ACNE TREATMENT

Acne management 

It takes approximately 3 weeks for a clogged pore in your skin to actually become a pimple/whitehead and make its way up to your face. When you start using these glycolic acid products you need to remember to give your skin time to rid itself of the clogged pores that have already formed under your skin. This may take up to 3 weeks.

 After the clogged pores have made their way out you will see a remarkable difference in the clarity of your skin! The glycolic acid will help to keep your pores clear so the process doesn’t keep repeating itself.

 Treat acne the professional way! Virtually every case of acne can be resolved. The key to getting rid of acne lesions and preventing new ones from forming lies in knowing that:  Resolving the condition takes time.  What works for one person may not work for another.  

Skin specialist’s help may be required. Resolving the condition takes time. Treatments that promise fast, miraculous or overnight results are not realistic. 

The simple fact is that acne seeing on your face, is not the only acne to be treated! There are many layers of skin below your stratum corneum (or outermost layer), and new clogs are forming every day. That is why the initial period of improvement takes so long.

On average, 6-8 weeks are needed to see initial results. Once acne significantly improves or clears, continued treatment is needed to keep acne from re-appearing. If acne does not improve in 6-8 weeks, treatment may need to be adjusted as not every acne treatment clears every case of acne. What works for one person may not work for another. 

What is an appropriate treatment for one person may not clear another is acne because many factors afeect resolution, including the causes of the acne, a persons skin type and the kind of acne lesions present. Blackheads and white heads can be treated fairly easily with salicylic acid and exfoliating type treatments .

salipeel or sali+mandelic peels i use for preventing clog formation, so this stops formation of new pimples.

 

every week or once in 2 weeks we need to do salycilic peel,  i charge Rs.500 per each sitting, which is the lowest price.

for any quiries or appointment reach me, call, sms, whatsapp me on my cell 9885260168

CHEMICAL PEEL ( CHEMICAL REJUVENATION)

Maintaining healthy skin is the key to looking and feeling good about ones self.   
Post inflammatory hyper pigmentation (the darkening of skin) may occur after an injury such as a cut, scrape, or burn, or after certain skin disorders such as acne or eczema. It is seen in all skin types but is more common and noticeable in darker skin.
Early treatment of the underlying problem can help prevent development of dark spots. Darkened areas of skin may take many months or years to fade, although medication may help. AHA, lactic acid peel, glycolic peel, TCA peel, salicylic peel, microdermabrasion, and bleaching medication prescribed by a dermatologist may fade pigment more rapidly.

Avoid picking, harsh scrubbing, and abrasive treatments unless prescribed by a dermatologist. Glycolic acid peels and products have been widely used by skin care specialists for many years because of their anti-aging properties.
The positive effects on acne prone skin and acne scaring have also been well documented.
 Skin peeling will accelerate the removal of dead skin, increase collagen, and reduce the appearance of fine lines, sun damage, and hyper pigmentation.
 Along with reducing the appearance of large pores and acne scaring, they will also help to clear up blackheads and oily/acne prone skin with continued use.
 The daily use of sunscreen is very important to prevent post inflammatory hyper pigmentation from becoming darker.

acne and scars

 Chemical peels
Chemical peels are just basically SUPER exfoliators but unlike the exfoliators you use at home… The chemicals used in chemical peels are more advanced and harsher and…
When you do a chemical peel a lot more of the acne scarred skin is removed making room for new acne free skin to grow but chemical peels work best only with cases of minor acne scarring.


 Microdermabrasion

Microdermabrasion is almost like dermabrasion except that a lot less skin is removed and just like a chemical peel… Microdermabrasion should only be use for cases of minor acne scarring.

Skin Needling

how balding happens

Results with growth factor injections for hair loss

Non surgical skin tightening and lifting using RF technology

The Technology
Radio Frequency is being heralded, in the medical world, as the panacea to skin rejuvenation treatments for the majority of those who are concerned about keeping the physical ageing process ostensibly at bay, without recourse to drastic surgical action.

