Latest / Clearly Hormonal / Ep 17: Understanding Hair Loss with Dr. Nancy Echefu

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Ep 17: Understanding Hair Loss with Dr. Nancy Echefu · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to the Reset Recharge podcast with your host, Dr.
• 0:05
  Dr. Komal Patil-Sisodia: Komal Patil Sisodia, a board certified endocrinologist, internist, and obesity medicine specialist.
• 0:11
  Dr. Komal Patil-Sisodia: This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health.
• 0:18
  Dr. Komal Patil-Sisodia: And recharge the conversations you are having with your healthcare providers.
• 0:22
  Dr. Komal Patil-Sisodia: While I am a physician, this podcast is purely for educational purposes.
• 0:26
  Dr. Komal Patil-Sisodia: No individualized medical advice is being given on this podcast.
• 0:30
  Dr. Komal Patil-Sisodia: If you do find information that is helpful, please discuss it with your healthcare provider at your next visit.
• 0:39
  Dr. Komal Patil-Sisodia: Hi, everyone.
• 0:40
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge.
• 0:42
  Dr. Komal Patil-Sisodia: Today, I am very excited to have Dr.
• 0:45
  Dr. Komal Patil-Sisodia: Nancy Echefu here with me.
• 0:47
  Dr. Komal Patil-Sisodia: She is a hair transplant surgeon based out of Georgia and has been running her practice, Havila Hair Restoration.
• 0:55
  Dr. Komal Patil-Sisodia: She is here to talk to us about hair loss in women.
• 0:59
  Dr. Komal Patil-Sisodia: And this is something women come to my office as an endocrinologist about so many times.
• 1:04
  Dr. Komal Patil-Sisodia: And I had the privilege of being on an Instagram live with Dr.
• 1:09
  Dr. Komal Patil-Sisodia: Achefu, where we talked about it from my perspective, but I thought it would be a great thing for our listeners to understand from.
• 1:17
  Dr. Komal Patil-Sisodia: a hair transplant surgeon's perspective.
• 1:20
  Dr. Komal Patil-Sisodia: What are all the different things we can be doing for hair loss?
• 1:22
  Dr. Komal Patil-Sisodia: Because as women, we start losing hair, post pregnancy and then we hit perimenopause and menopause.
• 1:28
  Dr. Komal Patil-Sisodia: And then there, there are so many other hormonal and nutritional issues that can pop up.
• 1:33
  Dr. Komal Patil-Sisodia: So without further ado, I would like to welcome Dr.
• 1:36
  Dr. Komal Patil-Sisodia: Achefu and pass the mic over to her to talk a bit about her background and expertise and what pushed her towards.
• 1:45
  Dr. Komal Patil-Sisodia: pursuing a career in hair restoration.
• 1:48
  Dr. Komal Patil-Sisodia: Dr.
• 1:48
  Dr. Komal Patil-Sisodia: Ocheifu, welcome.
• 1:49
  Dr. Nancy Echefu: Thank you, Dr.
• 1:50
  Dr. Nancy Echefu: Patil.
• 1:51
  Dr. Nancy Echefu: My name is Dr.
• 1:52
  Dr. Nancy Echefu: Nancy Echeifu.
• 1:53
  Dr. Nancy Echefu: I'm a board certified internal medicine physician and hair transplant surgeon.
• 1:59
  Dr. Nancy Echefu: I'm the owner of, owner and founder of Habila Hair Restoration.
• 2:03
  Dr. Nancy Echefu: Also the owner of Hair Loss Exhibition Shows in Georgia, which is a hair loss exhibition from the name.
• 2:10
  Dr. Nancy Echefu: Hair Loss is a visual show we do annually in Georgia where we showcase everything about hair loss, hair restoration, machines we use for hair loss, everything about hair loss, basically, where people get to ask their questions.
• 2:23
  Dr. Nancy Echefu: Everything hair loss, that's your girl, Dr.
• 2:25
  Dr. Nancy Echefu: Chaim.
• 2:27
  Dr. Komal Patil-Sisodia: Alright, fantastic.
• 2:28
  Dr. Komal Patil-Sisodia: And how did you decide to pursue that?
• 2:30
  Dr. Komal Patil-Sisodia: We don't often hear of people going from internal medicine towards hair restoration.
• 2:35
  Dr. Komal Patil-Sisodia: What was it that made you feel passionate about this?
• 2:39
  Dr. Nancy Echefu: Now, if you know me, my pathway has never been straight.
• 2:43
  Dr. Nancy Echefu: So, from internal medicine, I've practiced as an emergency doctor.
• 2:47
  Dr. Nancy Echefu: So, internal medicine, emergency physician.
• 2:49
  Dr. Nancy Echefu: Right after residency, I jumped into emergency medicine because I liked it.
• 2:53
  Dr. Nancy Echefu: The adrenaline and all that.
• 2:55
  Dr. Nancy Echefu: Helping people on the spot.
• 2:57
  Dr. Nancy Echefu: Let's say fast forward a couple of years.
• 2:59
  Dr. Nancy Echefu: Two years down the line, I started losing my hair.
• 3:02
  Dr. Nancy Echefu: Oh.
• 3:04
  Dr. Nancy Echefu: I was the doctor in the hospital that you would never catch me with the same hairstyle every month.
• 3:09
  Dr. Komal Patil-Sisodia: Like, you know,
• 3:11
  Dr. Nancy Echefu: so I didn't know that was damaging to my hair.
• 3:14
  Dr. Nancy Echefu: So I started losing my hair.
• 3:16
  Dr. Nancy Echefu: And I never, and I ignored it, it's one thing to lose hair.
• 3:20
  Dr. Nancy Echefu: That is one thing to recognize.
• 3:21
  Dr. Nancy Echefu: You're losing your hair.
• 3:22
  Dr. Nancy Echefu: You might be in denial because well, we have the wigs, the extensions so what, and how did I come to, how did I come to the realization that, hey, Nancy, you need to do something about it.
• 3:36
  Dr. Nancy Echefu: It made me depressed.
• 3:37
  Dr. Nancy Echefu: I was depressed looking at myself like, you know, when you get back from work, you take out your scrubs, take out your weave and your wigs.
• 3:45
  Dr. Nancy Echefu: Then you have to face yourself.
• 3:48
  Dr. Nancy Echefu: I didn't like what I was looking at.
• 3:50
  Dr. Komal Patil-Sisodia: So I
• 3:51
  Dr. Nancy Echefu: had traction and lopecia.
• 3:53
  Dr. Nancy Echefu: I was having hair shedding.
• 3:55
  Dr. Nancy Echefu: And with the stress in the emergency room, I was doing like 20 shifts, 25 shifts a month.
• 4:01
  Dr. Nancy Echefu: I want you to understand that.
• 4:02
  Dr. Nancy Echefu: The stress of that, I can tell you that.
• 4:06
  Dr. Nancy Echefu: In addition to the traction that I was having with the different hairstyles I was having to keep up.
• 4:13
  Dr. Komal Patil-Sisodia: So
• 4:13
  Dr. Nancy Echefu: I had to say, hey Nancy, you need to do something about it.
• 4:16
  Dr. Nancy Echefu: So I went to a couple of doctors.
• 4:18
  Dr. Nancy Echefu: And I went to a couple of hair transplant doctors, but the problem I was having is that one, there's no continuity of care and there are no options.
• 4:29
  Dr. Nancy Echefu: You see, continuity of care and options.
• 4:31
  Dr. Nancy Echefu: So why do I say that?
• 4:32
  Dr. Nancy Echefu: A lot of people complain that when they just go see their doctor, talk about their hair loss.
• 4:38
  Dr. Nancy Echefu: They just, give them medication and send them home, I'll see you back in six months and they can't get into the doctor's office.
• 4:44
  Dr. Nancy Echefu: Yeah, so that's number one.
• 4:46
  Dr. Nancy Echefu: And when there's no continuity of care, guess what patient will stop taking your medication.
• 4:50
  Dr. Nancy Echefu: It's not like it's blood pressure.
• 4:51
  Dr. Nancy Echefu: It's not like it's diabetes that you need to keep up with it.
• 4:54
  Dr. Nancy Echefu: And that's number one.
• 4:55
  Dr. Nancy Echefu: Then number two is that there are no options on what to do with my hair.
• 5:00
  Dr. Komal Patil-Sisodia: Yeah.
• 5:02
  Dr. Nancy Echefu: African American as an African American.
• 5:04
  Dr. Nancy Echefu: And I'm like, okay.
• 5:06
  Dr. Nancy Echefu: You have to go see someone that can, that is able to teach you, tell you what to also do to your hair.
• 5:11
  Dr. Nancy Echefu: So it's not just the hair loss.
• 5:13
  Dr. Nancy Echefu: It's also someone that can tell you, Hey, you need to stop doing this.
• 5:17
  Dr. Nancy Echefu: Why don't you substitute this for this?
• 5:20
  Dr. Nancy Echefu: Okay.
• 5:22
  Dr. Komal Patil-Sisodia: So
• 5:22
  Dr. Nancy Echefu: the options, the education was lacking.
• 5:25
  Dr. Nancy Echefu: So guess what?
• 5:26
  Dr. Nancy Echefu: I'm like, what am I doing with my life?
• 5:28
  Dr. Nancy Echefu: What am I doing with myself?
• 5:29
  Dr. Nancy Echefu: So I had to research, look up so many options, came up with my own treatment plan.
• 5:36
  Dr. Nancy Echefu: My own treatment plan.
• 5:38
  Dr. Nancy Echefu: And I took care of myself, took care of my hair.
• 5:43
  Dr. Nancy Echefu: And that's where we are right now.
• 5:45
  Dr. Komal Patil-Sisodia: That is so inspiring.
• 5:47
  Dr. Komal Patil-Sisodia: And it's amazing to hear how your purpose was born out of a personal struggle.
