where hair-bearing skin is removed from the lower scalp at the back of the head-the “donor area”-and transferred to thinning or balding areas. The most popular varieties are micrografting (1-2 hairs) and mini-grafting (3-8 hairs). With Neografting, the hair follicles are artistically implanted in the areas of the scalp where balding has occurred to complement the facial structure and current hairline, resulting in a discrete, natural-looking hair transplant.
Hair Economics – A theory that states only a limited or decreasing supply of hair exists, but the demand for hair increases as balding patterns develop.
Hair Flaps – Techniques to rotate large portions of hair from the sides and back of the scalp to the front and central areas of the head. Most effective when used with a tissue expander. See also “Scalp Rotation Flaps.”
Hair Follicle – A strand of hair and its root which is extracted from the donor area and transplanted to the recipient area during hair restoration surgery.
Hair Grafts – Hair follicles that have been harvested from the donor area and are ready for transplantation into the recipient area of the scalp. The numbers of hair follicles per graft vary widely depending upon the transplantation technique used. A graft may contain a single hair follicle, a single follicular unit or multiple follicular units.
Hair Plugs – A slang term typically used to describe the large round grafts that were used more commonly years ago.
Hair Shaft – The dead portion of the hair that protrudes from the surface of the skin. It is made predominantly of the protein keratin.
Hair Transplant – A surgical technique that transfers hair follicles from the donor area to the recipient area.
Hairline Refinement – Hairline Refinement or “Hairline Correction” refers to the use of a variety of newer, more delicate grafting techniques to alter, camouflage or soften the “pluggy” looking results of older hair transplant techniques.
Harvesting (in reference to hair restoration) – harvesting is the most common technique for removing hair and follicles from a donor site. A surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. Harvesting with follicular unit extraction (NeoGraft) using miniaturized rotary device. 0.9 to 1.0mm in diameter to obtain follicular unit grafts.
Hypertrichosis – Excessive growth of hair all over the body.
Infundibulum – the superior, or highest portion, of the hair follicle.
Keratin – A tough, fibrous, insoluble protein forming hair and fingernails.
Ludwig Classification – The Ludwig Classification separates female pattern baldness (androgenetic alopecia) into 1 of 3 unique stages, referred to as the Ludwig Scale. By classifying hair loss according to severity, the Ludwig Scale helps both patients and physicians to better understand three major factors in the diagnosis and treatment of female hair loss:
M.A.G.A. – Male AndroGenetic Alopecia, also known as “male pattern balding”. Testosterone turns into DHT (Dihydrotestosterone) and damages hair follicles causing hair loss in a well defined pattern, usually beginning above the temples, along with thinning of the crown and progressing into partial or complete balding.
Male Pattern Baldness – An inherited condition in men which is triggered by the hormone Dihydrotestosterone which causes gradual miniaturization (and eventual loss) of hair follicles. Starting anytime after puberty with a recession of the hairline and thinning of the crown areas, it can eventually lead to complete baldness at the top of the scalp. The areas around the sides and back of the scalp are not typically affected by male pattern baldness.
Melanin – Pigmenting granules within the keratin fibers of the hair shaft that determine hair color. They usually decrease with age, resulting in gray or white hair.
Micrograft – A graft containing 1 or 2 hairs, obtained from the donor area with a micropunch or sliced off from a round graft (see below). A micrograft is typically placed into holes made in the scalp with a microneedle or punch.
Minigraft – A graft containing 3 or 4 hairs (small minigraft) or 5 or 6 hairs (large minigraft). There are many variations of minigrafts derived from round grafts.
Minoxidil – A prescription medication taken orally for the treatment of high blood pressure and used topically to retard hair loss and/ or encourage hair growth. Generic name for Rogaine.
Multi-Unit Grafting – Hair transplantation using multi-unit grafts. In practice, these grafts may be placed into small round holes, slots, or slits. This would always be in combination with the use of FUT in the same procedure.
Multi-Unit Grafts – Grafts that contain two or more follicular units in a single graft. This term replaces the older “minigraft”. In practice today, MUGs contain 2-6 follicular units per graft.
Norwood Scale – a scale for the classification of hair loss
Nutrition – An adequate supply of nourishing vitamins and minerals is fundamental to healthy hair growth
Oily Scalp – The sebaceous glands in our skin secrete sebum designed to waterproof and protect the skin. When the sebum glands in our scalp are overactive our skin pores may become clogged and hair growth impeded.
Papilla – The small root area at the base of hair, which receives the nutrients from the follicle needed for hair growth.
Placebo – a pill, topical, or injection made to appear exactly like a test medication, but without any of its active ingredients.
Polysorbate 80 – an emulsifying agent that has been marketed extensively by “private” companies as a hair growth promoting agent.
Postauricular Flap – Surgical procedure during which a strip of hair-bearing scalp is taken from the area behind the ear and is rotated 90 degrees to the front, forming a hairline.
Posterior Scalp – Back of the head.
Preauricular Flap – Surgical procedure during which a strip of hair-bearing scalp is taken from the temple area and is rotated about 90 degrees to the front, forming a hairline.
Progesterone – Female sex hormone that induces secretory changes in the lining of the uterus essential for successful implantation of a fertilized egg. Synthetic compounds with progesterone like activity have been developed that, along with estrogen , are used in oral contraceptives.
Propecia – The brand name for 1mg dose of finasteride , approved for the prevention and treatment of male pattern baldness.
