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Pressure alopecia from pillow compression

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Pressure alopecia from pillow compression

Post  Xenon on Wed Feb 25, 2015 11:47 pm

I strongly believe that the conditions required to induce pressure alopecia are also required to induce male pattern baldness. There are, of course, other contributory factors concerning the latter, but the fact that pressure induced ischemia can cause baldness, leaves me in little doubt that sleeping on the temples for several hours, repeatedly, assists in keeping follicles in an ischemic state.

As mentioned in another post of mine, I recently experienced some mild pressure alopecia at the back of my head after being bedbound for a week. Now had I have continued having my head pressed against pillows and head board, this would have no doubt caused the condition to worsen. Edited: And I'd have likely developed a permanent typical MPB bald patch on my crown and surrounding area. The more the crown was pressed against the pillow, the more inflamed it became.

The fact that we mainly sleep on our temples throughout the night, would - to an extent - cause a level of ischemia (and shearing). I know this is true because I used to wake up with inflammation throughout the temple I'd been sleeping on the most. Can it really be coincidence that a) I experienced inflammation b) hair had previously thinned here? Since sleeping with my galea not touching the pillow I have a) stopped experiencing inflammation b) experienced a few terminals coming through.

"Postoperative (pressure) alopecia after general anesthesia is a rare but disturbing complication. Although this condition has been widely reported in the surgery and dermatology literature (1–4), it has received scant attention in anesthesiology journals. An English language Medline® search produced only two reports in the anesthesia literature during the last 35 yr (5–6). These reports describe patients subjected to procedures longer than 6 h (5) or to cardiopulmonary bypass (6). We present a case of postoperative (pressure) alopecia after general anesthesia for cosmetic plastic surgery in which none of the previously documented risk factors were identified.


Case Report

A 50-yr-old, 64-kg, ASA physical status class I woman presented for elective bilateral breast reduction. Her preoperative arterial blood pressure was 118/90 mm Hg, and her heart rate was 96 bpm. The remainder of the physical examination was unremarkable. She was premedicated with 5 mg of midazolam IV. General orotracheal anesthesia was induced with 90 mg of propofol, 200 μg of fentanyl, and 50 mg of rocuronium IV. All pressure points were checked and padded, and the head was placed over folded sheets in a neutral position. Anesthesia was maintained with isoflurane and nitrous oxide. The patient remained supine throughout surgery, and the head was not repositioned during the case. The surgical and anesthesia times were 4.0 and 4.5 h, respectively. The intraoperative period was unremarkable. Specifically, there were no episodes of hypotension <90 mm Hg. The estimated blood loss was 100 mL. The patient received 1250 mL of lactated ringer’s fluid IV.Twelve hours after surgery, the patient complained of soreness and tenderness over the occipital area. She was discharged from the hospital 23 h after admission. During the following days, she noticed progressive hair loss over the previously tender area. Two weeks after surgery, an area of alopecia of 3.5 X 2.5 cm in the occiput was observed (Figure 1). Hair growth was noted within weeks. A follow-up visit 6 mo after surgery revealed normal hair distribution within the affected area.

