Synthetic hair as a health hazard


Dear readers,

For people suffering from the hereditary or traumatic loss of hair, this can lead to a painful pressure that makes them look intensely for a solution to this problem. However, it should be noticed that any medical procedure that may be suitable for the restoration of hair loss is associated with certain risks to the patient. In this context, the conscientious disclosure of each patient should be self-evident to all surgeons and physicians who offer such services.

Unfortunately, when researching the Internet, I see again and again that there is a certain number of providers of these techniques who abdicate from their responsibility for a sustainable patient education. This ultimately leads to the fact that patients suffering from hair loss are still treated with questionable methods. These are praised as fast, cheap and lasting, which is above all the implantation of artificial hair. However, it is now the case that rapid and serious complications can be caused by this method, the subsequent treatment of them can also be very expensive and time-consuming. In the worst case, the attribute sustainable can only be given to the damage that can be caused by an artificial hair implant.

Even though the number of providers of artificial hair implants has shown a decline in recent years, there are still too many rogue providers who try to lure customers with “bargain” offers, and regrettably often enough they succeed. On the basis of my personal experience, such patients are subsequently also becoming clients of our clinic, since partial catastrophic damage arises due to the artificial hair implantation. For this reason, I would like to make you aware of the dangers of such treatment and to encourage you to seek more than one opinion on the treatment of hair loss.

Therefore, enjoy reading!
Sincerely Yours, Angela Lehmann

What is an artificial hair implantation and how does it work?

An artificial hair implant is a surgical-aesthetic treatment method applied to people suffering from hair loss (alopecia). The cause of hair loss is of secondary importance for artificial hair implantation. The suppliers of this procedure claim to be able to treat both traumatized hair loss and androgenetic alopecia as a natural form of hair loss. As the name suggests, the technique is based on the fact that the (still) existing hair of the patient is not used for transplanting to the receiving area, as it is the case with my hair transplantation technique. Instead, artificial hair is implanted that can be selected according to the texture, length and color. Artificial hair is not necessarily equal with plastic hair. There is artificial hair, which is obtained from plastic polymers, as well as from “natural” sources. It is more of secondary medical and health importance, from which source the artificial hair originates. However, the origin of the artificial hair is used for marketing purposes. There are some offers on the internet that advertise with “bio artificial hair”, but it is not quite clear what about plastic is to be called “bio”.

1. artificial hair, 2. unspecific connective/scar tissue (potentially inflamed), 3. sebum gland, 4. basal layer, 5. natural hair, 6. hair muscle, 7. epidermis, 8. upper skin layer, 9. dermis, 10. blood vessels

Apart from this, many major producers of artificial hair have in common that they are coating their products with collagen. Collagen is a protein that also occurs in the human body and regulates, for example, the elasticity of the skin. The collagen on the artificial hair is said to cause a better anchorage of the artificial hair and to lead to an enhanced wound healing. Since the manufacturers of the artificial hair are aware of the risks of such treatment, the artificial hair is additionally advertised with the attribute that silver ions have been applied to the anchor of the synthetic fiber which are to have antimicrobial action and to protect against inflammation. A common material for synthetic hair is, for example, polybutyl terephthalate, which is said to be mechanically very resistant. In addition, it is advertised that this material would also be used in non-resorbed surgical sutures, for example, in vascular surgery.

Basically, the artificial hair and real hair have in common a longer hair shaft. At the end, which is transplanted into the skin, there is a small loop which should ensure the later anchoring of the hair within the scalp. In addition, the artificial hair should be resistant to everyday chemical substances or heat.

The providers of an artificial hair transplant state on their internet pages that the artificial hair implantation takes place under local anesthetic anesthetization. The implantation is carried out with a special device that creates a stitching channel in the scalp, thus simultaneously introducing the artificial hair into the skin. The implantation of each hair is performed individually, each time a wound channel with a diameter of about 0.3 millimeters is formed.

