Benefits of Combining FUE and Scalp Tattooing


Certified by the American Board of Hair Restoration Surgery and member of the International Society for Hair Restoration Surgery, I am a practicing hair restoration surgeon serving DuPage County surrounding Chicago, Illinois and Orange County, California; a specialist in a procedure termed Follicular Unit Extraction (FUE), a method of hair transplantation. I have found that combining scalp tattooing with FUE can allow for greater patient satisfaction, particularly in African American patients that wear a short hairstyle.  I have done several patients employing this method with outstanding results both African American and Caucasian.

FUE is a method of hair transplantation where the donor hair is punched out of the donor region scalp with a 0.8 mm to 1.0 mm punch. After the donor hair is removed, the punch site heals perfectly without the evidence of a huge linear transplant scar. When doing FUE, it is critical that the surgeon disperses the extraction pattern in mosaic fashion. The mosaic pattern gives the best aesthetic results for the donor area. The FUE method allows the patient to wear his/her hair very short in the back without any evidence of having a hair transplant. This gives the patients more options for hairstyling than previously.

We have all seen the long “strip scars” on the back of people’s scalps, visible after a traditional hair transplant. The scars look very obvious and unsightly when the hair is closely cropped. Combining FUE method of hair transplantation with scalp tattooing is a win-win situation. Scalp tattooing gives the scalp the appearance of natural, permanent density that most likely could not be achieved by transplantation alone. The versatility of scalp tattooing allows the hairline to be placed in a more youthful position than most hair transplant surgeons usually allow.  Any concerns of donor depletion become a non-issue.

Even with several hair transplants, it is sometimes difficult to achieve the density desired by patients that want to wear a close cut hairstyle.  It is well known, the longer the length of hair, the more appearance of density; alternately, shorter hair appears less dense. By first tattooing the desired area, then four to six months later following with a FUE hair transplant, the patient can then attain the results that could not be accomplished using one method or the other solely. The tattooed scalp does not prohibit hair growth of transplanted hair. The hair transplant provides “texture” producing natural and youthful results.

Since the tattoo has provided the necessary appearance of density, the hair transplants can be strategically placed to allow for the best results.  Usually in the traditional hair transplantation hair is placed uniformly through an area. With this combined method there is not a need to do this. We can now place hair only in the areas needed to enhance the results. Usually this is in the hairline and frontal scalp to give these areas texture. An area in the frontal scalp that would require at least 2,000 grafts for coverage would now require at most 600 to 800 grafts to get the desired results.

The tattoo may require addition of ink every 12 months to keep the appearance crisp. Also, as patients continue to gray over a lifetime the permanent tattoo background does appear to look unnatural.

FUE can be also be used with tattooing to improve the appearance of traditional strip donor scars. Just as before, tattoo the donor site first, and then 4-6 months later add hair to the scar with the FUE method. Sometimes after the tattoo alone, the result is so good, added hair may not be of any benefit. I have also written an article on this subject in the “Hair Transplant Forum International”.

The following cases illustrate the point further. The first is a 32 year old African American in good health with a Norwood 3A level of alopecia (Figures 1-4). He has been on Propecia for 2 years with successful slowing of further hair loss. He wants the appearance of density in the frontal one-third of the scalp and at the same time desires to wear his hair short.  He has visited with other surgeons that suggest at least 1600 grafts by the traditional strip method. The patient was opposed to any linear scars and saw me.  Due to the paucity of the donor and his style preferences I recommend scalp tattooing followed by FUE to the frontal scalp.  He completed 1,000 grafts with the results as shown.  Notice texture seen after the transplant and the artificial nature of the results before the transplants were done.

Case number two is a 26 year old Caucasian male that completed a hair transplant to the frontal area years ago and was not satisfied with the resultant density and the result of the donor scar.  He was diagnosed as a Norwood 3A and also had been on Propecia for several years. He had a scalp tattoo to add the appearance of background density (Figures 5-7).  Following this procedure he came to me for FUE to add texture to his result.  He completed 1100 grafts to the frontal area, and his six-month results are seen in Figure 6.