It is one of the safest and least invasive, yet most effective, anti-aging treatment available, to people of all skin colours. Unlike IPL® (Intense Pulsed Light) and laser treatments, it is not dependent on light targeting chromophores such as melanin in the skin cells, and consequently does not carry any associated risks in terms of skin pigmentation. Light energy tends to scatter or absorb into the upper layers of the skin, making it difficult to deliver sufficient heat into the deeper layers without damaging the skin's surface. Lasers (and IPL®) therefore affect collagen in the upper dermis, improving fine lines, wrinkles and skin texture, while RF energy is able to penetrate deeper into the skin and affect the deeper dermis and subcutaneous layers, causing tightening and improvements to the underlying tissue structure, but with little change in skin texture.

Radiofrequency (RF) surgery has a lengthy history of use in oral, ophthalmic, plastic, and gynaecological surgery of over 70 years. Low frequency alternating currents are also used in physiotherapy for their ability to cause contractions in muscles. RF surgery traditionally utilizes a wave of electrons to cause frictional heating of tissues to incise, excise, ablate or coagulate the targeted tissue.

However more recent developments have rendered non-ablative RF energy to be the latest addition to the treatment options available for skin tightening and cellulite. It is possible to deliver RF energy to the deep dermis and sub-dermal layers of the skin, whilst protecting the epidermis. Heating in this area, without damaging the outer layers of skin, causes microscopic changes to the tissues and collagen contraction, with subsequent collagen remodelling over the ensuing months.

How it works

Compared to other skin tightening treatment, the major difference RF is that the epidermis or outer skin layer is not damaged in any way but the radiofrequency energy heats the deeper skin layers during the treatment. The body’s natural wound healing response then causes collagen changes in the skin with resultant skin tightening. A series of these treatments is usually performed.

RF is generally used therefore in 3 principle areas in cosmetic procedures:

1.    Tightening
Non specific heating of the dermis by RF will not only stimulate new collagen production but can shrink collagen fibres by up to one third. This minimises the appearance of fine lines and wrinkles as the lines become tighter.

2.    Deeper lines and wrinkles
As RF can penetrate into the subcutaneous and deeper dermal layers, the heat produced in the targeted regions can result in the stimulation of the body’s natural collagen (in contrast, for example, to the injection of collagen derived synthetically or from animals). This, has a much longer lasting effect over a course of treatments (8 sessions), than the more short term effects of injected collagen from an alien substance. However, the immediate results from RF treatment are not as dramatic.

3.    Cellulite
Over the years many devices have been developed to reduce the effects of cellulite. Many of these have used a combination of a vacuum and rollers to aid circulation to the affected areas and to physically break down fat. However, it has recently been shown that RF can denature these affected areas.
Cellulite is visible when fat clusters in the dermis become distended and elastin fibres are rigid, causing dimpling at the surface. RF heating disrupts fat clusters and over time causes new ‘stretchy’ elastin fibres to be produced and results in a smoother skin surface.

To summarise therefore, RF is not a treatment for weight loss in overweight individuals. It is however suitable for the smaller pockets of trapped fat cells that can be found in cellulite, and it is very effective for long term reduction in wrinkles at the deeper level, in addition to providing some more immediate skin tightening at the superficial level.
RF is not legislated by the Care Quality Commission, as it is regarded as a relatively safe treatment to administer.

Tripolar RF is more safe and efficient

New novel system for treatments of cellulite and skin tightening using

Tri Polar technology for simultaneously heating deep and shallow layers of the skin without the need for active cooling.

Non-Surgical Skin Tightening Benefits

• A non-invasive technique that can tighten facial or body skin
• No surgery required
• Minimal discomfort
• Minimal risk of change in skin
• May be used for all skin types
• Rare downtime

Non-Surgical Skin Tightening Considerations

• Non-surgical skin tightening cannot give the same results as a facelift or body tuck procedure.
• These treatments are useful after a surgical procedure to improve skin quality
• Multiple treatments are usually be needed

What is the treatment like?

