What it is
A consultation whose purpose is to work out why the hair is falling, before anything is treated. It combines the history, examination of the scalp and the part, a pull test and trichoscopy, and blood tests where the picture calls for them — iron and ferritin, thyroid, vitamin D, and after weight-loss surgery also protein, zinc and B12. Pattern loss, telogen shedding, traction from tight styling and scarring alopecia look alike to the patient and are treated very differently.
What this page covers
- History, pattern recognition, part-width measurement and hair pull test
- Trichoscopy of the scalp and the hairline
- Separating androgenetic, telogen, traction and scarring causes
- Telogen effluvium, including post-partum shedding
- Post-bariatric and post-GLP-1 hair shedding, with nutritional screening
- Iron, ferritin, thyroid and vitamin D work-up where indicated
- Traction alopecia from tight ponytails, extensions and head-covering fastening
- Recognition of frontal fibrosing alopecia before any hairline procedure
- Hair shaft breakage from chemical straightening, keratin and heat, which is not shedding at all
- Hair restoration candidacy and donor area assessment
- Referral for a diagnostic scalp biopsy where the diagnosis changes the plan
Honestly
What this visit produces is a diagnosis, not a product. A scarring alopecia has to be named early, because hair lost in scarred areas does not grow back and months spent on cosmetic sessions are months that cannot be recovered; and where the cause is nutritional or thyroid, correcting that matters more than any scalp session, since no injection compensates for a deficiency that has not been treated.