Once the artificial hair is introduced into the skin, the body tries to close the resulting puncture channel by infiltrating healthy cells into it and finally filling it with connective tissue. At the same time, the new connective tissue grows into the loop of the artificial hair, which is said to anchor this more strongly in the scalp.

Regarding the after-care, the providers give very little information. It is said to be possible to model and to dress the hair like a real hair. However, some of them admit that a significant loss of up to 20 percent of the transplanted artificial hair can occur per year. These are, however, rather isolated details; to what extent the providers are more honest in the counselling interview can not be assessed at this point.

As already mentioned, the providers of the artificial hair transplant are not afraid to advertise their services with flowery words. Primarily, advertising-promoting predicates are used, e.g. individually, immediately visible, naturally, aesthetically, quickly, simply and without pain. These statements clearly reduce the medical nature of such an intervention and make it appear to the reader of such offers that it would be a hairdresser’s visit. Most striking in the offers, however, appears the constant reference to the “excellent price-performance ratios”. This is one reason why extreme caution is needed because one of the most important rules of economy is that when providers of a service interfere with one another in price competition, the quality of the service offered must necessarily suffer. Serious providers of a medical service or treatment would hardly cite the price as a sales argument, since the patient’s well-being is the highest priority and this can not be expressed as monetary value.

However, this is not the only reason why you should be extremely critical of an artificial hair transplant. I would like to draw your attention to the following.

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Why should you avoid artificial hair implantation

As already mentioned, an artificial hair implant represents a lasting intervention in the body and is therefore to be considered under the same precautionary aspects as other medical interventions.

Sichtbare Entzündungen und Narbengewebe durch Kunsthaarimplantate auf der Kopfhaut eines Mannes

Visible inflamation and scar tissue caused by prothetic hair fibers on the scalp of a man

The idea of replenishing lost hair by artificial hair is relatively old. For example, the patent for a device with which artificial hair can be transplanted into the scalp and held there by small loops, as described above, reaches back to 1976 (patent number: US 4103365 A). It may be surprising that the US Food and Drug Administration (FDA) has banned artificial hair implantation in the United States in 1983. This ban was formulated in Section 895.101 of Code 21 of the Federal Regulations of the FDA. As a reason for this, the FDA argues that the artificial hair presents risks for illness or injury due to the lack of biocompatibility and that they do not meet the performance requirements for medical products. Furthermore, according to the FDA, artificial hair transplantation is a deceptive act (lit. fraud), since the procedure is linked to the spread of misinformation on the effectiveness of the treatment; insufficient information on the risks of an artificial hair transplant; and the procedure would not benefit public health. Despite the fact that in the intervening 20 years there were many advances in artificial hair transplantation, these provisions were again confirmed in this form by the FDA in 2016. On the other hand, however, it must also be said that many health authorities around the world do not share these concerns and artificial hair transplantation is still allowed there. We shall return to this later.

Sichtbare Entzündungen und Narbengewebe durch Kunsthaarimplantate auf der Kopfhaut eines Mannes in Nahaufnahme

Visible inflamation and scar tissue caused by prothetic hair fibers on the scalp of a man (close-up view)

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Lack of sustainability

One of the first reasons why you should be suspicious of an artificial hair transplant is the fact that you will not have a lasting pleasure in a one-time treatment. For example, if we take recourse to the numbers of the suppliers, about 10 to 20 percent of the grafted artificial hair implants are lost every year. This means that the treatment effect would be completely reversed after five to ten years at the latest.

At this point, however, it might be more realistic to consider higher failure rates than stated by the providers of artificial hair implants. For example, treating physicians who carry out restorations after an artificial hair transplant indicate that it would be between 20 and 50 percent per year (Imagawa, 2010). In addition to this fact, there is no reason to assume that the loss of the artificial hair would be uniform. Rather, it is the case that a person has a predilection for sleeping on a certain side or scratching more frequently on the left than on the right side of the head. Accordingly, at different locations on the scalp, differently forces act on the artificial hair, which can lead to them failing differently quickly at different points on the head.

