Is a Hair Transplant a Solution for Traction Alopecia?

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Is a Hair Transplant a Solution for Traction Alopecia?

Traction alopecia is an especially distressing type of hair loss to experience. Unlike other types, it’s caused by repeated, prolonged tension on the hair follicles. When caught early enough, the condition can be reversed and hair can resume healthy growth. In advanced cases, the follicles are too damaged to recover, and hair loss is permanent

Although we always say “knowledge is power,” the knowledge unfortunately sometimes comes too late to prevent permanent hair loss from traction alopecia. The situation is not hopeless, as we’ll answer our own question now and affirm that a hair transplant can restore hair to the areas of the scalp left bald or patchy by traction alopecia. However, learning more may help you recognize if you’re experiencing this condition in its early or advanced stages, and take the appropriate action.

Common Causes of Traction Alopecia

Traction alopecia is the term for hair loss from mechanical damage to the hair follicle caused by repeated tension or pulling. This can be caused by wearing the same hairstyle for long periods of time – especially those that tug on the hair. Tight hairstyles applied to chemically relaxed hair can lead to even greater damage. 

Because traction alopecia progresses over time, those affected may not connect the hairstyling method they’ve practiced for years with the reason for their hair loss. Moreover, many of the styling techniques that cause traction alopecia – collectively known as protective styles – have a long tradition in Black cultural identity and beauty.

A protective style refers to hairstyles that tuck away the ends of each hair strand to protect them from the elements, as the end is the oldest, most fragile part of the strand. Protective styles include but are not limited to twists, braids, updos, weaves and wigs. However, protective styles ultimately have the opposite effect. According to Kimberly Lewis, CEO and co-founder of CurlMix – a clean beauty brand for curly hair – protective hairstyles actually damage hair and hurt hair growth.

“Tension can be worse when you have short natural hair because the braider has to pull tighter to get all of your hair into the braid,” says Lewis. “Braids can seem like a better alternative to straightening your hair because there is less risk of ruining your natural texture but that doesn’t mean there is no risk. And many styles even go a step further by adding extra weight. The excessive use of ponytails weaves, and extensions are working double-time to give you tension damage. And what happens when your hair is pulled tightly and something heavy like extensions is weighing on it?”

What happens is the beginning of traction alopecia. However, women – and men – of color who wear protective hairstyles aren’t the only ones at risk. Gymnasts, ballerinas and women in fields that require their hair be pulled back can also develop it, as well as those who wear helmets or hats over extended periods, and repeatedly put them on and take them off. 

Recognizing the Early Signs of Traction Alopecia

When caught early, the effects of traction alopecia can usually be reversed. The signs aren’t always obvious, so it’s important to be aware of them in order to take action and avoid permanent hair loss.

The first signs of traction alopecia can include:

  • Redness or soreness around the hairline or scalp.
  • An itching or stinging sensation.
  • Pimples, small bumps or ulcers on the scalp or around the hairline.
  • Areas of thin or broken hair, especially where the hair has been under particular strain.

Should these early warning signs not be recognized, signs of advanced traction alopecia include:

  • Extensive hair loss and bald patches.
  • Irreversible scarring – the scalp may appear smooth and shiny.
  • A tender, inflamed scalp.
  • Frequent headaches.
  • A receding hairline – which typically occurs around the forehead, nape and temples. For some, the part might also widen over time.

Steps to Prevent Traction Alopecia

The best way to prevent traction alopecia is to wear a hairstyle that doesn’t create constant tension on the roots. If you must pull your hair up into a ponytail or bun, keep it loose and low on your head.

Other recommendations include the following:

  • Change your hairstyle every couple of weeks. For example, alternate between braids and wearing your hair down.
  • If you wear a ponytail, don’t use rubber or elastic bands to hold it in place. They can pull out your hair.
  • Avoid chemically processing your hair if you use weaves or braid your hair. The chemicals can damage your hair, making it more likely to break.
  • If you have weaves or extensions, wear them for only a short period of time and take a break between each use.
  • When you braid your hair or put it in dreadlocks, make the braids thick. Thinner braids pull more tightly.
  • Don’t use hair relaxers.
  • Keep the heat setting low on your hair dryer and flat iron.
  • Don’t sleep in rollers. Wrap your hair instead.
  • If you wear a wig, choose one with a satin wig cap, as it won’t pull as hard on your scalp.

