Nonscarring Alopecia 2018-12-18T09:34:31-06:00



The most common type of hair loss among men is male pattern baldness, known as androgenetic alopecia. This affects up to 80% of men by the age of 80. It is a condition caused by age, genetics and a specific hormone called DHT (dihydrotestosterone) that attacks hair follicles leading to a disruption of the normal hair growth cycle. This disruption causes follicles to shrink and grow at a slower pace, eventually leading to the hair falling out and the pattern repeating itself with other hair follicles in other parts of the scalp. This process can affect the entire scalp, except for the hair at the back and sides of the head, which is not subject to male pattern baldness. This is a genetically permanent zone, which makes it a viable solution to be used for hair transplant surgery.


It is perfectly normal for people to shed 50 to 100 hairs per day. This generally doesn’t cause noticeable thinning of scalp hair because new hair is growing in at the same time that hair is shedding. However, hair loss occurs when this hair growth cycle and shedding is disrupted or when the hair follicle becomes destroyed and replaced with scar tissue. Female pattern hair loss (androgenetic alopecia) is the most common form of hair loss in women. This occurs gradually and is caused by genetics (from either side of the family), age, and the action of a specific male hormone, dihydrotestosterone (DHT). This hormone is found in lesser amounts in women and it preys on the hair follicles, preventing them from receiving vital nutrients for proper hair follicle growth, leading to the hairs shrinking, and resulting in a shorter lifespan. Interestingly, DHT does not need to be elevated to generate hair loss. Estrogen, when lowered as commonly seen in menopause, creates a change in the ratio of male to female hormones, giving an edge to these male hormones. Compounded with the sensitivity of DHT to the hair follicles, heredity can affect the age at which a woman begins to lose her hair, as well as the rate of hair loss and the extent of baldness.


Telogen effluvium is one of the most common types of hair loss. On average, 80-90% of the hair follicles on the head are active and growing (anagen state) and 10-20% are resting (telogen state). As a result, we normally shed between 50 and 100 hairs per day. In telogen effluvium, more than 25% of hair follicles are prematurely pushed into the resting state, as a result of the body’s reaction to a specific stressor. This results in excessive shedding and diffuse thinning that may happen abruptly. Styling may reveal areas of thinning, such as a wider part line or a thinning crown. TE usually presents itself 6-12 weeks after the insult began and can last up to 6 months, however chronic telogen effluvium can occur when shedding continues past this range and can last for several years. Plano, TX hair restoration surgeon, Dr. Joseph Yaker, offers nonsurgical treatments for patients suffering from this condition and will perform a thorough assessment so that a proper diagnosis can be made and a custom treatment plan put into place.


Causes of telogen effluvium include medical conditions such as thyroid dysfunction, iron deficiency, anemia, diabetes and hormone imbalances such as changes in estrogen seen soon after childbirth and with menopause. Others include nutritional disorders (crash dieting, anorexia, bulimia, nutritional deficiencies), severe physical stress such as acute illness, hospitalization, surgery or even severe emotional stress (i.e. sudden death in family). Some medications may also induce TE, by interfering with the hair growth cycle. These medications include blood thinners, medications for acne, cancer, blood pressure, cholesterol, diabetes, thyroid dysfunction, epilepsy, depression and gout. Hair shedding can also occur with starting, switching, or even discontinuing birth control pills that a woman has been on for a long period of time. Unfortunately, no cause is found in approximately one third of patients.

A physician can usually identify telogen effluvium through a detailed medical history including list of medications, and examination of the hair and scalp. The physician may also perform blood work, scalp biopsy and a gentle hair pull test, where small amounts of hair are gently pulled in order to determine if there is excessive loss.


Patients usually have return of their hair density within 12-18 months once the trigger has been identified, and removed or treated. If the cause of hair loss is due to medications, the patient may need to have a discussion with their physician about switching medications. Unfortunately for some, telogen effluvium is a mysterious chronic disorder and can persist for months or even years without uncovering the triggering factors or stressors.

Nonsurgical Treatment

Telogen effluvium is commonly self-correcting and one must allow time for the body to recover following the specific insult. However, for persistent TE or if the causal factor cannot be identified, there are a few treatment options. Minoxidil (brand name: Rogaine®), platelet rich plasma (PRP) with placenta-derived extracellular matrix therapy, and low level laser therapy can all be used to slow hair loss and stimulate new hair growth. Dr. Yaker’s HairScan Plan will help track the progress of nonsurgical treatments to monitor if the hair is growing back effectively.


In a typical person, 80-90% of hair follicles are in an active growing (anagen) phase. Anagen effluvium describes a condition where hairs in the anagen phase stop growing suddenly and fall out. Hair loss occurs because the hair shafts are broken and not shed as seen in telogen effluvium. The result is widespread and noticeable hair loss. Anagen effluvium affects hair follicles in the scalp and also hair follicles throughout the body, such as the eyebrows and eyelashes. It is usually associated with cancer treatments, but other causes are possible. The amount of hair loss varies in each person, and the possibility for hair to return is often location and dose dependent. Plano, TX hair restoration surgeon, Dr. Joseph Yaker, offer patients with hair loss of this nature various nonsurgical options to restore their hair. Medications and other at-home remedies are usually effective to help the hair regrow.


Anagen effluvium is usually a side effect of cancer treatments such as chemotherapy and radiation, and can occur as early as a few days to a few weeks after beginning chemotherapy or radiation. Since the purpose of cancer treatments is to poison rapidly dividing cancer cells, your body’s other rapidly dividing cells, including hair follicles, are greatly affected. The result is the sudden shedding of hair. Although anagen effluvium due to chemotherapy is usually reversible, certain chemotherapy regimens can cause dose-dependent permanent hair loss. Radiation therapy affects hair only in the area where the radiation has been administered. Patients with hair loss may or may not be permanent and is dose and location dependent. In cases where hair loss is reversible, anagen effluvium stops when treatment is finished, and hair will likely begin to grow again in about 1-3 months.

Anagen effluvium can also be caused by exposure to toxic chemicals such as arsenic, as well as exposure to certain medications, and some autoimmune diseases. In these cases, the condition will stop after the cause is found and treated. After anagen effluvium, some people may have a different texture or color of hair. This may be temporary or permanent. The diagnosis is usually made by taking a detailed medical history, and by examining the scalp and shed hair.


Anagen effluvium hair loss can dramatically alter a person’s appearance and affect their self-esteem. Wigs, hats, and scarves can be used to mask hair loss and counseling may be helpful. Scalp cooling with cold caps may help reduce hair loss during chemotherapy. It works by cooling the scalp causing the blood vessels to contract, which may limit the amount of the chemotherapeutic agent carried to the hair follicles. Scalp cooling doesn’t work with all chemotherapy drugs and certain factors must be taken into consideration when determining whether it will be successful. Applying Minoxidil (brand name: Rogaine®) to the scalp during chemotherapy treatment won’t stop the hair loss from occurring, but it will speed hair growth after treatment is complete. Patients who are told they will lose their hair during a medical treatment may seek the advice of a hair restoration surgeon, such as Dr. Yaker. He is able to guide them during the hair loss process and offer nonsurgical methods to keep the scalp clean and moisturized so that the health of the scalp can be maximized for future hair growth.


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.


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.


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 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.


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.


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.