Discussion

Abel and Lewis (7) first described postoperative (pressure) alopecia in 1960. They reported eight cases of pressure-related alopecia in women after prolonged gynecologic procedures. Abel (Cool also demonstrated experimentally induced lesions in cats that were clinically and histologically similar to his initial series in women. Subsequent reports have demonstrated that this complication can develop in patients of both sexes and of all ages (1–4).The putative cause of postoperative (pressure) alopecia is localized pressure-induced ischemia to the scalp caused by head immobilization during prolonged periods of unconsciousness. The continuous pressure of the immobilized human head causes ischemic changes to the blood vessels. Furthermore, severe hypotension, massive blood loss, and the use of vasoconstrictors aggravate ischemia on the scalp. Other risk factors include prolonged endotracheal intubation, prolonged head immobilization, and the intraoperative use of the Trendelenburg position (1,3,5,6). None of these known risk factors were present in our patient.Patients with this condition typically complain of occipito-parietal pain and tenderness within 24 hours of surgery. Signs observed during the first week also include swelling, edema, crusting, and ulceration. Histological findings are dependent on the stage at which the biopsy specimen is obtained and have been described elsewhere (9). Hair loss is usually complete within 3–28 days after surgery. As in our patient, most cases are self-limiting with regrowth occurring within 12 weeks (5). Lawson et al. (1), however, reported cases of permanent alopecia. In their series, 65 cardiac surgical patients developed postoperative (pressure) alopecia; of those, 29 developed permanent alopecia. All the patients with permanent alopecia remained endotracheally intubated for periods of 24 hours or more, whereas none of the patients intubated for 17 hours or less developed permanent alopecia.Postoperative (pressure) alopecia is believed to be preventable. A prospective study that incorporated head repositioning every 30 minutes in cardiac surgical patients, both during general anesthesia and recovery, significantly reduced the incidence of alopecia from a prospectively determined value of 14% to 1% (1). The role that IV or inhaled anesthetics may play, if any, in the genesis of this condition has not been studied. There are no case reports of patients’ receiving spinal or epidural anesthesia as their primary anesthetic. This final observation lends further credence to the notion that frequent head repositioning is protective.In summary, we have presented a case of postoperative (pressure) alopecia in a patient after elective cosmetic surgery. Based on the proposed etiology of this condition and the available prospective evidence, practitioners are encouraged to periodically reposition the head during surgery in all but the briefest general anesthetics"

http://journals.lww.com/anesthesia-analgesia/Fulltext/1999/10000/Postoperative__Pressure__Alopecia__Report_of_a.46.aspx

Also worthy of note: the study mentions the use of vasoconstrictors aggravating the condition because vasoconstrictors typically reduce oxygen from the skin. So, I suppose that if we are in a generalized state or even heightened state of anxiety, then vasoconstricting hormones such as adrenaline would likely aggravate the condition.
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Re: Pressure alopecia from pillow compression

Post  salty on Mon Mar 23, 2015 6:19 am

Interesting references you've provided there Xenon. I feel sure, pressure on the scalp when sleeping can affect the hair, as a couple of years ago, for various reasons, I had to begin only sleeping on my back, and not on my sides. I therefore tend to remain completely still and in one fixed position the whole night.

In the time since I began sleeping on my back.I have developed a slight thinning pattern in almost the exact same parts of my scalp that is in contact with the pillow.

You mentioned you are sleeping in such a way that you galia is no in contact with the pillow. How are you managing this exactly.

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Re: Pressure alopecia from pillow compression

Post  Xenon on Mon Mar 23, 2015 9:17 am

here's link to my other thread: http://immortalhair.forumandco.com/t11051-sleep-position-diagram-for-nwo-and-anyone-else-interested?highlight=sleep

rofl or bogv?? mentioned a cylindrical shaped pillow being better for letting the galea hang over the edge because they felt it to be too uncomfortable to sleep like this with a normal pillow. However, I just fold my pillow into an arch shape, and this is fine for me.
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Re: Pressure alopecia from pillow compression

Post  salty on Mon Mar 23, 2015 11:12 pm

Thankyou, that was interesting.

There seems to be a fair amount of contradictions though, which presumably together produce a 'sweet spot' for hair growth.
One of the significant contradictions seems to be the theory that hypoxic conditions (at some level and for some particular period of time) are required for stem cell activity. For instance the Japanese study (titled: A new apparatus for hair regrowth in male-pattern baldness by Toshitani S) on the scalp compression device postulates both improved blood flow (after the compression is relieved) and hypoxic conditions (as a result of the contraction) led to increased hair growth.

Plus stemoxydine is also said to work via the creation of a hypoxic environment.

Good blood flow, as well as providing better nutrients and energy, also tends to raise temperature in the local area.

What are your thoughts on these contradictions, especially the apparent need for hypoxia at some level, to activate follicle stem cells.

One interesting observation, is that in the area of thinning on my vertex, the skin is of a significantly reduced sensitivity compared to that around it. Of course it may be that such is the case anyway (and the same for everyone), but it also may be a result of particular factors.

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Re: Pressure alopecia from pillow compression

Post  Xenon on Tue Mar 24, 2015 2:07 am

Well, I guess the analogy is comparable to increased mitosis from wounding, i.e., the stress response is said to make cells stronger. So, I suppose what that guy is saying is, hypoxic stress would lead to increased mitochondria. I've read this numerous times, yet, from my own experience, sleeping on the temples and crown, caused continued inflammation and no regrowth, whereas when I started to do the opposite, it has, no doubt, assisted in causing some hairs to develop into terminals.