Hair Transplantation as a Solution for Advanced Traction Alopecia

When hair loss is permanent, many women turn to wearing a wig. But having to wear a wig full-time to cover bald areas when out in public is very different from wearing one to be stylish. Even the highest quality wigs quickly become hot and uncomfortable. A hair transplant offers a permanent solution that can provide outstanding aesthetic results.

Our blog post – “Advanced Treatments for Non-Pattern Hair Loss” – relates the story of J.D. – a patient of  Dr. Marco Barusco – Founder and Chief Medical Officer of Tempus Hair Restoration – who sought treatment for her traction alopecia. At the time, J.D. was a pharmaceutical representative – a profession that requires a polished appearance when visiting multiple physician offices on a daily basis. As her hair loss progressed, J.D. tried to conceal it with wigs, weaves and extensions, which made the condition even worse. After consulting with Dr. Barusco, J.D. underwent a procedure that restored her hairline and temples with the full look of natural growth – which not only restored her confidence, but provided the extra boost for J.D. to start her own business.

Dr. Barusco typically recommends the Follicular Unit Transplantation (FUT) for traction alopecia. Also known as the “strip” method, this technique harvests hair follicles by removing a strip of hair from the back of the head (donor area). This strip is then dissected into smaller segments in order to implant individual follicles. The FUT has undergone refinements over the years so that the only evidence is a pencil-line linear scar easily concealed by hair – even at a shorter length. Dr. Barusco covers this method and its advantages for African-heritage women in his YouTube video – “Afro Hair Transplantation: FUT or FUE?” – on his Hair Loss Medical Advice channel.

The technology for the Follicular Unit Excision (FUE) procedure has developed to allow people of all ethnicities to have this option. However, it is typically not recommended for women dealing with traction alopecia, as it decreases the volume of the donor area.

The curling and twisting of African-heritage hair provides the appearance of good scalp density, which is an advantage in hair transplants. As our blog post – “Why is Ethnicity an Important Consideration for a Hair Transplant?” – covers, its curliness allows coverage of scalp areas with a fewer number of hair follicles needed to achieve an aesthetically pleasing “full” coverage – thereby reducing the number of follicles needed for transplantation.

However, hair may emerge at a variety of angles from the scalp, which can make the harvesting of donor hair more challenging. Both the follicles and hairs have a degree of curvature in relation to the scalp that must be accommodated when harvesting.

The ability to create a natural-looking hairline that’s flattering to each individual woman is essential in achieving an aesthetically successful outcome. For these reasons, it is especially important to choose a hair transplant surgeon with extensive experience in performing procedures for those with African-heritage hair.

Another factor to keep in mind is that Black patients may be at risk for developing keloid scarring. This appears as a puffy or raised pinkish area, and occurs when the skin is injured, or cut during a surgical incision. A conscientious hair transplant surgeon will ask if a prospective patient has a history of such scarring, or any other scarring scalp disorders. The surgeon will also monitor for scarring post-op, as well as watch for ingrown hairs, which can occur two to three months after surgery, when the hair begins to grow.

If you are considering a hair transplant to restore your hairline and temples due to traction alopecia hair loss, we hope we’ve provided the information you need to make an informed decision. Ultimately, choose your surgeon based on experience, results and integrity. Dr. Barusco’s long list of accomplishments, his notable artistic ability and his successful surgical team make Tempus Hair Restoration a renowned practice.

We understand that the main concern you may have is cost, which is why we offer financing options that can place this important goal within reach. Putting yourself at risk of the consequences of a hair transplant procedure at an overseas black market clinic – or even an unscrupulous domestic clinic where unlicensed non-medical personnel harvest and implant hair grafts – isn’t worth the perceived savings.

Contact us to schedule your free virtual consultation. Dr. Barusco conducts every consultation himself, giving you the opportunity to learn your options in the comfort of your home – or any location, on any internet-enabled device. 

Dr. Barusco conducts consultations in English, Spanish and Portuguese. For your greater convenience, Tempus Hair Restoration offers a two-night complimentary hotel stay to out-of-town clients who travel 100 miles or more to our Port Orange, Florida, surgical center. No matter how far the distance, we welcome the opportunity to help you on your hair restoration journey!

