The Challenges of Long-Hair FUE

Despite long-hair FUE’s appeal, performing this procedure can be very challenging. Long-hair FUE procedures use traditional notched or slotted punch tools, but they often require high manual precision and can increase the risk of hair shaft breakage during extraction. The hair is also prone to breakage during the extraction process.

Dr. Sanusi Umar Addresses Long-Hair FUE with His Patented Dr.UGraft® Zeus Device

This is why Dr. Sanusi Umar felt compelled to advance the field of long-hair FUE. He invented the Dr.UGraft® Zeus Device, a FUE device that performs long-hair FUE without the use of recessed punch tools. The device makes use of the Intelligent Punch, an all-purpose punch patented by Dr. Umar. It features a flared, frustoconical cutting tip designed to accommodate a wide range of follicle types, including long, curly, and textured hair. 

Meanwhile, the Zeus Console is a compact, portable device that offers preset FUE modes. This makes it adaptable to any hair or skin type. Due to the design of the Dr.UGraft® Zeus Device, it is the only all-purpose device capable of performing FUE on textured hair, including type 4c Afro hair. It is the most versatile and inclusive option for dermatologists and hair transplant surgeons.

According to a global, peer-reviewed study published by Dr. Umar, the use of the Dr.UGraft® Zeus system resulted in a low graft transection rate (GTR), a low shaft breakage rate (SBR), a quicker procedure speed, and a higher surgeon adoption rate compared to recessed punch long-hair FUE devices. 

A Solution For Celebrities and Influencers

Celebrities and influencers are always under public scrutiny, and every little move they make is judged online. While there’s nothing controversial about getting a hair transplant, it can still become fodder for the rumour mill. Since the Dr.UGraft® Zeus Device can harvest longer hairs without breakage, longer hairs can be transplanted into the problem area and can disguise swelling and wound healing. 

A Discreet Option for Executives and Professionals

High-level executives meet with different clients, business owners, stakeholders, and colleagues. While they’re not necessarily in the limelight the way celebrities are, they still need to look professional. They usually can’t get that much time off work, too, especially when they have such demanding schedules. The Dr.UGraft® Zeus Device can give these professionals discreet results. This allows them to jump back into work meetings, client presentations, and business dinners.

A Sensible Choice For Women

According to the International Society of Hair Restoration Surgery, 87.3% of hair transplant procedures in 2022 were performed on men. Meanwhile, only 12.7% were performed on women. Shaving one’s head to harvest grafts might not be an option for women. Since the Dr.UGraft® Zeus Device can harvest long hair, hair transplant surgery has become a viable option for women suffering from different types of alopecia. 

An Inclusive Invention For Afro-Textured Hair

The device has minimal assist navigational (MAN) ability. The punch self-navigates and adjusts its trajectory in real-time to correct misalignments, reducing the risk of follicle transection and shaft breakage. The MAN ability has made the Dr.UGraft® Zeus successful among patients of African descent with type 4 hair textures. They are a challenging group when it comes to traditional FUE. 

Follicular unit excision often yields inconsistent results in patients of African descent and those with afro-textured hair. Innovations in standard FUE often leave these communities behind. Factors like hair texture and skin thickness lead to low or inadequate graft yields. Dr. Umar tackled these problems head-on when he factored in these conditions when inventing the Dr.UGraft® Zeus, and an independent study by him showed consistent access in African-descent patients who underwent FUE using the device, with less than 10% of follicular units showing breakage or transection.

Long-Hair FUE Done Right With The Dr.UGraft® Zeus System

By developing an all-purpose FUE device through the Dr.UGraft® Zeus, Dr. Umar has shown how understanding patient pain points and prioritizing inclusivity can lead to innovation and advancement in FUE technology. Today, the Dr.UGraft® Zeus is the most advanced tool for performing Long-Hair FUE across all hair types. This includes 4c afro-textured hair.  “I’m not the inventor of the technique,” he acknowledges. “I invented the best technology for the technique. It is a system that is now widely used as the premium tool for performing the procedure by doctors globally. I have also published the most compelling peer-reviewed global multicenter study on the subject.”

For individuals who need long-hair FUE done right, Dr. Umar, as the inventor of the Dr.UGraft® Zeus is the expert to see. To schedule a consultation, fill out the Dr. U Skin and Hair Clinic online consultation form. 

Individual results may vary. This story reflects a sample size of patients who have gone through hair transplant surgery with the Dr.UGraft® Zeus system. Consult with a physician for personalized advice.

The post Dr. Sanusi Umar Pioneers Long-Hair FUE Advancement with Dr.UGraft® Zeus™ Technology appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

If this sounds like you, this article is for you:

• You are consistent with treatment, but your hair loss or baldness still progresses.
• Minoxidil and/or finasteride helped at first, then results slowed or stopped.
• You have “dandruff” or scalp irritation that keeps coming back.
• A hair transplant result was disappointing, unpredictable, or did not last.

If you are doing “all the right things” for your androgenetic alopecia or pattern baldness, but results are stalling, read this.

Androgenetic alopecia (AGA), also known as male pattern baldness (MPB) or female pattern hair loss (FPHL), is common, visible, and emotionally heavy. Many patients do everything they are told: minoxidil, finasteride (or dutasteride), devices, shampoos, supplements, and still find that progress slows, stops, or becomes unpredictable.

When that happens, it is not always “bad luck,” and it is not always “you waited too long.”

The study titled “Perifollicular Inflammation and Fibrosis in Androgenetic Alopecia: Implications for Diagnosis and Treatment – A Comparative Histopathologic and Clinical Study with Normal-Appearing Scalp” was published in the peer-reviewed Clinical Cosmetic and Investigational Dermatology journal. There, we describe a specific histologic pattern that can live quietly under the surface and help explain why some AGA and pattern baldness patients stop responding as expected, progress faster, or respond unpredictably to both medical therapy and hair restoration surgery.

It is called PIILIF, short for Perifollicular Infundibulo-Isthmic Lymphocytic Infiltrates and Fibrosis.

Quick takeaways

• PIILIF is a low-grade, immune-type inflammatory and early fibrotic pattern found around the upper portion of hair follicles (infundibulo-isthmic region) that can coexist with AGA and pattern baldness.
• It can be easy to miss clinically and can be mislabeled as “seb derm” or “just dandruff.”
• It may help explain why finasteride or minoxidil alone may not be enough for some people over time.
• It supports a dual-pathway strategy: address the hormonal pathway and the immune-fibrotic pathway, not one or the other.
• This is exactly why I created the Inflammatory AGA Screen Program (PIILIF Track).
• Important classification insight: the paper proposes that what has been described as fibrosing alopecia of patterned distribution (FAPD) aligns with a later stage of AGA-PIILIF, and recommends staging AGA-PIILIF by the degree of perifollicular fibrosis to support earlier recognition and intervention.

The missing link for AGA medication non-responders

This section is for the patient who is not planning surgery (or not yet), but is frustrated because the standard plan is not delivering what it should.

If the scalp environment is immunologically active and early fibrosis is already present, “more of the same AGA routine” is not always the answer.

The answer is:

• better biology control
• better targeting
• better timing

Here is the practical point

If PIILIF is present, “DHT control only” can leave a second driver running.

Standard AGA treatment often focuses on androgen signaling and follicle cycling support (for example, finasteride and minoxidil). That can be appropriate, but in a subset of patients, there is an additional layer: a perifollicular inflammatory and early fibrotic process that may continue even when DHT is addressed.