• 5:53
  Dr. Komal Patil-Sisodia: I feel when we find our passion it's oftentimes due to something that we have experienced personally and it's deeply impacted us in a way.
• 6:03
  Dr. Komal Patil-Sisodia: I can say that your patients are so lucky because you yourself have walked in their shoes and you understand and you took the Have The impetus to develop your own treatment plan.
• 6:15
  Dr. Komal Patil-Sisodia: And now you're sharing that wealth of knowledge with other people.
• 6:18
  Dr. Komal Patil-Sisodia: That's such a beautiful thing.
• 6:19
  Dr. Komal Patil-Sisodia: Thank you for sharing that.
• 6:20
  Dr. Komal Patil-Sisodia: I know that's a deeply personal story.
• 6:22
  Dr. Nancy Echefu: The one thing that my patients tell me, I try not to use the word patients.
• 6:27
  Dr. Nancy Echefu: I love to use clients, one of my clients, they tell me is that, yeah, where have you been all my life?
• 6:34
  Dr. Nancy Echefu: You're almost like my long lost sister.
• 6:36
  Dr. Komal Patil-Sisodia: Yeah.
• 6:37
  Dr. Nancy Echefu: You know why?
• 6:38
  Dr. Nancy Echefu: Because I don't just talk to you as just as a physician, I talk to you as someone that has pastoral and what I did.
• 6:45
  Dr. Nancy Echefu: And I tell you my own personal story.
• 6:47
  Dr. Nancy Echefu: You don't have to, your treatment option might not be the same as mine.
• 6:52
  Dr. Nancy Echefu: But you have to understand that the struggle is the same.
• 6:54
  Dr. Nancy Echefu: Oh, absolutely.
• 6:56
  Dr. Komal Patil-Sisodia: It's funny, you were talking a bit about how we we as physicians tend to ignore our own symptoms and things like that.
• 7:03
  Dr. Komal Patil-Sisodia: And I think I had kind of downplayed the same thing.
• 7:06
  Dr. Komal Patil-Sisodia: Like, oh, I'm having hair shedding and hair loss.
• 7:09
  Dr. Komal Patil-Sisodia: Because of stress, this, that, and the other.
• 7:11
  Dr. Komal Patil-Sisodia: I went to see a friend of mine, who's a dermatologist for a skin related issue.
• 7:17
  Dr. Komal Patil-Sisodia: And she said to me, she said, well, are we going to talk about your hair loss?
• 7:20
  Dr. Komal Patil-Sisodia: And I just kind of stare at it.
• 7:21
  Dr. Komal Patil-Sisodia: And she was my friend, so she could be really blunt with me.
• 7:26
  Dr. Komal Patil-Sisodia: She said, girl, you are losing your hair.
• 7:28
  Dr. Komal Patil-Sisodia: Like it's, what is happening here?
• 7:31
  Dr. Komal Patil-Sisodia: And I looked at her and I said, it's just stress.
• 7:33
  Dr. Komal Patil-Sisodia: She said, no, no, this is female pattern, hair loss pattern that you're seeing.
• 7:37
  Dr. Komal Patil-Sisodia: What did your mom's scalp look like?
• 7:39
  Dr. Komal Patil-Sisodia: And I thought back to it and I thought, oh my gosh, my mom was around my age where, the hair started thinning and there's such a big genetic component to it, but I would have never acknowledged it.
• 7:49
  Dr. Komal Patil-Sisodia: I was just, putting my hair up in a ponytail or, moving my part further and further to
• 7:53
  Dr. Nancy Echefu: the side.
• 7:55
  Dr. Nancy Echefu: No, no, no, you're right.
• 7:56
  Dr. Nancy Echefu: And I tell people that.
• 7:57
  Dr. Nancy Echefu: How people tell me when I give lectures or talk and all that, I tell people if it's not bothering you, you're not my client, you're not my patient.
• 8:04
  Dr. Nancy Echefu: until it starts bothering you.
• 8:06
  Dr. Nancy Echefu: Yeah.
• 8:06
  Dr. Nancy Echefu: Then you come and see me.
• 8:08
  Dr. Nancy Echefu: Cause you know, so that's when you acknowledge that there's something wrong.
• 8:12
  Dr. Komal Patil-Sisodia: Absolutely.
• 8:13
  Dr. Komal Patil-Sisodia: And it took her to point it out to me, because it was bothering me.
• 8:17
  Dr. Komal Patil-Sisodia: I was doing all the things to try and cover it up, but I wasn't acknowledging it.
• 8:20
  Dr. Komal Patil-Sisodia: Because a lot of times we tend to.
• 8:22
  Dr. Komal Patil-Sisodia: ignore and hide the things that are uncomfortable.
• 8:25
  Dr. Komal Patil-Sisodia: So I'm very grateful to her for saying something because it actually put me on a path to start treating it.
• 8:30
  Dr. Komal Patil-Sisodia: Yeah.
• 8:31
  Dr. Komal Patil-Sisodia: I would love to hear from you how you classify different types of hair loss.
• 8:37
  Dr. Komal Patil-Sisodia: When we were on the Instagram live, I loved your breakdowns of what different types of hair loss are and then what the most, what I'd also like to hear, and I'm sure our listeners would like to hear as well, is what are the most common types of hair loss that you see?
• 8:51
  Dr. Nancy Echefu: Okay, so I'm going to use this analogy so that people can understand.
• 8:56
  Dr. Nancy Echefu: When you look at your hair, imagine a tree that has roots, okay?
• 9:05
  Dr. Nancy Echefu: Yep.
• 9:05
  Dr. Nancy Echefu: So when you're planting, there's a root and there's a tree, and let's assume there's some branches, okay?
• 9:11
  Dr. Nancy Echefu: So I want you to imagine your hair is a plant.
• 9:15
  Dr. Nancy Echefu: That has root and a tree.
• 9:17
  Dr. Nancy Echefu: So if you understand that, so every other thing I'm going to discuss moving forward, I'm going to use this analogy.
• 9:23
  Dr. Nancy Echefu: Okay.
• 9:24
  Dr. Nancy Echefu: So now the major thing, major, major classification of hair loss.
• 9:30
  Dr. Nancy Echefu: It's for easy classification.
• 9:32
  Dr. Nancy Echefu: It's called, we say scarring alopecia
• 9:35
  Dr. Komal Patil-Sisodia: versus
• 9:36
  Dr. Nancy Echefu: non scarring alopecia.
• 9:37
  Dr. Nancy Echefu: Why do we say that?
• 9:39
  Dr. Nancy Echefu: We're looking at the roots.
• 9:40
  Dr. Nancy Echefu: Remember I said the tree and the roots.
• 9:43
  Dr. Nancy Echefu: So the scarring, there's an inflammatory process going on.
• 9:46
  Dr. Nancy Echefu: There's attacking the roots that you cannot see that's underneath the skin.
• 9:53
  Dr. Nancy Echefu: So that's the scarring.
• 9:55
  Dr. Nancy Echefu: Then the non scarring is what is a lopecia that there's no inflammatory process going on.
• 10:02
  Dr. Nancy Echefu: It's just natural progression of life.
• 10:06
  Dr. Nancy Echefu: You get that?
• 10:06
  Dr. Nancy Echefu: So if we look at that, we'll understand that.
• 10:08
  Dr. Nancy Echefu: So when we say non scarring, let's start with the non scarring.
• 10:13
  Dr. Nancy Echefu: Most people that come into my office, let's say 50 percent of them, almost everyone you see suffering from some form of pardon hair loss.
• 10:19
  Dr. Nancy Echefu: What we call it, male pardon or female pardon hair loss.
• 10:23
  Dr. Nancy Echefu: That's what we're, so that's the non scarring.
• 10:25
  Dr. Nancy Echefu: What do I mean by that?
• 10:27
  Dr. Nancy Echefu: Your friend told you about, you're having some hair loss.
• 10:30
  Dr. Nancy Echefu: How does your mom look?
• 10:31
  Dr. Nancy Echefu: How was her hair?
• 10:32
  Dr. Nancy Echefu: So that's what we're trying to spot on hair loss with his genetics.
• 10:37
  Dr. Nancy Echefu: So most everyone that walks into the office is suffering from genetic hair loss.
• 10:43
  Dr. Nancy Echefu: So that's easy.
• 10:43
  Dr. Nancy Echefu: If you understand that you've won the battle, 50 percent that everyone that walks into your office, they're likely to suffer from that.
• 10:51
  Dr. Nancy Echefu: So for non scarring, for scarring alopecia now, that's what we're worried about.
• 10:57
  Dr. Nancy Echefu: That's what every hair loss physician is worried about.
• 11:01
  Dr. Nancy Echefu: Why?
• 11:01
  Dr. Nancy Echefu: Because those ones are difficult to treat.
• 11:04
  Dr. Komal Patil-Sisodia: Yeah.
• 11:05
  Dr. Nancy Echefu: Because there's an inflammatory process going on on the scalp on the scalp.
• 11:09
  Dr. Nancy Echefu: The roots, something is going on.
• 11:11
  Dr. Nancy Echefu: The roots have been damaged.
• 11:12
  Dr. Nancy Echefu: There's no regeneration.
• 11:14
  Dr. Nancy Echefu: It's not going to grow.
• 11:15
  Dr. Nancy Echefu: Because the roots are damaged.
• 11:18
  Dr. Nancy Echefu: Oh, wow.
• 11:19
  Dr. Nancy Echefu: Okay?
• 11:19
  Dr. Nancy Echefu: So there are so many of them.
• 11:21
  Dr. Nancy Echefu: We hear CCCA, LP, uh, there are so many of them.
• 11:27
  Dr. Nancy Echefu: But it's easy for people to understand.
• 11:29
  Dr. Nancy Echefu: When you walk into the office, or when you walk into my office, that's what I'm worried about.
