Telogen effluvium is a condition where a large number of hair follicles enter the resting phase known as telogen. As these hairs may fall off, it is not replaced with new hair at the same area and this leads to a bald patch on the eyebrows. A number of hormonal factors (like with hypothyroidism and pregnancy) may be responsible and it is also related to certain diseases, nutritional deficiencies, chronic medication use and even metal toxicity. It is now also known that stress can push many more hair follicles than normal into this phase.
The recipient sites in the eyebrow can be conveniently made with 20 to 22-gauge needles parallel to the skin, so that hair grows flat on the skin and does not stick out from the face. About 150 hairs are required for a full eyebrow graft. Poddar et al. described good results with a technique of creating recipient tracks with the erbium yttrium aluminium garnet laser.
The most common type of hair loss seen in women is androgenetic alopecia, also known as female pattern alopecia or baldness. This is seen as hair thinning predominantly over the top and sides of the head. It affects approximately one-third of all susceptible women, but is most commonly seen after menopause, although it may begin as early as puberty. Normal hair fall is approximately 100-125 hairs per day. Fortunately, these hairs are replaced. True hair loss occurs when lost hairs are not regrown or when the daily hair shed exceeds 125 hairs. Genetically, hair loss can come from either parents side of the family.
For other women, the problem with estrogen dominance is that they’re also experiencing lower levels of progesterone relative to estrogen—and progesterone helps protect hair follicles from the hair-thinning effects of testosterone, DHT, and estrogen. Evidence suggests that progesterone may act as an aromatase inhibitor and other research suggests that the genes involved in aromatase activity are implicated in female hair loss.
Like with low thyroid, there can be a myriad of imbalances at play with PCOS related hair loss making it a complex issue that’s often written off as merely high testosterone. While androgen excess and hypersensitivity of the hair follicles to these hormones are part of the issue, these are other contributing factors to PCOS related hair loss as well:
*Photograph used with permission of the Journal of the American Academy of Dermatology. This photograph was published in the Journal of the American Academy of Dermatology, Vol. # 60, Gathers RC, Jankowski M, Eide M, et al. “Hair grooming practices and central centrifugal cicatricial alopecia,” 660-8. Copyright Elsevier (2009). Journal of the American Academy of Dermatology.
The real culprit appears to be dihydrotestosterone (DHT), a more potent form of testosterone. DHT is made from testosterone by a specific enzyme in the body, and while both testosterone and DHT are known to have a weakening effect on hair follicles, there appears to be something unique about the conversion process of testosterone to DHT that relates to thinning hair. This is why some drugs that are marketed for hair loss block the conversion of testosterone to DHT. (It’s important to note, however, that these drugs tend to be less effective in women than men, and that one of them—finasteride—is only approved for hormonal hair loss in men, not women. What’s more, the drug has been associated with increased risk of sexual side effects, depression, nausea, hot flashes, and increased estrogen levels—and too much estrogen is its own risk factor for thinning hair; more on that below.)
Last week, we schooled you on the foods and vitamins for long, healthy hair. Today, Kristin Dahl, a Los Angeles-based nutritionist and women’s wellness educator, is back again to talk about all things hormones and hair loss. Keep reading for Dahl's guide to maintaining optimum hormonal balance, how stress can mess with your mane, lock-block hair growth, and more. As the founder of The Women’s Wellness Collective and the holistic lifestyle hub, Dahl House Nutrition, Dahl knows what she's talking about so we'd take notes if we were you.
Various techniques have been described over the years. Nylon implants were used by some people. Now, they are banned in many countries because of sequelae-like scarring and infection. Follicular unit transplantation has been found to give very good results and is now the procedure of choice for most types of hair transplantation. The details of the procedure with respect to eyebrow and eyelash reconstruction will be discussed here.
Madarosis is the hallmark of lepromatous leprosy. It was reported in 76% of patients with multibacillary leprosy. Bilateral symmetric cicatricial madarosis occurs in lepromatous leprosy due to histiocytic infiltration of hair follicles[77,78] [Figure 4]. It occurs in multibacillary leprosy after at least 5 to 10 years of untreated disease. Loss or atrophy of the eyelashes may follow. Madarosis adds to the cosmetic disfigurement caused by leprosy. Absence of madarosis is a good prognostic sign in long-standing cases. Unilateral madarosis may occur in tuberculoid leprosy due to the facial patch in the eyebrow region. In tuberculoid leprosy, madarosis occurs due to granulomatous infiltration of hair follicles leading to their destruction.
“The biggest mistake I see is people being too heavy handed with their eyebrow products,” says Megan Studabaker, a registered nurse and owner of Finespun Brow Design in Scottsdale, Arizona. “I recommend applying products in hair-like strokes, versus just filling in with powder because it often gets smeared and messy which isn’t achieving the polished look you are going for.” I’ve had good luck using Benefit Precisely, My Brow Pencil ($24) and Foolproof Brow Powder ($24).
The hormone imbalance known as hypothyroidism is a common cause of abnormal eyebrow thinning, especially in women; roughly 27 million Americans suffer from thyroid disease, and about 80 percent of them are women. Thinning eyebrows appear as a symptom of both hypothyroidism (underactive thyroid production) and hyperthyroidism (overactive thyroid production), alongside issues such as excessive fatigue, difficulty losing weight and constantly feeling cold. If your brows appear particularly thin around the edges, visit your doctor for a thyroid screening, which should include thorough blood work. With prescription medication, your eyebrows should fill back in over the ensuing months.
There’s no doubt that estrogen and hair loss are connected, but there are certain factors that determine how much of an effect estrogen levels have on your hair. As one of the main visible measures of your health, hair growth is often one of the first areas affected when hormones are off-balance. Let’s take a look at the links between estrogen hormonal imbalance and hair loss.