The treatment is fairly relaxing and pain free.
Areas that are commonly treated include the face, neck and décolletage for skin rejuvenation and the tackling of deeper lines and wrinkles than those which can be targeted using the principle of photothermolysis (ie light based technologies such as laser and IPL®). Areas that are prone to slack (rather than overweight) skin, such as the jaw line, and under eye area are often of particular concern. Likewise, those where lines usually form, such as the nasal labial folds running from the sides of the nose to the mouth, and the expression lines in between the brows, the sides of the eyes and upper cheeks, and the forehead.
On the torso, treatments are often administered on the stomach area, particularly following childbirth or rapid weight loss. The loose skin under the upper inner arms can often benefit from the treatments. On the legs/thighs/buttocks it is usually cellulite that is targeted. The ideal temperature that we are aiming to heat the skin up to is 41-42 degrees centigrade. This is the optimum temperature to stimulate the production of collagen, without causing any tissue damage. The aesthetician uses an infra red device to take the skin temperature before the treatment. The aesthetician then marks out the areas to be treated and applies a cool conducting gel to the epidermis (skin surface) of about 2mm in thickness. This will bring the skin temperature down a couple of degrees or so; therefore the temperature is taken again, before the treatment commences. A small circular handpiece is gently rolled across the skin area to be treated until the ideal temperature is achieved. Once that temperature has been reached, the aesthetician moves on to the next small area to be treated, until the whole of the area has been raised to the level at which collagen production has been stimulated. The skin will feel increasingly warm in the treated area, but not usually uncomfortably so. It is important if there is any excessive warmth felt, to the point of discomfort, that the client informs the aesthetician who will stop and move on to another area. Clients do have varying degrees of sensitivity to the treatment depending on thickness of skin, skin condition and elasticity, age, and specific area (for example, the cheekbones and forehead are often more sensitive and reach temperature more quickly as they are less fleshy). If a client has a tendency to get hot quickly during exercise, then this could be reflected in their ability to reach a higher temperature more quickly than others, during the RF treatment. Clients with skin conditions such as rosacea or other sensitivities could also find that their temperature rises more quickly than those with naturally ‘cooler’ skin.

Therefore treatment times do vary, but typically a full face, neck and décolletage session will take around 50 minutes including preparation; and a face only, about 30 minutes.
Following the treatment proper, a hydrating serum is applied to the heated area.  This is a cosmeceutical serum, unable to be purchased ‘over the counter’ and is formulated with sodium hyaluronate. It is a dermal hydrator which holds 1000 times its molecular weight. It is easily accepted and recognised at the cellular level, allowing active ingredients to effectively penetrate the skin. This hydrating serum is then followed by the application of an antioxidant soothing serum. This calms sensitive skin and contains powerful plant extracts and copper to strengthen the skin and reduce redness and inflammation. Thirdly a moisturising cream is applied, which leaves a silky, refined texture, while penetrating deeply into the dermis to hydrate and stimulate collagen and elastin development. This cream is formulated with moisturisers, anti-aging plant extracts, and antioxidants.
Finally, a high protection sun screen, protecting against both UVA and UVB rays, and with antioxidants and ingredients to help repair DNA, is applied to the skin. This contains zinc oxide which absorbs quickly without leaving a white residue on the skin. In addition to having a broad spectrum of coverage, protecting the skin from harmful UVA and UVB rays, its antioxidant and DNA repair ingredients provide the skin with further protection. If the RF treatment is being performed during the day an optional application of the highest grade of mineral make up can be provided. However, if makeup is not required, then it is recommended to leave the serum and creams on the skin overnight.  

  How many treatments are required?

 This very much depends on the age and skin condition of the individual, and the areas being treated. In general we recommend a course of 6 facial treatments and 10-15 body treatments. Thereafter, occasional maintenance treatments are advised.

Non invasive fat reduction with cavitation technology

 

What is Cavitation Instant Fat Loss & what can it do for me?

Cavitation is body sculpting with no anesthesia, no scars, no discomfort, no down-time and presents a risk-free alternative to liposuction. The result is instant loss of fat cells

Cavitation is a natural phenomenon based on low frequency ultrasound. The ultrasound field creates the bubbles in the liquid, which gradually grow, and implode at certain size. The energy in the form of heat (minor effect) and pressure wave (major effect) is released. As the membranes of fat cells do not have the structural capacity to withstand the vibrations, the effect of cavitation easily breaks them, while sparing the vascular, nervous and muscular tissue. The result is instant fat loss.