• 11:34
  Dr. Komal Patil-Sisodia: What was the first one, the first acronym that you gave the CC, what was that?
• 11:39
  Dr. Nancy Echefu: CCCA is centrifugal alopecia.
• 11:43
  Dr. Nancy Echefu: It's like a whole long name, centrifugal.
• 11:46
  Dr. Nancy Echefu: What does that mean?
• 11:46
  Dr. Nancy Echefu: It's just alopecia when people are losing their head right in the center of their head.
• 11:51
  Dr. Komal Patil-Sisodia: Oh.
• 11:52
  Dr. Komal Patil-Sisodia: And it's
• 11:52
  Dr. Nancy Echefu: mostly in African American women.
• 11:54
  Dr. Nancy Echefu: Oh.
• 11:54
  Dr. Nancy Echefu: Because of our hairstyles.
• 11:56
  Dr. Nancy Echefu: Oh, interesting.
• 11:57
  Dr. Nancy Echefu: Okay.
• 11:58
  Dr. Nancy Echefu: Okay?
• 11:59
  Dr. Nancy Echefu: So CCCA is a whole long name.
• 12:01
  Dr. Nancy Echefu: Centrifugal alopecia and all that.
• 12:04
  Dr. Nancy Echefu: So talked about the scarring and non scarring alopecia.
• 12:08
  Dr. Komal Patil-Sisodia: Yeah,
• 12:08
  Dr. Nancy Echefu: Talked about the concept behind it once we make sure that it's not a scarring alopecia, then the Non scarring, which is the parting.
• 12:19
  Dr. Nancy Echefu: Parting hair loss is easy for us to treat.
• 12:22
  Dr. Nancy Echefu: Did you get the concept?
• 12:23
  Dr. Komal Patil-Sisodia: Yeah, I love the analogy of the tree that actually breaks it down in such a great way So if you think of your hair as a tree The non scarring is just a regular life cycle process.
• 12:37
  Dr. Komal Patil-Sisodia: The scarring is where the roots get damaged.
• 12:39
  Dr. Komal Patil-Sisodia: Did I sum that up properly?
• 12:41
  Dr. Nancy Echefu: Yes.
• 12:42
  Dr. Nancy Echefu: Okay.
• 12:42
  Dr. Komal Patil-Sisodia: I love that.
• 12:43
  Dr. Komal Patil-Sisodia: That is such a easy way to break it down where I can actually see it in my mind better.
• 12:49
  Dr. Komal Patil-Sisodia: I'm a very, you see,
• 12:51
  Dr. Nancy Echefu: and that's the way I tell people that if I cannot explain things for you, ABC.
• 12:56
  Dr. Nancy Echefu: Then that means that's too long.
• 12:58
  Dr. Nancy Echefu: That's why you can see some of our patients can't understand.
• 13:01
  Dr. Nancy Echefu: They can't relate the message because well, we use a lot of medical terms so they don't understand what we're saying.
• 13:07
  Dr. Nancy Echefu: So that's why I like to break this down.
• 13:09
  Dr. Nancy Echefu: So for the whole concept, for the CCCA is central, centrifugal, cicatricial, and lopecian.
• 13:16
  Dr. Nancy Echefu: It's a long name.
• 13:17
  Dr. Nancy Echefu: So what it just short form is CCCA.
• 13:20
  Dr. Nancy Echefu: Okay.
• 13:21
  Dr. Nancy Echefu: Perfect.
• 13:22
  Dr. Nancy Echefu: Okay.
• 13:22
  Dr. Komal Patil-Sisodia: How do you differentiate that?
• 13:23
  Dr. Komal Patil-Sisodia: Is that just the pattern or do you need to do a scalp biopsy?
• 13:27
  Dr. Komal Patil-Sisodia: What are the, how do you differentiate that between, the regular like genetic hair loss?
• 13:33
  Dr. Nancy Echefu: So now let's say someone walks into my office and say, Hey, I'm dealing with hair loss.
• 13:38
  Dr. Komal Patil-Sisodia: Yeah.
• 13:39
  Dr. Nancy Echefu: That I'm going to, I need to ask.
• 13:41
  Dr. Nancy Echefu: Any itching, any burning,
• 13:43
  Dr. Komal Patil-Sisodia: any
• 13:44
  Dr. Nancy Echefu: redness of the scalp, any tingling sensation.
• 13:47
  Dr. Nancy Echefu: See, these are the questions that are going to lead you towards scarring.
• 13:52
  Dr. Nancy Echefu: Okay.
• 13:52
  Dr. Nancy Echefu: There's an underlying issue, so once it, that's number one, then number two is your physical exam.
• 13:58
  Dr. Nancy Echefu: Where is the location of the alopecia?
• 14:01
  Dr. Nancy Echefu: Yeah.
• 14:02
  Dr. Nancy Echefu: Like from the name, it's central.
• 14:04
  Dr. Nancy Echefu: So it means that it's going to be central area of the scalp.
• 14:07
  Dr. Komal Patil-Sisodia: Yeah.
• 14:07
  Dr. Nancy Echefu: Like the top of your head.
• 14:09
  Dr. Komal Patil-Sisodia: You
• 14:09
  Dr. Nancy Echefu: look at that, then remember I was talking about African Americans.
• 14:13
  Dr. Nancy Echefu: Yeah.
• 14:18
  Dr. Nancy Echefu: Okay.
• 14:19
  Dr. Nancy Echefu: Then biopsy is just to confirm what you're already thinking.
• 14:22
  Dr. Nancy Echefu: So you have to do your history, make sure if they have the signs of the inflammation.
• 14:27
  Dr. Nancy Echefu: I tell people, I tell other practitioners, hair loss practitioner, when I give my lecture, once they complain about it's itching, it's burning, that is out of your scope.
• 14:36
  Dr. Komal Patil-Sisodia: Yeah.
• 14:36
  Dr. Komal Patil-Sisodia: They
• 14:36
  Dr. Nancy Echefu: need more.
• 14:38
  Dr. Nancy Echefu: They need more treatment.
• 14:39
  Dr. Nancy Echefu: They need a professional to take care of them, they need a physician to take care of them.
• 14:44
  Dr. Nancy Echefu: Okay.
• 14:45
  Dr. Nancy Echefu: So that's how you know, then you cannot decide to get a biopsy to confirm what you're already thinking.
• 14:51
  Dr. Komal Patil-Sisodia: Yeah,
• 14:51
  Dr. Nancy Echefu: so someone can come to my office when I do my virtual consults.
• 14:54
  Dr. Nancy Echefu: And I asked them Hey, have you had a biopsy?
• 14:56
  Dr. Nancy Echefu: I said no.
• 14:57
  Dr. Nancy Echefu: Do they have a dermatologist a doctor that can do biopsy where they are to say?
• 15:01
  Dr. Nancy Echefu: Yes, I say I think this is what you have.
• 15:03
  Dr. Nancy Echefu: Yeah Let's go ahead and get a biopsy and when they come back and tell me this is what the doctor said They have CCCA.
• 15:09
  Dr. Nancy Echefu: I'm like I already knew it, but I just wanted to confirm it to document it for you So it just to help you comment.
• 15:14
  Dr. Nancy Echefu: It's not everyone that needs a biopsy
• 15:16
  Dr. Komal Patil-Sisodia: Okay.
• 15:16
  Dr. Nancy Echefu: But it's just to confirm, what you're already thinking that this is what might be.
• 15:20
  Dr. Nancy Echefu: Okay.
• 15:21
  Dr. Komal Patil-Sisodia: Okay.
• 15:22
  Dr. Komal Patil-Sisodia: That makes good sense.
• 15:23
  Dr. Nancy Echefu: And then,
• 15:24
  Dr. Komal Patil-Sisodia: With the, I know we're going to talk a little bit about a treatment, but one of the other things that you and I talked about on the Instagram live that I think was very interesting, and I think it requires probably a little bit more breakdown for people who are struggling with hair loss and may not have that medical background is what is the difference between hair loss and hair shedding?
• 15:45
  Dr. Komal Patil-Sisodia: It's important to understand the distinction between the two, because there, there is a, probably a normal amount of shedding that can happen, but people have a hard time differentiating between the two.
• 15:56
  Dr. Komal Patil-Sisodia: And you
• 15:57
  Dr. Nancy Echefu: know, that's why when we're having an interview, I kept on saying hair loss or hair shedding.
• 16:01
  Dr. Komal Patil-Sisodia: Yes.
• 16:01
  Dr. Nancy Echefu: Hair loss or hair shedding.
• 16:03
  Dr. Nancy Echefu: Yeah.
• 16:03
  Dr. Nancy Echefu: Because people tend to, now you can have both at the same time.
• 16:06
  Dr. Komal Patil-Sisodia: Yes.
• 16:07
  Dr. Nancy Echefu: Because remember I told you one is genetic.
• 16:09
  Dr. Nancy Echefu: Yes.
• 16:09
  Dr. Nancy Echefu: No.
• 16:10
  Dr. Nancy Echefu: male pattern or female pattern hair loss, then the hair shedding is almost like the trigger.
• 16:14
  Dr. Nancy Echefu: So let's go back to my analogy, the roots and the tree.
• 16:18
  Dr. Nancy Echefu: So when there's hair loss, true hair loss, which is progressive, it's coming from the roots.
• 16:26
  Dr. Nancy Echefu: When there's hair shedding, it's just the tree or the branches that are just falling off.
• 16:31
  Dr. Nancy Echefu: I see.
• 16:32
  Dr. Komal Patil-Sisodia: Oh, I like that.
• 16:33
  Dr. Nancy Echefu: Yeah.
• 16:33
  Dr. Nancy Echefu: So it's easy.
• 16:34
  Dr. Nancy Echefu: So whatever trigger.
• 16:37
  Dr. Komal Patil-Sisodia: Postpartum,
• 16:38
  Dr. Nancy Echefu: flu, COVID, fever, surgery, Viretric surgery, weight loss, GLP medication, stress, yeah.
