Crown Clinic surgeon Asim Shahmalak answers 7 of the most common questions about hair loss

POSTED: 08 May 2019

What are the main causes of premature hair loss?


Asim Shahmalak, consultant hair transplant surgeon at Crown Clinic,  said: "Premature hair loss is primarily a hereditary
condition. You can see how this gene is passed down the generations
most powerfully if you look at the royal family.

Male pattern baldness has gone from the
grandfather (Prince Philip), to the father (Prince Charles) and now on
to the son, Prince William. We can only hope that it skips the next
generation - young Prince George!

"Experts are split on whether this hereditary gene is more powerful on
the mother or the father's side. From my long experience working in this field, I would say the father's side is more powerful. That
certainly seems evident when you look at the royal princes.
"There are other causes for premature hair loss. Obviously ageing is a
factor - 20% of men under 30 experience hair loss, increasing to 40%
by the age of 35 and 65% by the age of 60.
"Around half of women experience some kind of hair loss by the time
they reach old age.

"There are medical factors which can also prompt hair loss.
"Stress is one factor because it can constrict the supply of blood to the hair.
"Other medical factors can also have an effect such as an under-active or
over-active thyroid.
"Women can suffer premature hair loss through polycystic ovary syndrome."

What are your top tips when it comes to working out which treatments
or products are likely to work and which are a waste of time?


Asim Shahmalak said: "When looking for treatments or products, I
recommend that patients use only those which are medically proven.
"There are two that I consistently use with clients - Finasteride and Minoxidil.

"I recommend that these are taken at the same time - Finasteride as a
pill and Minoxidil as a mousse spread on the scalp.
"Both have been shown through clinical trials to halt the loss of hair
and, in some cases, promoting the regrowth of small baby hairs.
"What Finasteride and Minoxidil are very effective at is helping men suffering from male pattern baldness to retain their natural hair. In 90% of cases, they have been shown to halt the process of baldness.
"What they don't do is grow new hair.
"The only long-term, permanent solution to baldness - both in men and women - is a hair transplant - either by FUE (follicular unit extraction) or FUT (follicular unit transplantation). Hair is taken from the the back or sides or scalp where there is an abundance of follicles and replanted in the areas where hair loss is most prevalent.

"I will often use Finasteride and Minoxidil in conjunction with a hair transplant. The transplant repairs the areas where the hair has been lost - all the transplanted hair will be permanent and should last the patient for the rest of their lives. Finasteride and Minoxidil halt the baldness and ensure that the patient will not need a further transplant because they will not lose any more of their natural hair. 
"Most other products are a complete waste of time.
"There is NO pill or shampoo that can promote the growth of hair. What some shampoos can do is nourish the hair so that it looks shinier and healthier.
"If there was so much magic pill you could take, why are 65% of men suffering from baldness by the time they are 60?"

Are there any risk factors which can make premature hair loss more likely?

Asim Shahmalak said: "Most people normally shed 50 to 100 hairs a day. This usually doesn't cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair loss occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue.

"The main risk factor making premature hair loss more likely is obviously illness.
"Patients who undergo chemotherapy or radiotherapy are likely to lose their hair but this tends to grow back a year or two years after treatment.
"Hormonal changes and imbalances can cause temporary hair loss. This could be due to pregnancy, childbirth or the onset of menopause. Hormone levels are also affected by the thyroid gland, so thyroid problems may cause hair loss.

"Infections, such as ringworm, can invade the hair and skin of your scalp, leading to scaly patches and hair loss. Once infections are treated, hair generally grows back.
"Diseases that cause scarring alopecia may result in permanent loss at the scarred areas. These conditions include lichen planus, some types of lupus and sarcoidosis.
"There is also a hair-pulling disorder. This condition, also called trichotillomania, causes people to have an irresistible urge to pull out their hair, whether it's from the scalp, the eyebrows or other areas of the body."

How do you think treatments and products will improve over the next decade?

Asim Shahmalak said: "I am very excited about the developments happening in stem cell research. I don't think anything major will happen overnight but in around 15 years we could be in position where scientists can take hair from the back of your skull and grow new follicles. This could lead to permanent solution to baldness.
"The advances being made are very exciting and I have been delighted to help an exciting research project into this area which was conducted by Professor Ralf Paus at Manchester University."


What's been the biggest development/improvement with regards to
treatments for premature hair loss over the past ten years?


Asim Shahmalak said: "The biggest development has been the introduction of the hair transplant technique known as Follicular Unit Extract. This is the method favoured by celebrities such as actor Jack P Shepherd, who plays David Platt in Coronation Street and the model Calum Best, both clients at Crown Clinic.
"In FUE, hair follicles are removed individually and transplanted into the areas of the scalp where hair is receeding. Immediate scarring is minimal - just a few red pin pricks in the area of the scalp where the hair is harvested.

"Many patients favour this more modern method which is particularly beneficial if you like to wear your hair short and don't want scarring around the donor area on the scalp.
"The traditional form of hair transplantation, Follicular Unit Transplantation or strip harvesting, is still popular - this is where a strip of hair is surgically removed from the scalp and the follicles are extracted.
"The other big development has been the introduction of proven methods to halt hair loss such as Finasteride and Minoxidil."

Is there a reason why customers should expect to pay more for a hair
loss shampoo or conditioner?


Asim Shahmalak said:"I would be wary of any customers buying shampoos or conditions which claim to promote hair growth. No such shampoo exists.
"Be wary of paying more for any shampoo or condition promising 'cures' for hair loss or promising to give you full hair.
"They won't give you fuller hair - they will give you better looking hair. There is a crucial difference."

Are there certain ingredients which you'd recommend within these types
of product?


"That is not to say that shampoos and conditioners cannot nourish hair and make it look much better. I do believe that caffeine shampoo - products such as Alpecin - can benefit the hair. There have been studies in Japan showing that caffeine can penetrate the hair roots, protecting the hair from hair loss."

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