What Will I Feel During the Instant Fat Loss Treatment?

The treatment does not require anesthesia. Most of the clients consider the procedure painless and comfortable. There may be, however, a slight discomfort due to the specific noise spreading inside your body, but it poses no harm and disappears as soon as you are not in contact with the applicator. You may also experience a little warmth during the treatment. If it turns burning hot, immediately request some extra ultrasound gel to be applied.

Can I Expect Any Side Effects?

There is a slight possibility of mild side effects such as transient redness, excessive thirst immediately after the treatment which always resolves by drinking water.Even though the studies have proven the treatment safe, the cavitation is not be used in clients with an acute illness, compromised liver function, severe bleeding tendencies, pace makers, or during pregnancy.

What Are the Expected Instant Fat Loss Treatment Results?

The cavitation treatment yields immediate and long lasting  results. Most of the clients experience 2 to 5 cm of circumference reduction after a single session with increasing results after each visit. The results may vary with different tissue structure, treatment area, age, metabolism, medications, and changes in hormones. Proper diet and increased physical activity will certainly improve and help to maintain the results

CT scan changes after cavitation treatment

 The Machine utilize a unique cavitation technology that allows for non-invasive removal of stubborn fat deposits that never seems to disappear no matter of your diet or how hard you work out. The most problematic body areas are: abdomen, flanks (“love handles”), thighs (“saddle bags”), buttocks, inner knees, upper arm, male breasts.

Ultrasonic cavitation uses 32-40 Khz focused ultrasound cavitation effect, to cause tons of microscopic air bubbles around lipocyte (fat cell) membranes with its resonant frequency, the bubbles will cause high pressure, and when the high pressure has reached lipocytes’ breaking point, the lipocytes membrane will break up instantly. The broken lipocytes will then be moved to the liver and safely metabolized out of the body.

The released fat is then eliminated gradually by the body in two days thanks to the normal process of energy production. The results which can be obtained are obvious after very few sessions( 4-6 treatments): accumulations of fat and cellulite are eliminated. The treatment is best suited for the average to moderately overweight people who have a healthy lifestyle and exercises regularly.

7. Recommndations for Successful Results

• Drink at least 2.0 liters of water daily, especially the day before and the day of treatment.
• Keep a balanced diet with regular exercise. After the treatment, exercise for at least 30min. A swift walk is recommended
• .*The recommended number of sessions is 6-12 sessions, one session every four days is reccomended. Ask for the 6-12 session package program

juvederm filler

JUVÉDERM® Injectable Gel is the only Hyaluronic acid fillerthat is FDA approved to last up to 1 year.

What Is JUVÉDERM® Injectable Gel?
As we age, our skin changes. Over time, the natural volume of youthful skin begins to diminish as wrinkles and folds form. But, with Juvéderm™ injectable gel, you don't have to just sit back and let it happen!
JUVÉDERM® Injectable Gel is a smooth consistency gel made of hyaluronic acid—a naturally occurring substance in your skin that helps to add volume and hydration. JUVÉDERM® Injectable Gel is injected under the skin to instantly restore your skin's volume and smooth away facial wrinkles and folds, like your “smile lines” or “parentheses” (nasolabial folds—the creases that run from the bottom of your nose to the corners of your mouth).
JUVÉDERM® Injectable Gel provides a smooth, natural look and feel—so everyone will notice (but no one will know)! In fact, studies show superior results of JUVÉDERM® Injectable Gel compared to a collagen-based dermal filler.†
JUVÉDERM® Injectable Gel is the first FDA-approved hyaluronic acid dermal filler that is proven to be safe and effective.