• 16:50
  Dr. Nancy Echefu: That can cause head shedding.
• 16:52
  Dr. Nancy Echefu: So that's just a bit of head shedding.
• 16:55
  Dr. Komal Patil-Sisodia: That is such a great way of breaking it down.
• 16:59
  Dr. Komal Patil-Sisodia: It makes so much sense.
• 17:01
  Dr. Komal Patil-Sisodia: That's
• 17:01
  Dr. Nancy Echefu: why you hear them, they say, Once that phase, once the stress is gone.
• 17:05
  Dr. Nancy Echefu: When you want to take away the stress, the hair will stabilize because the roots are still there.
• 17:11
  Dr. Nancy Echefu: It's just the trees that fell
• 17:12
  Dr. Komal Patil-Sisodia: off.
• 17:13
  Dr. Komal Patil-Sisodia: The question that people ask is how much is normal hair shedding?
• 17:17
  Dr. Komal Patil-Sisodia: How much hair can you expect to lose in a day on average?
• 17:21
  Dr. Komal Patil-Sisodia: And I know it will be different for different people but what would you consider a normal amount of hair loss per day?
• 17:27
  Dr. Komal Patil-Sisodia: Okay.
• 17:28
  Dr. Komal Patil-Sisodia: Or hair shedding, rather.
• 17:29
  Dr. Nancy Echefu: We can lose anywhere a hundred hair fifty to a hundred or eighty to a hundred.
• 17:34
  Dr. Nancy Echefu: But hair shedding is the terminology when you're losing more than normal.
• 17:37
  Dr. Nancy Echefu: Okay.
• 17:38
  Dr. Nancy Echefu: Okay?
• 17:38
  Dr. Nancy Echefu: So, eighty to a hundred is normal for us to lose every day.
• 17:41
  Dr. Nancy Echefu: Then, when you're not having, when there's a trigger that you're having hair shedding, you can lose more than normal.
• 17:48
  Dr. Komal Patil-Sisodia: And those are like the underlying illnesses that are not the inflammation of the root.
• 17:53
  Dr. Komal Patil-Sisodia: Okay.
• 17:53
  Dr. Komal Patil-Sisodia: Okay.
• 17:53
  Dr. Komal Patil-Sisodia: Okay.
• 17:53
  Dr. Komal Patil-Sisodia: Yes,
• 17:54
  Dr. Nancy Echefu: it's not it.
• 17:55
  Dr. Nancy Echefu: This is not inflammation.
• 17:56
  Dr. Komal Patil-Sisodia: Yes.
• 17:57
  Dr. Nancy Echefu: We're not talking about inflammation now.
• 17:58
  Dr. Nancy Echefu: We're just adjusting normal.
• 18:00
  Dr. Nancy Echefu: There's a trigger.
• 18:00
  Dr. Nancy Echefu: There's a norm.
• 18:01
  Dr. Nancy Echefu: What happens with that?
• 18:02
  Dr. Nancy Echefu: Remember I told you about the tree?
• 18:04
  Dr. Komal Patil-Sisodia: Yeah.
• 18:05
  Dr. Nancy Echefu: So what happens is that there's growth cycles of the hair.
• 18:09
  Dr. Komal Patil-Sisodia: Oh,
• 18:09
  Dr. Nancy Echefu: there's growth cycle.
• 18:10
  Dr. Nancy Echefu: Yes.
• 18:10
  Dr. Nancy Echefu: There's growing phase.
• 18:12
  Dr. Nancy Echefu: There's a transitional phase.
• 18:14
  Dr. Nancy Echefu: There's a resting phase.
• 18:15
  Dr. Nancy Echefu: So that hair shedding is all about.
• 18:18
  Dr. Nancy Echefu: There's a trigger that stopped that arrested the growth phase.
• 18:22
  Dr. Nancy Echefu: Let's say arrested.
• 18:24
  Dr. Nancy Echefu: Arrested the growth cycle to the, in the resting phase.
• 18:27
  Dr. Nancy Echefu: That means the hair stays in that resting phase.
• 18:30
  Dr. Nancy Echefu: So it's not growing.
• 18:31
  Dr. Nancy Echefu: It's just resting.
• 18:32
  Dr. Nancy Echefu: It's just lazy.
• 18:33
  Dr. Nancy Echefu: Right there.
• 18:34
  Dr. Nancy Echefu: Oh, I see.
• 18:35
  Dr. Nancy Echefu: So that's why it's shedding.
• 18:37
  Dr. Komal Patil-Sisodia: How long is the hair cycle from start to finish usually?
• 18:41
  Dr. Komal Patil-Sisodia: So it depends.
• 18:42
  Dr. Nancy Echefu: So growth phase can last anywhere to three to eight years.
• 18:47
  Dr. Nancy Echefu: Oh, wow.
• 18:47
  Dr. Nancy Echefu: Okay.
• 18:48
  Dr. Nancy Echefu: Three to five years.
• 18:49
  Dr. Nancy Echefu: Now, it depends on what area of the hair we're talking about, the scalp hair, or, the eyebrows.
• 18:55
  Dr. Nancy Echefu: So it depends.
• 18:56
  Dr. Nancy Echefu: Growth phase for different places are different, but we're talking about the scalp now.
• 19:01
  Dr. Nancy Echefu: Okay.
• 19:01
  Dr. Nancy Echefu: So the growth phase is between anywhere from two to eight years, which is the longest phase.
• 19:07
  Dr. Nancy Echefu: Okay.
• 19:07
  Dr. Nancy Echefu: So our hair is always growing.
• 19:09
  Dr. Nancy Echefu: That's why you can shave off your hair now and the next week is great because it's always growing.
• 19:14
  Dr. Nancy Echefu: Okay.
• 19:15
  Dr. Nancy Echefu: Okay.
• 19:16
  Dr. Nancy Echefu: Then we have the resting phase.
• 19:18
  Dr. Nancy Echefu: Remember when it grows, it rests.
• 19:20
  Dr. Nancy Echefu: When it grows, it transitions to the resting phase.
• 19:23
  Dr. Nancy Echefu: So growth growing phase, transition phase and resting phase.
• 19:28
  Dr. Nancy Echefu: So the resting phase can last maybe two months, two to six months.
• 19:32
  Dr. Nancy Echefu: Usually I can give an average of three months for the resting phase.
• 19:36
  Dr. Nancy Echefu: So that's what happens when you start a new medication.
• 19:39
  Dr. Nancy Echefu: That's a hair loss medication sometimes is a trigger and it stays in that resting phase.
• 19:44
  Dr. Nancy Echefu: So you have hair shedding.
• 19:45
  Dr. Nancy Echefu: I
• 19:45
  Dr. Komal Patil-Sisodia: see.
• 19:46
  Dr. Nancy Echefu: That phase, if you understand how the analogy I gave to you and the growth phases, or the cycle.
• 19:54
  Dr. Nancy Echefu: You understand each cycle when someone walks into your office, what's going on.
• 19:58
  Dr. Nancy Echefu: And it also helps when we do hair transplant.
• 20:00
  Dr. Nancy Echefu: To understand what phase, the hair is in right now.
• 20:03
  Dr. Komal Patil-Sisodia: That makes sense, so if I were to break it down a little bit more, the resting phase is where, if the fall, if the leaves on a tree are going from summer to fall, the leaves are falling off and that's the resting phase.
• 20:17
  Dr. Nancy Echefu: Okay.
• 20:17
  Dr. Nancy Echefu: And that's why where the telogen uvv, when people say telogen effluvium that's resting phase.
• 20:22
  Dr. Komal Patil-Sisodia: Okay?
• 20:23
  Dr. Nancy Echefu: It stays in that resting phase.
• 20:25
  Dr. Komal Patil-Sisodia: Okay?
• 20:25
  Dr. Nancy Echefu: So if that's, but the roots are still there.
• 20:27
  Dr. Komal Patil-Sisodia: Okay, that makes sense.
• 20:29
  Dr. Komal Patil-Sisodia: So if that's lasting two to six months, then to me it seems that if somebody is starting a hair loss treatment, they would need to try it for.
• 20:38
  Dr. Komal Patil-Sisodia: At least that period of time in order to see a difference,
• 20:41
  Dr. Nancy Echefu: right?
• 20:41
  Dr. Nancy Echefu: Yeah, I tell them like, you need to be, number one, you need to be patient.
• 20:45
  Dr. Nancy Echefu: Number two, your hair is going to go through an ugly phase.
• 20:49
  Dr. Komal Patil-Sisodia: So
• 20:49
  Dr. Nancy Echefu: once you realize that, just give your hair some time, we don't expect any miracles.
• 20:54
  Dr. Nancy Echefu: We just have to wait till four to six months.
• 20:57
  Dr. Komal Patil-Sisodia: I love that.
• 20:58
  Dr. Komal Patil-Sisodia: And that's such a, it's such an exercise in patience, right?
• 21:02
  Dr. Komal Patil-Sisodia: For most of us, so much of our identity is tied to our hair.
• 21:06
  Dr. Komal Patil-Sisodia: For women, their concept of femininity is tied to their hair.
• 21:09
  Dr. Komal Patil-Sisodia: And so it seems unfair that we lose it so much faster than we can grow it back.
• 21:14
  Dr. Komal Patil-Sisodia: I
• 21:15
  Dr. Nancy Echefu: know, I promise you, Lea, it's easier to take care of a man's hair than for women when they're dealing with hair loss because we have to think about everything like age
• 21:25
  Dr. Komal Patil-Sisodia: yes
• 21:26
  Dr. Nancy Echefu: what phase at what stage of their life they're in what is going on so so many things how many are in that so many things for women yeah so that's why it's very important here
• 21:35
  Dr. Komal Patil-Sisodia: It is definitely a challenge.
• 21:37
  Dr. Komal Patil-Sisodia: It is much more complex.
