Hair and Culture


Dr. Harris understands the phenomenal results that can be achieved when expertise, technology, and cultural sensitivity are used in harmony. This integral approach for hair repair and restoration has often been overlooked by the aesthetic care community. Hair stylists and barbers are frequently confronted with clients concerns regarding hair loss. Yet, typically they are without the clinical expertise to make appropriate recommendations. Dermatologists have the expertise, but often do not devote the time to exploring the nuances of healthy hair care practices outside of clinical advice for an itchy or dry scalp.

Trichologists, specialists in the study of hair structure and diseases, can bridge the expertise/time gap, but are unable to prescribe pharmaceutical treatments when indicated. Surgeons frequently seek out candidates who would best benefit from a surgical solution. The Center for Aesthetic Modernism team believes we are at a crossroads given the fragmented nature of these professionals and the very real epidemic of hair loss confronting women of all ethnicities, but particularly those of African descent. Dr. Harris brings together multiple disciplines of expertise, combined with state-of-the-art technology, to provide each patient with exceptional and individualized care.

Hair has many functions.  It provides ultra-violet radiation exposure protection from the sun.  It serves as a primary source of heat insulation and cooling for the head.  By gender, it provides sexual differentiation and non-verbal communication through attraction and social grooming.  Its sensory function extends the sense of touch beyond the surface of the skin and provides warnings, as well as, a barrier against foreign substances.

HAIR ANATOMY

The scalp is composed of three main layers. The outer layer of skin is the epidermis. Beneath the epidermis is the dermis, a tough layer of connective tissue.  Beneath the dermis is a layer of subcutaneous fat and connective tissue. The blood vessels that nourish the skin run deep in this layer.  In the scalp, the lower portions of the hair follicles are found in the upper part of this fatty layer.

Each hair follicle measures about three to four millimeters in length and produces a hair shaft about 0.1 millimeter in width. The hair follicle has five key components.   Starting from the bottom of the follicle, they are the dermal papillae, matrix, outer root sheath, inner root sheath, and the hair shaft.

The dermal papillae contain specialized cells called fibroblasts that regulate the hair cycle and hair growth. The dermal papillae contain androgen receptors sensitive to dihydrotestosterone, an androgen hormone. For many years, scientists thought that hair growth originated from the dermal papillae. Recent evidence has shown that the growth center extends from the dermal papillae all the way up to the region of the follicle where the sebaceous glands are attached. It is now believed that the primary function of the dermal papillae is to regulate follicular growth and differentiation. If the dermal papillae is removed (this sometimes happens during a hair transplant), the hair follicle is often able to regenerate a new one, although the growth of the new hair will be delayed.

The matrix sits over the dermal papillae and contains actively dividing, immunologically privileged cells. Together, the dermal papillae and the matrix are referred to as the hair bulb. The size of the bulb and the number of matrix cells will determine the width of the fully-grown hair. The cells of the matrix differentiate into the three main components of the hair follicle: outer root sheath, inner root sheath and hair shaft.

The outer root sheath surrounds the hair follicle in the dermis and then blends into the epidermis on the surface of the skin, forming the structure commonly referred to as the pore (from which the hair emerges).

The inner root sheath essentially forms a mold for the developing hair shaft.  The cuticle, the innermost portion that touches the hair shaft is formed by a layer of overlapping cells that interlock with the cuticle of the hair shaft. This overlapping mechanism holds the hair shaft securely in place, but also allows it to grow in length.  The cells of the inner root sheath give it rigidity and strength.

The hair shaft is the only part of the hair follicle to exit the surface of the skin. The hair shaft is composed of three layers. The cuticle, the outer layer that interlocks with the internal root sheath, forms the surface of the hair and is what we see as the hair shaft emerges from the follicle. It is the middle layer, the cortex comprises the bulk of the hair shaft and is what gives hair its strength and most or its pigment. It is composed of an organic protein called keratin, the same material that comprises rhinoceros horns and deer antlers. The center or core of the hair shaft is the medulla.  It is also called the pith or marrow and is often absent in fine or very fine hair.

Racial variations are felt to be due to the asymmetric formation of the inner root sheath. If you look at the cross section of the inner root sheath, the shape is elliptical in Africans, round in Asians, and oval in Europeans.  The shape of the follicle determines the shape of the hair shaft as it grows from the follicle.  Since the hair shaft actually grows out of the hair follicle the diameter of the hair fiber will be the same as the diameter of the inside of the follicle. 

