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Throughout my entire medical career, I don’t think I have been satisfied with the status quo. I am fortunate that things keep changing in medicine and keep improving. Beyond new discoveries in hair restoration, I also keep looking for a better way to perform various procedures, searching for continuous quality improvement with technology, equipment, and timing.

Over the past couple of weeks, I had two new female patients come in, ages 46 and 63, complaining of loss of hair in their hairline and eyebrows.

One common topic I often get questions about is follicular units. A common misconception about hair growth is that all hairs grow out of the scalp separately (aka “single hair growth”). While there are singular hairs that do in fact grow individually, the rest of the hairs, known as follicular units, grow very close to each other, and sometimes even out of the same exit point. They appear as closely-clustered units consisting of two, three, four, and sometimes even five terminal hairs per grouping.

I have been following a 48-year-old female for the past year who was diagnosed with breast cancer some three years ago and was experiencing generalized thinning over her scalp and eyebrows when she came to see me. She was negative for the gene mutation of BRCA1 and BRCA2 genes with no positive nodes at the time of surgery when she underwent bilateral mastectomies with reconstruction.

Before consultations, I ask new patients to fill out a detailed questionnaire which allows for providing information I need to determine the etiology of their hair loss. In general, during the consultation, I am looking to assess the pattern and course of hair loss as well as any associated symptoms.

In the medical field, for a few decades, there has been the concept of CQI or Continuous Quality Improvement process that encourages all members of the medical community to continuously ask, “How are we doing?” and “Can we do it better?” This idea has evolved over time.

Most of us can’t live without using some form of heat on our hair, whether it’s a blow drier, flat-iron, or curling iron, but unfortunately these heat styling tools can cause, among others, a condition that dermatologists call bubble hair. A sign of thermal injury, bubble hair is the result of bubbles formed within the hair shaft when water in the hair is heated and turns into steam. Clinically, hair appears to be kinked, break off, and the condition may develop into localized alopecia over time.

According to the Centers for Disease Control and Prevention (CDC), tobacco is the most significant preventable cause of death and disease in the United States. Nicotine, a component of tobacco found in cigarettes, cigars, and e-cigarettes, is a highly addictive substance which contributes to compulsive use, relapse after abstinence, and physical dependence. In spite of the well-documented health hazards, an estimated 17% of Americans smoke cigarettes leading to nearly a half million deaths each year.

In March of this year, I updated all of my PRP equipment and invested in technology to maximize the growth factors found in platelets which involves using a top of the line centrifuge to achieve a high platelet count, but more importantly, incorporating sonication, an additional step to the process.