Proscar – finasteride as an FDA approved treatment for BPH .
Prosthetic – An artificial replacement
Punch Graft – A group of ten to twenty hairs in a circular graft.
Recipient Area – Area where hair loss has occurred and hair follicles will be implanted during a hair transplant procedure.
Rogaine – The brand name for minoxidil topical hair growth solution, available over the counter in 2% solution and 5% extra strength solution.
Round Graft – The first type of graft used in hair transplantation, a round graft has many variations. A large round graft may contain many hairs (20 or more). The round graft is obtained from the donor site by surgical removal and may be used “as is” or may be sliced into smaller sections for micro-, mini- or slit grafts.
Saw Palmetto – A natural herb that has been shown to be an effective antiandrogen
Scalp Reduction – A procedure that removes bald scalp and brings the edges of hair-bearing scalp closer together. Scalp reduction is most often used in patients with crown baldness. See also “Alopecia Reduction.”
Scalp Reduction – Surgical procedure in which an ellipse of bald scalp is removed from a small midline bald spot and the hair-bearing scalp between the ears is pulled together and sutured closed. This reduces the bald area.
Scalp Rotation Flaps – A type of procedure that involves the lifting and rotation of a strip of hairy scalp which is placed into an area of simultaneously removed balding skin.
Scarring Alopecia – Patchy hair loss with obvious sign of scalp inflammation.
Scleroderma – A disease of the skin and connective tissue that can cause hair loss over the affected areas.
Sebaceous Glands – Fatty glands found in hair follicles throughout the body that secrete an oil into the hair and surrounding skin.
Seborrheic Dermatitis – A condition marked by small discolored patches or spots on the skin and frequently occurs on the face and scalp.
Sebum – An oily secretion manufactured by tiny sebaceous glands near the follicles that keeps your hair lubricated and shiny.
Senescent Alopecia – the type of hair loss that naturally occurs with age. During the process of aging, both the duration of hair growth and the diameter of the hair follicle decrease.
Shock Fallout – The condition that occurs when hair transplantation is performed on men and women with a significant amount of naturally occurring hair left on their head. Trauma due to the procedure itself induces a telogen phase for much of the hair around the implanted grafts. Hair lost due to shock fallout returns in many cases.
Slit Graft – Hair obtained from a donor site directly or sectioned from a larger round graft is inserted into a slit made in the scalp by the tip of a scalpel blade.
Spironolactone – A diuretic drug that acts as an antiandrogen. Used in the treatment of androgen related disorders such as female pattern baldness. Brand name is Aldactone.
Stretch Back – A condition that occurs after a scalp reduction procedure due to the elastic characteristic of the skin. The bald area that could not be eliminated totally during a scalp reduction, increases in width three months after the procedure, thus reducing the procedure’s effectiveness.
Suture Implants – A method of attaching a hairpiece that involves sewing stitches in the scalp and securing the hairpiece to them.
Suture – Joining of the edges of a wound similar to a stitch.
Systemic Side Effects – undesirable effects produced throughout the body. For example, some antiandrogens will cause decreased sex drive and breast enlargement in men.
Telogen effluvium – is generally considered to be the second most common type of hair loss. The telogen phase, or resting phase, lasts for about three months. Most people will have 10-15% of their hairs in this phase at any given time. The majority of people will lose around 100 hairs a day as a part of the telogen phase, but if someone is suffering from telogen effluvium, they will usually be experiencing hair loss on their entire scalp.
Telogen Effluvium – the second most common form of hair loss, and it’s characterized as different phases of the hair growth cycle. The telogen phase is when the scalp does not produce hair; it’s also known as the resting phase. Typically, 80 percent to 90 percent of the hair follicles are growing at one time, but with telogen effluvium, the number of hair follicles producing hair drops significantly during the resting phase, resulting in shedding or hair loss.
Temples/Temporals – The two upper outer corners where the forehead meets the hairline. This is usually the first area where male pattern baldness is observed, causing the hairline to recede.
Temporal Point – The two triangular shaped areas of hair located in the lower outer corners of the forehead, where the temporal hairline meets the sideburns.
The best course of treatment.
The degree to which hair has already been lost.
The potential for additional hair loss in the future.
Tissue Expander – A reconstructive balloon-like device which can be used to enlarge hair-bearing scalp on the sides of the head, providing a larger supply of hair with which to replace the bald areas. Often used in hair flap techniques and scalp reductions.
Tissue Extender – A device used to stretch scalp. Often used to speed up the process of scalp reductions by stretching the sides of the scalp that contain hair to achieve rapid elimination of bald areas. The tissue extender is temporarily inserted below the scalp and remains in place for a three-week period.
Traction Alopecia – a type of hair loss that happens over time. It’s caused by putting the hair under constant strain or tension.
Trichotillomania – A compulsive disorder in which someone experiences strong urges to tug or pull out their own hair. This weakens the hair follicles and results in hair loss.
Type 1: In this stage, hair loss is considered to be mild.
Type 2: In this stage, hair loss is considered to be moderate.
Type 3: In this stage, hair loss is considered to be most extreme.
Vertex Area – The area in the top/back portion of the head which contains a swirl or spiral pattern of hair growth. Also called the ‘crown,’ it may be the first area where male pattern baldness is noticed.
Vertex – Another name for the crown: the top part of the scalp near the back of the head.