• 21:39
  Dr. Komal Patil-Sisodia: So when, what is your approach?
• 21:41
  Dr. Komal Patil-Sisodia: You talked about your clients coming in for hair loss.
• 21:44
  Dr. Komal Patil-Sisodia: I, and we've heard how you divide them into, is this scarring or non scarring alopecia?
• 21:51
  Dr. Komal Patil-Sisodia: Could you break it down like for your patients with non scarring alopecia versus scarring alopecia?
• 21:58
  Dr. Komal Patil-Sisodia: What are some things you have each group try and obviously the scarring alopecia will probably be more complicated because it really depends on what's causing that.
• 22:07
  Dr. Komal Patil-Sisodia: But for the non scarring alopecia, I guess maybe we'll focus on that.
• 22:10
  Dr. Komal Patil-Sisodia: What is your formula?
• 22:12
  Dr. Komal Patil-Sisodia: What is your approach to, thinking about like how you can help treat those women?
• 22:17
  Dr. Nancy Echefu: Okay.
• 22:18
  Dr. Nancy Echefu: So someone walks into my office.
• 22:22
  Dr. Nancy Echefu: He should take him.
• 22:23
  Dr. Nancy Echefu: First of all, I send them the medical history before they come to the office so they can really have time to just read through their medical history.
• 22:29
  Dr. Komal Patil-Sisodia: Yeah.
• 22:29
  Dr. Nancy Echefu: Then talk to them.
• 22:31
  Dr. Nancy Echefu: Is this hair loss progressive?
• 22:32
  Dr. Nancy Echefu: How long have you had it?
• 22:33
  Dr. Nancy Echefu: Or just, it's just sudden.
• 22:35
  Dr. Nancy Echefu: Cause it's very important.
• 22:35
  Dr. Nancy Echefu: Cause we want to make sure is this an arrest?
• 22:38
  Dr. Komal Patil-Sisodia: Yeah.
• 22:38
  Dr. Komal Patil-Sisodia: Or
• 22:38
  Dr. Nancy Echefu: is this, a progressive hair loss?
• 22:40
  Dr. Nancy Echefu: No?
• 22:41
  Dr. Nancy Echefu: So it depends on what they say.
• 22:43
  Dr. Nancy Echefu: Then I have to do a physical exam.
• 22:45
  Dr. Nancy Echefu: Remember I already talked to you about the itching, the burning and all that.
• 22:49
  Dr. Nancy Echefu: To help me, is this scarring versus non scarring?
• 22:52
  Dr. Nancy Echefu: So it depends on what I see.
• 22:55
  Dr. Nancy Echefu: Or what I also, based on the history that I take, I have to determine, do they need blood tests?
• 23:02
  Dr. Nancy Echefu: Do they need a biopsy?
• 23:04
  Dr. Nancy Echefu: Okay.
• 23:05
  Dr. Nancy Echefu: Now, if they need blood tests, what do I do?
• 23:07
  Dr. Nancy Echefu: I have to ask them, Hey, do you have a regular doctor?
• 23:10
  Dr. Nancy Echefu: If they say yes, when was the last time they had their physical exam?
• 23:13
  Dr. Nancy Echefu: Yeah, they're about to have it within the next one, one to two months.
• 23:18
  Dr. Komal Patil-Sisodia: I will
• 23:18
  Dr. Nancy Echefu: add the blood test.
• 23:19
  Dr. Nancy Echefu: I want them to add together with their physical exam.
• 23:22
  Dr. Komal Patil-Sisodia: Okay.
• 23:23
  Dr. Nancy Echefu: Okay.
• 23:23
  Dr. Nancy Echefu: So I give them a whole comprehensive list to add to what they're already going to be doing with your regular doctor.
• 23:29
  Dr. Nancy Echefu: So they don't have to, do it twice.
• 23:31
  Dr. Nancy Echefu: That makes sense, that number.
• 23:32
  Dr. Nancy Echefu: Then number two, have to determine do they need a biopsy?
• 23:35
  Dr. Nancy Echefu: You have to explain, Hey, have they been dealing with these hair loss for a long time?
• 23:39
  Dr. Nancy Echefu: Some of them come in and say, Hey, I would just want hair transplant.
• 23:42
  Dr. Nancy Echefu: That's what I want.
• 23:43
  Dr. Nancy Echefu: Yeah.
• 23:43
  Dr. Nancy Echefu: Or I've heard of microneedling, or I've heard of this.
• 23:45
  Dr. Nancy Echefu: I have the PRP and I have to ask them, what have the most important question I have to ask que clients now.
• 23:52
  Dr. Nancy Echefu: What have you tried before?
• 23:53
  Dr. Nancy Echefu: Who have you seen?
• 23:55
  Dr. Nancy Echefu: Most of them have seen trichologists, dermatologists.
• 23:59
  Dr. Nancy Echefu: Most of them have been given medication.
• 24:00
  Dr. Nancy Echefu: So I have to know the back history.
• 24:03
  Dr. Komal Patil-Sisodia: So once I
• 24:04
  Dr. Nancy Echefu: know the back history, then I know what to do build on that.
• 24:08
  Dr. Nancy Echefu: Have they tried Minoxidil, which is like almost everyone knows about minoxidil at this point.
• 24:13
  Dr. Nancy Echefu: What dose have they tried?
• 24:14
  Dr. Nancy Echefu: So everyone that walks into my office basically depends on age, history, what they've tried.
• 24:20
  Dr. Nancy Echefu: So everyone was typically start everyone make sure you're minoxidil.
• 24:23
  Dr. Nancy Echefu: Then what dose of minoxidil have they tried?
• 24:26
  Dr. Nancy Echefu: Whether taking it every day or every two days or every three days.
• 24:30
  Dr. Nancy Echefu: So are they taking the foam?
• 24:31
  Dr. Nancy Echefu: Are they taking, are they using the foam or the liquid?
• 24:34
  Dr. Nancy Echefu: So it depends really.
• 24:36
  Dr. Nancy Echefu: On the history on water.
• 24:37
  Dr. Nancy Echefu: So everyone starts on minoxidil.
• 24:38
  Dr. Nancy Echefu: Then we build on what we want.
• 24:41
  Dr. Nancy Echefu: So I have a whole protocol what I want you to ask.
• 24:44
  Dr. Nancy Echefu: Now if they don't have a primary care doctor, I will have to do all the blood tests.
• 24:48
  Dr. Komal Patil-Sisodia: Yeah.
• 24:48
  Dr. Komal Patil-Sisodia: But
• 24:49
  Dr. Nancy Echefu: I'll have to also make sure they go and get a primary care doctor.
• 24:52
  Dr. Nancy Echefu: Or I look for a DPC physician.
• 24:54
  Dr. Komal Patil-Sisodia: Yeah.
• 24:55
  Dr. Nancy Echefu: To refer them to.
• 24:56
  Dr. Nancy Echefu: Because I have to make sure that you have someone else, that makes sense.
• 24:58
  Dr. Nancy Echefu: Watching over you, not just your head.
• 25:00
  Dr. Komal Patil-Sisodia: Because hair loss is often a symptom for other things that are ongoing systemically, right?
• 25:06
  Dr. Komal Patil-Sisodia: Like we talked about.
• 25:07
  Dr. Nancy Echefu: Yeah.
• 25:08
  Dr. Komal Patil-Sisodia: That makes good sense.
• 25:09
  Dr. Komal Patil-Sisodia: How often can a patient who comes to see you expect to follow up with you?
• 25:13
  Dr. Komal Patil-Sisodia: Are you checking in with them monthly, every few months knowing how long it takes for hair to actually come back?
• 25:20
  Dr. Komal Patil-Sisodia: How do you track that progress?
• 25:22
  Dr. Nancy Echefu: So what I do is Now, what I do is that when someone comes in with me, I'll tell them, you have to give me one year of your hair's life.
• 25:28
  Dr. Nancy Echefu: You understand that?
• 25:29
  Dr. Nancy Echefu: You have to give me one year.
• 25:31
  Dr. Nancy Echefu: Why do I say one year?
• 25:32
  Dr. Nancy Echefu: Because your hair is going to go through different phases and your emotions are going to be all over the place.
• 25:37
  Dr. Nancy Echefu: So I've had patients I've placed on, we've started treatment and they call me, I feel this part is falling off.
• 25:42
  Dr. Nancy Echefu: I feel I'm not, they will start noticing so many things that I didn't, that was not there before.
• 25:47
  Dr. Nancy Echefu: So I do three months, six months, nine months, 12 months.
• 25:50
  Dr. Nancy Echefu: And it depends on what treatment you're also getting.
• 25:52
  Dr. Nancy Echefu: The couple of treatments I have, there are some of the treatment, which is my TED Hair Restoration, which is good for women because there are no needles, no blood draw, nothing.
• 26:00
  Dr. Nancy Echefu: The TED Hair Restoration is almost like an ultrasound based machine.
• 26:04
  Dr. Nancy Echefu: We induce hair growth.
• 26:06
  Dr. Nancy Echefu: Interesting.
• 26:06
  Dr. Nancy Echefu: The numbers.
• 26:07
  Dr. Nancy Echefu: So we induce it.
• 26:08
  Dr. Nancy Echefu: We, it's almost like vibrational.
• 26:10
  Dr. Nancy Echefu: We use our hair serum, our hair vitamins that has everything you need.
• 26:16
  Dr. Nancy Echefu: Then we use that machine, the TED machine and induce hair growth.
• 26:20
  Dr. Nancy Echefu: So that's what we do.
• 26:20
  Dr. Nancy Echefu: It's most especially women love that.
• 26:22
  Dr. Nancy Echefu: We use that treatment once a month for three treatments.
• 26:26
  Dr. Nancy Echefu: If they decide to go with the Ted Hair Treatment, I have to see you every month in my office.
