About Hair Loss

Trichotillomania – Hair Restoration – Plano TX

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Trichotillomania is a condition where a person experiences an urge to pull out his or her own hair from the scalp, eyebrows, eyelashes, or body, oftentimes creating unusual patterns of hair loss. If the hair plucking continues long term, permanent damage to the hair follicles occurs, leading to permanent hair loss (scarring alopecia). Plano, TX hair restoration surgeon, Dr. Joseph Yaker, can treat hair loss that results from this disorder, but the patient must be fully cured first from the psychological disorder. If caught early enough, hair will likely grow back. If hair does not regrow, hair transplantation would be the treatment of choice.


The causes of trichotillomania can be quite complicated. It is often seen more in women and mainly occurs around puberty and even menopausal age. In many cases, the urge to pull out hair is unintentional and patients don’t realize that they are doing it. Others may have underlying stress, anxiety or depression and pluck their hair out as a coping mechanism. As a result, they find that pulling out hair feels gratifying. Many people with this disorder are so embarrassed by their actions that they deny having this compulsive habit, so they don’t seek help. The diagnosis is made following a thorough medical history and scalp and hair examination. Prolonged trichotillomania will leave hair in short, uneven broken hairs in the area of hair loss. The bald patches tend to be worse on the side of the person’s dominant hand.


Once diagnosed, cognitive behavior therapy (CBT) and certain medications may help treat trichotillomania. CBT includes techniques that can help a person recognize and change their thoughts, feelings, or behaviors. There are also numerous support groups available. Unfortunately, it is impossible to predict how long someone may suffer from this disease or if and when it will return. Without treatment, trichotillomania tends to be a persistent condition that may wax and wane in severity throughout a lifetime. Psychological treatment must be completed first so that once the hair is restored, the patient does not repeat the behavior of pulling it out again.

Nonsurgical Treatment

For patients who have been cured of trichotillomania for at least one year and their hair follicles are still alive, Dr. Yaker offers numerous nonsurgical options to help the hair regrow. Minoxidil (brand name: Rogaine®), platelet rich plasma (PRP) with placenta-derived extracellular matrix therapy and low level laser therapy may be used to help strengthen and restore hair. Dr. Yaker’s HairScan Plan will help track the progress of hair growth every 90 days after starting any form of nonsurgical therapy.

Surgical Treatment

Once a patient has undergone full treatment for trichotillomania, and it has been confirmed that there has been no relapses for a period of at least one year, Dr. Yaker will discuss hair transplant surgery has an option to restore the lost hair. Hair transplant surgery will involve either Follicular Unit Transplantation (FUT), known as the “strip method", or Follicular Unit Extraction (FUE). Both of these surgeries take hair from the back of the scalp and transplant it into the balding areas. The only difference is in the way the hair is removed from the back of the scalp. Dr. Yaker will have a thorough consultation with the patient to ensure the pulling habits no longer exist so that a successful outcome can be had and maintained after surgery.

Patients who wish to have their hair restored with transplantation surgery must meet the following criteria:

  • They must complete a psychological evaluation and seek therapy to break the pulling habit and compulsion to pull their hair.
  • The patient has not pulled their hair, nor had the urge to pull hair for at least a full year.
  • There are no scalp irritations or ongoing symptoms such as tingling or itching.
  • The hair loss has not progressed.
  • There is enough donor hair to use for hair transplantation.