That is why some patients report:

• good early improvement, then slow decline again
• a stable period, then sudden acceleration
• “I’m consistent, but the response does not match the effort”

What this changes in real life

For the non-responder, the best move is not to guess harder.

It is to confirm what is actually happening in the scalp environment, and then treat the relevant pathways when indicated.

That does not mean every patient needs a biopsy.

It means:

• for non-responders, ambiguous cases, or high-stakes decisions, it is worth considering early diagnostic confirmation, not late.

What is PIILIF, in plain language?

PIILIF describes a subclinical perifollicular inflammatory pattern that concentrates around the upper follicle and is associated with early perifollicular fibrosis.

Key idea: it can be present even when the scalp looks “quiet,” and it can be present even in areas that are not yet visibly thinning or bald.

This matters because once fibrosis progresses, it can reduce the predictability of regrowth and restoration. That is why early recognition is the whole game.

Seeing PIILIF makes the concept clearer.
The short video below illustrates how PIILIF can exist beneath visible pattern baldness and why scalp biology matters when treatments or hair transplants stop responding.

Where FAPD fits: why this paper matters beyond “routine AGA”

If you have heard the term FAPD (fibrosing alopecia of patterned distribution), you already know it sits at the crossroads of two worlds:

• pattern hair loss that looks like AGA or male pattern baldness, and
• fibrosing/scarring biology that behaves more like early scarring alopecia

The key contribution of the paper is that it proposes a unifying framework:

• FAPD may represent a later, more fibrosing stage within the AGA-PIILIF spectrum, rather than a completely separate diagnosis.
• The paper recommends staging AGA-PIILIF by the degree of perifollicular fibrosis, which supports earlier recognition and more informed management decisions.

For patients, the takeaway is not to panic about “scarring.”
The takeaway is precision: if inflammatory and fibrotic drivers are present, it changes what “optimal care” looks like and why durability sometimes requires more than growth stimulation alone.

Why PIILIF gets mislabeled as seb derm or “just dandruff”

Many people with PIILIF report flaking, scale, or irritation. So it is easy to default to seborrheic dermatitis (“seb derm”) or “dandruff.” Whatsmore, the trichoscopic features of PIILIF may show similar findings associated with seborrheic dermatitis

But in our cohort, true seborrheic dermatitis on biopsy was rare compared with PIILIF.

Even when anti-dandruff shampoos temporarily improve scale or redness, that does not necessarily address the deeper perifollicular inflammatory process.

If you are treating “seb derm” aggressively and hair outcomes are still slipping, it is time to consider whether the label is wrong.

Why this matters for hair transplant planning

If the scalp environment is immunologically active and early fibrosis is already present, “more grafts” is not the answer.

The answer is:

• better biology control
• better planning
• better timing

In higher-risk candidates, pre-transplant control of PIILIF and biopsy-informed planning are advisable.

That does not mean every patient needs a biopsy. It means that for non-responders and high-stakes surgical candidates, diagnostic confirmation should be considered early rather than late.

Who should consider PIILIF screening?

You should at least consider PIILIF screening if you relate to one or more of these:

• You are not responding as expected to a well-run AGA regimen (meds, topical plan, lifestyle, compliance is solid).
• You have been told you have “seb derm” for years, but hair continues to miniaturize.
• You have advanced AGA or you are a complex case (including prior surgery, donor depletion, body hair follicular unit excision (FUE) or beard hair FUE reliance).
• You are planning a transplant and you want to reduce the risk of disappointing yield, ongoing thinning, or unpredictable healing.
• You are 44 years or older.
• You have perifollicular scale, redness, itch, tenderness, or shedding that does not match the clinical look of “routine AGA.”
• You developed overt features of scarring alopecia or severe inflammation after a hair transplant.

The Inflammatory AGA Screen Program (PIILIF Track)

I created this because too many complex patients with hair loss and baldness were being managed with a one-pathway playbook.

Program name: Inflammatory AGA Screen Program (PIILIF Track)
Format: Virtual first (with in-person follow up when needed)
Deposit: Required to protect quality, reduce no-shows, and allow proper time allocation

What the PIILIF Track helps us do

• Identify whether a patient’s AGA is likely “standard AGA” alone, or AGA plus PIILIF biology.
• Decide when a biopsy is appropriate and where it should be taken to improve diagnostic yield.
• Build a personalized plan aimed at:
  • controlling the inflammatory axis when indicated
  • reducing progression and improving durability
  • planning surgery only when the scalp biology is optimized

Long-Term Care Matters Long-term

Sustainable treatment matters because AGA‑PIILIF is a long game
When PIILIF is present, the goal is not a short burst of change. The goal is long-term stability of the scalp environment. PIILIF is best understood as a chronic, genetically influenced tendency toward follicle‑centered inflammation and early fibrosis that is not “cured” once and for all. It is managed. That reality changes how we choose treatments.

Control, not cure, means the plan must be livable for years
If control may need to be maintained for the long term, the foundation of care should be something a patient can realistically sustain. This argues against building the core plan around high‑burden or high‑risk approaches, especially because AGA‑PIILIF can be subtle compared with overt primary scarring alopecias. The biology may be meaningful even when the scalp looks “quiet,” but the management must remain practical and tolerable over time.

What we evaluated in our cohort
Because the working model involves long-term control, the study emphasized steroid-sparing options that may be suitable for longer-term use, with short-course therapies used selectively. Selections were informed by peer-reviewed literature on steroid-sparing management in primary cicatricial alopecias. Treatments used in the cohort, often in combination and individualized to the patient, included:

• Dutasteride and finasteride
• Oral minoxidil
• Topical calcineurin inhibitors
• Minocycline or doxycycline (typically as a time‑limited course)
• A selected phytoactive approach: Gashee topical and Gashee oral

What showed the clearest statistical signal in our analysis (and what did not)
In this retrospective cohort analysis, only some interventions showed a clear statistical association with improvement. In order of p‑value significance, the strongest signals in our dataset were observed with:

1. Topical and oral phytoactives (Gashee)
2. Topical calcineurin inhibitors
3. Minocycline
4. Dutasteride

Other treatments used in the cohort (including finasteride, oral minoxidil, and doxycycline) did not show the same level of statistical signal in this dataset. This may reflect sample size, duration, selection bias, combination regimens, dosing, or when and how an agent was deployed, rather than proving a treatment has no role.

The practical takeaway
The point is not that every patient needs every component. The point is that when AGA‑PIILIF biology may require long-term management, the strategy should prioritize approaches that are realistic to sustain, steroid‑sparing when appropriate, and matched to the level of inflammatory and fibrotic activity.

How this relates to Phytoactives
Within a long-term, steroid‑sparing framework, a phytoactive topical or oral option may be considered as supportive care as part of a broader plan, particularly when long‑term tolerability is a priority. In our cohort analysis, the use of Gashee in both topical and oral forms showed the strongest statistical signal among the steroid‑sparing measures evaluated, but this study is observational, and larger studies are needed to confirm and refine these findings. Gashee is not a substitute for diagnosis and is not positioned as a cure. It may be one tool within a clinician‑guided program when it fits the patient’s overall plan and risk profile.

Where a phytoactive product like Gashee fits (and where it does not)

Important points of clarification.

What Gashee is not

• It is not positioned as a “cure” for AGA, hair loss, or baldness.
• It is not a replacement for diagnosis.
• It is not a substitute for physician-directed therapy when stronger interventions are warranted.

Where Gashee can fit logically in the PIILIF conversation

PIILIF changes the strategy from “only push growth” to “optimize the scalp environment and protect follicle viability.”

