Trichology Introduction
Hair is perceived as a sign of vitality and youthfulness. While having thick shiny bouncy hair builds your image and confidence, hair loss generates feelings of low self-esteem and anxiety from a perception of diminished attractiveness. Trichology is a subspecialty of dermatology which deals with study of anatomy, physiology and disorders of hair and scalp. This term is derived from the Greek word Trikhos meaning hair. Dermatologists are academically trained to diagnose Hair and scalp disorders and manage them efficiently.
An average scalp contains about 100,000 hairs. 80-90% of which is in active growing phase, 8-9% is in transition phase from growing to resting phase and only about1% is in resting phase which falls off daily while combing, shampooing etc. That is why trichologists consider hair fall of approximately 100 per day as normal.
Hair growth is a complex process which occurs in multiple phases:
- Active growth phase (Anagen) – Lasts for 2 – 5 years
- Transitional phase (Catagen) – lasts for 2 – 3 weeks
- Resting phase (Telogen) – Lasts for 3 – 4 months
Each hair on human body is in different stage of development.
In humans, sex hormones and Thyroid hormone influence the hair growth cycle.
Anagen: During this phase, hair grows in length. Rate of growth of scalp hair is usually 1-1.25 cm per month. This rate may differ according to your genetics or age and may get affected due to hormonal disorders and certain medicines.
Catagen: At the end of anagen phase, hair is signaled to go into catagen phase where it is converted into club hair which is not growing.
Telogen: hair is resting in the follicle in this phase. As new hair starts growing from stem cells below, it pushes this club hair to fall off.
There are various causes of hair fall.
Telogen Effluvium
Stressful events in life like surgery, severe physical or mental stress, recent illness, Post pregnancy, thyroid disorders, anemia, crash diets, sudden weight loss and certain medicines can trigger excessive hair fall. Finding and controlling underlying cause will arrest further progression of hair fall. If untreated this may progress to chronic telogen effluvium which may last for months to years.
Male pattern hair loss (Androgenetic Alopecia)
This is the most common cause of hair fall in men leading to baldness. A hormone responsible for this gradual onset hair loss is DHT (Dihydrotestosterone) which is converted from an androgen (Testosterone) in the skin with the help of an enzyme called 5-alpha reductase. This manifests as receding hairline or balding crown area which may further progress involving most of the scalp. Chances of baldness are increased if you have a family history of the same. A comprehensive consultation with your dermatologists and timely intervention in early stages of hair fall can arrest the progression of baldness.
Female pattern hair loss
This condition is characterized by a gradual reduction in hair density over the crown and widening of hair partition with retention of the frontal hairline. As opposed to Telogen effluvium, most of these women do not experience major hair fall but notice gradual thinning of pony tail and decreased density of hair on scalp. This can lead to psychological distress and social embarrassment.
Alopecia Areata
Commonly referred as Chaai or Undri in Marathi language, this condition presents as localized patches of baldness on scalp, beard, eyebrows and other body parts. It can affect any age group. It is an autoimmune condition wherein your own immune cells attack hair roots causing localized patches of baldness. Sometimes it may be associated with disorders of thyroid or diabetes mellitus.
Other hair and scalp disorders
- Fungal infections of scalp
- Scalp Psoriasis
- Follicular lichen planus
- Hair shaft disorders
- Autoimmune diseases like Lupus erythematosus
- Folliculitis of scalp
- Contact dermatitis to hair dye
Treatment of hair fall includes investigating and diagnosing the exact cause of hair fall. We at ETERNIS clinic aim at providing you the highest standard of care and individualized affordable treatment options which are supported by latest medical evidence.
Treatments available
Mesotherapy, PRP Therapy, Micro-needling, Low laser therapy, hair transplant.
The growth of coarse unwanted hair is embarrassing for both male and females and can sometimes become a cause of psychological distress if not treated.
Traditional methods of hair removal (waxing, threading and plucking) are painful, tedious and temporary. They need to be repeated at fixed interval for lifetime of an individual. As oppose to this Lasers work on the roots of hair affecting the growth cycle of the hair thus leading to permanent hair reduction over time. Some individuals may need prolonged maintenance treatments but at less frequent intervals. Thus Laser proves to be cost effective over a long run.
Hair growth can be classified as:
- Hypertrichosis is the excessive growth of body hair in a normal or abnormal pattern. It may be genetic or due to medications, hormones.