The only thing that is sustainable in the artificial hair implantation seems to be the profit of the providers of this service, because by already including a loss of the artificial hair in the advertising offer they are able to build a firm customer base for post-implantations, as long as the customers are willing to participate in this procedure.

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Questionable use of silver ions

As mentioned above, the silver ions with which the implants are coated are intended to impart an antimicrobial effect and thus prevent inflammation at the puncture site. In theory, this may seem plausible, but the application is not so easy in practice. It is true that silver ions already have antibacterial (antimicrobial) and antifungal (antifungal) effects even in very low concentrations. This is because the silver ions react with certain functional groups of the proteins of these organisms and thus inactivate them. This effect, however, applies only to the external application of silver ions. For this reason, they are preferably used in creams, lotions or soaps. If, on the other hand, the silver ions are incorcporated into the body as in the case of artificial hair implants, it is highly unlikely that an antimicrobial effect is mediated there as well. In addition to the fact that these organisms do not occur in a healthy body under the skin but, if at all, have been brought there through the puncture, it must be held in mind that the patient offers the silver ions much more body-specific proteins as targets than the microbes could ever present. The effect that the silver ions are supposed to have must therefore be assessed as at least questionable, if not misleading.

In addition, the US-American FDA established its own office concerned with silver ions in 1999. This office monitors, for example, food supplements containing silver ions, due to the health risk, side effects as well as lack of medical evidence regarding the positive effects.

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Deficient biocompatibility

Despite the fact that the artificial hair implants have been developed further since the original patenting of the procedure, their implantation results in a central problem which can not be eliminated: they represent a foreign body for the organism, whereupon the organism initiates a immune reaction.

In the course of a hair transplantion, as I do in my clinic, there is no such problem, since the cell material is only transplanted from one part of the organism to another. The body of the patient recognizes that this is a particulate tissue, so that no rejection is initiated. This is different, however, in the case of tissues of foreign organisms or artificial materials, since here a certain form of rejection always takes place (this, however, is not identical in all aspects with, for example, organ rejection after a transplantion).

In the case of biological or semi-biological artificial hair, for example, there are particular dangers with regard to the allergy-inducing potential of the artificial hair implants. The reactions of the organism can range from mild acute to severe chronic inflammation or even go to result in a cell death near the implants as a result of the immune reaction. This allergenic potential may be lower for synthetic artificial hair implants, but allergic reactions also occur.

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Inflammation and infections

The main problem with artificial hair implants, however, does not necessarily rely on the material used. Rather, there is a systemic problem in the restoration with artificial hair. This is due to the fact that the introduction of the artificial hair into the scalp produces a wound channel which is opened outwards.

Even if the providers of artificial hair implants emphasize that the hair consists of the same material that is common in surgical practice, it must not be forgotten that, for example, a seam in the abdomen is shielded from the environment, since it is located inside. A healthy person has no microbes in the abdomen, as this would lead to serious illnesses. On the other hand, the wound canal can not heal through the artificial hair inserted, and at the same time there is always an open access from the outside. This is the entry site for bacteria and other microbes, which then trigger inflammatory reactions that go far beyond the already existing allergenic potential of the artificial hair. The infection must necessarily occur, because the head conditions offer pathogens an ideal environment. If the artificial hair is washed, a very high humidity is produced between the hair at least for a short time and the body heat released via the head contributes to ideal growth conditions. The consequences of these exposed wounds are therefore mandatory infections with all their undesirable effects. In addition to inflammation, swelling may occur. Due to the persistent immune reaction in the scalp, necrosis can occur. As a result, nerve endings in the scalp can be damaged, which can lead to a complete loss of feeling in the affected regions. At the same time, scarring can occur, since the body replaces the necrotic, thus dead tissue, by unspecific connective tissue. Another problem is an itching, which can not be underestimated, caused by infections and inflammations. The itching can lead to a stronger mechanical load on the artificial hair and the remaining biological hair, so that this is also permanently damaged, which has a very detrimental effect on the aesthetic appearance. Further open wounds can also develop, which promote the further inflammatory process and thus the necrosis.