How JUVÉDERM®Injectable Gel Works
JUVÉDERM® Injectable Gel dermal filler is a nonsurgical treatment. JUVÉDERM® Injectable Gel is injected under the skin using a fine needle to augment, or fill, the soft tissue of the dermis—the dense inner layer of skin beneath the epidermis—to add volume and diminish wrinkles and folds. JUVÉDERM® Injectable Gel l is great for your "laugh lines," "smile lines" or "parentheses" (nasolabial folds), or "marionette lines" (oral commissures).
JUVÉDERM® Injectable Gel is a "next-generation" filler. It is made from hyaluronic acid—a naturally occurring substance in your skin that helps to hydrate and add volume. Hyaluronic acid may diminish with age, contributing to the formation of wrinkles and folds. JUVÉDERM® Injectable Gel works to correct this by restoring hyaluronic acid in your skin, helping to smooth wrinkles and folds

What to Expect During Treatment
Because JUVÉDERM® Injectable Gel is a simple, nonsurgical wrinkle treatment, there is minimal recovery or downtime. So you can make an appointment to stop by the office for treatment on the way home from work or the gym. Here's what to expect when you visit for treatment.

Before you go: Avoid any medications that can prolong bleeding, such as aspirin and non-steroidal anti-inflammatories (NSAIDs), for at least a week prior to treatment in order to reduce the risk of bruising and bleeding at the injection site. (Tylenol is okay).
When you arrive: If this is your first visit, Dr. will ask about your medical history, including any allergies you may have or medications you may take, and will tell you more about wrinkle treatment with JUVÉDERM® Injectable Gel . An allergy test is not required.

Determining your treatment needs: Dr. will examine the soft tissue of your face to assess the depth of wrinkles and folds to determine your treatment. JUVÉDERM® Injectable Gel is available in two formulations—Juvéderm™ Ultra for versatility in contouring and volumizing facial wrinkles and folds, and Juvéderm™ Ultra Plus, a robust formulation for volumizing and correcting deeper folds and wrinkles.

Before the procedure: Dr. will use topical and/or injectable anesthesia to numb the treatment area first.
The procedure: Dr. will ease the JUVÉDERM® Injectable Gel under your skin to augment, or fill, wrinkles and folds. Following the injection, he may gently massage the treated areas. The procedure is quick and easy. The injection itself usually takes only about 15 minutes.
After the procedure: With JUVÉDERM® Injectable Gel , there is minimal recovery or downtime.

For the first 24 hours following treatment, you should avoid strenuous exercise, excessive sun or heat exposure, and consumption of alcoholic beverages in order to help minimize the risks of temporary redness, swelling, and/or itching at the treatment sites. After the treatment, some temporary injection-related reactions may occur, including redness, pain, firmness, swelling, and bumps. Studies have shown that these are usually mild to moderate in nature and clear up on their own in 7 days or less. If you experience swelling at the injection site, you can apply an ice pack for a brief period.

Seeing results: You should see an immediate improvement in the treatment areas. Most patients need one treatment to achieve optimal wrinkle smoothing. And one treatment could smooth your lines and wrinkles for up to 1 year! However, results may vary and correction is temporary. Supplemental “touch up” treatments may be required to achieve and maintain optimal results.