- Hirsutism is excessive growth of coarse hair in women following a male pattern — such as the beard, mustache or lower abdomen and may be due to heredity, hormonal problems, medications or sometimes tumors
How does laser treatment works?
Hair reducing lasers work by targeting the pigment in the hair follicle to produce heat, as a result of which the hair root is damaged to an extent which restrains the growth of hair in future.
Am I a candidate for laser hair removal?
As laser focuses on the pigment in the hair follicle, the ideal candidate is fair-skinned with dark hair. Grey or white hair does not respond to laser hair removal as there is no pigment to target.
Suitability of a laser for your skin and hair will be assessed by your dermatologist before going on to the treatment.
How is the procedure carried out?
The patient and treating physician or therapist wear safety eyewear to protect eyes from the laser light during the procedure. After applying cooling gel, Laser light is delivered through a hand piece of a laser machine, by gently touching the area to be treated. The laser light is given in very small pulses, usually fraction of a second. This might feel as little discomfort but most of the people describe it as tolerable. A test area will be done prior to the entire treatment.
Is the laser treatment painful?
As Laser treatment settings vary according to individual skin and hair types, so do the level of discomfort. Most patients describe the procedure as a little uncomfortable rather than painful. The inbuilt cooling system of our laser machine allows cooling the treatment area, hence reducing the discomfort level. However if you are having this treatment in a sensitive area, you may require an anesthetic cream to make the treatment more comfortable. A test patch performed at the consultation will give you an idea as to the discomfort level.
Are there any side effects?
Redness or mild transient swelling might be seen immediately after laser therapy which subsides in some time. In some patients pigmentary changes like hypo or hyper-pigmentation might occur which can last for few weeks to month but is reversible.
What precautions do I need to take?
Sun protection is must before and after the procedure to avoid pigmentary changes. You should also avoid waxing, plucking or threading during the whole course of laser hair reduction.
How many treatment will I need?
Hair grows in cycle and all the hairs are in different phase of growth cycle. Laser energy damages only hair which is in growing phase (Anagen). That is why you need several treatments to target all of the hair in its active growth phase. Due to individual variations in skin and hair type, some patients get substantial results in 3-4 sittings while others might require more than 8-10 sittings. Results also vary depending on the site to be treated and underlying hormonal disorders present.
Over time, few of the laser treated hair follicles may grow hair due to hormonal influence and thus maintenance treatments are recommended at less frequent interval in few individuals.
Can I remove the hair between treatments?
Only shaving with a razor is permitted during the course of laser hair reduction. You should avoid waxing, plucking or threading.
Is treatment safe over long term?
Lasers have been used in the medical profession for over 20 years with no long-term side effects reported.
Cosmetic Dermatology
What are professional peels & how do they work?
Peeling is a procedure in which concentrated extracts from certain plants or fruits are applied to your skin to enhance the appearance of the skin. This solution when applied to skin causes exfoliation of dead and damaged layers of skin to reveal fresh and glowing skin underneath. It also stimulates deeper dermal tissue leading to newer collagen formation and regeneration of skin.
What are chemical peels used for?
- Acne & Acne scars
- Skin Pigmentation – Melasma, Tanning, Freckles, Dark elbow & knees, Pigmented underarms
- Fine wrinkles
- Sun damaged skin
- Facial Rejuvenation
- Under eye dark circles
- Dark Lips
- Dull lusterless skin
What are professional peels & how do they work?
Peeling is a procedure in which concentrated extracts from certain plants or fruits are applied to your skin to enhance the appearance of the skin. This solution when applied to skin causes exfoliation of dead and damaged layers of skin to reveal fresh and glowing skin underneath. It also stimulates deeper dermal tissue leading to newer collagen formation and regeneration of skin.
What are chemical peels used for?
- Acne & Acne scars
- Skin Pigmentation – Melasma, Tanning, Freckles, Dark elbow & knees, Pigmented underarms
- Fine wrinkles
- Sun damaged skin
- Facial Rejuvenation
- Under eye dark circles
- Dark Lips
- Dull lusterless skin
How do I decide which peel to do?
A thorough consultation with your dermatologist is required to decide which peel is best suitable for your skin type and condition to be treated
How long does the treatment take?
An individual peeling session may last from 15 min to half an hour depending on area to be treated and indication.
How many sessions do I need to undertake?