• 26:31
  Dr. Nancy Echefu: After that, I'll let you go for another three months and watch your hair grow and give you other treatment options that you'll be doing at home.
• 26:38
  Dr. Nancy Echefu: So while I'm taking care of you in the office, I also give you what to do at home.
• 26:42
  Dr. Komal Patil-Sisodia: What do you generally recommend?
• 26:45
  Dr. Komal Patil-Sisodia: there's so many things that we hear, topical minoxidil, I'm happy to hear, right?
• 26:49
  Dr. Komal Patil-Sisodia: Because that is the first line.
• 26:52
  Dr. Komal Patil-Sisodia: Are there like other things like laser hair caps, the derma rollers for the scalp and the scalp massage,?
• 26:59
  Dr. Komal Patil-Sisodia: Are these things that you think are more myth versus fact, or is there some data to it that might be helpful to women?
• 27:07
  Dr. Nancy Echefu: What I do is medical, that's why, we're medical doctors.
• 27:10
  Dr. Nancy Echefu: Yeah.
• 27:11
  Dr. Nancy Echefu: We believe in medical science.
• 27:12
  Dr. Nancy Echefu: Yes.
• 27:14
  Dr. Nancy Echefu: So standard treatment, minoxidil, finasteride, spironolactone.
• 27:18
  Dr. Nancy Echefu: That is a standard.
• 27:19
  Dr. Nancy Echefu: We don't have to give spironolactone to everyone, but I'm just saying these are the three medications you would generally see.
• 27:24
  Dr. Nancy Echefu: So that's the standard.
• 27:25
  Dr. Nancy Echefu: So medical treatment in addition to plot that.
• 27:28
  Dr. Nancy Echefu: What I mean is plus
• 27:29
  Dr. Komal Patil-Sisodia: PRP
• 27:31
  Dr. Nancy Echefu: we want to do because PRP number one is number dependent.
• 27:37
  Dr. Nancy Echefu: The dose of the growth factors you need is almost like 1.
• 27:41
  Dr. Nancy Echefu: 4 million.
• 27:42
  Dr. Nancy Echefu: And your PRP as you age decreases.
• 27:47
  Dr. Nancy Echefu: So PRP is basically has so many factors.
• 27:49
  Dr. Nancy Echefu: Then we have the microneedling, which is good.
• 27:52
  Dr. Nancy Echefu: I love microneedling a lot.
• 27:54
  Dr. Nancy Echefu: I have the TED hair restoration, and we also have the laser cap.
• 27:58
  Dr. Nancy Echefu: You can do that at home.
• 28:00
  Dr. Nancy Echefu: I also tend to do the laser treatment too, which is the low laser light therapy.
• 28:04
  Dr. Nancy Echefu: We also have to make sure there is a medical device.
• 28:07
  Dr. Nancy Echefu: We're not just buying something on the internet and all that.
• 28:10
  Dr. Nancy Echefu: We have to make sure it's the range we're looking for.
• 28:12
  Dr. Nancy Echefu: Because it's low laser.
• 28:14
  Dr. Nancy Echefu: You can't buy a high laser and burn your scalp.
• 28:17
  Dr. Nancy Echefu: Ugh.
• 28:17
  Dr. Komal Patil-Sisodia: That sounds like that would be scarring.
• 28:19
  Dr. Komal Patil-Sisodia: See?
• 28:19
  Dr. Komal Patil-Sisodia: So.
• 28:20
  Dr. Nancy Echefu: The roots.
• 28:21
  Dr. Nancy Echefu: It has to be low laser light therapy that you can do at home, but you can't do that alone.
• 28:27
  Dr. Nancy Echefu: Your head is not going to grow.
• 28:28
  Dr. Nancy Echefu: Like it's going to grow, but it's the rate at it is going to grow compared to you adding the medical therapy that you need because they all have different mechanism of action.
• 28:38
  Dr. Nancy Echefu: Medical treatment in addition to either PRP.
• 28:42
  Dr. Nancy Echefu: Or microneedling or the third hair restoration or hair transplant.
• 28:45
  Dr. Nancy Echefu: The best one is the hair transplant.
• 28:47
  Dr. Nancy Echefu: That is for sure.
• 28:48
  Dr. Nancy Echefu: Your hair is going to grow.
• 28:49
  Dr. Nancy Echefu: The way I combine the treatments is if someone doesn't like needles, Have to stay away from anything needles.
• 28:55
  Dr. Nancy Echefu: Some people have this ov vagal syncope where you try to draw blood.
• 28:58
  Dr. Nancy Echefu: You don't wanna do all that to a client, so you have to respect people's wishes.
• 29:02
  Dr. Nancy Echefu: That's the way I approach my taking care of clients.
• 29:05
  Dr. Komal Patil-Sisodia: It's such a comprehensive approach, and I love that you've developed your own treatment protocol.
• 29:11
  Dr. Komal Patil-Sisodia: My next question would be is how closely are you working with the other specialists?
• 29:16
  Dr. Komal Patil-Sisodia: So it sounds like you are very much pro them having a primary care at baseline minimum.
• 29:22
  Dr. Komal Patil-Sisodia: But are you referring out to other specialists as well if you're suspecting other things?
• 29:26
  Dr. Nancy Echefu: I always refer.
• 29:27
  Dr. Nancy Echefu: Like I have a young lady coming to me with PCOS.
• 29:31
  Dr. Nancy Echefu: I'm like, when was the last time you saw your regular doctor?
• 29:33
  Dr. Nancy Echefu: I need to see your labs.
• 29:34
  Dr. Komal Patil-Sisodia: Yeah.
• 29:35
  Dr. Nancy Echefu: I need to see, what it said.
• 29:37
  Dr. Nancy Echefu: So where is he at?
• 29:38
  Dr. Nancy Echefu: What are you taking?
• 29:39
  Dr. Nancy Echefu: So I need to know.
• 29:40
  Dr. Nancy Echefu: I have, I've had clients that come in and they break down crying.
• 29:43
  Dr. Nancy Echefu: Then I have to think about their psych history.
• 29:45
  Dr. Nancy Echefu: That's the one part that I have to deal with a lot in the office because they get so emotional with the hair loss.
• 29:52
  Dr. Nancy Echefu: And, we always have to think about trichotillomania.
• 29:55
  Dr. Nancy Echefu: Are they pulling your hair?
• 29:56
  Dr. Komal Patil-Sisodia: Yes.
• 29:57
  Dr. Komal Patil-Sisodia: How common is that?
• 29:58
  Dr. Komal Patil-Sisodia: I was reading actually that it
• 30:00
  Dr. Nancy Echefu: I'm sorry.
• 30:02
  Dr. Nancy Echefu: people like, oh, let's say denial.
• 30:04
  Dr. Nancy Echefu: That's what we face.
• 30:05
  Dr. Nancy Echefu: We're faced with for physicians.
• 30:07
  Dr. Nancy Echefu: Anyone that is dealing with a hair loss practitioner or hair loss physician.
• 30:11
  Dr. Nancy Echefu: Denial trichotillomania.
• 30:12
  Dr. Nancy Echefu: I've had clients coming in and we do our the mitoscopic exam, which is, we take a look, we have a specialized camera
• 30:19
  Dr. Komal Patil-Sisodia: or
• 30:19
  Dr. Nancy Echefu: microscope.
• 30:20
  Dr. Nancy Echefu: Let's put microscope.
• 30:21
  Dr. Nancy Echefu: We take a look at the.
• 30:21
  Dr. Nancy Echefu: that we're missing.
• 30:24
  Dr. Nancy Echefu: Remember what I was telling you?
• 30:25
  Dr. Nancy Echefu: What everyone see is their hair, but what I'm looking for is that roots.
• 30:29
  Dr. Nancy Echefu: Is that roots?
• 30:30
  Dr. Nancy Echefu: Okay.
• 30:30
  Dr. Komal Patil-Sisodia: Yeah.
• 30:31
  Dr. Nancy Echefu: What is underneath your skin, your scalp?
• 30:34
  Dr. Nancy Echefu: Is it okay?
• 30:35
  Dr. Nancy Echefu: To make sure and the assigns we look for to see if this person is dealing with trichotillomania, like he's pulling their hair by themselves.
• 30:42
  Dr. Nancy Echefu: Do they have an autoimmune disorder going on?
• 30:44
  Dr. Nancy Echefu: So these are the things we look for in our examination of the scalp.
• 30:48
  Dr. Komal Patil-Sisodia: Yeah.
• 30:49
  Dr. Nancy Echefu: Okay.
• 30:50
  Dr. Komal Patil-Sisodia: So
• 30:50
  Dr. Nancy Echefu: this is what, then I'd have to have a different conversation because you want to also, are this person dealing, are you dealing with body dysmorphia?
• 30:58
  Dr. Komal Patil-Sisodia: Yeah.
• 30:59
  Dr. Nancy Echefu: You see what I'm saying?
• 30:59
  Dr. Nancy Echefu: So I have to have this different conversation.
• 31:01
  Dr. Nancy Echefu: I've had someone come in and I want microneedling.
• 31:04
  Dr. Nancy Echefu: Oh, she'll change her mind.
• 31:05
  Dr. Nancy Echefu: I want this.
• 31:06
  Dr. Nancy Echefu: I want that.
• 31:07
  Dr. Nancy Echefu: I'm like, okay, let's sit down and talk about this.
• 31:09
  Dr. Nancy Echefu: I need to refer you back to your psychiatrist.
• 31:13
  Dr. Komal Patil-Sisodia: Yeah.
• 31:13
  Dr. Nancy Echefu: Talk about it.
• 31:15
  Dr. Nancy Echefu: Then we come back, and you have to present in such a way that you're not dismissing their complaints.
• 31:20
  Dr. Komal Patil-Sisodia: Or
• 31:20
  Dr. Nancy Echefu: what, you have to say, no, you're stressed out and you're already on this medication.