I believe the combinations of scalp tattooing and FUE hair transplantation yields superior results for naturalness and density. I have found many times after a traditional hair transplant particularly in African Americans patients, both density and the appearance of the scar need to be addressed. Scalp tattooing in conjunction with FUE removes these potential problem areas.


An Overview of Biotin As It Relates To Hair Loss

Does Biotin supplementation actually help encourage hair growth or simply create expensive urine?  (Biotin is water soluble and any excess consumed is excreted in the urine.)

Biotin was first recognized as an essential nutrient factor in mammals in 1936. 1

Biotin is one of the water-soluble B vitamins that helps the body to convert food (carbohydrates, fats and amino acids/protein) into fuel (glucose)..  The body only needs a small amount of biotin for its metabolic functions. and is easily obtained through various foods such as yeast, whole-wheat bread,  egg or yolk , leafy green vegetables, nuts, legumes, cheese, liver, port, salmon, avocado, raspberries and cauliflower.  Also, the intestinal flora produce biotin that the body can use and the vitamin is essentially recycled every day. 3so deficiency is rare because the intestines produce biotin in excess of the body’s daily requirements.For this reason, most countries including the USA and Australia do not prescribe a recommended daily intake or allowance of biotin. The Adequate Intake level (AI) for adults is 30 mcg per day 2 that is usually available in most multi-vitamins and numerous foods.   The recommended dose to treat deficiency for adults varies from 3,000 mcg per day for brittle fingernails up to 7,000 to 15,000 mcg per day for diabetics. 6The usual dose I see recommended for hair loss patients by physicians is 3000 mcg per day.

There are basically only a few causes of true biotin deficiency.  The first is by inherited metabolic disorders where an individual’s metabolism of biotin is abnormal, such as a deficiency in the holocarboxylase synthetase enzyme or biotinidase which covalently links biotin onto carboxylase, where biotin acts as a cofactor.  6

 Biotinidase or Holocarboxylase synthetase deficiency prevents the body’s cells from using biotin effectively, and thus interferes with multiple carboxylase reactions (these are complex bio-chemical reactions that occur to convert biotin to a usable form by the body).  7   2  This enzyme deficiency is rare and is usually discovered in infants when they present with symptoms.  Clinical findings as described below are usually adequate to make the diagnosis but a serum assay is available.  6

The other causes of Biotin Deficiency are related to lack of consumption or more likely malabsorption, prolonged intravenous (parental) feeding without biotin supplementation and consumption of raw egg white for prolonged periods (many weeks to years).  Raw egg whites contain avidin, a protein which binds strongly to biotin, making it unavailable to the body.  Some anti-seizure medications and long-term antibiotic therapy can create a deficit.  Additionally, conditions such as Crohn’s disease, partial gastrectomy and alcoholism make it hard to absorb nutrients and can cause deficiency.

Regardless of the etiology of biotin deficiency, clinical manifestations are essentially the same.  The first symptoms of biotin deficiency are associated with the skin and hair.  Symptoms develop within 3-5 weeks of the onset of deficient biotin intake or absorption.  The most common cutaneous findings include the following:

  • Dry skin
  • Seborrheic dermatitis
  • Fungal infections
  • Rashes, including erythematous periorofacial macular rash
  • Fine and brittle hair
  • Hair loss or total alopecia

Approximately 1-2 weeks later, neurologic symptoms begin to develop.  The most common neurologic findings include the following:

  • Mild depression, which may progress to profound lassitude and, eventually, to somnolence
  • Changes in mental status
  • Generalized muscular pains (myalgias)

Intestinal tract symptoms also develop and most commonly include the following:

  • Nausea, occasionally severe
  • Vomiting
  • Anorexia8

As indicated above, symptoms of biotin deficiency present as a syndrome or cluster of symptoms.  Supplementation adequately treats and corrects these symptoms. 1,2

An isolated finding such as hair loss is not indicative of biotin deficiency but is most likely related to another cause.