The Truth About Robotic Devices in Hair Transplant Procedures

Robotic assisted devices are promoted by many hair transplant clinics as a quick, foolproof tool for performing the Follicular Unit Excision (FUE) procedure. However, the truth is very different. Unfortunately, many men considering a hair restoration procedure don’t learn the truth, because misinformation is more prevalent than facts – be it on the websites of unscrupulous hair transplant or plastic surgery clinics, articles in men’s lifestyle and fashion publications, or social media.

As we at Tempus Hair Restoration always say, “Knowledge is power.” In the interest of giving you the knowledge to make an informed decision, here is what you need to know about robotic devices, and why you should expect (and demand) manual extractions and implantation by an experienced surgeon.

How a Robotic Assisted Device is Used in FUE Hair Transplants

Instead of the surgeon choosing which hair follicles to harvest from the donor area, a robotic assisted system evaluates the hair and – based on a complex algorithm – chooses the follicles that it identifies as being the best for transplantation. The device then harvests these follicles by means of a computer-controlled robotic arm. Although practices that utilize this device advertise it as the future of hair transplantation, there are limitations, even when used according to medical ethical standards and within the law (more about this later).

Narrow range of good candidates – The best-known robotic assisted device is very limited in those who are appropriate candidates. It can only be used on people with straight, dark hair – a fact that isn’t always mentioned in the media. People with blond, fair or curly hair (even dark or black hair) are not good candidates.

Restricted donor areas – Many patients require an extended donor area when the back of the head doesn’t have enough hair for a successful transplant. A robotic device can’t be used in such a scenario, as it is only able to extract hair from the back and sides of the head.

The possibility of healing complications – The best-known robotic device uses large diameter punches to extract follicles, which can cause complications in healing and even damage nearby follicles.

Graft survival – An experienced surgeon performing manual hair graft extractions can expect a survival rate of 97-95%. The robotic device has a survivability percentage of around 90%. This lower percentage can be attributed to the fact that after being harvested, the hair grafts are left in place by the device until the doctor removes them. This delay can lead to drying of the grafts, leaving fewer that are viable.

There is another type of system marketed for FUE transplants that you may see advertised. It uses automatic equipment to perform hair restoration surgery, and comes with a pneumatic motor – which operates through the expansion of air inside the device. This controls the pressure for extracting hair grafts from the back of the scalp and then implanting them into the recipient site. This is technically not a robotic device, as it features hand-held devices that should be operated by the hair transplant surgeon. The “should be” is important to note. Although it can be useful when operated by a qualified surgeon, this system has the potential for abuse by unethical clinics to relegate the procedure to untrained technicians due to its high level of automation.

How Marketing Messages Mislead Consumers About Robotic Devices

It may sound like somewhat of a generalization, but we expect things to be easy and convenient. Most of us also believe that advanced technology can improve our life, and feel ahead of the curve when we buy the newest smartphone. So most of the groundwork of promoting robotic devices as “the future of hair transplantation” is already done. Marketing messaging positioning robotic assisted FUE as an infallible high-tech procedure sets misleading, unrealistic expectations for success, yet often finds a receptive audience.

Still, ethical hair restoration surgeons recognize red flags when they’re raised. For example, the website of one clinic positioned the ability of robotic devices to allow less-experienced doctors to perform FUE procedures as an advantage. Now, ask yourself if it sounds like an advantage to the patient – that is, you – that using a robotic device makes it possible for a less-experienced doctor to offer hair transplants. According to this clinic’s website, “A less experienced doctor can rely on the [name redacted] machine to handle the delicate job of extracting grafts.”

Think about it. Why would you want a doctor with relatively little experience – not to mention knowledge – in performing hair transplants performing yours? Would you really feel confident that such a person is depending on a device to extract hair grafts? What does this imply about the experience of the doctor who has this statement on his website?

This robotic device also implants the harvested hair grafts – which may sound like a positive selling point to those who don’t realize that implantation requires an extremely high degree of knowledge, technical skill and both the professional experience and sense of aesthetics to place the grafts properly to achieve a natural-looking growth pattern. The popular buzz phrase “artificial intelligence” is used to explain how the device determines optimum placement, but this is no substitute for the eyes (and hands) of an experienced, skilled hair restoration surgeon.

This leads to the slippery slope of unlicensed, non-medical personnel performing some or all aspects of an FUE hair transplant procedure – which is much more common than you may know. If you’re new to our blog, our post – “Don’t Let a Technician Perform Your Hair Transplant Surgery” – covers this important topic in detail. We encourage you to read it.

