Before deciding on hair transplantation, the hair restoration surgeon should definitely look for the reasons of hair loss by examining the scalp with hair. If the surgeon suspects that there may be other reasons of alopecia than the women or men type genetical alopecia, they should reveal the underlying cause by conducting researches for other diagnosis. After treating the cause of hair loss, hair transplantation should be applied in the area that hair loss occurs.
Hair pull test: 25-50 hairs are grasped and slightly pulled by finger tips, and checked to see how many hair detaches. While only a couple of hairs should detach in normal circumstances, if there is a detachment in many numbers, one should suspect of an abnormal situation; and hair bulbs should be examined under the microscope, and hair shaft and root should be analyzed. During hair pull test, if the number of detaching hairs is 5 or more, it means that the alopecia has increased depending on “telogen effluvium”. Losses depending on telogen effluvium may recover; and it may be caused by reasons such as pregnancy, stress and drug use. Such losses are seen 3 months after the stress, and it affects 30-50% of the total hair amount. In this case, the daily amount of losses (50-100 hairs in normal circumstances) can be 300 or more hairs.
Phototrichogram: Hairs are clipped or cut from a certain area, and their close-up photos are taken and their growth patterns are examined at 3-5 day intervals.
Hair window: Hairs are clipped or cut from a certain area, and the hair growth is monitored within 3-30 days. An opinion is formed about the hair cycle.
The hair loss caused by the abnormality in the hair growth cycle is rare but can be seen at any age. Thyroid diseases, nutritional inadequacy, side effects of some drugs, anemia, some systemic diseases and psychological stress can be listed among cases that may cause hair loss by affecting the hair growth cycle.
Skin biopsy: Despite the fact that it is rarely necessary, it can be required in order to define some cicatricial alopecia (losses seen upon the loss of hair follicle) and diagnose infiltrative skin diseases that may cause hair loss.
Hair evaluation: If there is a doubt of an abnormality or infection in the hair shaft, then the hair is removed from the scalp and examined under the microscope. Fungal, bacterial or viral infections my cause hair losses that are seen in the form of split ends in hairs.
Hair analysis: This is a laboratory test. In order to understand the cause of hair shaft abnormalities, a biochemical analysis of the hair is performed. It is a reliable test in order to understand whether the cases like genetically modified hair-protein profile and/or drug use or heavy metal poisoning are the cause for the hair loss. It is not performed for the diagnosis of systemic diseases or nutrition problems.