Stop Hair Loss

FDA/CFSAN - Cosmetics--Hair, From Personal Statement to Personal Problem U. S. Food and Drug Administration FDA Consumer December 1991 HAIR! From Personal Statement to Personal Problem by Devera Pine From the shaved heads of medieval monks, to the long-haired hippies of the '60s, to the spiked hairdos of today's punkrockers, hair has always made a personal statement. "It's one of the leading ways people can establish their individuality and express their style," says Jerome Shupack,M.D., professor of clinical dermatology at New York University Medical Center in New York City. "Hair has had sociologicalimportance throughout the ages." Because of its importance, anything that happens to our hair that we can't control--falling out or turning gray, forinstance--can be the source of much anxiety. In the United States, some 35 million men are losing or have lost their hair from male-pattern baldness, according to theAmerican Hair Loss Council. Approximately 20 million women have experienced a similar loss of hair (from female-patternhair loss), and an estimated 2.5 million Americans have lost their hair due to other causes. THE BASICS Hair is produced by hair follicles--indentations of the epidermis (outer skin layer) that contain the hair root, themuscle attached to it, and sebaceous, or oil, glands. Hair is made up of dead cells filled with proteins, most of whichare known as keratins. The cells are woven together like a rope to form the hair fiber. The hair fiber, in turn, hasthree layers: the outer cuticle with its fish-scale-like structure; the cortex, which contains the bulk of the fiber;and the center, or medulla. Hair color is determined by melanocytes, cells that produce pigment. When these cells stopproducing pigment, hair turns gray. Although it seems as if the hair on your head is always growing, hair actually has active and rest phases. The growthphase, known as anagen, lasts for two to six years. At any given time, about 90 percent of scalp hair is in the growthstage. The remainder is in the rest phase, known as telogen; this lasts from two to three months. Once the rest phase is over, the hair strand falls out and a new one begins to grow. As a result, it's considered normalto lose from 20 to 100 hairs a day, says Diana Bihova, M.D., a dermatologist in private practice in New York City. Onlya change in your regular pattern of loss is considered abnormal--but many things, including genetic factors, diet, stress,and medications, can change that pattern. BALDNESS: MANIFEST DESTINY? The most common cause of hair loss in both men and women is rooted in a genetic predisposition. Called androgenicalopecia, it is known as male-pattern baldness in men and female-pattern hair loss in women (alopecia is the scientificterm for baldness). According to the American Hair Loss Council, genetics accounts for 95 percent of all cases of hairloss in this country. Baldness results from a combination of genetic factors and levels of testosterone (a hormone produced by the adrenalgland in both sexes and also by the testes in men). If hormone levels are right, then the hair follicles will expresstheir genetic destiny by growing for shorter periods and producing finer hairs. In men, who have higher levels oftestosterone than women, this eventually results in a bald scalp at the crown of the head and a horseshoe-shaped fringeof hair remaining on the sides. In women, the hair thins all over the scalp; the hairline does not recede. This typeof hair loss doesn't usually show up in women until menopause; until then, estrogen tends to counteract the effects oftestosterone. ONE APPROVED DRUG (See updated information below) The only drug approved by the Food and Drug Administration to treat pattern baldness or hair loss is minoxidil topicalsolution (Rogaine), which is rubbed into the scalp. Originally approved for hereditary male-pattern baldness in 1988, itwas also approved for treating female-pattern hair loss in August 1991. However, it should not be used by pregnant ornursing women. In his dermatological practice, Arthur P. Bertolino, M.D., Ph.D., director of the hair consultation unit at New YorkUniversity, says that this lotion helps hair grow in 10 to 14 percent of the people who try it. He estimates thatapproximately 90 percent of the time, Rogaine at least slows down hair loss. (Minoxidil is also available in tablet formto treat severe high blood pressure. Oral minoxidil has a potential for serious side effects and is not approved to treatbaldness.) No one is certain yet just how topical minoxidil works to promote hair growth. "One theory is that it dilates the bloodvessels, so it may stimulate nourishment of follicles," says Bihova. Alternatively, Rogaine may convert tiny hairfollicles that produce peach fuzz into large hair follicles that produce normal-size hairs. Again, no one knows for sure. What is certain is that, at least in men, Rogaine works better on patients who fit a certain profile: they've generallybeen bald for less than ten years, have bald spots on top of the head that are less than four inches in diameter, andthey still have fine hairs in their balding areas. "The process begins very early," says Bihova. "I see 19-, 20-year-oldmales who have it." The most common side effects with this medication are itching and skin irritation. Also, according to Bertolino, once youstop using it, any hair that grew as a result will fall out. Finally, the drug is expensive: in 1990, it cost about $600a year to use it twice a day. TRANSPLANTS Baldness can also be treated with hair transplants, in which plugs of "donor" follicles from the patient's scalp areused to fill the hairline. Although hair transplants work well in both men and women, the treatment tends to have a moredramatic effect on appearance in men with bald spots than it does on women with thinning hair. "The less hair you have, the more drama in the change," says Robert Auerbach, M.D., associate professor of clinicaldermatology at New York University School of Medicine. However, the American Hair Loss Council warns against attemptingto replace lost hair with hair pieces sutured to the scalp. FDA has not approved any products specifically intended forthis purpose, however, this does not preclude a physician from using sutures, which are approved devices, for thispurpose. According to the council, although the procedure is legal, it can result in scars, infections and evenbrain abscesses. Another treatment for male-pattern baldness, hair implants made of high-density artificial fibers surgically implanted inthe scalp, was banned by the FDA in 1984 because it causes infection. This is the only device FDA has ever banned. PRODUCTS THAT DON'T WORK So-called "thinning hair supplements," "hair farming products" and "vasodilators" for the scalp will not promote hairgrowth, says Mike Mahoney, a spokesperson for the