So, on that note, if the hypoxia / hair growth theory was true, the level of compression the tissue is subjected to from sleeping, alone, would surely be enough to cause improved blood flow and regrowth, no?  

And just in case you're already not aware, I don't consider the compression issue the hub of MPB, rather a significant secondary component which assists in the reduction of growth factors. It's not just hypoxia which is the issue here, but too much pressure on the papilla when forced into the pericranium. This is like constantly standing on the root of a plant and crushing it, or perhaps trampling on grapes and deforming them into mush. When this cycle is repeated often enough, it begins to lose mass and shrinks.

If I can just show you the following diagram:



See the layer of fat beneath the papilla and blood vessels? This, generally, provides cushioning for the papilla and prevents it from being crushed against the hard mass of the pericranium, but when this layer of fat is largely depleted, then there is little protection from pressure, and damage results within the matrix cells responsible for the growth of terminal hair (crushed grapes).

So, in summary; when matrix cells are constantly crushed against the skull, they suffer damage and cannot form terminal hair.

ETA:

Also, salty, there are studies which claim that CD34+ progenitor cells increase with heightened oxygen levels. I'd imagine that compression would also squash the hair bulge - the storehouse of these progenitors - and likely prevent an adequate number of them forming / migrating. Without these progenitors, matrix cells cannot form, nor, therefore, can terminal hair.

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Re: Pressure alopecia from pillow compression

Post  sanderson on Tue Mar 24, 2015 11:18 am

Xenon, can you explain how you avoid compression? one thing i've thought about is, what if you had a pillow that sits off the edge of the bed. i'm thinking, what if you had your neck perfectly straight when you lie down, and then you had a custom pillow to fit your skull shape exactly to support your head, but leaves your neck perfectly straight, so your body is is completely straight and not tilted up or down.
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Re: Pressure alopecia from pillow compression

Post  NYJets on Tue Mar 24, 2015 11:50 am

Interesting thread guys. I've noticed I sleep really hard on my left temple and at an angle! This is by far my most troubled area and even the sides above the ear has taken a massive hit on the left side over the years.
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Re: Pressure alopecia from pillow compression

Post  salty on Tue Mar 24, 2015 2:55 pm

Xenon wrote:rather a significant secondary component which assists in the reduction of growth factors

Thankyou for the explanation.
When you write growth factors here, are you meaning in general or specifically, particular proteins or steroid hormones.
If the latter, what's you understanding of the usefulness of topically applied growth factors, that are claimed to be present in various products. There appears to be a new generation of products (and marketing) based on claims of growth factors and stem cells.

BTW, I re-read the Japanese study I referenced, and I should clarify it doesn't mention hypoxia at all. Rather it was my presuming hypoxia was involved because of the constriction involved - however, the study actually states that blood flow (somehow) increased both when the band was applied, and after the band was removed.

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Re: Pressure alopecia from pillow compression

Post  Xenon on Wed Mar 25, 2015 3:52 am

salty wrote:
Xenon wrote:rather a significant secondary component which assists in the reduction of growth factors

Thankyou for the explanation.
When you write growth factors here, are you meaning in general or specifically, particular proteins or steroid hormones.
If the latter, what's you understanding of the usefulness of topically applied growth factors, that are claimed to be present in various products. There appears to be a new generation of products (and marketing) based on claims of growth factors and stem cells.

BTW, I re-read the Japanese study I referenced, and I should clarify it doesn't mention hypoxia at all. Rather it was my presuming hypoxia was involved because of the constriction involved - however, the study actually states that blood flow (somehow) increased both when the band was applied, and after the band was removed.

Well, I mean a bit of everything really. But the main problem is basically shearing and pressure from boney prominences. When cells are subjected to too much mechanical overload, then they will malfunction. Sure I'm not ignorant to the fact that cells need a balanced level of pressure so that they don't atrophy (as in the case of astronauts who spend too long in a zero gravity environment), but IMO, too much pressure is a major problem here.

As for topicals? They're not my domain, though I did read about research into a potential stem cell cream some time ago... never knew it had been marketed, though.