Because AGA is a long-course condition, and because PIILIF (when present) can behave like a persistent, low-grade inflammatory process, long-term tolerability matters. That pushes smart clinicians toward steroid-sparing approaches whenever feasible.

In our PIILIF work, the practical takeaway is that some patients benefit when care includes scarring alopecia or PCA (primary cicatricial alopecia)-style anti-inflammatory and anti-fibrotic measures alongside appropriate androgen management.

In that context, phytoactive support can be part of a long-term maintenance philosophy, particularly for patients who need a plan they can sustain.

Gashee exists in both topical and oral forms. In my practice, when it is used, it is used as part of a broader plan, not as a standalone promise.

Important note: Gashee is designed to support the scalp environment as part of a broader hair loss program. It is not intended to diagnose, treat, cure, or prevent disease. Individual results vary.

The bigger point: stop guessing. Start staging.

If the biology is wrong, the plan will be wrong.

PIILIF gives us a clearer framework for:

• earlier detection
• better durability
• better surgical planning
• fewer “mystery non-responders”

If you are a patient who feels stuck, or a clinician managing difficult AGA cases, the PIILIF Track is built for you.

Next steps

Patients: Request a PIILIF Track evaluation
Start the PIILIF Track Intake

Clinicians: Refer a complex AGA case for PIILIF screening
Clinician Referral: PIILIF Track

Medical and product disclaimer

1. Gashee is designed to support the scalp environment as part of a broader hair loss program. It is not intended to diagnose, treat, cure, or prevent disease.
2. This article is for educational purposes and does not provide medical advice. Diagnosis and treatment should be individualized and guided by a qualified clinician. Product statements have not been evaluated by the FDA. Products are not intended to diagnose, treat, cure, or prevent any disease.

FREQUENTLY ASKED QUESTIONS

PIILIF, FAPD, treatment resistance, and what to do next

1) What is PIILIF?

PIILIF stands for Perifollicular Infundibulo-Isthmic Lymphocytic Infiltrates and Fibrosis. In plain terms, it describes a low-grade immune-type inflammation and early fibrotic change occurring around the upper portion of the hair follicle. It can coexist with androgenetic alopecia (AGA), also known as male pattern baldness or female pattern hair loss, and may be present even when the scalp looks “normal” on casual inspection.

2) Is PIILIF the same as FAPD?

Not exactly. FAPD (fibrosing alopecia of patterned distribution) is a term typically used when patterned hair loss shows a more advanced fibrosing or scarring-leaning biology. The key insight from this publication is that FAPD may align with a later stage within an AGA-PIILIF spectrum, rather than representing a completely separate condition.

From a practical standpoint, this means that earlier recognition of inflammatory and fibrotic drivers matters. Identifying AGA-PIILIF before extensive fibrosis develops allows clinicians to plan care with durability in mind, when the biology may still be more modifiable.

Waiting until the histologic features associated with FAPD are fully established may correspond to a more treatment-resistant stage. For this reason, the authors emphasize the value of recognizing and addressing AGA-PIILIF earlier, rather than deferring evaluation until later stages when fibrotic changes are more entrenched.

3) Do I need a biopsy to know if I have PIILIF?

Not everyone needs a biopsy. A biopsy becomes more relevant when your provider finds signs of inflammation on magnified (trichoscopic) examination of your scalp. The threshold is reduced if you are already a non-responder, your presentation is ambiguous, you have symptoms that do not fit “routine AGA” (itch, tenderness, burning, persistent scale), or you are making high-stakes decisions like hair transplant planning. The goal is not to biopsy everyone, it is to confirm scalp biology early when the stakes or uncertainty are high.

4) Why did my finasteride or minoxidil stop working?

There are several reasons treatments may stop working, and not all are about the medication itself. The main concept here is that AGA or pattern baldness is often treated as purely androgen-driven, but in a meaningful subset of patients an inflammatory and early fibrotic process may be operating in parallel. If that second driver is active, “more DHT control” alone may not fully stabilize the situation, which is why biology-aware evaluation and a dual-pathway strategy may be needed in selected cases.

5) Can PIILIF affect hair transplant outcomes?

It can. Hair transplantation is not just about graft numbers or technique, it is also about the health of the recipient scalp environment and long-term stability of surrounding native hair. If inflammatory-pattern biology and early fibrosis are active, predictability and durability can be affected, which is why scalp optimization and biopsy-informed planning can be important in higher-risk candidates.

6) What are phytoactives, and where do they fit in a long-term plan?

Phytoactives are plant-derived compounds that may support the scalp environment as part of a broader hair loss program. In a long-term maintenance context, many patients and clinicians prefer steroid-sparing approaches when appropriate, especially when scalp inflammation behaves as a chronic, low-grade process. In that framework, a phytoactive topical or oral product can be considered as supportive care, but it is not a replacement for diagnosis, and it should be used as part of a clinician-guided plan when stronger interventions are indicated.

7) Does PIILIF require lifelong treatment?
PIILIF, when present, may behave like a chronic, genetically influenced inflammatory tendency around hair follicles. The practical goal is long-term control and stability, not a one-time cure. Some patients may need ongoing maintenance for years, with the plan adjusted over time based on symptoms, exam findings, and overall risk profile under clinician guidance.

8) Do I need strong steroids or immunosuppressants to control PIILIF?
Not necessarily. AGA-PIILIF can be subtle compared with overt primary scarring alopecias, so aggressive therapy is not automatically the default. In our cohort, the emphasis was on steroid-sparing strategies that can be considered for longer-term use when clinically appropriate. Treatment choice and intensity should be individualized and supervised by a qualified clinician.

9) What kinds of long-term, steroid-sparing treatments were used in the study?
In this cohort, patients were managed with a steroid-sparing approach tailored to clinical context and often used in combination. Treatments used included dutasteride or finasteride, oral minoxidil, topical calcineurin inhibitors, and time-limited tetracyclines (such as minocycline or doxycycline). A selected phytoactive topical and oral option (Gashee) was also used as part of the broader scalp-care plan when appropriate.

In this retrospective dataset, the clearest statistical associations with improvement were observed in regimens that included: Gashee topical, Gashee oral, topical calcineurin inhibitors, minocycline, and dutasteride. Because many patients received combination regimens, these findings do not establish that any single component alone caused the observed outcomes. Observational findings do not prove cause and effect, larger studies are needed, and individual results vary. Gashee is not intended to diagnose, treat, cure, or prevent disease.

Important note: Products and supplements are not intended to diagnose, treat, cure, or prevent disease. Individual results vary, and medical decisions should be individualized with a qualified clinician.

The post VIDEO: Read This If Your Hair Loss Treatment or Hair Transplant Has Stopped Working. What Science Shows appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

Anwar Wants People to Notice Him, Not His Scalp Condition

Anwar knows that if he has a more common condition like acne or vitiligo, people might not ask him many questions, and the condition would have less of an impact on his life.  Instead, due to FD not being very common or well-known, Anwar finds himself the object of stares and the subject of questions. He is afraid people see his disease, and not him.

“I think best case scenario is I’m left with a more flatter, hairless scar, which people might, attribute to nothing, and what that changes is that folks will have less questions because it’s not something that’s widely known about,” Anwar states…”But what I have, folks don’t really know what it is, so the conversation starts out as what is that, as opposed to, what are the other parts about you.”.

Watch Anwar’s Story

Watch the fifth chapter of Anwar’s transformation here:

• Also available on Instagram and TikTok

Take the Next Step

If you or someone you know is struggling with Folliculitis Decalvans (FD), don’t wait. Early intervention and expert care can change lives.