You will appreciate results right from first sitting itself but to see the visible difference you may need 4-6 sessions spaced at every 2-4 weeks.
Are there any side effects?
If done under the guidance of expert dermatologist and trained staff there are no major side effects associated with peels. But mild redness, transient swelling or darkening of skin and sometimes exfoliation of the skin is expected. For best results and to reduce any untoward side effects, you should follow post peel instructions given by your dermatologist diligently.
Crystal free Microdermabrasion or skin polishing is a simple, non invasive and painless procedure which removes superficial dead skin layer to give you refreshing look. It is a type of superficial mechanical resurfacing technique which also stimulates underlying skin collagen, leaving your skin smooth and supple.
It is done using probes which are studded with diamonds and used for superficial scars, fine wrinkles, sun damaged skin, uneven skin texture and non inflammatory acne. It can be combined with other procedures like electroporation to enhance the results.
Advantages
- No discomfort or pain
- No downtime
- No anesthesia or chemicals used
- Visible Instant results
Platelet rich plasma (PRP) therapy is a novel, revolutionary and innovative treatment which works on healing and regenerative power of your own blood cells called platelets.
Platelets form a major component of your blood and are helpful for healing of tissue injury or damaged skin by secreting multiple growth factors.
During this procedure, a small sample of your own blood is drawn in a special test tube which is centrifuged to form a solution rich in platelets, which is then injected or used with dermaroller for specific skin or hair condition.
Dermatological/Aesthetic indications
- Hair re-growth
- Face rejuvenation & fine wrinkles (Vampire facelift)
- Acne scars
- Stretch marks
- Non healing wounds like Diabetic ulcer, Leg ulcers or burn wounds
Advantages of PRP
As this procedure utilizes your own blood, there is no risk of allergy to any chemicals or transmission of diseases like HIV, Hepatitis, etc.
It is virtually painless as it is performed under topical anesthesia.
It has minimal or no downtime.
Treatment is comfortable and well accepted by most patients.
Mesotherapy is a minimally invasive, virtually painless technique involving the placement of micronutrients, amino acids, hyaluronic acid, peptides and vitamins, with micro injections into the skin.
It is mostly used for hair fall management where growth factors and vitamins for hair are directly injected in to scalp skin using very fine needles to stimulate hair roots and providing nutrition to growing hair. It is repeated every couple of weeks initially for few sessions then frequency of treatment is reduced till desired results are obtained. A Maintenance treatment might be required in few individuals depending on severity of the condition.
Other indications
- Skin rejuvenation
- Skin pigmentation
- Deep skin hydration
No needle Mesotherapy/Electroporation: This novel technology is intended to achieve same results as Mesotherapy but without use of needles. Micronutrients or vitamins are pushed into the skin with the help micro current which creates micro channels in the skin cells. Treatment feels as tingling sensation on the skin but won’t make you uncomfortable. It makes dull lusterless skin glowing and radiant.
It is used for
- Fine wrinkles
- Pigmentation
- Skin tightening
- Skin hydration
- Vit C infusion
Micro-needling or medical needle therapy is a novel form of collagen induction therapy.
Collagen is an integral part of our skin imparting firmness and elasticity. It provides structural support to various components of skin thus giving smooth and plump appearance to skin. As we age, collagen starts degrading and decreasing in quantity thus leading to lax and wrinkled skin. Skin disorders like acne and chickenpox can cause localized damage to collagen forming depressed scars.
DERMAROLLER is a simple instrument having a wheel covered with multiple fine small sterile needles on it. When rolled on to skin it creates micro channels into skin and stimulates new collagen formation in deeper layers of skin. Medicines for skin and hair can be applied immediately to treated skin surface which penetrates deeper in the skin and enhance the treatment effects.
Procedure of dermaroller therapy
A topical anesthetic cream is applied on the area of skin to be treated for an hour to make the procedure comfortable. After cleansing the area thoroughly, dermaroller is passed on the skin gently in multiple directions. Redness and tiny bleeding points can be noticed on the skin at the end of the procedure. At the end of procedure, antibiotic cream is applied and patient can leave the clinic. Strict sun protection is advised before and after the procedure for optimal results.
MICRONEEDLE RADIOFREQUENCY (MNRF) is latest advance in the field of collagen induction therapy. In this technique RF energy is directly delivered to deeper layers of skin with the help of small sterile needles. The procedure is almost similar to dermaroller therapy but the results obtained are much superior.