As for the scalp tension reliever paper... looking into this, it seems that it would in fact decompress cells because it pushes the scalp upwards and slightly away from the skull. I guess this is a similar effect produced by Maliniak's stretching techniques. Now if the scalp was pulled down, then this would pull it tighter against the skull and compress cells in a similar way to what the pillow does.

"A newly devised apparatus (Scalp-Tension-Relaxer, STR) can efficiently promote hair regrowth in patients with male-pattern baldness. When this apparatus is applied, the scalp is pushed up to relieve tension on the vertex. The efficacy rate of hair regrowth in alopecia patients was 40%. An investigation into the basis for the hair regrowth caused by this apparatus was directed toward the changes in hemodynamics and skin temperature of the scalp. During and after use of this apparatus, subjects exhibited an increase both in the cutaneous blood flow rate (as determined by laser Doppler flowmetry) and in the cutaneous temperature (as determined by thermography)."

@Sanderson, I'll upload a diagram for you a little later, but feel free to experiment with your pillow in any way you feel.
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Re: Pressure alopecia from pillow compression

Post  Xenon on Tue May 03, 2016 10:23 pm

Thought I'd update. This is definitely a factor in a receded hairline, there is no question about it. Everytime I wake up on temple I've been sleeping on, the tissue is inflamed, then when I remove my temple from the pillow the inflammation starts to die down. The mechanical overload on tissues situated over bony prominences are subjected to crush and shear injury, and I am convinced that this is preventing matrix cells from proliferating.

Here's something else I've observed. For a while I'd been having my laptop rested on my pec muscles while I was in bed, and this caused an inflammatory disorder to develop in the tissue above my ribs (bony prominences again) due to chronic pressure. The condition is only just starting to heal now since I stopped having laptop rested on affected area. So, no doubt about it, pillow compression is having the exact same affect on the follicles of the temples.

The only problem is, in counteracting this, is that I can never manage to always remain on my back during sleep, I always end up waking up mainly on my left temple. I'm convinced that if I can start sleeping on my back more, the tissue of the temples will start to heal and matrix cells will begin to multiply around the papilla. They cannot do this while undergoing longstanding episodes of inflammation.

Another thing, I've mentioned in the past that my temples tend to heat up a great deal, especially during exercise. Well, I wonder if this is because bloodflow has been somewhat impaired because capillaries have been so heavily compressed, and this is some form of localized blood pressure? That's conjecture of course, but no doubt about it, the pillow is a major player here. The smoking gun is inflammation upon awakening.

I am considering trying out some sort of harness to try keep me positioned on my back during sleep, so it becomes impossible for me to turn on my sides. I cannot think of any other way to stop myself from doing this. I tried sleeping with my temple hanging over the pillow, but i always end up with my temples back on it by morning.
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Re: Pressure alopecia from pillow compression

Post  harechallenge on Tue May 03, 2016 11:48 pm

Did you read the various  post on sleep position? http://immortalhair.forumandco.com/t11051-sleep-position-diagram-for-nwo-and-anyone-else-interested?highlight=sleep+position
you could also try a cervical pillow which is helpul for back pain as well

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Re: Pressure alopecia from pillow compression

Post  Xenon on Wed May 04, 2016 12:02 am


Yeh, hare, I did, and the ones suggested were better than sleeping with the head hanging over the pillow. The only problem is remaining like this throughout the night because I always end up with my temples against the pillow. As mentioned, the only thing I can think of, to prevent this, is to sleep with some sort of harness which prevents me tossing and turning at night, and ending up on my temples. I need to start sleeping on my occipitalis muscle moreso than my temples.

I am convinced that this compression issue is the silent assassin. Of course other factors are involved, but they all have a synergistic relationship in increasing inflammation and inhibiting growth factors. I have no doubts about that. I think it is pretty evident to see for ourselves -- hair bulb being crushed against a bony skull prominence for eight hours or more is definitely going to cause issues concerning hair growth. If said follicle has issues regenerating (due to hormones and genetics), then i think it is obvious that mechanical overload is going to make things much worse.
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Re: Pressure alopecia from pillow compression

Post  harechallenge on Wed May 04, 2016 10:06 pm

Tossing and turning is going to happen. But I've seen these cervical like pillows that wrap around the neck and don't come off like a person who has a whiplash collar.
Anyways my method is to sleep with risers on my foot side (3 inches higher) which makes my heart and head lower. Common sense and gravity says it shouild help circulation to the scalp and limit blood flow to legs, but I'm not sure if it is safe for someone with medical issues. Also, my feet are pointed west and head east. There are other people who sleep with the head and chest higher up and feet lower due to reflux etc.  I usually sleep fine.