• 31:24
  Dr. Nancy Echefu: Maybe your medication needs to be adjusted or something.
• 31:26
  Dr. Nancy Echefu: Walking in the emergency room, I've seen so many kinds of people.
• 31:30
  Dr. Nancy Echefu: So I'm exposed to so many behavioral situations when people go from happy to sad to crying.
• 31:36
  Dr. Nancy Echefu: I have to think about that before I do any procedure because sometimes we have to think about physicians.
• 31:42
  Dr. Nancy Echefu: It's not really about what they're presenting with, there's something that's going on.
• 31:45
  Dr. Nancy Echefu: If not, you're going to see a client coming to your office every week.
• 31:48
  Dr. Komal Patil-Sisodia: We see that in our weight management clinic as well.
• 31:50
  Dr. Komal Patil-Sisodia: If there is underlying depression or anxiety.
• 31:53
  Dr. Komal Patil-Sisodia: The treatment, that also needs to be addressed before you put somebody or body dysmorphia, somebody down the line of weight management treatments that, so I can see the analogy there.
• 32:06
  Dr. Komal Patil-Sisodia: Same thing with hair loss.
• 32:08
  Dr. Komal Patil-Sisodia: Now with the trichotillomania, The pulling of the hair.
• 32:10
  Dr. Komal Patil-Sisodia: I've read traditionally it can be scalp hair.
• 32:13
  Dr. Komal Patil-Sisodia: It can be eyebrows.
• 32:14
  Dr. Komal Patil-Sisodia: Is there an age range or a demographic like that is more susceptible to this?
• 32:21
  Dr. Komal Patil-Sisodia: Like where is there an age group or gender that you see it more commonly in?
• 32:25
  Dr. Komal Patil-Sisodia: It's more in women.
• 32:26
  Dr. Komal Patil-Sisodia: Okay.
• 32:28
  Dr. Nancy Echefu: More in women.
• 32:29
  Dr. Nancy Echefu: But I don't think there's any age range, but I think it's more people dealing with anxiety, panic disorder, that have other undiagnosed, mental disorders, sometimes that's the way we say, okay, maybe there's something else going on.
• 32:41
  Dr. Nancy Echefu: But they never, agree that this is what they're dealing with.
• 32:44
  Dr. Nancy Echefu: I know.
• 32:45
  Dr. Nancy Echefu: There's always a denial.
• 32:46
  Dr. Nancy Echefu: That's number one.
• 32:47
  Dr. Nancy Echefu: There's always And I don't have to argue with you.
• 32:49
  Dr. Nancy Echefu: I just have to give you my opinion.
• 32:51
  Dr. Nancy Echefu: That's what I tell my clients.
• 32:53
  Dr. Nancy Echefu: I don't have to argue with you.
• 32:54
  Dr. Nancy Echefu: You don't have to agree.
• 32:55
  Dr. Nancy Echefu: But this is what I'm thinking.
• 32:57
  Dr. Nancy Echefu: And this is the way we're going.
• 32:58
  Dr. Nancy Echefu: Because that changes your treatment option because you don't want to keep treating and treating and treating.
• 33:03
  Dr. Nancy Echefu: We don't even do hair transplants.
• 33:05
  Dr. Nancy Echefu: Why?
• 33:05
  Dr. Nancy Echefu: Because what they're still going to pull it out.
• 33:07
  Dr. Nancy Echefu: Then they're going to blame you that the hair doesn't grow.
• 33:09
  Dr. Nancy Echefu: So you want to be really, really be cautious.
• 33:11
  Dr. Nancy Echefu: So that's one thing I deal with heavily.
• 33:14
  Dr. Nancy Echefu: Mental disorders in association with hair loss.
• 33:17
  Dr. Komal Patil-Sisodia: I imagine that's much more common.
• 33:20
  Dr. Komal Patil-Sisodia: I was seeing a patient a few weeks ago and I just noticed that when they were stressed out, they were talking about some stressors that were going on and we were trying to figure out whether there was a hormonal issue.
• 33:31
  Dr. Komal Patil-Sisodia: But the whole time, the hands were in the hair, pulling at the back or pulling at the front.
• 33:37
  Dr. Komal Patil-Sisodia: And I just thought, oh my gosh, I wonder how much of the hair loss is going to jump the gripping of the hair, right?
• 33:43
  Dr. Komal Patil-Sisodia: They weren't even actually pulling, but you could see them clenching on the roots of their hair.
• 33:47
  Dr. Komal Patil-Sisodia: It really makes it better.
• 33:50
  Dr. Nancy Echefu: Always see people reading a book or watching something, see them playing with their hair, like, rolling it on their finger.
• 33:55
  Dr. Komal Patil-Sisodia: Yeah, oh gosh.
• 33:57
  Dr. Komal Patil-Sisodia: You know, you're
• 33:57
  Dr. Nancy Echefu: breaking
• 33:58
  Dr. Komal Patil-Sisodia: that.
• 33:58
  Dr. Nancy Echefu: I should monitor myself.
• 34:02
  Dr. Nancy Echefu: So, we're looking at severe cases, but there are mild cases too.
• 34:06
  Dr. Komal Patil-Sisodia: Yeah.
• 34:07
  Dr. Nancy Echefu: Oh, that's so interesting.
• 34:08
  Dr. Nancy Echefu: Yeah, so when you're watching TV or eating something or, you're lost in thought and you're just really curling that hair around your finger like, you
• 34:15
  Dr. Komal Patil-Sisodia: know.
• 34:17
  Dr. Komal Patil-Sisodia: That might be me watching TV, watching Netflix.
• 34:23
  Dr. Nancy Echefu: I mean, you can do that, but let you not get to the point that you're breaking the hair.
• 34:26
  Dr. Nancy Echefu: God that's fascinating.
• 34:27
  Dr. Komal Patil-Sisodia: I'm gonna have to, yeah.
• 34:29
  Dr. Komal Patil-Sisodia: I'm gonna have to observe that a little bit closer for myself.
• 34:32
  Dr. Komal Patil-Sisodia: Is that, yeah.
• 34:34
  Dr. Komal Patil-Sisodia: I just never really made that association.
• 34:36
  Dr. Komal Patil-Sisodia: So it can be something as benign as just like staying with the ends of your hair and you don't realize what you're doing,
• 34:42
  Dr. Nancy Echefu: even when you do ponytails.
• 34:44
  Dr. Nancy Echefu: I would just want people to be more aware of it.
• 34:46
  Dr. Nancy Echefu: I'm not saying don't do what you're supposed to do, but just to just be more aware of it.
• 34:51
  Dr. Nancy Echefu: This can cause you losing your hair because you can be on all the Minoxidil and all that.
• 34:55
  Dr. Komal Patil-Sisodia: But
• 34:55
  Dr. Nancy Echefu: behavioral changes are number one,
• 34:58
  Dr. Komal Patil-Sisodia: yeah, we got a pizza oven last summer and I was not being careful and I leaned over to look in it And I like burned off the front row of my hair.
• 35:08
  Dr. Komal Patil-Sisodia: I was just standing there like turning the pizza around.
• 35:10
  Dr. Komal Patil-Sisodia: I was like It smells like hair burn Oh my god, it's my hair At a freakout moment and then I just had this like very thin layer of hair here that you would see had been burned down to like one centimeter now I'm super careful with that, but I think we, there's just so many like daily hazards that we don't think about, right?
• 35:31
  Dr. Komal Patil-Sisodia: Hot tools, I'm sure doesn't help with hair breakage and things like that, which is not a real problem, but still.
• 35:38
  Dr. Komal Patil-Sisodia: Can contribute to that, but yeah.
• 35:40
  Dr. Komal Patil-Sisodia: Dr.
• 35:41
  Dr. Komal Patil-Sisodia: Fu, thank you so much.
• 35:41
  Dr. Komal Patil-Sisodia: This has been so enlightening.
• 35:44
  Dr. Nancy Echefu: Thank you so much.
• 35:45
  Dr. Nancy Echefu: Thank you for having me.
• 35:47
  Dr. Komal Patil-Sisodia: I have loved this conversation.
• 35:49
  Dr. Komal Patil-Sisodia: I have two things that I wanted to ask.
• 35:51
  Dr. Komal Patil-Sisodia: you.
• 35:51
  Dr. Komal Patil-Sisodia: The first thing will be is if you were to give advice to, somebody, some listener out there that's sitting here thinking, gosh, I'm losing my hair and I don't even know what to start with or what to do right now before I get in to see my doctor, what would be the one thing that you would recommend they start doing to start addressing their hair loss?
• 36:12
  Dr. Komal Patil-Sisodia: That they can do before.
• 36:13
  Dr. Komal Patil-Sisodia: Is it like tracking their symptoms or their habits?
• 36:17
  Dr. Komal Patil-Sisodia: Is it trying to make an outline?
• 36:18
  Dr. Komal Patil-Sisodia: Like what would you want them to do before they come in to see you as a patient?
• 36:23
  Dr. Nancy Echefu: Like I always say, behavioral, you have to see what you do every day with your hair.
• 36:27
  Dr. Nancy Echefu: How do you wash your hair?
• 36:28
  Dr. Nancy Echefu: Your hair washing days?
• 36:30
  Dr. Nancy Echefu: What do you do?
• 36:31
  Dr. Nancy Echefu: Because once you wash your hair, I noticed some people after washing their hair, they had a pack.
• 36:35
  Dr. Nancy Echefu: It depends on what you do when you have your hair washing days.
• 36:39
  Dr. Nancy Echefu: Depends on what you use.
• 36:41
  Dr. Nancy Echefu: A lot of oils.
• 36:43
  Dr. Nancy Echefu: lotions on your hair and all that.
• 36:45
  Dr. Nancy Echefu: So you need actually need to know what your hair practices.
• 36:49
  Dr. Nancy Echefu: That's just what I'm getting to.