What Consumers Aren’t Told About Robotic Hair Transplant Devices

Most accounts of hair transplants are in men’s lifestyle magazines (including online versions), and on social media. While you might think you’re educating yourself, the authors, publications and social media influencers often have their own agenda. And it isn’t to inform you. It’s to earn revenue from the clinics that advertise – either overtly in display ads, or subtly, in the free services and perks that writers and editors receive for featuring them in editorial content.

To start with the basics, the best-known robotic assisted device takes the critical elements of an FUE transplant that should be performed by the surgeon out of his/her hands – such as hairline design, the selection of hair grafts, recipient site preparation, harvesting of grafts, preparing grafts for implantation and graft implantation.

As Dr. Marco Barusco – Founder and Chief Medical Officer of Tempus Hair Restoration – writes in his article – “The Truth Behind Advertising Devices Instead of Surgeons”:

“Behind these devices there needs to be a competent doctor, and with the doctor, a competent team. Otherwise, no robot or vacuum-assisted gizmo will help you. But here is the big problem: these companies are advertising, selling and promoting these devices to doctors all over the country and the world who have no training in the complex procedure of hair restoration surgery. And they couldn’t care less. Their investors need to make their money, so therefore machines need to be sold … to whoever is buying.”

Modern Aesthetics describes the situation as follows:

“Unfortunately, some FUE medical device companies deceive some doctors into believing that after they buy this FUE motorized surgical drill that they can delegate these steps of hair transplant surgery to hair transplant technicians. Hair transplant technicians are medical assistants (MAs). MAs do not have to graduate from any school (even high school), do not have to pass any test, and are not licensed/certified by any medical governing body. A medical device company has no authority to provide MAs medical licenses to practice medicine. However, some FUE medical device companies are deceiving the public and doctors by giving these MAs certificates stating that they are certified and can be delegated to do these critical aspects of the surgery. This is illegal and probably criminal since it is aiding and abetting the unlicensed practice of medicine.”

In fact, it is illegal. As we always emphasize, hair restoration surgery is surgery. Any person recommending procedures and/or treatments is practicing medicine without a license, which is a felony crime in Florida and many other states.

The International Society of Hair Restoration Surgery (ISHRS) is an international, non-profit medical society comprised of over 1,200 members representing 70 countries dedicated to promoting the highest standards of medical practice and medical ethics. Its Position Statement on Qualifications for Scalp Surgery includes the following:

“The position of the International Society of Hair Restoration Surgery is that any procedure involving a skin incision for the purpose of tissue removal from the scalp or body, or to prepare the scalp or body to receive tissue, (e.g., incising the FUE graft, excising the donor strip, creating recipient sites) by any means, including robotics, is a surgical procedure. Such procedures must be performed by a properly trained and licensed physician. All FUE harvesting tools, including robotic devices, are considered extensions of the hand of the operator, and as such, all operators of these devices must be physicians.*”

Dr. Barusco is a Fellow of the ISHRS – a distinction only given to those who achieve certain landmarks on teaching and leadership. Currently, fewer than 10% of the ISHRS members are Fellows.

How to Educate Yourself and Choose Your Surgeon Wisely

Earlier, we mentioned that knowledge is power. However, we know that being able to tell the difference between marketing hype and facts can be hard – especially when you don’t know where to look. The ISHRS website is an excellent place to start. It provides consumers with unbiased information on a wide range of issues – including how to be sure that a properly trained and licensed physician performs your hair transplant procedure, questions to ask during your consultation, and many others.

We also invite you to visit Dr. Barusco’s YouTube channel, Hair Loss Medical Advice, where you can learn as he discusses such issues as the types and causes of hair loss, hair transplant procedures, and much more. And of course, our blog features informative posts, updated every month.

Ultimately, choose your surgeon based on experience, results and integrity. Dr. Barusco’s long list of accomplishments, his notable artistic ability and his successful surgical team make Tempus Hair Restoration a renowned practice. Contact us to schedule your free virtual consultation. Dr. Barusco conducts every consultation himself, giving you the opportunity to learn your options in the comfort of your home – or any location, on any internet-enabled device. 

Dr. Barusco conducts consultations in English, Spanish and Portuguese. For your greater convenience, Tempus Hair Restoration offers a two-night complimentary hotel stay to out-of-town clients who travel 100 miles or more to our Port Orange, Florida, surgical center. No matter how far the distance, we welcome the opportunity to help you on your hair restoration journey!