Current literature is conflicting regarding the benefits of biotin supplementation for brittle nails and diabetes.  No literature or scientific studies exist that show that biotin supplementation assists with hair growth.  Some uses for biotin discussed are speculative but include studies that show biotin supplementation might help reduce blood sugar levels in people with either type 1  or type 2  diabetes and possibly reduce the symptoms of diabetic neuropathy.  However, no double-blind, placebo-controlled studies have been reported on these potential uses of biotin.  Two double-blind studies have found benefit for diabetes with a mixture of biotin and chromium; however it is not clear how much the biotin in this combination contributed.  9

Very weak evidence, too weak to rely upon , has been used to support biotin supplementation for brittle nails.  Biotin has been proposed for treating cradle cap in infants.8 but there is no scientific evidence to support this theory,

Again, there are no studies to date that show improvement in hair loss while taking biotin supplements.  However, biotin is one of the most frequent recommendations by health care providers for individuals suffering from hair loss.

Because biotin is a water-soluble vitamin, no risk for toxicity or overdose exists.10 as any excess biotin is excreted in the urine. 

To date, very few treatment modalities are available to correct significant hair loss. Prescriptions such as minoxidil (Rogaine) and propecia have been shown beneficial for certain types of hair loss.  Correcting other underlying disease processes that cause alopecia is key, however. Exhibiting a healthy lifestyle with regular exercise, proper nutrition while limiting alcohol intake and not smoking are also essential.

In all of my years of practicing medicine, first as an ICU surgeon and lastly as a hair transplant surgeon, I have never encountered a patient with a true biotin deficiency.    While practicing as a critical care surgeon in ICU, most of our critically ill patients were routinely tested for vitamin B deficiencies but  none of my patients ever had an abnormal result. I have not requested any serum laboratory testing for my hair transplant patients to check for biotin level deficiency, but there has been not ancillary reason to do so.  As noted above, biotin deficiency seemingly creates a global set of symptoms that does include hair loss. Isolated hair loss not accompanied by the constellation of symptoms discussed here would not occur in this deficiency.

To date, 60-75% of the patients I see in my hair restoration practice take biotin supplementation as prescribed by their other health care providers and physicians in hopes that this would be the panacea to cure their hair loss.  The data that even suggest it might be beneficial to hair is based on poor data at best for nail growth and brittle nail therapy. 

Although no scientific evidence exists that supports biotin supplementation is beneficial to help treat hair loss, it certainly doesn’t cause any harm. Hopefully, this article will help us to better understand the scientific mechanism of biotin while we continue to seek more data and other treatments for hair loss.

1 http://emedicine.medscape.com/article/984803-overview#a010

2 http://en.wikipedia.org/wiki/Biotin

3 http://lpi.oregonstate.edu/infocenter/vitamins/biotin/

4 Otten, JJ, Hellwig, JP and Meyers, LD., ed. (2006). Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. The National Academies Press. ISBN 0-309-10091-7

5National Health and Medical Research Council: Nutrient Reference Values for Australia and New Zealand

6 Beth Israel Deaconess Medical Center. “Biotin”. Retrieved 15 May 2012.

7 http://en.wikipedia.org/wiki/Acetyl-CoA_carboxylase

8 http://emedicine.medscape.com/article/984803-overview#a0104

9 Beth Israel Deaconess Medical Center. “Biotin”. Retrieved 15 May 2012

10 Fiume (2001). “Final report on the safety assessment of biotin”. International Journal of Toxicology 2: 45–61


Motorized FUE with Blunt Punch


FUE in Patients of African Descent: Pearls and Pitfalls


Hair Transplantation Options For
African American Men & Women

Manuscript Type: Original Communication

Dr. William D. Yates M.D, FACS
ABHRS Diplomat
120 Oak Brook Center, Suite 308
Oak Brook, IL 60523
312-391-0429
Fax: 630-472-8809
Yates7579@yahoo.com

