Traction Alopecia And How To Fix It

This is a unique case. What’s so unique and interesting about it? Well, let’s just let the pictures do the talking. Traction alopecia! You might be asking yourself, “What's so unique about this”? It looks like some guy with a Norwood 3a pattern of hair loss and you'd be right. I mean, it's kind of kind of like a Norwood 3a but i'll show you the other pictures here in just a minute but before we do i'm going to read some comments by the patient before we get started. So he starts off with 

Hey I'm a Sikh male, age 23. I’m in the Sikh religion and I've suffered from traction alopecia. It’s extremely common amongst the community but the content and information out there regarding this specific issue is extremely rare. You’ve been in the field for quite some time so I would assume you've come across it but i will give you some background to the case anyway”

I have seen a lot of these cases because I've had a lot of Sikh males come in to the local office where I used to work so, yeah, I've seen this quite a bit and I've had a lot of cases submitted to me online over the past several years, but back to his email. 

In case you haven't seen this before Sikh males keep their hair long and typically keep the hair in a bun, which tends to be tied on the top of the frontal hairline area due to the repetitive style. The tight keeping of this bun means the hairs are being pulled in that area so they are damaged quite badly…” He says here ”The reason to contact you is because there's literally nothing of any depth out there on the issue and i know many friends and relatives who have suffered the same problem now. With the extent it gets to after childhood and teenage years it gets to a point where there is nothing that can be done to repair the areas damaged, apart from surgical intervention”. He’s correct. “I had a consultation with a trichologist and we're in agreement to look to pass this on to the doctor…” 

He goes on to talk about the doctor which is, again, another doctor that I work with. 

“I don't have male pattern baldness and it's just traction alopecia. I know for younger people surgery at such a prestigious clinic would only be carried out in exceptional circumstances he's talking about his age here he's 23 which i would believe mine to be what sort of hairline would you look to create on me what would be a sensible one and realistic one that the doctor may suggest if you could just draw one on here but keep my personal details in face anonymous um blur my face etc please uh some more details about my case my current state has been the same…”. 

Okay, that’s the basics of it. He’s been to a trichologist who examined his hair and gave him some input on what his situation is. It was mainly just affirming what he already knew which is that he’s got traction alopecia but there’s a note in the assessment that he sent me from the trichologist that i'm going to address later on. So you've seen this image, let's look at the sides and this is the telltale sign of traction alopecia. I’ve seen this on just one side on a lot of patients but I've also seen it like this case where it's both sides and you can even see the demarcation of the line on his forehead. That’s a tan line because Sikh males wear their turban very low above their eyebrows, or at least the ones I've seen, and so that's why you see that line . Before I continue with the photo showing you his case, one problem I ran into is that his photos are showing his hair without separating it so I can't see his donor area. This is his donor photo which would have been okay. The lighting is too low, but besides that his hair is just really long. It’s going down the back and he's not separating it. I know it would be really difficult in this case so I have to use some baseline assumptions. Then when we also look at the top, again the hair is going back and it's really long so I can't really see through the top. He’s not separating it so I can't really see the top. If there's any sort of actual male pattern baldness going on besides the traction alopecia, the patient said that there's not, but i can't take his word for it. This is this is what I do so a lot of times patients will say I don't have this or I don't have that and I look at the photos I'm like, yeah you do. In this case it's more difficult because the hair is so long and it's covering the areas that I want to look at but i can still see some things that I'll get to in just a moment. Before i do I want to read the report from the trichologist themselves. 

