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C L I N I C A L

aestheticmed.co.uk HAIR RESTORATION

In particular ask about hair breakage or hair loss at the curly and coily hair are more likely to purchase products
vertex (CCCA) or temples (traction alopecia) specifically for textured hair rather than general market
• Changes in hair fall – It is worth noting that there is more products, according to the 2018 TextureTrends Report
natural breakage in the kinkier curl pattern naturally, from NaturallyCurly. 8
however there can be treatable reasons
• Change in rate of growth and hair texture changes It is also important to assess the psychological state
• Associated symptoms – Including itching, burning, pain or of the patient, and a questionnaire completed before the
tingling of the scalp, or scalp scaling consultation can be helpful.
• Past Medical History – Medication history including
supplements, plus nutrition history HAIR-CARE PRACTICES AND THEIR SIGNIFICANCE
• Family history – Important in central centrifugal People with natural Afro-textured hair wash their hair
cicatricial alopecia and androgenetic alopecia approximately once every one to two weeks. This is
• Previous treatment – Patients may have seen other partially due to lower levels of sebum on the hair shaft, as
professionals in the past such as a trichologist or hair the hair grows away from the scalp with resulting dryness
transplant surgeon. It can be helpful to find out more and breakage if shampooed too frequently.
• Hair care practices – Including bleaching or processing Afro-textured hair in its natural state free from chemical
• Hair-maintenance products used – Figures reported processing is the healthiest option for hair. Certain hair-
by Black Hair Magazine in 2018 revealed that in the UK, care practices and hairstyles are unique among women
£5.25 billion is spent annually on hair care. Spending by (and some men) of African descent, which may contribute to
black women accounted for 80% of total hair product specific types of hair loss.
sales, and black women reportedly spend six times more A variety of hair-care practices may have been engaged
on their hair compared with white women. 7 Women with in throughout life. It is important to get as much detail
about the practices and products that are used and how
often. Natural hair may have been straightened, or its
texture altered using heat or chemical means. In general,
consumers will tend to buy brands with product formulas
specifically made for them in mind. Haircare regimes
designed to maintain and style natural hair are growing in
popularity, with chemical product use declining (in the US). 9

Styles that can cause tension
Afro-textured hair can be manipulated into various styles
including braids, twists, cornrows, dreadlocks and weaves.
If too much tension is used, this can accelerate hair loss. In
all of these styles (except dreadlocks), human or synthetic
hair may be added for increased length and volume.
• Braids and twists: Where the hair is parted into sections
and two or three strands are repeatedly crossed over
• Cornrows: Formed by braiding the hair into the scalp in
rows
• Hair weaving: The hair is cornrowed, and additional hair is
sewn or glued to the cornrows
• Locks (also known as dreadlocks, locs or dreads): Where
the natural hair is sectioned into small areas that are then
twisted, braided or coiled using the finger, palms or tools.
The new hair growth is re-twisted after six to eight weeks
and allowed to mat.
Figure 3. Fringe sign in traction alopecia
Styles that can cause thermal damage
High temperatures applied to the hair cause the expulsion
of water from the hair, which leads to deficits in the cuticle
(outer hair layer) which then becomes fragile and more
susceptible to breakage.
• Hot combing or pressing: The hair is coated with a
lubricating oil and then combed with a hot metal comb
heated to 300 to 500°F
• Flat iron: The hair is placed between two hot, smooth,
ceramic plates with temperatures ranging from 180 to
450°F
• Silk press: Flat irons are used with products containing
silicones, such as dimethicone and cyclomethicone, which
are applied prior to heat application to create a lighter,
Figure 4. Traction alopecia Figure 5. After camouflage fibres
before applying keratin fibres less weighed-down straightened look compared to the

Aesthetic Medicine • June 2020 31