body contouring

Body Contouring:
Contouring of the abdomen, arms, back, legs and total body can be obtained with mesotherapy. Lipodissolve agents are used to remove areas of fat by block the internal signal of fat uptake, trigger fat release inprove circulation, and burn energy, while vitamins and amino acids are used to tighten sagging skin, restore a more youthful and athletic appearance.
Many patients develop unevenness, divots, or lumps after undergoing liposuction. These areas can be successfully treated with Mesotherapy. The scar tissue that forms under the skin after liposuction is directly targeted and dissolved. Patients see and feel smoothing of divots and lumps, and the unevenness resolves.
Cellulite Reduction:The medical term of cellulite is "dermatomyoliposclerosis". Cellulite affects the majority of women over the 20. It is caused by poor circulation, fat herniation weakening of connective tissue, lymphatic congestion, and hormonal imbalance. Cellulite is not a disease of over weight. It appears in the subcutaneous level of skin tissue. Fat cells are arranged in chambers surrounded by connective tissue called sepatae. As water retained, fat cells held within the perimeters of this area expand and stretch the connective tissue. Eventually this connective tissue contracts and hardens (scelerosis) holding the skin at a non-flexible length, while the surrounding tissue continues to expand with weight or water gain. This result in areas of the skin being held down while other sections bulge outward, resulting in lumpy, orange peel appearance. It can be divided into 4 clinical stages:-
-Stage 0:- no visible cellulite, even when skin pricked or compress
-Stage 1:- no visible cellulite when standing or lying down, however present when skin is pricked or compressed.
-Stage 2:- visible cellulite when standing, but not appear when lying down
-Satage3:- visible all time.
Mesotherapy treatment is targeted to correct these problems by improving circulation, strengthening, connective tissues, remove fibro tic & hardening connective tissue, improve lymphatic drainage, and dissolve excess fat.
Hair Restoration :-Hair loss affects both affects both men and women. I6t’s resulted from poor circulation, nutritional imbalances and in men the excess of a hormone known as DHT (dihydrotestosterone) Mesotherapy can correct these problems, by stimulating scalp to naturally grow the lost hair.
Face and neck rejuvenation / mesolift:-
Aging, sagging and wrinkling of the skin occurs from accumulation of fat, loss or skin elasticity, and excessive free radical damage. Infusing potent antioxidants and amino acids by mesotherapy into dermis at level of contact with cellular matrix can reverse free radical damage, and tightening the loose skin. It can rejuvenate and revitalize the skin of face and neck without the unnatural appearance and downtime recovery period.
People who have had a "Mesolift" describe their skin as firm, radiant, youthful and glowing. The Mesolift is usually performed in an initial series of 2-4 treatments spaced a week apart. Results are maintained by twice a year touch up sessions.
Mesotherapy skin rejuvenation is a wonderful compliment to any of the other skin treatments we offer including, photo rejuvenation, chemical peels, BOTOX® and dermal fillers. But it also stands on it’s own as a powerful anti-aging therapy.
Facial Pigmentation:Facial pigmentation like Melasma ,post inflammatory pigmentation(following aggressive treatment with chemical and Lasers),Black discoloration around eyes and pigmentation due to sun damage can be effectively controlled by using specific mesotherapy solutions. The effect of these medicines is virtually dramatic.
Eye Bags:For the problem of buldging fat under the eyes Mesotherapy provides a very effective to surgical treatment called Blepharoplasty.
Double Chin:Infection lipolysis by mesotherapy using different fat dissolve solution treayts double chin effectively.The results are very quick in these cases since area to be treated is small.The combination of medicaments to tighten the skin together witgh lipolysis agent further compliments the treatment.

What is the treatment protocol?For cellulite, weight loss, and spot weight reduction, the medications are injected directly to the areas being treated. Treatments are administered weekly, and patients usually begin seeing results by the fourth treatment. After 10 treatments, patients see a significant decrease in size, improved skin tone, and smoothing of cellulite. Typically patients lose 4 to 10 inches in 10 weeks.
For facial rejuvenation weekly injections are given and usually 4-5 treatment sare sufficient to get the desired results.

chemical peels in acne

Peels in acne

Chemical peels using either alpha-hydroxy acid or beta-hydroxy acid are both highly effective in treating mild to moderately severe facial acne, researchers at the Saint Louis University School of Medicine have found the first study to compare the two different types of acid peels as therapies for the skin disorder.
Peels using beta-hydroxy acid (or BHA) had slightly fewer side effects and results that lasted a bit longer than did peels using alpha-hydroxy acid (or AHA), the study found. But overall, both types of treatments were similarly effective in reducing lesions caused by acne vulgaris, which affects some 85 percent of all people 12 to 24 years old.
AHA (which is also called glycolic acid) and BHA (also called salicylic acid) are frequently used by physicians to induce light skin peels, which help treat fine lines and wrinkles, acne and uneven texture and coloration. The peel removes a very thin layer of skin, which in turn promotes the growth of new, smoother skin.
Both types of acid are derived from organic compounds. AHA has the same active ingredient that's found in sugar cane juice, sour milk and tomato juice, while BHA is derived from salicin, which is closely related to the active ingredient in aspirin.
The study involved 20 patients with moderate to severe facial acne. Their average age was 24 years; 13 were women. Each was treated with a chemical peel every other week for six weeks, with follow-up visits one month and two months after the last treatment.
Each treatment involved applying alpha-hydroxy acid to one side of the face and beta-hydroxy acid to the other side. Neither the patient nor the person who later evaluated them were aware which side of the face had been treated with which acid.
The study found that both types of chemical peels significantly reduced acne lesions within two weeks of the first treatment, and patients continued to see a reduction in lesions through the first follow-up visit a month after the treatments had finished.
At the time of that first post-treatment visit, 94 percent of patients were judged to have had good or fair improvement in acne lesions on both sides of the face, as assessed by a blinded evaluator.
A month later, at the second post-treatment visit, 81 percent of the sides of the face treated with beta-hydroxy acid still showed good or fair improvement in acne lesions, compared with 75 percent of the sides of the face treated with alpha-hydroxy acid. However, the sides of the face treated with alpha-hydroxy acid had developed a few new lesions though this was judged not to be significant.
In general, both types of acid peels yielded the same side effects, which typically decreased over the course of the treatments. The most common of these included redness, peeling and scaling though with alpha-hydroxy acid, the degree of the peeling and scaling was judged to be greater.

