• What can cause sudden hair loss? The most common causes are hormonal changes from childbirth or after surgery involving general anesthesia, cancer chemotherapy, and HRT (hormonal replacement therapy), but lesser-known causes can be the start of new medications such as antibiotics, antifungals, antidepressants, birth control pills, anticoagulants and statins.

The hormones that usually cause hair loss are testosterone with HRT and hypothyroidism (low thyroid hormone). Lab tests and a good history and physical can reveal these issues so they can be treated.

Other causes are stress and nutritional deficiencies. Anorexics are a perfect example of the latter. Typically, people lose 50 to 100 hairs per day. Stress and nutritional deficiencies can increase this hair loss by 300%. This increased shedding occurs about three months after the event.

Tension on the hair, such as braids or tight ponytails, commonly cause permanent hair loss.

• How do I know if I am permanently losing my hair? For men, there might be hair loss in the crown, or the hairline is receding. However, losing 100 hairs per day is normal.

Generally, a receding hair line and baldness is a combination of family history and aging.  Hair loss can start out slow and increase with age.

For women, thinning on top is the first sign of female pattern baldness. There might also be a noticeable decrease in hair volume. A loss of 50% of hair will look thinner and baldness becomes visible.

Approximately one in five people in the United States will have some sort of hair loss by age 35 in men and age 50 in women.

• What can be done to slow this hair loss? There are now pills, shampoos, and sprays that can show some decrease in hair loss and, in combination, might show an increase in hair density.

Platelet Rich Plasma (PRP) has shown promise in a range of results from slowing hair loss to increasing hair density significantly. This is particularly beneficial in women. Some patients, however, are non-responders.

PRP involves using your own blood to isolate the platelets with their growth factors and injecting them into the scalp with a tiny needle. Virtually no recovery time is needed following PRP injections.

Ultimately, one may choose a hair transplant procedure. Performed by a team that is experienced and skilled, this will yield the best and most natural result. Modern hair transplants use one hair per graft for the hairline and two to four hairs per graft for the top and crown for more density.

The direction of the grafted hairs must be placed properly. This can be done with the strip method or FUE, e.g. NeoGraft. The difference is in how one procures the grafts. Your hair specialist will discuss the benefits of the different methods.

A hair transplant does not prevent your existing non-grafted hair from thinning. The other methods, e.g., PRP, sprays, pills, etc. may still be beneficial to continue having maximum hair density through the future years.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. fingerandassociates.com