Corresponding Author:
Robin McIntyre, RN
425 S East Ave
Oak Park, IL 60302
505-944-5221
Fax: 630-472-8809
redrobiny@yahoo.com

Over 35 million men and 21 million women in the United States alone suffer from hair loss with the majority of androgenetic alopecia (male pattern baldness) being caused by genetic factors. Although certain medical therapies such as finasteride for men and minoxidil for men and women help to slow hair loss, no medical treatments to date cure this unfortunate event. Surgical hair transplantation remains the only permanent solution. Within this surgical specialty, advances have been made through a newer technique known as Follicular Unit Extraction (FUE). With this method, each hair follicle can be punched out and then transplanted to balding areas with minimal or no visible scarring left in the donor area. With the traditional method of performing hair transplants, we remove a strip of hair from the back of the head and then dissect out each hair follicle to transplant into the front or balding areas of the scalp. Unfortunately, this method leaves a visible, linear scar on the back of the head that can easily be seen when the hair is worn short. (Figure 1) The FUE technique allows us to remove the hair, follicle by follicle, without leaving a visible scar.

Follicular Unit Extraction (FUE) can be a successful solution for hair transplantation in African American patients. Most younger, African American patients want the ability to wear their hair closely cropped. Even the best, healed donor scar will be visible when the hair is very short. Many of my colleagues have doubted the results and the feasibility of performing FUE in African American patients because of the innate challenges associated with the coarseness and curliness of this hair type. I have performed numerous procedures with very predictable results as well as high patient satisfaction.

Below is a 38-year-old male with classical Norwood 3A status (Figure 2-4). He has been on finasteride and minoxidil for years without any noticeable reversal of miniaturization in the frontal 1/3 of the scalp. He is healthy and denies history of keloid formation. His exam revealed good donor hair with course texture and significant thinning throughout the frontal 1/3 of the scalp. His density in the donor area was estimated at 80 follicular units per square centimeter. Average density in the occipital region for Caucasian hair is 90 to 110 follicular units per square centimeter with African American density typically being less. The patient wanted to thicken the front without the traditional donor scar. FUE was decided upon.

The patient had 1,000 grafts FUE to the frontal 1/3 of the scalp. 200 single hairs were placed in the immediate hairline; the remaining 1-4 hair follicular units were placed behind this. (Figure 5) The SP-89 blade was used for the recipient sites. It is vital that the hairs be placed in the correct direction, growing forward and down. The donor was shaved from the occipital to the parietal area to get an even dispersal of density when the hair regrew (Figure 6). The transection rate or percentage of damaged grafts was measured at 8%. Every 100 grafts removed were examined for transection. The patient’s hair follicles, as expected, were curved. (Figure 7) A Harris 1.0 mm punch with the SAFE System was used for the entire surgery. The harvesting required two hours.
His results are typical. By 4 months new hair growth was seen and by 8 months remarkable growth was noticed (Figure 8-9). He wears the back of his hair close and the area is virtually undetectable of surgical scars. Since his original procedure, we have transplanted another 500 grafts to the frontal ½ of the scalp to add increased density. (Figure 10)

In today’s world, traction alopecia, scarring alopecia and genetic hair loss are very common dilemmas for African American women. Traction Alopecia is seen in supermodels and women from every socioeconomic class. This occurs when extensions or tight braiding pull on the natural hair causing it to weaken and cause severe inflammation to the hair follicle under the skin. This usually affects the hairline just above the forehead or the sides, where the hair is more fragile and a finer texture. (Figure 11-12) Initially traction alopecia is reversible but prolonged tension will destroy the hair follicles preventing any possible new growth of hair. If the tension or the extensions are removed, it can take between three months to a year for hair to grow back in moderate cases. Similar hair thinning and damage to hair follicles is seen with overuse of chemical relaxing agents to straighten hair. Some medical treatments such as minoxidil can help to re-stimulate the hair follicle to grow in early cases where the hair follicle is not permanently injured. In my opinion, a combination of minoxidil and a hair transplant is the best solution to restore hair in both of these conditions.

