Excessive hair loss can be devastating, but it isn’t always inevitable.


Wisps on the pillow in the morning. Clumps nestled in the teeth of a comb. A palm full of strands after removing a ponytail band. These typical early signs of abnormal hair loss are enough to strike fear in any man or woman’s heart.

Hair is one of the first things we notice about each other, and it’s deeply connected to our sense of self. Loss of hair can cause emotional distress, frustration and sometimes even depression. There are various causes for hair loss and, fortunately, you can help clients with a number of them.
It’s important for clients to understand that some amount of hair loss is normal. Scalp hair grows in cycles, with each hair follicle undergoing 10 to 30 cycles in its lifetime. The cycles are comprised of three phases of growth:

• Anagen, or active phase, which can last two to eight years
• Catagen, or transitional phase, which typically lasts four to six weeks
• Telogen, or resting phase, which continues for two to three months

Each follicle works independently; while one is growing the other may be resting. This keeps the same amount of hairs on the head, approximately 100,000 on a healthy scalp. As dead hair is released, loss of about 100 hairs a day is normal. More than that may signal trouble.

The Root of the Problem

Alopecia is the medical term for hair loss, but there are many types under that diagnostic umbrella. For instance, hereditary hair loss resulting in a pattern of bald spots is very different from alopecia caused by medication or postpartum changes.

The type of hair loss a client is experiencing will determine his or her best treatment options. And while some spas and salons have hair and scalp analysis equipment to help clients classify their alopecia, it’s always best to refer hair loss clients to a dermatologist for diagnosis first, as blood work and microscopic study might be required. (Once an individual client’s problem is understood and serious medical conditions ruled out, your spa should conduct a thorough lifestyle intake to settle on a course of action.)

The most common type of excess hair loss is telogen effluvium, in which anagen-phase follicles prematurely transition to the telogen phase, explains Dr. Wilma F. Bergfeld, senior dermatologist and co-director of dermatopathology at the Cleveland Clinic in Ohio. Causes of telogen effluvium vary greatly. “Drugs, hormones, nutrition, emotional or medical stress all can influence follicle recycling adversely, resulting in shedding of up to 40% of hair density,” Bergfeld says.

There’s generally a trigger that sets off hair loss. Working with clients to identify that trigger will help form a timeline that can be used to measure progress, says Bergfeld. A single occurrence of acute telogen effluvium may present two to three months after a triggering event, whereas repeated triggers may result in chronic effluvium. Hormonal changes such as those that occur around childbirth and menopause should be noted, as well as changes in diet and weight.

“The anagen bulb has many receptors, and hormones—including insulin, corticosteroids and others—influence this growth center,” says Bergfeld. “Also, any local inflammation or nutritional deficiency can reduce growth.”

Liana Robinson, the owner of Y-O-U Hair Wellness & Lifestyle Spa in Jamaica Estates, New York, is an iridologist—or alternative medicine practitioner who examines the iris of the eye to determine health and illness—and she also specializes in trichology. Trichologists receive training in hair and scalp disorders, and may function as consultants to dermatologists. In the case of the follicularly challenged, “Something in the body is usually missing,” Robinson says. “We conduct an assessment with a body scan and a urine test. Sometimes a client’s pH balance is off, and we may need to help support the client’s lymphatic system.”

At Suddenly Slimmer Wellness Center & Day Spa in Phoenix, a naturopathic doctor or acupuncturist examines hair-loss clients and may recommend female hormone panel testing. Stress testing may be indicated as well. “We do an analysis to test the tissue of the live hair closest to the scalp and send it to a lab to find out the levels of metals like copper and iron, which will be high when a body is stressed,” explains spa director Jeanie Marcelino. “Sometimes, there are multiple reasons for the hair loss that need to be addressed.”

Great Lengths

Because hair loss is such an emotional issue, it’s essential that you and your client discuss treatment goals and expectations in advance. Hair loss can be traumatic and clients may be desperate. “First of all, we have to talk about how aggressive the client wants to be,” says Robinson. “We have to find out how fast they want to try to grow the hair back and how much treatment they can take, as well as what their budget restrictions may be.”

Surgical hair replacement procedures are the most obviously corrective solution, but they’re not always financially feasible, nor necessarily preferred by clients. Hair-loss centers and medical spas often turn to the less extreme measure of laser therapy. Practitioners who use laser treatments have seen evidence that the laser light actually stimulates cell metabolism, enabling damaged follicles to repair themselves. Even the Federal Drug Administration recently approved a laser comb to treat hair loss.

“Laser therapy serves several purposes,” says Carole Nauman, co-owner of Amirage Salon, Day Spa & Hair Loss Center in Dubuque, Iowa. Nauman cites the laser’s ability to clean off oily excesses of DHT (dihydrotestosterone), a byproduct of testosterone that builds up on the scalp and chokes hair growth. “A healthy scalp equals healthier hair,” she says. “The laser can also thicken existing hair strands by 25% to 40%, which makes the hair feel fuller.” Nauman works with clients on a multiphase laser program beginning with 30-minute treatments, twice a week.

Spas that prefer to take a less technology-dependent approach may opt for a regrowth program that includes vitamins and supplements. Biotin, a B-complex vitamin sometimes lacking in people under great stress, is often suggested to promote hair growth. Bergfeld recommends seeking to correct deficiencies of iron, zinc and vitamin D with supplements and/or dietary changes.

A vitamin regimen combined with acupuncture works well for Suddenly Slimmer clients, according to Marcelino. “Acupuncture can diagnose which organ system is not in balance,” she says. Such imbalances can lead to hair loss. She also offers an infrared LED treatment to encourage blood flow, and scalp massage to stimulate nerve endings and increase circulation to the area. “We try to keep the follicles from becoming dormant,” Marcelino says, “because if they do, nothing may be able to help after that.”

Ongoing application of topical preparations, such as the widely used minoxidil, is probably the best-known strategy for restoring and preventing hair loss. There’s also a range of shampoos, conditioners and haircare systems developed to keep the scalp unclogged and encourage hair growth. Bergfeld recommends shampoos containing zinc or the antifungal ingredient ketoconazole, used twice weekly. Products that act as DHT blockers can help correct scalp imbalances; natural versions often contain saw palmetto.

Looking Well-Tressed

Cosmetic fixes offer the advantage of immediate, visible results and give clients a boost of confidence: Hair-loss concealers and topical shading work to subtly camouflage thinning areas; and hair extensions can be used in conjunction with other treatments.

Amirage’s Nauman ties Cyber-Hair onto clients’ existing hair with links, sometimes increasing their hair volume by as much as 400%. The service is performed every six weeks so that it’s continual, mimicking a natural hair cycle. Amirage also offers an integration unit, similar to a hair net, in which the client’s own hair is pulled through to blend in with the artificial locks.

Despite all of the treatment options at your disposal, some hair-loss conditions are beyond a spa’s reach. In these instances, you can assist clients by referring them to a trusted dermatologist and, perhaps most important of all, providing an uplifting and healing spa experience.

The American Academy of Dermatology cautions that the following styling habits can cause hair loss or breakage:

  • Too much shampooing, combing or brushing
  • Frequent brushing or combing of wet hair
  • Rubbing wet hair dry with a towel
  • Improper use of dyes or relaxers
  • High heat from blow dryers and hair irons
  • Unprotected hairpins, hairclips and rubber bands (use ball-tipped pins, clips with rubber padding and fabric-covered bands worn loosely)
  • Daily wear of styles that pull on the hair, such as ponytails, cornrows or braids

Andrea Renskoff is a freelance writer based in Los Angeles.

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