In straight or wavy hair, hair follicles are more or less vertical to the surface of the scalp, with a slight “tilt”.  The angle of the hair follicle determines the natural flow or wave pattern of the hair.  The follicle in straight or wavy hair is typically round or oval.  In hair that is tightly curled, the hair follicles grow from the scalp almost parallel to the surface of the scalp.  The hair follicle that produces a tightly curled hair has a flattened, elliptical shape.

HAIR GROWTH


Hair is composed of strong structural protein called keratin. This is the same protein that makes up the nails and outer layer of the skin. Hair follicles grow in repeated cycles. The hair growth cycle consists of three stages; the anagen or growing phase, the catagen or intermediate phase, and the telogen or shedding phase.

The normal human scalp contains between 100,000 to 150,000 follicles that produce thick terminal hair. These hairs do not emerge individually from the scalp, but are arranged in small groups of one to four hairs each, called follicular units. There are approximately 50,000 to 65,000 follicular units on the human scalp. By comparison, the human body has approximately five million follicles that produce fine vellus hair.

Scalp hair grows at a rate of about 0.44 millimeters per day or 1/2 inch per month. Each hair follicle goes through the hair cycle 10-20 times in a lifetime.  At any given time, about 85% of terminal hairs on one’s head are actively growing. This phase, called the anagen phase, can last from two to seven years, though the average is about three years.

In the catagen phase, which is the shortest phase lasting about two to three weeks, growth of 5% of the hairs on one head halts, the middle of the follicle constricts and the lower portion expands to form the “club.” The other remaining 10% of scalp hairs are in a resting state called telogen that, in a normal scalp, lasts about three to four months.

When a hair enters the telogen phase, growth stops, and the bulb detaches from the papilla, and the shaft is either pulled out when combing one’s hair or pushed out when the new shaft starts to grow. When a hair is pulled out or falls out on its own, a small white swelling is found at the bottom of the hair shaft. Most people assume that this is the growth center of the hair, but it is just the clubbed, detached lower end of the hair shaft. The dermal papillae and the growth center of the hair remain in the scalp.

Humans normally lose about 100 hairs per day. Everyone has a few hairs stuck to the comb each time they comb their hair. The presence of a large number of hairs on the comb, in the sink, or in the tub, can be a sign of hair loss caused by traumatic grooming practices, poor nutrition, medications or underlying disease. Common genetic balding, however, is not caused by excessive hair loss, but rather by the successive replacement of hair that is normally lost with smaller, finer hair – a process called “miniaturization.”

DIGITAL HAIR ANALYSIS

A camera system is used to clearly document each patient’s hair growth progress.  Using the Do Good H.A.I.R. customized hair therapy solution; the hairs can be coaxed into the anagen phase of growth. These photos demonstrate improvement throughout therapy.

MICROSCOPIC IMAGES OF WHAT YOU DON’T SEE!

HAIR: SPLIT END

Split ends are the splitting or fraying of the hair shaft due to excessive heat and mechanical stress. Thermal, chemical or mechanical stress can cause split ends. For example, the use of curling irons and other thermal heat treatments may cause split ends. Excessive application of hair products such as relaxers, perms and hair coloring may strip the protective layering off the outside of the hair's shaft and weaken the hair, making the hair prone to split ends. Mechanical stresses include pulling a comb forcefully through tangled hair and repeated combing.   Reducing or eliminating the causes will usually prevent split ends. Trimming the ends of the hair at least every 6- 10 weeks may prevent split ends.

HAIR: CHEMICAL RELAXER + TRACTION

A relaxer is a type of lotion or cream generally used by people with curly-textured hair, which makes hair less tangled and also easier to straighten by chemically "relaxing" the natural curls. The active agent is usually a strong alkali. Hair relaxing, or lanthionization, can be performed by a professional cosmetologist in a salon, or at home with relaxer kits. As with hair dye, the treated portion of the hair moves away from the scalp as the new growth of untreated hair sprouts up from the roots, requiring periodic retreatment approximately every 6–8 weeks to maintain a consistent appearance. The relaxer is applied to the roots of the hair and alters the hair's texture by a process of controlled damage to the protein structure by permeating the protein structure of the hair and weakening its internal bonds, causing the natural curls to loosen out as the entire fiber swells open. The hair can be significantly weakened by the physical overlap of excessive applications or by a single excessive one, leading to brittleness, breakage, or even widespread alopecia.  When the relaxer has worked to the desired degree, the hair is rinsed clean. Regardless of formula, relaxers are always alkaline to some degree, so it is prudent to neutralize or even slightly acidify the hair with a suitable shampoo immediately afterward. The prompt use of hair conditioner is also important in order to replace some of the natural oils that were stripped away by the process.