Fill out our free online consultation form to have your case personally reviewed by Dr. Sanusi Umar.

Individual results may vary. This story reflects one patient’s personal experience with Folliculitis Decalvans (FD) and treatment with Dr. Umar. Consult with a qualified physician for personalized advice.

The post A Scar Would Be Nice: Anwar Hopes for Complete Removal of the Folliculitis Decalvans Mass appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

Scalp Micro-Pigmentation VS. Head Tattooing

While SMP and head tattooing may seem similar, they have different purposes and will give patients distinct results. Head tattooing employs traditional tattooing methods, and the results are more decorative and artistic than realistic. It employs standard tattoo ink applied deep into the dermis, and it could discolor to blue or green, migrate on the skin, and can be difficult to reverse without the use of laser tattoo removal.

Meanwhile, SMP is a clinical technique performed by trained practitioners to simulate the appearance of natural follicles. “We use specialized ink and a specialized technique,” said Dr. Umar. “Usually very superficial, to impact this look of scalp, creating the effect of stubble on the head in a pattern that mimics the natural distribution of hair.” Ultra-fine needles are used to deposit pigment into the upper dermis, resulting in a natural-looking hairline and density.

Why Patients Choose Head Tattoos

Many individuals seek head tattoos to reclaim confidence or camouflage balding. While the sentiment is valid, it’s important to distinguish between artistic intentions and clinical outcomes. SMP is tailored to restore the appearance of hair, not simply distract from its absence. Our patient Michael came into the Dr. U Hair and Skin Clinic seeking a procedure like this to achieve a fuller look while sporting a crew cut style. That’s when Dr. Umar suggested he get scalp micropigmentation (SMP) to complement his hair transplant results.

This technique is especially effective for:

• Camouflaging hair transplant scars
• Enhancing the appearance of hair density
• Refining hairlines after transplantation
• Creating a natural buzz-cut look

Patients like Michael demonstrate that hair restoration is not always about regrowth. Sometimes, it’s about recreating the illusion of density in a way that aligns with a patient’s lifestyle and appearance goals. SMP provides a subtle, impactful solution that empowers patients to wear shorter styles with confidence.

A Nonsurgical Approach To A Fuller Head Of Hair

SMP involves strategically tattooing pigment to the skin to create the appearance of stubble, making the scalp look fuller while softening harsh hairlines that were a result of hair transplants. In Michael’s case, it was used to disguise his strip hair transplant scar and give his buzzed hairdo a dense yet natural appearance. Because of his successful hair transplant with the Dr.UGraft® system, he was the ideal candidate for this procedure. “It’s the perfect use of SMP,” said Dr. Umar. “You have the hair, and then you just augment the density.” 

Subtle Yet Impactful Results Through SMP

Now, Michael can happily shave his head without worrying about bald patches and his previous scarring. The combination of FUE and SMP gave him realistic results, a softer hairline, and scalp density that he can be proud of. “I think this is the only combination of procedures that could’ve achieved this result from any doctor,” said Michael. “It looks so natural that nobody has commented on it.” These results fade gracefully within 18 to 24 months, and the procedure can be redone to achieve a fuller appearance of hair without the need for invasive surgeries.

Is Scalp Micropigmentation Right For You?

Follicular unit excisions have steadily grown in popularity, but many patients don’t realize that they have the option to complement their hair transplant results with SMP. As you have seen with our patient Michael, this procedure can render a realistic hairline and fullness that elevates your look, whether you’ve had hair transplantation surgery or not. To learn if scalp micropigmentation is right for you, book a free online consultation with Dr. Umar by filling up this form.

Individual results may vary. This story reflects one patient’s personal experience with scalp micropigmentation with Dr. Umar. Consult with a qualified physician for personalized advice.

POV: It looks cool… until you realize it’s your hairline #reels #shorts #hair #tattoo #DrU

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The post Scalp Micropigmentation vs. Head Tattoo: Which Is Right for Your Hair Loss Journey? appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

Why Standard Tools Fail

Afro hair is tightly curled underneath the skin, and the follicles curve in a way that’s hard to see or follow with regular FUE tools. Most standard punches are straight and can’t adapt to this curvature, so they cut through the follicles instead of removing them intact. This is what’s called a transection, and it renders the graft unusable. When surgeons attempt FUE with these conventional devices, the results are often discouraging: high transection rates, poor graft survival, and patients left feeling hopeless about restoring their hair density.

Dr. Sanusi Umar’s Solution To Afro Texture FUE

Designed with inclusivity in mind, the Dr.UGraft Zeus system adapts intelligently to different hair and skin types, including tightly coiled, Afro-textured follicles, reducing the risks that have historically excluded these patients from FUE procedures

The device includes intelligent presets for:

• Afro-textured hair
• Straight or wavy hair
• Beard and body donor hair
• Long hair FUE

The system efficiently covers all FUE scenarios by providing adjustable torque, rotational speed, and movement dynamics. These work in tandem with an advanced hybrid smart punch to optimize follicle harvesting for different skin and hair types. Other standard devices don’t have these custom modes, and, combined with a sharp punch, they more often transect coiled Afro hair. The Dr.UGraft Zeus device is the only all-purpose device capable of performing FUE on textured hair, making it a particularly useful tool for African descent patients who want to undergo hair transplant surgery.

Watch the Dr. UGraft Zeus device in action in this Youtube Short:

POV: Afro beard hair, pulled to perfection by Dr. Umar #reels #shorts #asmr #satisfying # #DrU #hair

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Proven Results Backed By Numbers

An independent study by Dr. Umar found that the Dr.UGraft Zeus device yielded consistent results across African descent patients who underwent FUE with it. Less than 10% of the follicular units extracted were broken and transected, whereas standard FUE tools with sharp punches can have a transection rate of up to 80% on coiled, Afro-texture hair.

An Inclusive Tool For All Hair Types

As the inventor of the Dr.UGraft® Zeus system, Dr. Umar has not only demonstrated his expertise in hair transplant surgeries, but he has also made the procedure more inclusive to traditionally underserved communities, particularly African descent patients, whose physical characteristics, heritage, and gene mixing have made them a particularly challenging group for FUE. By embracing the diversity of hair types, including those traditionally labeled “too difficult,” Dr. Umar has created a pathway for healing, confidence, and inclusion.

If you have Afro-textured hair and practitioners told you that hair transplants are not an option, it is time to explore the possibilities with Dr. UGraft Zeus. Fill out our online consultation form and discover a treatment designed for you.

Individual results may vary. This story reflects one patient’s personal experience with follicular unit extraction with Dr. Umar. Consult with a qualified physician for personalized advice.

The post Why Standard Hair Transplants Fail Afro Hair and How Dr. Umar’s Innovation Restores Hope appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

During a hair transplant, the practitioner takes grafts from a donor area, typically the back of the scalp. But what happens when this area has an insufficient number of hair follicles to harvest? This was the case for Jon, who wanted to overcome male pattern baldness while having a minimal donor supply to work with. After numerous failed transplants, he found Dr. Sanusi Umar, who used his expertise and cutting-edge tools to help Jon achieve a restored hairline and density.

When Traditional Hair Transplants Aren’t Enough

Our patient was desperate to bring back a full head of hair. He had undergone multiple hair transplant procedures that had failed, so his doctors referred him to Dr. Umar, an expert and innovator in follicular unit excision (FUE). Upon the first examination and testing, it was discovered that Jon suffered from perifollicular infundibulo-isthmic lymphocytic infiltrates and fibrosis (PIILIF). This inflammatory scarring condition attacks hair in an autoimmune fashion.