Below is a 35-year-old female patient who wore tight braids and hair extensions from the age of 12. She had typical traction alopecia. (Figure 11-12) She was assessed and determined to be a good candidate for hair transplantation. The traditional strip method was performed and at 8 months, she already has increased density in the areas of hair loss. (Figure 13-14) Full hair growth isn’t realized until 12 months following transplant.

African American patients who suffer from hair loss are great candidates for hair transplantation. The course, curly hair is ideal for better coverage and final density. Furthermore, FUE is a great hair transplantation technique for African American patients provided the absence of a history of keloid formation, or any other contradictory medical/dermatological conditions.


Balding Gracefully

I personally have never seen this. I have no idea what it really means, but sounds very mature and responsible when said. I have heard many men publicly say this but in private they always say they wish they had more hair. If it was such a bad thing why would we have those strong locks growing up anyway? Hair creates

a frame for the face just as curtains on a window. I think some of us look better with more frame, others are ok with less. But if you could create the frame why not get it.

I see many men that are depressed to the point of taking medication or even considering taking their lives because they are balding. Once the “big man on campus”, now they are looking more like their dad while their non-balding friends remain with a youthful appearance. I remember going into clubs in my late twenties and thinking to myself I looked like everyone’s dad. I am not sure if anyone else had this thought, but it did not matter because I was convinced it was true, because my hair was thinning. Finally after several years of thinking about my receding hairline at age 38, I had a hair transplant. This turned out to be a great decision. I looked much younger after the hair grew in providing a frame for my face.

I have also seen the balding process breakup marriages when the husband’s self-esteem has plummeted; so low he always accuses his spouse of cheating or starts to cheats himself to gain conformation from other seemingly attractive women that he is still desirable.

Several patients mention their performance at work is suffering because they feel their clients want a more youthful person to handle their business. I have heard this countless times from men of all walks of life. Some people feel intimidated by their coworkers with hair, creating a non-healthy work atmosphere. Some believe men in power always have hair. Look at all the presidents except Ford. Would Barrack have been elected the president sporting a shaved head? I would like to think so but I cannot prove that.

The overwhelming theme is frustration leading to overall dissatisfaction with your own appearance. The frustration stems from the fact for the most part baling it is out of control, and is governed by our genetic makeup. I always felt cheated that my hair was receding and most of my friends were not. As you will see, you can have some control over what is going to take place and there are several good options you can utilize to improve on your looks.

This is very serious sensitive stuff! Saying to your husband/significant other “honey, you look great” usually will not make these feelings go away. This is a perfect thing to say especially if you mean it. How you proceed from here is very important. The options for slowing the process or surgically improving your appearance are:
1. See Dermatologist.
2. Eat a healthy diet and exercise.
3. Take Vitamin B Complex and Biotin.
4. Learn more about Minoxidil/Propecia/and Laser Therapy.
5. Visit with an expert hair transplant surgeon.


Brazilian Hair Treatment

With actual origins in Brazil, the Brazilian Keratin Treatment (BKT) has become increasingly popular in its use on African American hair. The Brazilian Hair Treatment is a method of hair straightening and conditioning. It’s recommended usage is for clients ages 12 and older. The Brazilian Keratin Treatment can serves as an alternative to traditional relaxers and chemical applications to straightening hair.

The Brazilian treatment is a hair reconditioning treatment that has keratin as the main ingredient. Keratin is a strong protein that makes up the structure of our hair, skin and nails. The keratin is applied to the hair in a liquid form and then with extreme heat, (approximately 450 degrees F) the hair is flat ironed to a straighter texture. The keratin penetrates and coats the hair shaft to add strength to the hair. Ideally, the treatment should be used to make the hair a straighter texture and not to allow the hair to remain curly.

