6 common questions about female hair loss

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Consultant hair transplant surgeon Dr Asim Shahmalak from Crown Clinic in Manchester is one of the UK's leading experts on hair loss.
His celebrity hair transplant clients include the Coronation Street star Jack P Shepherd, model Calum Best, TV doctor Christian Jessen, former footballer Didi Hamann, Homes Under The Hammer presenter Martin Roberts and Gogglebox star Chris Butland-Steed.
Dr Shahmalak also specialises in some more unusual procedures largely used by women including eyebrow and eyelash transplants. These tend to be for women who have permanently damaged their eyebrows by overplucking or have ripped out their eyelashes through an accident or the misuse of stick-on eyelashes. In 2009, Dr Shahmalak performed the first eyelash transplant ever performed in the UK.

1. What are the symptoms of thinning hair and how can you determine whether you’re suffering from hair thinning or hair loss?
In women, hair loss more often involves a general thinning across the entire scalp. Known as diffuse thinning, most women affected loss a lot of their hair volume, making their scalp more visible. In general, the hair remain intact, but in some rarer cases women with hair loss may experience a receding hairline. But more commonly, female hair loss starts in the central area of the scalp and then spreads outwards if it is left untreated.  
As with men, the most common cause of female hair loss is genetics. If you have female pattern baldness on the mother or father's side of the family, there is a greater risk of it happening to the next generation of women in the family. This hereditary hair loss is permanent as opposed to the temporary thinning of the hair which can be caused by other factors such as pregnancy, stress, poor diet, menopause and some medications.
Permanent hair loss tends to happen differently in women to men.
Whereas men typically tend to first start losing their hair in the crown area or in the hairline at the front of the scalp and then go on to develop bald patches, in women hair loss manifests itself through general thinning rather than more noticeable bald patches.
Hair loss tends to be subtler in women than it is in men. Hair may also fall out in large clumps during brushing and showering.
“This kind of thinning hair, while not as immediately noticeable as male pattern baldness, can still undermine a women's self-confidence and age her appearance appreciably. It is why so many women seek permanent remedies for permanent hair thinning/hair loss. Around 10% of my clients are women.

2. What are the specific causes thinning hair? (do genetics, lifestyle, stress, medicine play a role?)

Below are the most common causes of hair thinning particularly in women.

* Androgenetic Alopecia – hereditary pattern hair loss with a typical pattern of diffuse thinning over the central scalp. It is the most common type of hair loss. It occurs in about 20% of women.
* Alopecia Areata – a recurrent disease of unknown cause that results in patchy loss of hair from the scalp and/or eyebrows.
* Telogen Effluvium – a condition that causes shedding of hair over the entire scalp; it may be chronic but may also be acute following a stressful event such as high fever, sever dietary deficiency, and chronic blood loss from heavy menstruation.
* Loose Anagen Syndrome – a condition that causes hair to shed before its normal growth cycle is completed. Hair can be pulled out by normal combing or brushing.
* Traction Alopecia – tight braiding and corn-rowing can, over time, cause permanent damage to hair and scalp and result in hair loss.
Chemicals – some chemicals used in hair styling can, over time, cause permanent damage to hair and scalp and result in hair loss.
* Trichotillomania – (compulsive hair plucking) – a person feels compelled to pluck hair in regular or bizarre patterns, resulting over time in traction alopecia and permanent hair loss.
* Scarring Alopecia – hair loss due to scarring of the scalp area. Scarring alopecia typically involves the top of the scalp and occurs predominantly in women. The condition frequently occurs in Afro-Caribbean women and is believed to be associated with persistent tight braiding or “corn-rowing” of scalp hair. A form of scarring alopecia also may occur in post-menopausal women, associated with inflammation of hair follicles and subsequent scarring.
* Hypothyroidism – thyroid deficiency can be associated with thinning, patchy hair loss.
* Pregnancy – hormonal changes and stress of pregnancy may cause temporary hair loss
* Menopause – due to hormonal changes in a women's body from the age of 45 onwards
* Stress – this cause cause temporary hair loss
* Poor diet – another cause of temporary hair loss
* Medicine – cancer treatments such as chemotherapy cause cause the temporary loss of hair. 

3. How common is it in women?

Hair loss in women is surprisingly common. Around 40% of women will suffer from hair loss at some point in their lives – for instance during pregnancy or the menopause. But unlike with men, hair loss in women is often temporary and the hair will eventually grow back.
However, permanent hair loss is still a relatively common problem in women and is largely for hereditary reasons.

4. What’s the growth phase/cycle of hair (does it all grow and shed at the same time) and what happens to the growth phase of those experiencing loss of volume?

