Hair transplant surgeon Asim Shahmalak answers 5 popular questions about hair loss

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Crown Clinic's hair transplant surgeon Asim Shahmalak is one Britain's leading experts on hair loss.

Here he answers 5 of the most common questions on hair loss and looks at the most popular hair transplant options.

1 What are the main causes of premature hair loss?

Dr Shahmalak said: “Premature hair loss is primarily a hereditary condition. You can see how this gene is passed down the generations
most powerfully if you look at the royal family. Male pattern baldness has gone from the grandfather (Prince Philip), to the father (Prince Charles) and now on
to the son, Prince William. We can only hope that it skips the next generation – young Prince George!
“Experts are split on whether this hereditary gene is more powerful on the mother or the father's side. From my long experience working in this field, I would say the father's side is more powerful. That
certainly seems evident when you look at the royal princes.
“There are other causes for premature hair loss. Obviously ageing is a factor – 20% of men under 30 experience hair loss, increasing to 40% by the age of 35 and 65% by the age of 60.
“Around half of women experience some kind of hair loss by the time they reach old age.
“There are medical factors which can also prompt hair loss.
“Stress is one factor because it can constrict the supply of blood to the hair.
“Other medical factors can also have an effect such as an under-active or
over-active thyroid.
“Women can suffer premature hair loss through polycystic ovary syndrome.”

2 What are your top tips when it comes to working out which treatments
or products are likely to work and which are a waste of time?

Dr Shahmalak said: “When looking for treatments or products, I recommend that patients use only those which are medically proven.
“There are two that I consistently use with clients – Finasteride and Minoxidil.
“I recommend that these are taken at the same time – Finasteride as a pill and Minoxidil as a mousse spread on the scalp and it can also be taken as drops.
“Both have been shown through clinical trials to halt the loss of hair and, in some cases, promoting the regrowth of small baby hairs.
“What Finasteride and Minoxidil are very effective at is helping men suffering from male pattern baldness to retain their natural hair. In 90% of cases, they have been shown to halt the process of baldness.
“What they don't do is grow new hair.
“The only long-term, permanent solution to baldness – both in men and women – is a hair transplant. Hair is taken from the back or sides or scalp where there is an abundance of follicles and replanted in the areas where hair loss is most prevalent – either by FUE (follicular unit extraction) or the more traditional method, FUT (follicular unit transplantation.
“I will often use Finasteride and Minoxidil in conjunction with a hair transplant. The transplant repairs the areas where the hair has been lost – all the transplanted hair will be permanent and should last the patient for the rest of their lives. Finasteride and Minoxidil halt the baldness and ensure that the patient will not need a further transplant because they will not lose any more of their natural hair. 

“I have also started stocking new Help Hair products which have been developed in the United States by Dr Larry Shapiro and have shown to be effective in treating hair loss. Dr Shapiro has treated more than 14,000 patients. We stock Help Hair shampoos, conditioner, protein shakes and vitamins. 
“Most other products are a complete waste of time.
“There is no pill or shampoo that can promote the growth of hair. What some shampoos can do is nourish the hair so that it looks shinier and healthier.
“If there was so much magic pill you could take, why are 65% of men suffering from baldness by the time they are 60?”

3 Are there any risk factors which can make premature hair loss more likely?

Dr Shahmalak said: “Most people normally shed 50 to 100 hairs a day. This usually doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair loss occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue.
“The main risk factor making premature hair loss more likely is obviously illness.
“Patients who undergo chemotherapy or radiotherapy are likely to lose their hair but this tends to grow back a year or two years after treatment.
“Hormonal changes and imbalances can cause temporary hair loss. This could be due to pregnancy, childbirth or the onset of menopause. Hormone levels are also affected by the thyroid gland, so thyroid problems may cause hair loss.
“Infections, such as ringworm, can invade the hair and skin of your scalp, leading to scaly patches and hair loss. Once infections are treated, hair generally grows back.
“Diseases that cause scarring alopecia may result in a permanent loss at the scarred areas. These conditions include lichen planus, some types of lupus and sarcoidosis.
“There is also a hair-pulling disorder. This condition, also called trichotillomania, causes people to have an irresistible urge to pull out their hair, whether it's from the scalp, the eyebrows or other areas of the body.”

4 How do you think treatments and products will improve over the next decade?

Dr Shahmalak said: “I am very excited about the developments happening in hair loss research. I don't think anything major will happen overnight but in around 15 years we could be in position where scientists can take hair from the back of your skull and grow new follicles. This could lead to permanent solution to baldness.
“The advances being made are very exciting and I have been delighted to help an exciting research project into this area being conducted by Professor Ralf Paus at Manchester University.”

5 What's been the biggest development/improvement with regards to
treatments for premature hair loss over the past ten years?

Asim Shahmalak said: “The biggest development has been the introduction of the hair transplant technique known as Follicular Unit Extraction. This is the method favoured by celebrities such as Wayne Rooney and my clients, model Calum Best, Coronation Street star Jack P Shepherd, Homes Under the Hammer presenter Martin Roberts and the soccer pundit and former player for Liverpool and Man City, Didi Hamann. 80% of clients at Crown Clinic now opt for FUE.
“In FUE, hair follicles are removed individually and transplanted into the areas of the scalp where hair is receeding. Immediate scarring is minimal – just a few red pin pricks in the area of the scalp where the hair is harvested.
“Many patients favour this more modern method which is particularly beneficial if you like to wear your hair short and don't want scarring around the donor area on the scalp.
“The traditional form of hair transplantation, Follicular Unit Transplantation or strip harvesting, is still popular – this is where a strip of hair is surgically removed from the scalp and the follicles are extracted.
“The other big development has been the introduction of proven methods to halt hair loss such as Finasteride and Minoxidil. The TV doctor Christian Jessen had two FUT transplants with me at Crown Clinic. 

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.