HAIR: BRAZILIAN KERATIN BLOWOUT

Keratin straightening is a method used by licensed hair stylists to temporarily smooth the hair by sealing a liquid keratin and a preservative solution into the hair with an iron. It can fill in gaps in the hair cuticle that are cracked, dry, or damaged. It is mixed with varying levels of formaldehyde, and applied to the hair, and then sealed in with the heat of a flat iron. The formaldehyde helps hold the keratin molecules together, which straightens your hair and keeps it that way.  Depending on the treatment used the downtime after it is performed ranges from no wait to a 72 hour period in which the recipient cannot wash or wet the hair, exercise, tuck the hair behind the ears, or pin it up with any hair clip, pony tail holder or headband, as doing so may compromise the result of the treatment. If any of the chemical touches the scalp, it usually leads to permanent hair loss. The U.S. Food and Drug Administration (FDA) warns that keratin treatments are hazardous to the health of the women who use them and the hairdressers who apply them.

UNDERSTANDING HAIR LOSS

Hair thinning and hair loss stem from four main causes:  genetics, stress, autoimmunity, and lifestyle. While some hair thinning and baldness may be predisposed based on ancestry, psychological stresses and hormone imbalances play a role. In addition, the body may sometimes reject hair as a foreign object which leads to hair loss.  A higher-calorie, higher-fat diet coupled with a more sedentary lifestyle increases one’s susceptibility to hair loss.

Excessive or abnormal hair loss is known as alopecia, and there are several kinds. What all hair loss has in common, whether it's in men or women, is a symptom of something that's gone wrong in your body. Your hair will remain on your head where it belongs unless hormone imbalance, disease, or some other condition occurs. That condition may be as simple as having a gene that makes you susceptible to male or female pattern baldness or one of the forms of alopecia areata, or it may be as complex as a whole host of diseases.

Fortunately, hair loss can be a symptom of a short-term event such as stress, pregnancy, disease, or medication, which can all alter hair's growth and shedding phases. In these situations, hair will grow back when the event has passed. Once the cause of the loss is addressed, hairs go back to their random pattern of growth and shedding, and your problem stops.

THE BIG THREE

TRACTION ALOPECIA

Traction alopecia is characterized by hair loss primarily along the hairline, especially around the temples and above the ears. It is attributed to hairstyling practices that result in prolonged tension on the hair – namely weaves, braids, dreadlocks and ponytails. Our Do Good H.A.I.R. approach to hair loss combines innovative therapies which are particularly useful for treating hair loss associated with traction alopecia. This integrative approach involves cutting edge hair analysis, a supportive stylist network to assist with healthy styling options, topical "hairceutical" treatments, laser light therapy and targeted surgical transplantation for advanced hair loss.

Traction alopecia is actually quite common and affects both men and women across the globe. For instance, traction alopecia was described as early as 1907 in Greenland. The traditional Greenlandic hairstyle at that time resembled the modern-day ponytail, and women developed a characteristic hair loss in the temple region. Similar patterns of hair loss have been described in many diverse cultures ranging from Danish girls who wore ponytails in the 1950s to the women of Northern Sudan who have traditionally worn their hair in tight cornrows with long extensions. Traction alopecia is most often observed in women; however, it has also been described in Sikh boys whose long hair is twisted into a tight bun on top of the scalp.

Although described in many different cultures and ethnicities, traction alopecia is most prevalent in women of African descent.  African American women often subject their hair to prolonged pulling and tension to straighten the natural kinky, curly texture. African American hair is significantly more fragile than Caucasian hair. As a result, hair breakage and loss are seen more commonly. Hair loss associated with traction results in hairs that are short and thin. If the pulling persists for long durations, total absence of follicles and balding can occur.