The entire treatment can take between 2 and 4 hours and should be done in a salon by an experienced professional. A certified stylist is recommended to insure the best results. The results on average are reported to last four to six months. It is recommended to wait 48 hours after the treatment before getting the hair wet to prevent frizziness. However, some of the newer BKT’s claim you can wet the hair the next day without fear of frizz. Most clients claim their hair is much easier to manage and style after the treatment, yielding a “life changing” newfound hair freedom. The treatment can also be performed on hair that has a relaxer or recently colored without harm. Using heat instead of chemicals to alter the hair’s texture, some stylist claim the more damaged hair can actually benefit from the treatment because the keratin can more effectively penetrate the weakened hair shaft.

The controversy that surrounds this treatment pertains to the presence of formaldehyde, a chemical mostly commonly used as a preservative (embalming fluid). It also seems to make the keratin treatment more effective. This chemical has a very pungent smell. Some brands utilize formaldehyde in their formula; others claim to be formaldehyde free.

Formaldehyde has been around a long time and controversy has always followed it. It has been linked with causing cancers such of the nasal lining and lymphatic system. Formaldehyde can also cause immediate irritation to the eyes causing burning, nosebleeds and severe wheezing and coughing. Salons will have their customers and staff wears a mask and goggles to minimize these effects. The risks posed by formaldehyde affect the stylist more than the client because of the repeated handling of the formaldehyde. The stylist can minimize this risk by wearing goggles and a mask and working in a well-ventilated salon.

Another concern with this treatment is that the heat is too extreme and can damage the hair. Extreme heat applied to the hair basically causes evaporation of the water in the hair shaft and destruction of the layers of hair shaft. The average among of heat applied by the flat iron is approximately 450 degrees F. In comparison, a chicken breast is fully cooked around 190 degrees F and McDonald’s coffee severely burned a lady’s inner thigh at 200 degrees F.

These treatments are costly and range between $150 and $500. The aftercare usually involves purchasing special shampoos and conditioners to enhance the results. The supplemental products can add another $350 to the total cost of the treatment.

For some the positives might outweigh the negatives. Many women feel their hair is much easier to manage in high humidity and will not frizz. Also not getting the hair wet does not seem to be a problem. Conversely if you are not pleased the results of your Brazilian Hair Treatment, just wait six months and your original hair texture will return.

Overall, the feedback about the quality of these treatments has been positive from the patients I have interviewed. Many women feel their hair is much easier to manage in high humidity and other adverse hair environments.


Eyelash Enhancement


Thick, long eyelashes symbolize glamour and beauty. Functionally, on the other hand, eyelashes protect the eye from dust and debris, similar to a windshield wiper.

People with less than long, thick eyelashes have several available options to improve their situation. To understand the options, we will need to discuss some eyelash biology.

The growth phase of eyelashes is much shorter than the hair on the scalp. Eyelashes will grow for approximately 100 days where scalp hair can grow for 2-6 years. That is why scalp hair is much longer. It also appears as we age, our eyelashes become thinner and shorter and loose their appearance of fullness.

The most common cause of eyelash hypotrichosis (thin, sparse eyelash hair) is thinning with age and loss from over plucking or loss from wearing artificial extensions repeatedly.

Eyelash transplantation is a great solution for a permanent enhancement of the eyelashes. Usually 50 grafts are used per eyelash (upper lid). The procedure is done as an outpatient procedure and can be completed in 2-4 hours. The hair for the eyelashes is taken from the back or sides of the scalp. The skin of the lid and the outer surface of the eye are numbed using local anesthesia. The eye itself is protected by placing an eye protector over the eye during the procedure.

Growth of the new eyelashes can be seen starting at 2 months but the final result may take 1 year for all grafts to mature. New grafted eyelashes will require maintenance. Trimming, curling, and tinting may need to be done monthly. Remember the graft hair is from the scalp, this hair grows much faster than normal eyelash hair. We require all patients to be committed to this extra maintenance before considering them for an eyelash transplant.

Patients who are not good candidates for the procedure are patients diagnosed with untreated Trichotillomania (self-induced hair pulling), inflammation of the eye or lid, bleeding disorders, patients with alopecia totalis, and patients unwilling to comply with the added maintenance that is required.