HAIR CYCLE---TELOGEN EFFLUVIUM

The Hair Growth Cycle
To understand telogen effluvium, we need to have some knowledge of the hair growth cycle. Hair does not grow continuously on the human scalp. The anagen (growing) phase for terminal hair can extend 3 to 7 years and is a reflection of the size of the hair follicle. Catagen is the transitional portion of the hair growth cycle, between anagen and telogen and lasts only 1 to 2 weeks. During this time, there is a rapid involution and regression of the hair follicle. The hair follicle then enters the telogen phase, which is a relatively fixed period of time, approximately 100 days, regardless of the size of the hair follicle. There is no growth of the hair shaft during this phase. It is at the end of the telogen phase that the entire hair shaft, also often referred to as the club hair, will spontaneously shed, while a new hair shaft is forming within the hair canal. The white bulb at the end of the hair, along with the loosely attached collection of friable debris gives the shed hair its characteristic appearance.In the scalp of the healthy, young human adult, approximately 90% of the hair will be in the anagen (growth) phase and approximately 10% will be in the telogen (dormancy) phase. Less than 1% will be in the catagen (transitional) phase. When you consider that the scalp contains 100,000 hairs, with 10,000 in the telogen (dormancy) phase... and 1% of those hairs in the telogen phase will be at the end of the 100 day long phase, you can easily understand why it is normal to shed 100 hairs per day.