He likely had this undetected condition throughout his previous hair transplants, which is why each surgery resulted in suboptimal results. This left him still bald and with a depleted supply of donor hair from the sides and back of his head. Before even considering a hair transplant again, Jon was treated for the PIILIF, and Dr. Umar used his experience and technology to harvest donor grafts from elsewhere on the body.

Turning To Body Hair Transplantation

Despite the complexity of Jon’s case, Dr. Umar believed a solution was still possible. He proposed a unique approach: performing a FUE hair transplant using body hair from the beard and stomach.

FUE on regions other than the scalp poses its problems, which make hair more prone to transection:

• Hair grows at different angles
• Each strand can have its own unique texture and curl pattern
• Different areas of the body have different skin thickness

It’s limitations like this that influenced Dr. Umar to develop and invent the UGraft Zeus device.

UGraft Zeus: A Game-Changer in Body Hair Extraction

Unlike other FUE devices, the UGraft Zeus is an advanced, all-purpose FUE device that offers practitioners different modes and settings, depending on the area from which they are harvesting grafts. Each mode automatically adjusts torque, rotational speed, and movement dynamics to optimize follicle harvesting for different skin and hair types.

The device is also designed to promote optimal skin healing and minimize scarring due to:

• The punch shape, which dilates the skin rather than cutting a hole
• Fluid-assisted extraction, which reduces trauma
• The ability to adjust to different skin thickness
• The way it creates small, collapsible wounds that close faster

Jon’s Improved Hair Coverage Post-Surgery

Using the UGraft Zeus system, Dr. Umar was able to harvest grafts from Jon’s beard and stomach area, totalling about 12,000 grafts. Each graft was transplanted onto the scalp, and Jon now has improved hair density, length, and a newfound sense of confidence. The donor areas, as well, only have minimal scarring thanks to the UGraft Zeus system.

Now, Jon is satisfied with the results and happy about how Dr. Umar provided him one last shot at restoring his hairline, despite all the failed attempts that weighed on him. “I wanted to see what we could do,” he said. “And it’s been a remarkable transformation because I had very, very little hair on top.”

You Can Overcome Male Pattern Baldness, Too

If you’ve been told you’re not a candidate for hair restoration due to limited donor hair, previous transplant failures, or scarring, know that you still have options. At Dr. U Hair and Skin Clinic, we specialize in treating challenging cases using body hair transplantation, UGraft technology, and a deeply personalized approach. Like Jon and our other patients who have undergone hair transplant surgery, you can take the first step in your hair transplant journey by filling out our free online consultation form to be reviewed by Dr. Umar.

Watch the Jon’s transformation here:

Individual results may vary. This story reflects one patient’s personal experience undergoing follicular unit excision (FUE) with Dr. Umar. Consult with a qualified physician for personalized advice.

The post After Failed Hair Transplants and No Donor Hair Left, Jon Found a Life-Changing Solution with Dr. Umar appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

FFA is primarily linked to hormonal changes and is very common in women in the menopause stage; younger women in their post-teenage years and men of African descent, Asians, and whites have recorded the most cases. 

We classify FFA into early and progressive stages. 

•   Early Stages

During the early stages of FFA, balding skin runs thinly on the front area of the scalp and sometimes on the sides. This condition starts slowly and progresses with time.        

• Progressive FFA

As the condition advances, the affected areas appear pale, with no follicle openings, presenting an unusual appearance.

What Causes Frontal Fibrosing Alopecia (FFA)?

Experts have yet to discover the leading cause of FFA as it is scarce. FFA cases are increasingly getting reported, with some diagnosed alongside the female pattern of Androgenetic Alopecia.

Some of the suspected causes are:

Hormones

FFA typically affects women in their post-menopausal stage, which leads to the belief that hormones play a significant role in its development for older women. Hormonal tests for patients with FFA, however, rarely show abnormalities.

Genetics

Research is still underway to connect genetics to the cause of FFA; however, several patients have reported that family members suffer from the condition. Specialists suspect that specific genes increase the chances of developing the condition.

Autoimmune Disease

FFA can be related to another autoimmune disease, Lichen Planopilaris (LPP), which attacks healthy hair follicles. As an underlying condition, LPP can lead to FFA, as affected hair follicles become damaged, leading to scarring.

Surgeries

Iccorectly done hair transplants can damage the scalp or beard. It is advisable to consult a certified board doctor for such procedures.

Environmental Factors

Excessive sunscreen, medications, intense sun rays, and viral infections might cause FFA.

Symptoms of Frontal Fibrosing Alopecia (FFA)

Unlike other forms of Alopecia, FFA has few unnoticeable symptoms, which include:

•         Hair loss on the front and scalp sides.
•         Scarring from damaged hair follicles.
•         Painful scalp.
•         Yellow-colored bumps on the hairline

The least common symptom is hair loss on the:

•         Eyebrows
•         Eyelashes
•         Beards
•         Underarms
•         Pubic areas.

How Do You Diagnose Frontal Fibrosing Alopecia (FFA)?

FFA is difficult to diagnose, considering its similarities with other scalp hair conditions. During the early stages, the symptoms are barely visible, which requires a consultation with an experienced specialist to avoid misdiagnosis.

Specialists physically examine the affected area,  followed by a biopsy, in which the doctor observes samples extracted from the hair and scalp under a microscope.

A histological examination can confirm the diagnosis and trace FFA cases to a patient’s lineage.

Doctors conduct trichoscopy to increase the accuracy of diagnosing eyebrows, eyelashes, and pubic hairs because subtle symptoms may go unnoticed. 

An association between FFA and other autoimmune diseases might require physicians to conduct additional tests, such as thyroid function and hematological and biochemical blood tests, to help establish the potential presence of different conditions. 

What Does Frontal Fibrosing Alopecia Look Like? 

What Treatments Are Available for Frontal Fibrosing Alopecia (FFA)?

There is no cure for FFA. However, there are several ways to manage and treat the symptoms and, in turn, slow down progression. With enough controlled trials, specialists can find a permanent solution to treat FFA. Therefore, patients must cautiously choose treatment methods to manage the condition effectively.

Some of the available methods include topical treatments and tablets.

Topical Treatments

• Inhibitor ointments. As a doctor prescribes, ointments can be applied directly on the scalp to reduce inflammation.
•  Steroid Injections. Doctors use the injections when a tiny scalp area has been affected. Side effects may include skin thinning and discomfort. However, doctors have credited steroid injections with reducing FFA progression.
• Topical steroids, such as gels, lotions, and mousses, help relieve symptoms in the affected scalp areas.

 Supplements

• Antibiotics. Patients can use supplements to reduce inflammation.
• Corticosteroids. Use steroid supplements in the short term to manage FFA symptoms. When used in the long run, one can experience side effects such as diabetes, high blood pressure, and weight gain. 
• Hydroxychloroquine. These supplements help reduce pain and scalp itchiness. When prescribed in early FFA stages, it can help in hair regrowth.
• Finasteride. This (or the dutasteride) medications slow down the development of FFA.

Other treatment forms include:

•         Laser therapy
•         Hair transplants can be considered after several years of managing the disease.
•         Medical tattooing to manage hair loss on the eyebrows.

Frontal Fibrosing Alopecia (FFA) Frequently Asked Question(FAQ)

Can Frontal Fibrosing Alopecia (FFA) be reversed?

If diagnosed early, you can manage FAA, and lost hair can be reversed. 

How long does Frontal Fibrosing Alopecia (FFA) last?