Advantages of MNRF therapy
- Combined benefits of micro-needling and RF energy
- Precise and controlled depth of needle penetration
Indications for Micro-needling therapy
- Acne and chickenpox scars
- Open pores
- Lax skin
- Stretch marks
- Fine lines and wrinkles
- Hair fall and baldness
Botox® (Botulinum toxin) is a purified protein derived from bacteria called Clostridium Botulinum. It blocks the release of a chemical in the nerve which causes muscles to contract, thereby relaxing them. It was initially used and approved by FDA for spasm of the delicate eye muscles. Since then it has been successfully and safely used for various dermatological and non dermatological indications.
Most common use of Botox® in dermatology is for wrinkles. Wrinkles can be static or dynamic. Wrinkles which are formed by overuse of muscle or repetitive facial expressions are called Dynamic. They include frown lines, crow’s feet and forehead wrinkles. By relaxing these hyperactive muscles, Botox® irons out wrinkles and smoothens out facial expressions.
How safe is Botox®?
It has been safely used over 20 years for various indications with low incidence of reversible side effects. Mild bruising may be experienced by few patients but disappears in few days. Other uncommon mild side effects include headache, nausea, flu like symptoms or temporary eyelid drooping.
Is Botox® painful?
It is given in tiny quantities with smallest possible needles. Patient may experience mild discomfort but not pain. If required, anesthetic cream can be applied in the areas to be injected to make it more comfortable.
How do I know whether Botox® is right for me?
Anyone between ages of 18 to 75 is a potential candidate for Botox® treatment. Meet our dermatologists to know whether you are the right candidate and allay your fears about the procedure. Botox® injections should be avoided if you have active infection at the injection site or you have neurological conditions like myasthenia gravis or EATON LAMBERT syndrome or you are on certain drugs.
What are dermatological indications of Botox®?
Dynamic wrinkles: Frown lines, Crow’s feet, Forehead lines, Bunny lines, Pebbly chin, Jaw line and Neck bands
Hyperhidrosis (Increased sweating) in axillae, palms and soles.
Non-Surgical skin tightening
With age, skin all over the body tends to loosen and sag. It becomes most obvious on the face and neck. Skin laxity may occur after delivery or due to sudden weight loss. A face lift or neck lift are permanent solutions, but they involve surgery while most women prefer a non-invasive solution. The non-surgical method of skin tightening involves heat reaching deep into the skin.
The heat causes some immediate tightening of the tissue under the skin and signals the body to start making new collagen. As the new collagen forms, skin starts to appear firmer, tighter and younger. Various technologies are used for skin tightening and non ablative radiofrequency is one of the most common.
Indications
- Firming of forehead and cheeks
- Lift the eyebrows
- Tighten jowls and neck
- Reduce wrinkles around the eyes
- Diminish the appearance of cellulite
- Tighten skin on the abdomen, buttocks, arms, and thighs
How is it performed?
Once the patient is ready, heat is sent deep into the skin through a probe of a radiofrequency device that is passed over the skin to be treated. Usually, multiple passes are made. The procedure may last anywhere from a few minutes to 1 hour depending upon the area to be treated.
After the procedure, the treated area is generally red and may be mildly swollen which subsides in couple of hours. You can apply makeup immediately after the procedure to hide the redness. While special care is not required after the procedure, sunscreen should be applied to protect the skin.
Usually it requires 4 to 6 treatment sessions every fortnight or month, to see visible results. You may see some improvement after the first treatment itself but gradual improvement will be noticeable over 6 months. In general, results of skin tightening may last about 1 year or longer depending on your age and lifestyle.
Non-Surgical skin tightening
With age, skin all over the body tends to loosen and sag. It becomes most obvious on the face and neck. Skin laxity may occur after delivery or due to sudden weight loss. A face lift or neck lift are permanent solutions, but they involve surgery while most women prefer a non-invasive solution. The non-surgical method of skin tightening involves heat reaching deep into the skin.
The heat causes some immediate tightening of the tissue under the skin and signals the body to start making new collagen. As the new collagen forms, skin starts to appear firmer, tighter and younger. Various technologies are used for skin tightening and non ablative radiofrequency is one of the most common.
Laser Introduction
Co2 Laser
Qs NdYag
Photo rejuvenation