When excessive amounts of hair simultaneously switch from anagen (growth) into telogen (dormancy) and subsequently shed several months later, the phenomenon is referred to as a telogen effluvium. Rarely are more than 50% of the hairs on the head involved. Telogen effluviums can be acute or chronic. When the shedding lasts more than six months or persistently recurs, it is referred to as a chronic telogen effluvium. Chronic telogen effluviums have been reported mainly in women. No racial predilection exists.
Although telogen effluvium can affect hair on all parts of the body, generally, only loss of scalp hair is symptomatic. The exact prevalence is not known and getting accurate statistics would be very difficult, but the condition is quite common.
Telogen effluvium can occur at any age. It is likely that most adults have experienced an episode of telogen effluvium at some point in their lives and, unbeknownst to most people, everybody has experienced the phenomenon early in life. In fact, mothers have been more aware of telogen effluviums in newborns and babies than most doctors have ever been. It is typical for a band like area of occipital hair follicles to enter the first telogen close to the time of birth and for these hairs to shed 2 to 3 months later. In the human infant, waves of hair growth occur before establishment of the mosaic pattern, which is usually present by the end of the first postnatal year.
What causes Telogen Effluvium?
In order to cause a large number of hair follicles to simultaneously switch from the anagen (growing) phase into the telogen (resting) phase, the body has to undergo some systemic insult. A telogen effluvium is not caused by topical medications. But because there is a required time lapse of several months between the inciting cause and the excessive shedding of hair, the exact cause of the telogen effluvium is often not positively identified.
A typical and common case of telogen effluvium would be the episode of severe shedding of hair that may occur approximately 100 days after a woman has given birth. The inciting factor is probably the abrupt hormonal changes that occur at the end of pregnancy. All of the hair grows back within a year.
Other causes of telogen effluvium include illness, major physical trauma, menopause, crash diets, severe psychological stress, major surgery (especially with general anesthesia), hypo- or hyperthyroidism, anemia's, acute and severe blood loss, heavy metal poisoning, etc. Chronic illness such as malignancy, and any chronic debilitating illness, such as systemic lupus erythematosus, end-stage renal disease, or liver disease can cause telogen effluvium. Immunizations also have been reported to cause acute hair shedding. Even jet lag and job changes have been reported to cause a telogen effluvium. In the United States, oral medications may very well be the most common cause of telogen effluviums. The list of medications associated with telogen effluviums is extensive and includes retinoids, beta-blockers, anticoagulants, SSRI’s, non-steroidal anti-inflammatories, calcium channel blockers, etc. In any and all cases, the common factor is metabolic or physiologic stress several months before the start of the hair shedding.
How do I know if I have TE?
Making the diagnosis of a telogen effluvium is usually quite straightforward. A ‘hair pull’ will determine whether or not a disproportionate number of hair follicles are in the telogen phase. And this is a test, which the patient can do himself or herself. Pinch a bunch of hair between your thumb and middle finger. You will have approximately 25 to 30 hairs within the pinch. Give the bunch of hair a sharp tug. Repeat this tug in several places over the scalp. It would be normal to dislodge one or two hairs with each pull, because approximately 10% of the hairs on the scalp are in the telogen phase. The hairs that are dislodged should have a small, friable, whitish bulb on the scalp end. If you pull out more than 4 or 5 hairs in each pull, it’s likely that you are having a period of telogen effluvium. For an accurate pull test, it is important that you have washed your hair regularly, i.e. daily or every other day. With infrequent washing, more hair than normal may pull out giving an erroneous interpretation. Since a telogen effluvium is not limited to the hair follicles at risk for MPB or FPB, shedding can involve hair on any part of the scalp (and even body hair). The underlying scalp has a normal appearance without scarring or inflammation and there should not be any areas of complete alopecia. A close examination of the scalp may reveal a higher than expected number of short new hairs growing in.If there is an obvious history of an inciting event and the time elapsed between the inciting event and the excessive shedding is consistent with the approximate length of a telogen phase, laboratory studies are of little use in making the diagnosis. Although a scalp biopsy can be performed to confirm the diagnosis, it would seldom be necessary if the history is characteristic and a ‘hair pull’ produces numerous telogen hairs.
There are no signs or symptoms, which allow you to anticipate the shedding from a telogen effluvium.Treating Telogen EffluviumBecause acute telogen effluvium is in reality a normal process, which occurred prematurely in a synchronized manner to a large number of hair follicles, and which resolves spontaneously, treatment can be limited to reassurance. The identifiable inciting factor should be avoided or discontinued or treated, whichever is appropriate. Assuming there is no intervening pathological process, all of the hair will be replaced in six to twelve months and the replacement hair should be identical to the hair that was shed. Telogen Effluvium and Miniaturization
Unfortunately, a telogen effluvium can be the harbinger of the onset of Male Pattern Baldness or the initial event in a period of accelerated MPB. In these cases, which are fairly common, the hair also grows back, but the hair may be significantly finer and smaller, because the hair follicles affected have miniaturized by the MPB process. While 5% topical minoxidil is not proven to promote recovery of hair in telogen effluvium, this medication has a theoretical benefit because minoxidil acts directly on hair follicles and promotes anagen growth. Patients who are eager to play an active role in their treatment may wish to use a 5% minoxidil solution. The use of DHT inhibitors is not recommended for the treatment of telogen effluvium.
In ConclusionChronic telogen effluvium is more likely to be caused by a chronic metabolic abnormality and is less likely to resolve rapidly. The underlying cause or disorder should be avoided or discontinued or treated, whichever is appropriate, and the patient should have reassurances that the hair loss will not progress to baldness.Hair transplantation is not a recommended treatment for telogen effluvium.