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Re: Pressure alopecia from pillow compression

Post  Xenon on Thu May 05, 2016 9:36 am

Yeh, tossing and turning does happen. The irony would be, sleeping on the back might start causing terminals to regrow on the hairline, but the back of the head would be taking the brunt of the pressure and likely start causing a bald patch to form there. In fact, as I mentioned in an earlier post, this has happened to me when I've been bed bound due to an injury.

The only reservations I have about having the bed tilted at an angle is, I fear a blood clot forming in the brain. I might be monumentally wrong about this, but it was a bit of a concern when it was suggested in the past. But IDK, how has it benefited you so far? No side effects of any kind?

BTW do you have any links to these cervical wrap around pillows? Might well be worth a shot.
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Re: Pressure alopecia from pillow compression

Post  Xenon on Thu May 05, 2016 5:33 pm

Well, for anyone who gives a shit, I slept on back last night, and just a few hours of the occipital area bearing the brunt of the pressure has left the area tender and inflamed, especially around the occipital bone. Temples = no inflammation at all.

Yep, this pressure is definitely a major player here.
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Re: Pressure alopecia from pillow compression

Post  harechallenge on Thu May 05, 2016 10:46 pm

I don't have cervical wraps or pillows, but a doctor recommended one after a back strain or injury. I never bought one but remember the varying shapes etc. I haven't had any problems sleeping at this slight angle and it's really not much different from putting a pillow under your calves.
Has it added hair density? I can't say as it's only been about 3 months that I sleep this way. Plus I'm exercising, eating pretty good with supplements and doing some scalp exercises. Realistically, I should wait another 6 months to make a judgment about my routine which started in November.
How much pressure can you be putting on your temples? It's not like when your forearm is on the edge of a table and a deep edge line produced or when you sit on patio furniture with shorts and your legs get markings.


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Re: Pressure alopecia from pillow compression

Post  shawarma on Fri May 06, 2016 8:06 pm

how about using travel pillow to sleep? so the only part of the head compressed would be the low back?

regarding blood flow, i have rosacea with a clear distinction of red and white area on my forehead, and strangely it's pattern mirrors my hair loss. I mean, i have hair above my red area on the forehead center and i lose/lost it on temples above white area on sides. Could be coincidence or not. With rosacea blood and lymph vessels are dilated. Maybe dht or inflammation chemicals get better recycled through dilated lymph vessels?

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Re: Pressure alopecia from pillow compression

Post  Xenon on Fri May 06, 2016 9:46 pm

shawarma wrote:how about using travel pillow to sleep? so the only part of the head compressed would be the low back?

regarding blood flow, i have rosacea with a clear distinction of red and white area on my forehead, and strangely it's pattern mirrors my hair loss. I mean, i have hair above my red area on the forehead center and i lose/lost it on temples above white area on sides. Could be coincidence or not. With rosacea blood and lymph vessels are dilated. Maybe dht or inflammation chemicals get better recycled through dilated lymph vessels?

I just Googled travel pillow and some U shaped pillow came up. This looks like it might be pretty ideal. Is this what you're talking about? http://www.soakandsleep.com/memory-foam-neck-pillow.html

RE: Rosacea and the red and white areas of skin, I have mentioned before about my skin being more pale in the very areas where my hairline has receded. I wondered if this might have been caused through bacterial toxins, as toxins are said to bleach the skin, but another possibility is localized ischemia caused by tissue compression. Whiter mottled skin is said to be indicative of compromised bloodflow.