Complications of the eyelash transplant procedure are few. Some patients report a “bumpy” appearance where the eyelash is inserted. If the hairs are not placed in the correct direction the new hair can irritate the eye. Also the eyelid can appear to droop if the placement is not correct. All these problems are correctable.

A non-surgical approach to enhance sparse eyelashes is using the FDA approved medication, Latisse (bimatoprost ophthalmic solution) 0.03%. This is a prescription medication applied to the upper lid nightly. It requires 6 weeks to 2 months of continued usage to show improvement. The medicine must be continued as long as the patient desires the thicker, longer and darker lashes. Once the medication is stopped the lashes will return to their original state. Side effects of Latisse include irritation and or itching of the eye in approximately 4% of patients and very rarely darkening of the skin around the lashes and darkening of the iris. The average cost per month is $120.


Hair Relaxing (lanthionization)

In a quest for African Americans to achieve straighter hair, at the turn of the century, many women began using the hot comb, which uses thermal heat to temporarily straighten the hair. This method was soon replaced by a chemical method that permanently altered the hair’s internal structure. This was called a relaxer.
There is a lot of controversy surrounding the use of excessive heat and chemicals to African American hair causing excessive hair breakage and irreversible hair loss and follicular damage.

It’s interesting to note that the hair relaxer dates back to 1910 to Garrett Augustas Morgan the same genius that invented the traffic light. He called his hair product hair refining cream and also patented it. It was advertised in the newspapers in he 1900’s to positively straighten hair in 15 minutes. He guaranteed it. Many people believe Madame CJ Walker invented the hair relaxer technique but to her credit she invented several creams and balms and also invented the hot comb.

A hair relaxer is a lotion or cream that makes hair easy to straighten and manage. It has become very popular in the African American community because it reduces the curl by altering the chemical structure of the hair making the hair resistant to returning to its original curly/textured state. The results will vary dependent on the coarseness of your hair but a relaxer will usually offer a straightened result for 6-8 weeks. Relaxers permanently alter the structure of hair where hot combs temporarily alter the structure. New hair growth is not affected by either process.

Relaxation of the hair changes the chemical bonds of the hair shaft permanently. New hair growth is visible at 6-8 weeks. This new hair growth is the only part of the hair that would need to be retreated with a relaxing chemical to maintain the straightened appearance. In fact, it is critical that further chemical application to the already treated hair shaft is emphatically avoided to prevent further damage to already potentially brittle hair.

The hair strand is composed mainly of protein. This protein is called keratin. There are several building blocks that give hair its texture and strength. These building blocks are called chemical bonds. The bonds crosslink protein in hair to impart strength and rigidity to the hair. The easiest way to think of this is a ladder. The steps or rungs are the bonds that hold the two side rails or protein together.

The shape of hair is party controlled by chemical bridges, (rungs in the ladder) called disulfide bonds that connect protein fibrils together. Because these bonds are so strong, a powerful chemical reaction is required to break them apart before the hair can be straightened. This reaction requires a very high pH. For those of you who fell asleep during chemistry class, pH is a measure of how acidic or basic a substance is. The pH scale runs from 1 to 14. Chemicals with a very low pH value (around 1 to 3) are very acidic and can be damaging to hair and skin. Chemicals with very high pH (10 to 14) are very basic and can also be damaging. Relaxers must have a very high pH (11 or above) in order to work. Unfortunately, this pH can also weaken your hair and damage your scalp.

The primary bonds that strengthen the hair shaft are sulfide and hydrogen bonds. Sulfide bonds appear to provide more strength to the hair shaft and are harder to alter/destroy. It is through destruction of these bonds that relaxers and other treatments work to alter the hair texture and appearance. The relaxers penetrate the layers of the hair shaft and cause chemical dissolution of the structural bonds at the cortex.

The mechanism of a relaxer is to break down the sulfide bonds and then to cap them so that they cannot reform. The more sulfide bonds present the coarser and tighter the curl of the hair; therefore, more of these sulfide bonds need to be destroyed to straighten the hair.