In some patients, FFA can last for years and progress further if left untreated. If you suspect FFA, consult a certified board dermatologist like Dr. Sanusi Umar through this link: https://dru.com/hair-free-consultation/ or use the consultation button below. 

Can Frontal Fibrosing Alopecia (FFA) be misdiagnosed?

FAA can be confused with female-pattern androgenetic alopecia (AGA) or, in some cases, with Traction Alopecia. 

References

Eva Maria Valesky, et al. Frontal Fibrosing Alopecia – Review of Recent Case Reports and Case Series in PubMed. 1 Aug. 2018, https://doi.org/10.1111/ddg.13601. Accessed 3 Aug. 2023.

Fertig, Raymond, and Antonella Tosti. “Frontal Fibrosing Alopecia Treatment Options.” Intractable & Rare Diseases Research, vol. 5, no. 4, 2016, pp. 314–315, https://doi.org/10.5582/irdr.2016.01065. It was accessed 8 Aug. 2020.

Lacarrubba, F., Micali, G., & Tosti, A. (2013). Absence of vellus hair in the hairline is a videodermatoscopic feature of frontal fibrosing alopecia. British Journal of Dermatology, 169(2), 473–474. https://doi.org/10.1111/bjd.12316

Tosti, A., Piraccini, B. M., Iorizzo, M., & Misciali, C. (2005). Frontal fibrosing alopecia in postmenopausal women. Journal of the American Academy of Dermatology, 52(1), 55–60. https://doi.org/10.1016/j.jaad.2004.05.014

The post What is Frontal Fibrosing Alopecia (FFA)? appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

There are two classifications: non-scarring and scarring forms of Alopecia. Hair loss affects people of all ages, genders, and ethnicities.

Types of Alopecia

Non-Scarring Alopecia 

Non-scarring Alopecia is hair loss that does not destroy the hair follicles, leaving a possibility of hair regrowth. It includes alopecia areata (AA), Alopecia androgenetic (AGA), Traction Alopecia, and Trichotillomania. 

• Alopecia Areata (AA)

Alopecia Areata, an autoimmune disorder, is one of the most common types of Alopecia, whereby the immune system attacks healthy hair follicles, leading to hair loss. 

Some characteristics of AA include patchy hair fall, which can also affect eyelashes, eyebrows, and any other hairy body part.

Researchers are still trying to establish the leading cause of Androgenetic Alopecia. At least 20% of people with AA have a close relative suffering from the condition. Thus, specialists have linked AA to genetics. 

• Androgenetic Alopecia (AGA)

Androgenetic Alopecia, also known as female-pattern hair loss or male-pattern baldness, is a form of Alopecia common in both genders. Specialists attribute the patterned baldness to genetics and environmental factors. 

• Male pattern: Hair loss starts on the crown with a receding hairline but rarely affects the sides and back of the head. It affects over 50% of males over the age of 50.
• Female pattern: Most common in older women, affecting about 50% of females above 65. Women rarely experience a receding hairline. Instead, tufts of hair go missing over the entire scalp, leading to general thinning.

• Traction Alopecia (TA)

Unlike other hair loss disorders, physical strain on hair follicles is the leading cause of Traction Alopecia (TA). TA occurs on any area of the scalp that is under strain.

These include: 

•         Wearing the hair tightly in dreadlocks, braids, or a ponytail
•         Tight headgear
•         Harmful chemical relaxers
•         Heavy hair extensions

Long-term strain on follicles results in frequent loss of strands of hair and might result in permanent damage to the hair follicles.

• Trichotillomania (Hair Pulling)

Also classified as an Obsessive-Compulsive Disorder (OCD) disorder, Trichotillomania is the overwhelming urge to pull out your hair. People diagnosed with the disorder often experience anxiety or tension, which they relieve by pulling out hair from different parts of the body, such as the head, pubic, or even the face, followed by a sense of gratification afterward.

Hair pulling is more common in females than males and is prevalent among teenagers and young adults.

Forms of Trichotillomania are:

•         Focused hair-pulling (intentional)
•         Automatic hair-pulling (subconscious)
•         Mixture of both focused and automatic hair-pulling

Both genetics and environmental factors can cause Trichotillomania.

Scarring Alopecia

Scarring Alopecia includes forms that destroy hair follicles, leaving scars on the scalp skin, which can prevent hair regrowth. Forms are Central Centrifugal Cicatricial Alopecia (CCCA), Frontal Fibrosing Alopecia (FFA),   Lichen Planopilaris (LPP) and Folliculitis Decalvans (FD). 

• Central Centrifugal Cicatricial Alopecia (CCCA)

Central Centrifugal Cicatricial Alopecia (CCCA), as the name suggests, is a scarring Alopecia that starts at the scalp’s center, gradually thinning the hair to leave scar tissue. Bad hair-grooming habits, with low chances of genetic interference, can trigger the disorder.

CCCA is very common among middle-aged women of African ancestry, but in rare cases, it affects both men and women of all ethnicities. Hair loss is permanent but can be managed by slowing or stopping it altogether. 

•   Frontal Fibrosing Alopecia (FFA)

This form of scarring Alopecia affecting the front part of the scalp is a form of localized inflammatory Condition-Lichen Planopilaris.

FFA causes slow but progressive hair loss, especially in postmenopausal women. Although linked mainly to hormonal changes, FFA may affect younger men and women, not only on the forehead but also on the eyes and other hairy body parts. In severe cases, FFA attacks the fine hairs on the face and hands, causing skin-colored bumps known as papules.

•     Lichen Planopilaris (LPP)

Lichen Planopilaris, or LPP, is another form of scarring hair loss that affects the mucous membrane and scalp skin. Common in women, some characteristics of LPP include scaly skin, bald patches, a red scalp, itching, and a painful burning sensation. Anyone can be affected by the disease; however, it is very prevalent in women between the ages of 30 and 60.

Specialists have yet to establish the cause of LPP, but it is termed a hair follicle autoimmune disorder.

•    Folliculitis Decalvans

Folliculitis Decalvans (FD) is a long-term (chronic) rare scarring alopecia that causes inflammation of the hair follicles.

FD is standard in middle-aged adults and can lead to permanent hair loss caused by permanent scarring on the affected areas.

It is one of the most persistent forms of hair loss attributed to its prolonged autoimmune nature.

Read about all the forms of alopecia in detail through this link: https://bumpinator.com/ or request a free consultation at: https://bumpinator.com/bumpinator-akn-free-consultation-form/

References

Bittencourt, C., Ferraro, D. A., Soares, T. C. B., Moraes, A. M., & Cintra, M. L. (2014). Chronic telogen effluvium and female pattern hair loss are separate and distinct forms of alopecia: a histomorphometric and immunohistochemical analysis. Clinical and Experimental Dermatology, 39(8), 868–873. https://doi.org/10.1111/ced.12406

Moseley, I., George, E. A., Tran, M., Lee, H., Qureshi, A. A., & Cho, E. (2023). Alopecia areata in underrepresented groups: preliminary analysis of the all of us research program. Archives of Dermatological Research, 315(6), 1631–1637. https://doi.org/10.1007/s00403-023-02548-y 

Ogechi Ezemma, Shivali Devjani, Balaji Jothishankar, Kelley, K. J., & Senna, M. (2023). Racial and Ethnic Diversity in Janus Kinase Inhibitor Alopecia Areata Clinical Trials: A Systematic Review. Skin Appendage Disorders, 9(5), 351–354. https://doi.org/10.1159/000531219 

Sperling, L. C., & Cowper, S. E. (2006). The Histopathology of Primary Cicatricial Alopecia. Seminars in Cutaneous Medicine and Surgery, 25(1), 41–50. https://doi.org/10.1016/j.sder.2006.01.006 

The post Understanding Forms of Alopecia appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

Research on AA shows that at least 20% of patients show signs of the disorder by the age of 20 years, whereas above 80% of cases are likely to experience symptoms before the age of 40 years.