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Re: Pressure alopecia from pillow compression

Post  long hair on Fri May 06, 2016 10:40 pm

welcome back xenon
i sleep on my right temple most of the time but i lose hair in a left temple too...also how about full hair heads they sleep too without hair loss.
i agree that contentious pressure cause hair loss but this happened because of 2 reason
1- galia muscles contraction without rest
2- skull expansion which you can see it in every bald man ,it is not a coincidence at all.
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Re: Pressure alopecia from pillow compression

Post  Xenon on Fri May 06, 2016 11:29 pm

long hair wrote:welcome back xenon
i sleep on my right temple most of the time but i lose hair in a left temple too...also how about full hair heads they sleep too without hair loss.
i agree that contentious pressure cause hair loss but this happened because of 2 reason
1- galia muscles contraction without rest
2- skull expansion  which you can see it in every bald man ,it is not a coincidence at all.

Yeh, man, the main issue is poor recovery conditions caused by hormones and genetics. The baldness gene basically causes 3 things to happen: 1. reduced progenitor cells within bulge 2. heightened immunoreactivity 3. slowed recovery.

In the case of MPB the increased inflammation tends to occur specifically within matrix cells within the papilla, therefore it's considered to be a non-scarring condition. These cells are constantly renewed via every hair growth cycle, but, due to them being so easily stressed, they inflame very easily and are quickly destroyed, thus terminals have little chance to develop.

There are a shitload of stressors which cause this to happen, but due to me recognizing inflammation upon awakening, this leads to me to feel that this compression issue is heavily involved in keeping hair in a miniaturized state. This compression problem might even be interfering with bone marrow derived progenitor cells migrating to the bulge. I mean, if the matrix cells are being squashed for several hours on end, then the likelihood is, that the bulge is also.

I just don't have the perfect solution to this compression problem, though. There's been some good ideas bandied about so far though.

One thing I'd tend to disagree with you on is baldness only happening in men with an expanded skull. I was once of the same opinion, until I started seeing countless men with small craniums and advanced baldness. Does the expanded skull play some sort of role? Possibly. It could be that pronounced bone prominences cause increased friction and shearing within tissues. OR a larger head is heavier, thus leading to increased weight pressure during sleep. Maybe both.
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Re: Pressure alopecia from pillow compression

Post  long hair on Sat May 07, 2016 7:22 pm

it is not about big or small skull , it is a shape of the skull... rounded head people lose their hair while the flat head doesn't ,when the head being rounded it will not going bald ! why? because it wait for something else which is DHT .
DHT is harmful only when it accumulate in our scalp due to poor blood circulation .
(that's why FIN works by reducing DHT) so a man who have rounded skull and  have full head of hair will possibly be under 15 or he have low in some male hormones (may be will not going to have  kids) or castrated.
i will say am not sure if really rounded  shape caused by skull  expansion  or calcification ...but what ever..only X-RAY will tell the truth .
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Re: Pressure alopecia from pillow compression

Post  Xenon on Sun May 08, 2016 1:19 am

Well, you might be correct. There's studies on T being converted into DHT in a hypoxic environment, so who knows? Perhaps this pillow compression issue + convex skull shape is partially responsible for this.

For me, I follow the inflammation and try my best to connect the dots. It is interesting that I wake up with inflammation on the side I've been sleeping on the most, and I've lost more hair there. This was not initially the case, though - my hair loss started out worst on the right temple because I used to comb that area excessively. The continuous friction to the skin caused inflammation and rapid hairloss, then I started parting the left side... same thing happened. At this point my hairline was pretty receded, so I started parting my hair in the middle, and the excessive combing caused the widow's peak area to start to thin, so I stopped combing altogether.

After I stopped combing, my hairloss slowed down, but then I started to wear a baseball cap very tightly, and the constant pressure around the temples caused my hairline to take another terrible hit. But unbeknownst to me back then, the pillow was also assisting in causing the hair to miniaturize. I just didn't manage to recognize this problem until many years down the line. Had I have known all these things back then, I have no doubt that I'd have still been around about an NW1.5 now.

RE Dut: well, we know in many cases dut helps to thicken hair and regrow it if caught early enough, so DHT + other inflammatory inducing factors work together in preventing hair from turning terminal. Prior to puberty, I could comb my hair all day without any issues, but when DHT started kicking in, this was no longer the case. First signs of recession actually started at 15, then became especially noticeable between 16 to 18.

Edited: the inflammation from pillow compression was nowhere near as bad as other factors, but it still makes it's mark, and due to it being a repetitive problem, I feel it is preventing weakened hair follicles from regenerating.
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