• 36:50
  Dr. Nancy Echefu: What are your hair practices?
• 36:51
  Dr. Nancy Echefu: You just need to be more aware of it.
• 36:53
  Dr. Nancy Echefu: All I, all what I always tell people, you need to stop whatever you're doing, just stop and start all over again and watch.
• 37:00
  Dr. Nancy Echefu: Okay.
• 37:00
  Dr. Nancy Echefu: What am I doing today?
• 37:02
  Dr. Komal Patil-Sisodia: Yeah,
• 37:02
  Dr. Nancy Echefu: what am I putting on my head today?
• 37:03
  Dr. Nancy Echefu: What am I doing?
• 37:04
  Dr. Nancy Echefu: And once you catch yourself doing that you need to stop
• 37:07
  Dr. Komal Patil-Sisodia: Oh, that's so interesting.
• 37:08
  Dr. Nancy Echefu: Simple.
• 37:09
  Dr. Nancy Echefu: Yeah, simple minoxidil over the counter five percent.
• 37:12
  Dr. Nancy Echefu: You can't use that You know, but if you, but you have also have to be careful if you're having burning sensation with, with the Minoxidil and all that.
• 37:20
  Dr. Nancy Echefu: If you're itching.
• 37:22
  Dr. Nancy Echefu: Yeah.
• 37:22
  Dr. Nancy Echefu: If you have scales, if you have dandruff, you have to think about, then you need more.
• 37:26
  Dr. Komal Patil-Sisodia: Yeah.
• 37:26
  Dr. Komal Patil-Sisodia: The
• 37:26
  Dr. Nancy Echefu: minoxidil is just one part of it.
• 37:29
  Dr. Nancy Echefu: That's
• 37:30
  Dr. Komal Patil-Sisodia: so interesting.
• 37:31
  Dr. Komal Patil-Sisodia: Okay.
• 37:32
  Dr. Komal Patil-Sisodia: Yeah,
• 37:32
  Dr. Nancy Echefu: so I also encourage people to do demo rolling.
• 37:35
  Dr. Nancy Echefu: Get a derma roller has needles, 0.
• 37:37
  Dr. Nancy Echefu: 5, which is like the shortest needle you can find.
• 37:40
  Dr. Nancy Echefu: Whatever treatment you're doing, add a derma roller to the area of hair loss, use that.
• 37:45
  Dr. Nancy Echefu: Don't use it excessively, but use it.
• 37:48
  Dr. Nancy Echefu: It's just going to help.
• 37:50
  Dr. Komal Patil-Sisodia: So I guess that's a great question.
• 37:52
  Dr. Komal Patil-Sisodia: And I've had somebody ask me whether they could use a derma roller.
• 37:55
  Dr. Komal Patil-Sisodia: And I was like, I have no idea because I'm not a transplant specialist or a dermatologist.
• 38:00
  Dr. Komal Patil-Sisodia: With the derma rollers, is there ever any concern of scarring the scalp?
• 38:04
  Dr. Komal Patil-Sisodia: Or, my assumption is that would be from overuse.
• 38:09
  Dr. Komal Patil-Sisodia: But if people are like, what is the appropriate cadence to use a derma roller?
• 38:13
  Dr. Komal Patil-Sisodia: Should it be like twice a week, once a week, That's
• 38:16
  Dr. Nancy Echefu: why we also have a protocol in our clinic.
• 38:21
  Dr. Nancy Echefu: Yeah, we send people protocols.
• 38:24
  Dr. Nancy Echefu: Protocol in a clinic.
• 38:25
  Dr. Nancy Echefu: Why do we need protocols?
• 38:27
  Dr. Nancy Echefu: Protocol saves us from the headaches.
• 38:30
  Dr. Komal Patil-Sisodia: Yeah.
• 38:30
  Dr. Nancy Echefu: You see, helps me know what you're doing wrong and what you're doing right.
• 38:34
  Dr. Nancy Echefu: I send you the protocol.
• 38:35
  Dr. Nancy Echefu: You don't have to follow the protocol to the T, but at least you have guidance.
• 38:38
  Dr. Nancy Echefu: So you do how many drops today and you roll it.
• 38:41
  Dr. Nancy Echefu: How to roll it.
• 38:42
  Dr. Komal Patil-Sisodia: Yeah.
• 38:43
  Dr. Nancy Echefu: How many times to roll it today, the next day, how many times to roll it.
• 38:46
  Dr. Nancy Echefu: So it's simple.
• 38:47
  Dr. Nancy Echefu: You can start with once a week with just to know, because some people also have sensitive scalp.
• 38:52
  Dr. Nancy Echefu: Yeah.
• 38:53
  Dr. Nancy Echefu: Their pain tolerance is like zero.
• 38:54
  Dr. Nancy Echefu: So 0.
• 38:56
  Dr. Nancy Echefu: 5 millimeters.
• 38:58
  Dr. Nancy Echefu: That's the side of the Dermaroller.
• 38:59
  Dr. Nancy Echefu: You can use that with your Minoxidil.
• 39:01
  Dr. Nancy Echefu: Once you put the drop, you just roll it once, start with once a week.
• 39:05
  Dr. Nancy Echefu: I'm talking about the, Dermaroller, You can use Minoxidil every day.
• 39:10
  Dr. Nancy Echefu: So once you do that, then once you build tolerance for it, you can do twice a week, then three times a week, and just improve that.
• 39:18
  Dr. Komal Patil-Sisodia: That's really great.
• 39:19
  Dr. Komal Patil-Sisodia: My last question for you is how can people connect with you?
• 39:22
  Dr. Komal Patil-Sisodia: Where can they find you?
• 39:23
  Dr. Komal Patil-Sisodia: Where's your practice?
• 39:25
  Dr. Komal Patil-Sisodia: And do you see people outside of your area and then do you have social media that they can follow you on?
• 39:31
  Dr. Nancy Echefu: Oh, yeah.
• 39:32
  Dr. Nancy Echefu: So my name is Dr.
• 39:35
  Dr. Nancy Echefu: Nancy Achebe for one more time, owner of Javila Hair Restoration.
• 39:40
  Dr. Nancy Echefu: Everything hair, hair loss, hair restoration and aesthetics.
• 39:44
  Dr. Nancy Echefu: We also do skin because skin, we have the face and the hair because sometimes we have to do both at the same time.
• 39:50
  Dr. Nancy Echefu: Anyway, so Javila Hair Restoration, we're in Peachtree City, Georgia.
• 39:55
  Dr. Nancy Echefu: You can also connect to us on Facebook, Javila Hair Restoration.
• 39:59
  Dr. Nancy Echefu: Website, hh restorations.com, or you can put in Illa hair restoration.
• 40:05
  Dr. Nancy Echefu: You also find us, okay.
• 40:08
  Dr. Nancy Echefu: Also, we have a hair loss exhibition show coming up this September, 13th, 2025.
• 40:14
  Dr. Nancy Echefu: And what is the exhibition show?
• 40:16
  Dr. Nancy Echefu: Everything.
• 40:17
  Dr. Nancy Echefu: Hair loss.
• 40:17
  Dr. Nancy Echefu: People that have dealt with hair loss.
• 40:21
  Dr. Nancy Echefu: growing.
• 40:21
  Dr. Komal Patil-Sisodia: Yeah.
• 40:22
  Dr. Nancy Echefu: We also have something called head tattoo.
• 40:24
  Dr. Nancy Echefu: Sometimes people don't want treatment, but you just want to shed off the shininess of their scalp.
• 40:29
  Dr. Nancy Echefu: When you walk into a room and that the light hits your bald spot.
• 40:33
  Dr. Nancy Echefu: People don't like that.
• 40:34
  Dr. Nancy Echefu: So sometimes we do something called scalp micropigmentation, which is head tattooing.
• 40:38
  Dr. Nancy Echefu: Oh, that's so interesting.
• 40:40
  Dr. Nancy Echefu: Yeah.
• 40:40
  Dr. Nancy Echefu: A lot of ladies love that.
• 40:42
  Dr. Nancy Echefu: But sometimes, especially people that have been on chemotherapy, because their hair is finer, their density is lower.
• 40:49
  Dr. Nancy Echefu: So sometimes they are on treatment, but they are not getting that oomph they want.
• 40:54
  Dr. Komal Patil-Sisodia: Right.
• 40:54
  Dr. Nancy Echefu: So sometimes we can shade up that scalp, the shininess.
• 40:59
  Dr. Nancy Echefu: It gives them that.
• 41:00
  Dr. Nancy Echefu: Fullness they have except when you come closer, you say, okay, there will be there's something going on with the scalp, but it makes you feel it makes a whole lot of difference.
• 41:09
  Dr. Nancy Echefu: So we have hair loss exhibition show September 13th.
• 41:12
  Dr. Nancy Echefu: So we're
• 41:14
  Dr. Komal Patil-Sisodia: here.
• 41:15
  Dr. Komal Patil-Sisodia: Yeah, that's phenomenal.
• 41:16
  Dr. Komal Patil-Sisodia: That's so exciting.
• 41:18
  Dr. Komal Patil-Sisodia: Thank you again for coming on and sharing your knowledge, sharing your personal story.
• 41:24
  Dr. Komal Patil-Sisodia: We're just lucky to be able to hear from an expert like you.
• 41:28
  Dr. Komal Patil-Sisodia: I hope
• 41:28
  Dr. Nancy Echefu: I didn't give them a whole lot of things to process.
• 41:30
  Dr. Nancy Echefu: I tried to break it down so they can understand.
• 41:33
  Dr. Komal Patil-Sisodia: I thought your analogies were great, and I'm sure that our listeners will think so as well.
• 41:39
  Dr. Komal Patil-Sisodia: And thank you again for your time today, Dr.
• 41:42
  Dr. Komal Patil-Sisodia: Achefu.
• 41:42
  Dr. Nancy Echefu: so much.