AA affects all races and genders. More incidences are among African Americans than in white people. The condition is, however, more prevalent in whites than in Asians. Conclusively, the most affected group of people are African Americans, followed by white people, and finally, with fewer cases, Asians.

Note: Alopecia means hair loss, while areata means patchy. 

Forms of Alopecia Areata (AA)

Forms of AA include:

•  Alopecia Areata (Patchy Hair Loss)

Manifests as oval or round patches on the scalp skin or other hairy body parts.

•  Alopecia Areata Totalis

Refers to when all scalp hair is lost. Most cases of AA Totalis start as patchy hair loss.

• Alopecia Areata Universalis

Commonly known as AU, this form of AA leads to hair loss on the scalp, eyelashes, eyebrows, and even the pubic area.

Patchy hair loss rarely proceeds to develop into other forms. According to past recorded cases, most people develop AA between Totalis and Universalis.

What Causes Alopecia Areata (AA)?

In most autoimmune diseases, the immune system mistakenly attacks healthy tissues, destroying them. In the case of AA, the immune system attacks healthy hair follicles and damages them. This, in turn, leads to hair loss and eventually to bald patches, as follicles can’t produce more hair.

We have yet to discover the exact cause of AA. Specialists are still trying to understand what triggers the attack on hair follicles. Some of the possible causes are:

Genetics:

AA is related to several genetic factors; however, not everybody with the specific factors develops the disorder. For some people, a genetic link to family members (especially those who experienced hair loss before the age of 30) increases the chances of AA development. 

Potentially, AA might skip generations, leaving out some members of a family without the disease. 

In light of recent research, 15 gene sequences referred to as gene alleles influence the cause of AA. Possessing a number of the gene alleles does not necessarily mean you will develop the AA condition. The higher the number of the 15 genes a person has, the more the chances of developing AA at some point in life.

Some of these gene sequences control: 

•         Hair growth
•         Immune cell responses

Environment: Based on the little research on environmental triggers in AA, specialists and dermatologists suggest it is hard to generalize the idea because people react differently to environments.

Some of the factors are:

•         Diets with soy oil suggested a level of connection in accelerating AA development
•         Chemicals
•         Microbes on the skin and gut sometimes affect immune responses, thus attacking healthy hair follicles.
•         Infections such as the Epstein-Barr virus have been found in some AA patients.

Stress: Hair follicles and the skin are known to produce stress hormones. These can affect the functionality of skin immune cells or hair growth.

Hormones: Observations on several cases have linked hormonal effects to AA. 

•         Women in their pre-menopausal stage sometimes experience hair loss
•         Pregnant women experience hair regrowth in their third trimester

Research on these observations suggests that increasing or decreasing estrogen levels may alter immunity activities.

Symptoms of Alopecia Areata (AA)

Early Symptoms

•         Bald patches on the scalp
•         Bald spots from conjoined patches
•         Sudden loss of significant amounts of hair within a short period

Advanced Symptoms

•         Hair re-growth in some areas
•         Brittle and red nails
•         Scalp itches

How Do You Diagnose Alopecia Areata (AA)?

Like most skin and hair conditions, AA is diagnosed by a specialist through physical examination of the scalp and affected skin on the manifesting symptoms.

A dermatologist can request a deeper examination of the hair and scalp through a biopsy, in which a strand or layer is observed under a microscope to ascertain the diagnosis.

What Treatments Are Available for Alopecia Areata (AA)?

Alopecia areata (AA) can be treated in several ways, depending on the age, extent of hair loss, and form of AA.

There is no cure for the disease; however, we have various options to manage symptoms: 

Topical Therapies

• Topical corticosteroids are the most common mode of treatment for patchy AA. They manage inflammation and enhance hair regrowth, especially in children. Application is painless, and research indicates 70% regrowth after three months of treatment.
•  Intralesional corticosteroids: These are injected into the bald patches to stimulate hair regrowth. This treatment has proven to be one of the most efficient, with results of up to 60% hair regrowth after 4 to 6 weeks. 
• Topical contact sensitizers: This immunotherapy includes DiPhenylCyloPropenone (DPCP) treatment. DPCP is applied directly to the scalp once every week. An increased dose every week causes itching on the scalp or contact dermatitis. Dermatitis then regulates T-cell activity, reducing the chances of immune attack on hair follicles.
• Topical minoxidil: Studies show that topical minoxidil regulates enzymes that play a role in hair growth. Hair growth can be noticed within the first three months of treatment. Possible side effects include headaches and dermatitis. Once the treatment is completed, the side effects can be reversed.
• Topical retinoids: Specialists recommend that AA patients apply retinoids on the affected areas for six months, after which hair regrowth is noticeable. 

Systemic Therapies

• Systemic corticosteroids: The treatment involves using oral supplements consecutively for two days every week. Prolonged use of systemic corticosteroids can result in significant side effects. Doctors recommend a treatment duration of between 1 to 6 months.
• Phototherapy: UV light therapy helps treat several skin conditions. It is, however, yet to effectively manage AA.
• Laser treatment: Excimer laser treatment is the most common, with minimal side effects. 
• Miscellaneous therapies: Some agents, such as onion juice and topical azelaic acid, manage AA symptoms.

Patients taking oral or applicable medications have complained of several side effects following a few months of treatment. Recent research on the safety and tolerability of a new topical botanical formulation, GASHEE, containing over 12 phytoactive ingredients, proved effective in managing hair loss, as shown below.

Alopecia Areata (AA) Frequently Asked Question (FAQ)

Who treats alopecia areata?

Dermatologists. Ensure you consult a certified specialist to receive up-to-date treatment options.

You can complete a free consultation for your hair loss with board-certified dermatologist Dr. Sanusi Umar by using this link: https://dru.com/hair-free-consultation/

How is alopecia areata diagnosed?

Through a physical examination by a board-certified dermatologist. Get a free consultation by clicking the button below.

                                                                                FREE CONSULTATION  

Learn more about hair loss conditions here.

References

Lawson, C. N., Hollinger, J., Sethi, S., Rodney, I., Sarkar, R., Dlova, N., & Callender, V. D. (2017). Updates in the understanding and treatments of skin & hair disorders in women of color. International Journal of Women’s Dermatology, 3(1 Suppl), S21–S37. https://doi.org/10.1016/j.ijwd.2017.02.006

Macbeth, A. E., Holmes, S., Harries, M., Chiu, W. S., Tziotzios, C., de Lusignan, S., Messenger, A. G., & Thompson, A. R. (2022). The associated burden of mental health conditions in alopecia areata: a population‐based study in UK primary care*. British Journal of Dermatology, 187(1), 73–81. https://doi.org/10.1111/bjd.21055

Umar, S., & Carter, M. J. (2021). A Multimodal Hair-Loss Treatment Strategy Using a New Topical Phytoactive Formulation: A Report of Five Cases. Case Reports in Dermatological Medicine, 2021, 1–12. https://doi.org/10.1155/2021/6659943

The post What is Alopecia Areata (AA)? appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

Some degree of genetic influence and hormones such as androgens can cause AGA. 

Research on the United States population estimates that about 50 million men and approximately 30 million women are at some point in their lives affected by Androgenetic Alopecia.