Approximately 90% of your hair is growing at any one time, while the other 10% enter a resting phase. Every two to three months the resting hair falls out and allows new hair to grow in its place.
Telogen effluvium is the excessive shedding of hair that occurs one to five months following pregnancy. This is not uncommon, as it affects somewhere between 40% to 50% of women; but like most changes during pregnancy, it is temporary.
Hair loss that is connected to pregnancy usually occurs after delivery. During pregnancy, an increased number of hairs go into the resting phase, which is part of the normal hair loss cycle.
This condition is not serious enough to cause bald spots or permanent hair loss. The rise in hormones during pregnancy keeps you from losing your hair. After delivery, the hormones return to normal levels, which allows the hair to fall out and return to the normal cycle. The normal hair loss that was delayed during pregnancy may fall out all at once.
Up to 60% of your hair that is in the growth state may enter into the telogen resting state. After around five months after birth hair follicles rejuvenate themselves and the hair grows back.”

Menopause is a natural biological process that all women experience at some point in their lives. During this time, the body goes through numerous physical changes as it adjusts to fluctuating hormone levels. Many women have unpleasant symptoms during menopause, including hot flashes, mood swings, and insomnia. Hair loss is another common occurrence.

Research suggests that hair loss during menopause is the result of a hormonal imbalance. Specifically, it’s related to a lowered production of estrogen and progesterone. These hormones help hair grow faster and stay on the head for longer periods of time. When the levels of estrogen and progesterone drop, hair grows more slowly and becomes much thinner. A decrease in these hormones also triggers an increase in the production of androgens, or a group of male hormones. Androgens shrink hair follicles, resulting in hair loss on the head. In some cases, however, these hormones can cause more hair to grow on the face. This is why some menopausal women develop facial “peach fuzz” and small sprouts of hair on the chin.

For women going through menopause, the cause of hair loss is almost always related to hormonal changes. However, there are many other factors that can contribute to hair loss during menopause. These include extremely high levels of stress, illness, or a lack of certain nutrients. Diagnostic blood tests that can help rule out other causes of hair loss include thyroid tests, and/or a complete blood count.

5. Can you self-treat or should you always seek a doctor/ trichologist?

It is always best to see a doctor or trichologist to get to the root causes of the problem. However, there are some over-the-counter remedies that can treat hair thinning and hair loss in women.
“Minoxidil [Rogaine] hair loss products are available over the counter in a weaker concentration than the 5% that is prescribed by doctors. It is usually applied directly to the scalp and is most effective as part of a treatment programme devised by a hair regeneration specialist. It is more effective in women than men and although has been proven to arrest hair loss is not particularly effective in the regeneration of hair.
Toppik Hair Building Fibrescan can instantly fill in balding or thinning areas, providing a temporary solution to the problem. Made of pure organic protein, Toppik is  undetectable and resistant to wind, rain and perspiration; yet easily washes out with shampoo.
If you're a woman with thinning hair, Toppik hair products can have an immediate positive effect and help to restore confidence.
Toppik fibres are made of all natural organic keratin protein, the same protein that hair is made of. The fibres in Toppik are charged with static electricity so they intertwine with your own hair and bond securely.”

How long does it take to see results using your treatments, how many sessions?

Minoxidil does take some time to work. Users won't start to see visible results after three months and it will probably be up to six months before you see a noticeable improvement. Toppik can provide immediate relief.

The only long-term solution to permanent hair loss is a hair transplant. Around 10% of my patients are female and hair transplants can be just as effective on women as men.”


Our Surgeon

Dr. Asim Shahmalak

Dr Asim Shahmalak is a world-renowned hair transplant surgeon who performed the UK’s first eyelash transplant in 2009. He runs Crown Clinic – one of Britain’s most successful and best known hair transplant clinics. He has treated a number of high-profile industry leaders and celebrities including the medical broadcaster Dr Christian Jessen, best known for Channel 4’s Embarrassing Bodies.

Expert hair transplant surgery by Dr Shahmalak

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When the sun comes out, we know that we need to apply sunscreen to protect our skin, but many people forget to pay the same care to protecting their hair. Between the sun, sea and swimming pools, many of our favourite summer activities can significantly damage our hair – so the next time you go out to enjoy the sunshine, find out what you can do to protect it.


Why does sun damage the hair?


Sun damage to the hair is caused by the harmful UVA and UVB rays, which damage the outermost layer of the layer – the cuticle – and weaken the protein structure of the hair, making it dry, brittle and more prone to breaking. Some people find that their hair lightens in the sun, as the rays act in a similar fashion to bleach, stripping the melanin from the hair.


Protecting your hair from the sun


Wearing a hat is an easy way to protect your hair and scalp from the sun, especially if you’re outside when the sun is at its strongest. Hair SPF is also an option, which can usually be bought as a spray to be misted over the hair. Pay extra attention to the scalp – many people forget that the scalp can burn just as easily as the rest of the skin, ending up with an itchy, flaky, burnt scalp. If you do burn your scalp, rinse your hair in cool water and apply aloe vera to the affected areas, and make sure to keep your head covered when going outdoors.

If your hair is looking dry, try a deep conditioning treatment to restore some of the lost moisture to the hair, and avoid wearing your hair in any tight styles that may pull on the scalp. Summer is also a good time to temporarily stop using hairdryers, straighteners and any other hot tools to avoid adding to the sun damage.