…and then scalp microscopic viewing showed some hair miniaturization however this can be due to ongoing telogen effluvium and i would like to see your blood test monitored here before confirming or recommending treatment”

So, pretty basic but what I'm seeing is something that does indicate male pattern hair loss. You can see the traction alopecia is pretty bad like the entire area above the uh the sideburn the temple point is obliterated and then when we look on the other side you can see that it's the same deal like you can see some little hairs in the traction zone, I'll call it, but those are just barely hanging on. When we look back into the mid scalp region from the side I'm seeing that it's almost like a thin spot here that I wouldn't normally expect to find on someone that doesn't have any sort of alopecia. While this isn't measured this isn't scientific. My gut tells me just based on knowing what I'm looking at, after looking at thousands of photos over the years I think that this is an indicator that his hair might be affected at least in some degree by DHT. These hairs are susceptible and when i look at the overhead shot again, there's no rhyme or reason to this, it's just what i think i'm seeing right here, behind the temple region. His left temple region this looks a little thin as well so i don't see it in the original frontal photo so it's really hard for me to gauge this. Because the trichologist said that they see potential miniaturization that tells me that, yes, there could be some alopecia going on here. I would recommend that there be medication involved with this but here's the problem; this is not a normal case. As far as you know he’s looking like a guy that has male pattern hair loss. The sides are the dead giveaway and i'm sure that this would be embarrassing for him out in the field, you know on the dating scene and just going through his everyday life. In fact. he does go on to talk about how it's affected him.

“It's really imperative that i do have a surgery as i'm forced to hide my hair constantly and i don't feel comfortable or free at the moment at all. It's been a deeply stressful and hard time for a number of years but I really feel that now is the best time to have it done as i can't carry on the way i am. It really takes its toll and I truly believe it would be very successful especially with the doctor that you work with carrying out my procedure”.

He is another hard luck story. It is a heartbreaking story of how hair loss affects all of us, so yeah man, I know. You're not the only one but I know you feel like the only one. First off, before you do anything, you do have to get on the medication. I’m sorry. You gotta at least give it a shot. If the trichologist says that there's miniaturization and then the doctor says that there's miniaturization, and he believes that there is male pattern hair loss at play here, then yeah, you need to give it a shot. You're 23 and dealing with your existing issue is not going to take just a few grafts. It’s going to be a big procedure and you probably need to have two passes just to get the proper density to blend in with the rest of your hair . You did also ask me if I could draw a hairline to give you an idea of what maybe the doctor will be telling you to expect. Let's give it a shot!

I did what I think is a reasonable approximation of what you should expect. Not too low on the hairline, not too aggressive on the temples and the temple points but it certainly restores you to a look of normalcy. This could be something that is suggested by the doctor that you're talking to or that you're considering. He doesn't like to be really aggressive as far as design. Whatever he does, it is a natural appearance every time and so i think that, yeah, it'll probably be something like this. We can look at the other side and that looks like it'll work out well.This is just a rough approximation of the hairline height.

All, right so I think that you know that's the general idea of what you can expect and because, I don't think I said this earlier, because the patient is talking about FUT strip surgery. I think that's a great way to go, especially because he's not gonna be shaving his head anytime soon. This is his deal. long hair for life, so yeah, FUE is not happening. I think your options like obviously medical intervention, look at finasteride, look at oral minoxidil, look at mesotherapy, look at non-surgical alternatives like PRP. Things like that, but in my view you can start with, in this case, you can start with the basics. Finasteride and give that six months because you're not in a huge rush, like you want to get it done, but you said this year. You didn't say like asap so give it at least six months, see what it does for your hair based on what the doctor says about your baseline. Where you're starting before you begin the medication  is important and give that six months. See if that works out for you and then you can consider surgery and maybe consider some sort of hairline design like i drew here or whatever the doctor suggests as well but i think that it's in your best interest to examine and seriously consider moving forward with this in two steps as opposed to one. That way you can better gauge the overall reconstruction and you can still wear that do-rag or wear that bandana to cover everything up just as you are today. I think that that's probably the best route to go and then once it all grows out you can go back in the doctor and you can assess on the next best step and tweak things here and there and add more density so that the final result blends in nicely with everything you got. You're not in a position to risk this because, I mean yeah, you can continue to hide bad work or poor growth with your head covering but you don't want to do that. If you could do that then why get surgery, right? You just got to keep in mind that nothing is guarantee. This is an elective surgery. It is a risk so never forget that, any of you that are watching this, and of course the patient.

That's it for hair transplant consultations number three. This video is done! Thanks for watching. Peace!

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