AGA development risks increase with age. 

Types of Androgenetic Alopecia

Male Pattern Baldness

This form of alopecia is common in males over 50. Hair loss begins on the crown, causing a receding hairline to the center of the head. In most cases, hair loss does not affect the back or sides of the head; thus, the name ‘patterned’ is used.

Male pattern manifests itself in seven stages:

Stage 1: Little hairline recession or hair loss.

Stage 2: Slight hair loss on the temple (area behind your eyes or between the forehead and the ears).

Stage 3: Hair loss on the temple proceeds to form a U or M shape.

Stage 4: Major hair loss on your crown. In some cases, the hairline recession grows further.

Stage 5: The bald area on the crown connects with the receding hairline.

Stage 6: The area between the crown and the temples is gone.

Stage 7: Thin band-sized hair surrounds the head, with complete baldness at the top.

Female Pattern Hair Loss

Female pattern hair loss (FPHL) often manifests in older women over 50. Statistically, about 50% of women over 65 develop the condition. Unlike the male pattern, females rarely experience a receding hairline. Instead, affected people manifest thinning of the hair all over the head followed by falling out of tufts of hair. 

Balding Stages in Female Pattern Hair Loss:

The first appearance of female pattern hair loss manifests through thinning the hair around the crown. In this case, the thinning affected part forms an oval shape, while the hair around it remains dense and regular. The female hair loss resembles male baldness but differs by the frontal area, which remains unaffected in females.

This form of androgenetic alopecia advances with age. Older women have more pronounced hair loss as the number of short and thin hairs increases.

In fewer cases, the crown might become completely bald in younger women yet to hit menopause.

The genetic predisposition responsible for AGA baldness in men also affects hair loss in women. Females, however, take longer to show signs. At the onset of menopause, women produce high estrogen levels, which protect the hair from falling off. 

Estrogen levels play a crucial role in fighting against dihydrotestosterone and other androgenic hormones that cause AGA. As estrogen levels reduce with menopause, hair starts to thin out and fall, leading to visible signs of FPHL. 

What Causes Androgenetic Alopecia?

Several factors lead to the development of Androgenetic alopecia. Ongoing and current research studies show that hormones, among other factors still under research, are most likely to cause AGA. 

Some of the factors are:

•  Hormones: Androgen hormones, specifically dihydrotestosterone (DHT), play a part in developing androgenetic alopecia, thus the name. Androgens ensure normal development for the male gender during puberty. Other functions include regulating sex drive and hair growth.
• Age: Development chances increase in male and female patterns of Androgenetic Alopecia.
• Genetics: If your parents develop hair loss at a certain point, you might as well experience it. The AR gene, found on the X chromosomes, also affects the production of androgens.
• Inflammatory condition: Attacks the follicle environment. 

Symptoms of Androgenetic Alopecia

These are some of the primary symptoms:

General

•  Predictable hair loss pattern

In Men

• Receding hairline
• Hair thinning on the crown
• Complete baldness at the top of the scalp area.

In Women

• Hair thinning on the whole scalp, with widening of the center
• Balding of various spots

What does it look like?

How Do You Diagnose Androgenetic Alopecia?

Androgenetic Alopecia is very easy to recognize. You should consult a certified specialist to examine the scalp physically. To ascertain if it is indeed the condition above, the doctor will check the hair follicles’ thickness, trace the scalp’s balding, and assess the hair loss pattern (if any). 

What Treatments Are Available for Androgenetic Alopecia?

AGA has no permanent cure. Patients experiencing the condition have been diagnosed with depression and anxiety linked to the worry and pressure brought about by losing hair, especially for younger people.

Treatments Used to Manage AGA

Drugs

Oral finasteride and topical minoxidil are FDA-approved in the United States to slow down hair loss and stimulate growth. Finasteride is recommended for male pattern balding, which negatively affects women of childbearing age and post-menopause. 

Topical Therapies

Patients with mild AGA who want to avoid side effects caused by oral medications can opt for:

• Topical Minoxidil: It is available in liquid and foam solutions and is applied on the front part of the scalp to accelerate hair regrowth by increasing strand density and diameter. A certified specialist advises that you will notice positive results within 4 to 8 months if applied effectively.  

Note: Involve a specialist to assess possible allergic reactions related to the treatment.

• Topical Finasteride: The gel reduces balding when applied chronically at least once to the affected scalp areas. 

Hair Transplant

The doctor transfers healthy hair skin grafts from other parts of your body onto the balding area. Side effects might include scarring, skin irritation, and scalp pain.

• Follicular Unit Strip Surgery (FUSS): FUSS is a procedure that involves surgically removing oval-shaped hair strips from the side or back of the head. A specialist then divides the strip into smaller grafts and transfers them to the bald area. This procedure is only applicable to specific patients as recommended by a doctor. Patients might acquire a deformed or unnatural look post-surgery.
• Basic Follicular Unit Extraction (Basic FUE): in FUE, a surgeon uses a unique tool to cut around single hair follicles from the back or sides of the head. The surgery rarely qualifies for most patients as the donor pool is limited to the head.
• Dr.UGraft Advanced FUE: Dr. Sanusi Umar’s Dr.UGraft Advanced FUE system has expanded the available donor source by utilizing body and scalp hair for transplants. Dr. Umar’s revolutionary advanced FUE invention uses a specialized tool that guarantees hair follicles are not damaged during extraction. The Dr.UGraft Intelligent Punch has proven to be a breakthrough in the industry, with hundreds of patients receiving long-term hair restoration.  

Temporary methods

These are treatment options that require everyday usage to manage AGA. They include wigs, hairpieces, scalp pigmentation, and hair loss concealers. It is one of the cheapest treatment methods to manage the condition, however, the results lack a natural look. 

Dr.Ugro Gashee FineTouch Laboratories

This topical formulation contains different vitamins, botanicals, and cosmeceuticals used to manage AGA. The liquid lotion contains methylsufomethane to help penetrate the treatment ingredients. 

Androgenetic Alopecia Frequently Asked Question(FAQ)

Can androgenetic alopecia(AGA) be cured?

It has no cure but can be managed with various treatment options.

Can hair grow back with androgenetic alopecia(AGA)?

It is possible but varies from patient to patient and the treatment option applied.

What causes androgenetic alopecia (AGA)?

Irregular androgen hormones play a part in hair growth regulation.

References

Kaliyadan, F., Nambiar, A., & Vijayaraghavan, S. (2013). Androgenetic alopecia: an update. Indian Journal of Dermatology, Venereology and Leprology, 79(5), 613–625. https://doi.org/10.4103/0378-6323.116730

Norwood, O. T. (2001). Incidence of Female Androgenetic Alopecia (Female Pattern Alopecia). Dermatologic Surgery, 27(1), 53–54. https://doi.org/10.1111/j.1524-4725.2001.00124.x

Olsen, E. A., Messenger, A. G., Shapiro, J., Bergfeld, W. F., Hordinsky, M. K., Roberts, J. L., Stough, D., Washenik, K., & Whiting, D. A. (2005). Evaluation and treatment of male and female pattern hair loss. Journal of the American Academy of Dermatology, 52(2), 301–311. https://doi.org/10.1016/j.jaad.2004.04.008

Umar, S., & Carter, M. J. (2021). A Multimodal Hair-Loss Treatment Strategy Using a New Topical Phytoactive Formulation: A Report of Five Cases. Case Reports in Dermatological Medicine, 2021, 1–12. https://doi.org/10.1155/2021/6659943

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