The image above showcases a woman of African descent from Virginia who presented with traction alopecia at the frontal hairline related to traumatic grooming practices (braids, weaves, wigs). She underwent targeted strip hair transplantation to restore density along her hairline. Note the increase in growth 6 months following her procedure by Dr. Harris.

ANDROGENETIC ALOPECIA OR FEMALE PATTERN HAIR LOSS

Androgenetic alopecia, otherwise known as female pattern hair loss occurs more commonly after menopause in females. It is characterized by diffuse thinning of hair on the scalp with a reduction in hair volume. Approximately 40% of women by age 50 show signs of hair loss and less than 45% of women actually reach the age of 80 with a full head of hair. Androgenetic alopecia has a strong genetic predisposition that could be inherited from either parent, or both. There are also a variety of other factors tied to the actions of hormones, including some ovarian cysts, high androgen index birth control pills and pregnancy, that may also contribute. Dihydrotestosterone, a derivative of the male hormone, testosterone is typically present in small amounts in women and appears to be at least partially to blame for the miniaturization of hair follicles in androgenetic alopecia.  

Effective treatments are available for androgenetic alopecia although there is no cure. It is important to manage expectations when seeking treatment, as the aim is to slow or stop the progression of hair loss rather than to promote hair regrowth. However, some women do experience hair regrowth with treatment. Results are variable and it is not possible to predict who may or may not benefit from treatment.  Two approaches commonly used involve the use of minoxidil on the scalp and hormonal treatment that block the effects of androgens. Once started, treatment needs to continue for at least six months before the effects are seen.  Long term treatment is usually necessary to sustain the benefits. Without medication, androgenetic alopecia tends to progress in severity over the next few decades of life.  

The majority of women with androgenetic alopecia have normal levels of androgens in their bloodstream. It is very uncommon for women to bald following the male pattern unless there is an excessive production of androgens in the body.   Other conditions may cause increased hair shedding and may be confused with androgenetic alopecia. It is important to differentiate between these conditions to ensure proper management of each condition. The Do Good H.A.I.R. approach utilizes laboratory blood tests that include hormone levels as well as thyroid function, vitamin D3 levels and anemia, as part of the diagnostic workup for your hair loss.

The image above showcases a woman of African descent from Maryland who presented with concerns regarding progressive hair loss and thinning due to androgenetic alopecia. With our hair repair home regimen and Low Level Laser therapy, she now has significant re-growth of her own natural hair 6 months following her treatment.

SCARRING ALOPECIA OR CENTRAL CENTRIFIGAL CICATRICAL ALOPECIA (CCCA)

Scarring alopecia is defined as hair loss associated with damage to the hair follicle that leads to scar tissue and permanent baldness.   While it is possible to have more than one type of hair loss condition, nonscarring forms of hair loss do not turn into scarring forms of hair loss.  The common theme of most scarring alopecia is inflammation directed at the upper part of the hair follicle.  This may first occur as small patches of hair loss that may expand with time.  In some cases, the hair loss is gradual, without noticeable symptoms, and may go unnoticed for a long time.  In other instances, the hair loss is associated with severe itching, burning, and pain, and is rapidly progressive. Inflammation of the scalp usually precedes scarring. The goal is to stop inflammation to reduce scarring and permanent hair loss. 

Central centrifugal cicatricial alopecia (CCCA) is a form of scarring alopecia that most commonly affects women of African ancestry.  It may occur in more than one family member. This condition has become more common and is especially related to the scalp becoming injured by chemicals (relaxer solutions, bleach, dyes or bonding glues), trauma from the frequent practice of using hair weaves and extensions or using too much heat during the drying process.   

Hair will not regrow once the follicle is destroyed. For this reason treatment of CCCA should be quite aggressive to treat and reduce the inflammation in and around surrounding follicles before they are destroyed. The Do Good H.A.I.R. integrative approach helps to encourage healthy hair growth, stimulate remaining unscarred follicles, and in some instances, provide targeted surgical hair restoration for more extensive hair loss.

The image above showcases a woman of African descent from Maryland who presented with concerns regarding progressive hair loss due to scarring alopecia. Following the aid of our home hair care regimen and 4 months of Low Level Laser therapy, the progression of hair loss has decreased and the patient now presents with an increase of hair density.