American Hair Loss Council. Thinning hair supplements are nothing more than hair conditioners that temporarily make your hair feel or look a littlethicker. The main ingredient in these products--polysorbate--is also found in many shampoos. Promotional materials forhair farming products claim that they will release hairs that are "trapped" in a bald scalp. Mahoney says these products,many of which are herbal preparations, can do no such thing. And so-called vasodilators do not increase the blood supplyto the scalp and do not promote hairgrowth. EVERYDAY HAZARDS While male- and female-pattern baldness results in permanent hair loss, other factors can cause temporary loss of hair.For instance, the drop in the level of estrogen at the end of pregnancy can cause a woman's hair to shed more readily.Two or three months after a woman stops taking birth control pills, she may experience the same effect, since birthcontrol pills produce hormone changes that mimic pregnancy. A major physical stress, such as surgery, or a majoremotional stress--positive or negative--can cause hair loss. "I've seen women start losing their hair before getting married," says Bihova. Even jet lag can have a similar effect. In most of these cases, the hormonal imbalance or stressful situation will correct itself, and the scalp will soon begingrowing hair again. But, says Bihova, since most women are extremely upset by even a temporary hair loss, manydermatologists treat these conditions with either topical steroid preparations or localized injections of low doses ofsteroids. Bihova emphasizes that these are local, not systemic, injections of steroids, therefore, the shots do not havethe same risk of dangerous side effects as systemic steroids. However, only a board-certified dermatologist shouldadminister this treatment, she says. The list of causes of temporary hair loss goes on: pressure on the scalp from wigs or hairdos that pull too tightly cancause it. A fever of 103 degrees Fahrenheit or more often causes hair loss six weeks to three months later. And somemedications can cause a temporary loss. These include vitamin A derivatives such as Accutane, cough medicines withiodides, anti-ulcer drugs, some antibiotics, beta blockers, antidepressants and amphetamines, anti-arthritis drugs, bloodthinners, some cholesterol-lowering agents, aspirin taken over long periods, some thyroid medications, and chemotherapy. YOU HAIR WHAT YOU EAT? Although nutrition does play a role in hair loss and in the overall health of your hair, only extreme nutritionaldeficiencies or excesses will cause hair loss. For instance, people with anorexia and bulimia may temporarily lose hair.So will others suffering from malnutrition. "It's pretty rare in the United States," says Bertolino. "If someone was on a real strange, restrictive diet, it couldhappen to them." Megadoses of some vitamins--particularly A and E--and an iron deficiency may lead to hair loss. People who claim they candetermine which vitamins are lacking in your diet by analyzing your hair, however, are not speaking from a scientificallysound basis. The test used with this type of hair analysis--atomic absorption spectrophotometry--is a legitimateanalytical chemistry method; however, used on hair, the results of this test do not correlate with nutritional status,says Shupack. "Because of the sociological importance of hair, a lot of people try to cash in on it," he says. "Hairanalysis is all witchcraft as far as I'm concerned." There are, however, a few legitimate hair tests for substances such as arsenic and lead. FOR BEAUTY'S SAKE Every time you shampoo, blow dry, perm, straighten or dye your hair, you damage it slightly, says Bertolino. For the mostpart, hair can withstand this type of treatment. But overzealous beautifying can damage the hair fiber, resulting in manybroken strands, and a frizzy, split-end look. For instance, if you bleach your hair and then have a bunch of perms donein a short time, you're heading for trouble. Misuse of hair cosmetics can cause the hair to break as it comes out of the scalp, says Frances Storrs, M.D., professor ofdermatology at the Oregon Health Sciences University. Permanent wave solutions break the bonds that hold hair togetherand then reform them. But with a perm that is not diluted right or not rinsed off properly, for instance, those bonds maynot re-form and the hair would soon fall out as a result. Fortunately, most professional hair dressers know how to useperms correctly, says Storrs. Most hair dyes are not as irritating as permanent solutions, mostly because they do not break the bonds between hairfibers and are therefore not likely to cause a hair loss, she says. However, a severe allergic reaction to hair dye couldcause hair loss. "The allergy is pretty common, actually," says Storrs. Permanent solutions can also cause allergicreactions, though that's a rare side effect. Other beauty-related manipulations of the hair can cause problems, too: hot irons, corn rows and braids may bring ontemporary or permanent hair loss. If the hair breaks often enough, the follicles may eventually not be able to producenormal hair, says Bihova. "If someone has a problem with thinning and excessive loss, we advise being gentle," she says."Don't use rollers; don't use blow dryers on a hot setting; don't wear tight hair styles." Rough shampooing may accelerateany loss, though it's usually not a problem in people with healthy hair. THE MEDICAL SIDE Some hair loss is the result of a type of immune disorder known as alopecia areata--some 2.5 million people suffer fromthis condition in which antibodies attack the hair follicle, causing the hair to fall out. Alopecia areata often causessmall, oval or circular areas of hair loss. However, in some forms of the condition, all the scalp hair falls out; inother forms, all body hair is lost. Although the loss is usually temporary, the condition can recur. Treatments includetopical steroids or the use of chemicals to produce an allergic reaction to start the hair growing again. Finally, chronic, systemic conditions--including one form of lupus, abnormal kidney and liver function, and hypothyroidismor hyperthyroidism--can affect the hair. If you're experiencing hair loss, see a doctor. He or she will want to order somebasic blood tests to rule out any medical cause of the condition. Devera Pine is a freelance writer in New York City who frequently writes about health and science. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service, Food and Drug Administration Office of Public Affairs, 5600 Fishers Lane, Rockville, MD 20857 For an update on this subject, please refer to the FDA Talk Paper," FDA Approves Finasteride to Treat Male Pattern Hair Lossin Men " (December 22, 1997). Cosmetics Foods Home | FDA Home | Search/Subject Index | Disclaimers & Privacy Policy Hypertext updated by dav/dms 2001-MAY-25