A devil’s circle is created for the affected patients, which can only be interrupted by continued medical care. In case descriptions, for example, patients with a failed artificial hair implant first have to take antibiotics until the infection is reduced to such an extent that further treatment can be carried out at all. In such a case, aesthetic aspects are not to be considered at first because a curative treatment regimen has to be established in order to initially alleviate the acute ailments before an aesthetic restoration of the affected areas can be considered again.

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Consequences for the follow-up treatment

This results in serious consequences for a follow-up treatment. The antibiosis must first be maintained until no further infection is detectable. It is then necessary to deal intensively with the affected patients.

Some of the patients are so traumatized by the sufferings that they prefer to have the artificial hair implants removed. On the basis of my experience, I am aware that this is a very unpleasant process for the practitioner and the patient because in spite of the described side effects of the treatment, many artificial hair implants are strongly interwoven with the scalp tissue and these can only be removed with a strong pull through a special instrument. This can lead to further injuries which make the subsequent treatment even more difficult.

However, patients are also described who are thinking about new artificial implants after removal of the artificial hair. This could be due to the fact that they feel attracted by the immediate optical effect of an implantation so that they have already forgotten the complications and late consequences. Still other patients want to keep the remaining artificial hair implants and instead combine them with a hair transplant from their remaining hair in the future. Such combination treatments are also mediated by providers of artificial hair implantation, but it must be taken into account that the smallest infection occurring on the artificial hair can overlap with one’s own implanted hair follicles and thus can even increase the damage. After this experience, other patients would like to return to the state of baldness before the artificial hair implant, since they have lost confidence in any medical care related to hair restoration.

At this point, a lot of empathy is always required. Patients should in a responsible sense not be forced or persecuted, but they must be made aware that a new artificial hair implantation may be associated with possibly even more catastrophic consequences for the aesthetic appearance than had already been caused by a previous artificial hair implantation. In the worst case, the scalp and remaining hair are so severely damaged that surgical hair restoration is no longer possible and, for example, half or full wigs or toupees have to be used.

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Appeal: More patient education and better patient protection

Any medical intervention involves risks and dangers for the affected patients. This applies to curative or palliative treatments, whereby a well-regulated educational practice has been established in the medical facilities. The elucidation of possible risks is particularly important in the field of aesthetic and plastic surgery, since not every surgery carried out is based on a medical indication. Especially if there is no threat to mental or physical health through non-treatment, the risks and chances of treatment or intervention need to be weighed against each other. For the sake of a fast profit, many dubious providers seem to forget such work, so that too much artificial hair implantations are still carried out. Patients with whom the procedure had the negative consequences are often desperately in our clinic and, if possible, treated as part of an follow-up treatment.

In the light of today’s scientific knowledge, the experience of authorities with such treatment and my personal professional experience, it appears to me as a catastrophic circumstance that artificial hair implantation is still accepted and approved in many countries of the world by the competent authorities as a treatment procedure. In principle, the task of these authorities would be to ensure a more rigorous monitoring of health-related medical practice and to prevent such treatment as the FDA has done in the United States almost 35 years ago.

Wherever the authorities seem to fail, serious physicians and other practitioners are all asked the more to educate their patients responsibly and stand up for their protection. Because it often seems that low-cost offers and rapid treatment exert a stronger attraction on the patients than a educational interview does. This is not the fault of the patients but those who practice such questionable methods despite the considerable known risks and negative consequences due to financial interests. At this point, the responsible practitioners are asked to pursue a comprehensive educational policy in order to protect the patients from ill-considered action and the false promises of the providers of artificial hair implants!

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