Protecting your hair from the sea


Salt water is notorious for drying out the hair. It leaches moisture out of it, making it incredibly brittle and tangled, which can cause significant breakage. Before you go swimming, saturate your hair with clean water to prevent it from absorbing as much salt water, and don’t let it sit in your hair – rinse it thoroughly as soon as you get out of the sea. Deep conditioners and hair masks will also help replenish the moisture.


Protecting your hair in a swimming pool


Just like salt water, chlorinated water is very harsh and drying on the hair, so you can take similar precautions to swim in the sea. You could also try a swimming cap, as this not only prevents the chlorine from damaging your hair, but it will also protect your scalp from sunburn. If you have highlighted or blonde hair, be especially careful when in a swimming pool, as the copper and chlorine in the water have been known to form a film that sticks to the proteins in hair, turning it a green shade. Thankfully, this isn’t permanent, but make sure to enter the pool with wet hair and rinse it as soon as you get out.

However you are spending your summer, if you have any questions or queries about your hair, take a look at our hair advice or give our team a call.

Over the past few months, there have been a significant number of reports in the news of people experiencing hair loss after being diagnosed with COVID-19. As a result, the Centres for Disease Control and Prevention (CDC) has listed hair loss as a possible long-term effect of the illness, along with symptoms such as fatigue, dizziness and joint pain. 

A study published by the medical journal The Lancet reported that 22% of the patients it had observed suffered from some degree of hair loss six months after falling ill, with women being more affected than men. 


Why does COVID-19 cause hair loss? 


Although there are several studies linking coronavirus and hair loss, many of the reports we hear about are anecdotal – at the moment, it’s too soon for scientists to officially establish a link between the two. 

However, the type of hair loss that COVID-19 sufferers are reporting seems to be consistent with telogen effluvium. Telogen effluvium occurs when more hairs than usual suddenly enter the shedding phase of the hair growth cycle at once, causing a more noticeable amount of hair to shed at once. It’s normal to lose up to 150 hairs per day, but if you spot that you’re losing much more than that – such as clumps coming out when you’re brushing or washing your hair – it could be telogen effluvium. 

Due to the length of the hair cycle, telogen effluvium typically occurs two or three months after a period of significant stress, which can include illnesses such as COVID-19. When undergoing stressful situations, the body puts all its resources into maintaining essential functions only – which, unsurprisingly, does not include hair growth. As a result, you end up with hair loss. 

However, several other conditions can cause hair loss – such as thyroid issues or nutritional deficiencies – so if you are concerned, visit your GP, who can rule out other underlying causes with a simple blood test. 


Will my hair grow back after having COVID? 


If the hair loss is the result of telogen effluvium, most people will find that the hair will eventually grow back without the need for treatment. Typically, once the trigger or stressor is removed, the hair will grow back on its own. 

If you notice that the hair loss is persisting, there are a number of medical, cosmetic and hair transplant treatments available to help – Crown Clinic offers a range of options to support those struggling with hair loss, so don’t hesitate to get in touch

When performed by a qualified, experienced hair transplant surgeon, hair transplants are a very safe procedure. Hair restoration is a minimally invasive treatment that allows patients to return home the same day, with the procedure only requiring local anaesthetic. 

However, if you undergo a hair transplant abroad – such as in Turkey – the risk attached is much higher. 


Risks of hair transplants in Turkey 


It’s no secret that undergoing hair transplant surgery in countries such as Turkey is a gamble. Every year, countless patients are reeled in by the low prices and package deals offered by overseas clinics. Many of the clinics boast ‘five-star’ ratings and an active social media presence, duping unsuspecting patients into thinking they are visiting a reputable clinic. Although, when you dig a little deeper, you may discover the reviews are faked and the ‘after’ pictures are heavily edited or taken from other clinics. 

Another trick that patients fall for is believing that a surgeon will be carrying out the procedure, as many of the clinics advertise that a surgeon leads them to convince patients that they are legitimate. Unfortunately, that doesn’t mean a surgeon will be carrying out the hair transplant itself. In fact, many clinics hire under-qualified technicians with little training to keep the costs down, only seeking the supervision of a surgeon if the procedure goes wrong. 

Over the years, Crown Clinic has fixed countless botched hair transplants, mainly from overseas clinics. The most common problems that we see are unnatural-looking hairlines and unsightly scarring as the result of the surgery being carried out by unlicensed practitioners. Other risks are infections, as sanitation is often extremely poor at the clinics and damage to the scalp due to the result of the incorrect tools being used to carry out the surgery. 


Are there any side effects to having a hair transplant? 


If you choose to have a hair transplant in the UK with a reputable surgeon, side effects will be minimal. The hygiene standards will be incredibly high, meaning the risk of infection is negligible, and you will be given clear instructions on how to take care of your scalp after the procedure. Crown Clinic has an excellent aftercare service, offering a day-by-day guide to ensure optimum healing and results.  

Unlike at overseas clinics, where it can be impossible to follow up after the procedure to discuss any concerns related to your hair transplant, Crown Clinic is more than happy to answer any questions you may have during this phase.