Hair Products

Shampoos - Hair Loss - Hair Care Products The World of Hair an on-line reference by Dr. John Gray, provided by the P&G Hair Care Research Center. For more beauty science, please visit www.pg.com For more information about disorders of the hair and scalp, visit oxfordhairfoundation.org Page 112 -- HAIR LOSS AND SHAMPOOS An abnormally shaped hair shaft associated with the condition known as cheveux incoiffables Two more examples of the congenital condition known as cheveux incoiffables Woolly naevus is another congenital hair condition HAIR FACTS Shampoos and hair loss When people change their regular shampoo, mousse, conditioner or other hair product, they naturally give some extra attention to the condition of their hair and scalp. If they notice any improvement they give credit to the new product. Equally, if they notice anything amiss they blame the product. If they find that they are shedding hairs, they blame the product too - even if the loss has been going on for months. They can begin to believe they are going bald. Research has shown that while many people understand that hair fall is a natural process in hair re-growth, others link it to the use of 'unsuitable' shampoos rather than to combing or brushing or to chemical changes like perming. Only a few people recognise factors like childbirth, medication, diet, genetic inheritance or illness as possible causes of hair loss, although all these are well known to hair scientists. The fact is that shampoos do not cause hair to fall. Nor do they have any effect on the daily rate of loss, or on the rate of hair growth. Not surprisingly, more hair is shed on days when the hair is shampooed than on other days because of the simple mechanical action of washing the hair. Scientists studying different kinds of shampoos (including '2-in-1' products) could find no differences between their effects on hair loss.

hair styles with our

Hairstyles pictures. 3000+ styles in our gallery. 1001 hairstyles Hairstyles advice 1000's free styles pictures in our gallery Browse our photo gallery extra short to extra long cuts or try our other sites. The pics on this site are from a straight ahead perspective whereas the pictures on the others are in a "fashion shoot" style. News and articles: Msn Women Google news alerts regarding hairstyles Yahoo hairstyle News Beauty & hair news at about.com HairstylesPictures. Takethe guess work out of choosing new hair styles with our free gallery Click here for our free picture gallery Want even more pictures? Please try our other sites. The pictures on our other sites take a more traditional fashion photo shoot style:- loads more pictures 100's more hair styles pics prom, wedding & formal styles for your special day find a short hair cut If you like our site why not click here to email a friend If you add up all the pictures on this site and our sister sites the count is around 4000. This site uses a special software package to generate images of virtually every style possible on the same model allowing you to compare just the style while everything else remains constant this provides a useful tool for choosing a hair style because many clash with various face shapes. Whereas the other sites reviewed here are simple model photographs like those that you would see in most hair magazines but are split into more themed categories. Before you browse our gallery we recommend that you read through the advice on choosing a cut that will compliment your face shape. Also on the advice page there is a link to a great new utility that you can try for free and will give you the opportunity to see your new look before you commit yourself and its in 3d! There are 1000s of pictures, 4 subsections:- curly or wavyhair,center parting, side parting and hair with no parting. Manyfit into many categories :- We have provided a few sample pages short hairstyles , hair cuts , pictures of newcuts , hairstyle pictures , long , curly , layered cuts , mens , womens st yles , medium there are thousands more in the main gallery. Firstly you need to determine what shape your face actually is. It may not be one exact type, in fact it will more than likely be a mixture of two or maybe even more but it should resemble one more than the others. In front of a mirror, pull your hair off your face by wetting it and combing it back or tying it at the back. Take a pace away from the mirror or, use a photograph of yourself facing straight into the camera with your hair off your face as above. Draw an outline of your face with lipstick on the mirror, on transparent paper or on the photo itself. Now look at your outline and compare it to the options . This site is funded by advertising we hope it doesn't spoil your visit. If you would like to block the "pop ups" simply download and install the google toolbar which has a free pop up blocker top 30 styles | gallery | extra short hair cuts | short hair cuts | medium short | medium hair styles | medium long | long cuts | extra long styles | mens hair | click here for our directory.

Laser hair removal Laser

channel4.com - Lust4Life -Look younger E4 More4 FilmFour FourDocs TV Listings Site A-Z NEWS FILM HOMES LIFE ENTERTAINMENT HISTORY SCIENCE COMMUNITY SHOP SPORT CULTURE CARS MONEY VIDEO LEARNING HEALTH MUSIC GAMES TEXT ONLY CREDITS See how ideals of beauty around the world have evolved over the centuries in this kaleidoscope of images that changes throughout the site. Ten people, 10 days and the challenge to the best experts in the field: make these willing guinea pigs look 10 Years Younger . In the news Check this page regularly to find out what's making the headlines – be it health scares or new advances – in the world of cosmetic treatments. Select option –––––––––––––––––––– Alternative facelifts Be your own personal stylist Botox Brow lift Chemical peel Dental veneers Dermal fillers Eyelid surgery Face/neck lift Great make-up Hair extensions and wefts Hair styling IPL skin rejuvenation treatment Laser eye surgery Laser hair removal Laser vein treatment Liposuction Manicure Men's grooming Nose re-shaping Personal trainer Stand straight, look young Tooth whitening Waxing What is it? Laser beam targeted at hair follicles to prevent new growth. Timings May take several sessions of 15-45 minutes to treat one area. Most people have some regrowth within a year, which can be treated as needed. Cost £40-£400 per session, depending on size of area treated. Lasers produce a high-intensity ray of pure light which gives off heat energy. This energy is absorbed by different body tissues, depending on the colour of the laser beam. That's why laser light can pass safely through the skin, and destroy targeted cells under the surface without harming surrounding areas. For hair removal, the heat energy damages the cells at the root of the hair, thus preventing further growth. In this article What is laser hair removal? What laser hair removal can do What laser hair removal can't do What happens during treatment? Results Risks Where to get laser hair removal Cost of laser hair removal Alternatives to laser hair removal Help and info The treatment can be used on the face or on any other part of the body including bikini line, under arms, legs and stomach. The treatment works best on new hairs that are just starting to grow, which is why you will need several treatments in the same area to deal with all the hairs as they begin their growth cycle. It probably won't remove all hair permanently, but should reduce growth significantly, and any regrowth is likely to be paler and weaker. Lasers are targeted at pigmented tissue, so they don't work on white, grey or platinum blonde hair. As with any cosmetic treatment, you should consult a qualified practitioner before deciding to go ahead. You may need to wear goggles, depending on the laser system used. A cooling gel or spray, or even an anaesthetic cream may be applied to the treatment area. Lasering stings or tingles, and takes 15-45 minutes, depending on the size of the area. The same area is lasered once a month for two to eight months, until all the hair follicles have been treated. After treatment the skin may look red and slightly swollen, but this should disappear within 24 hours. You can return to normal daily life straight away. Most people need at least three sessions for best effect. The damaged hairs are shed gradually in the two weeks after treatment. The treatment works best, and has fewest risks, on pale skin. Let any sun tan fade before you consider treatment. The skin can be left with dark marks or pale patches, which should fade over several months. Lasers don't always work well on red hair. Because laser energy is absorbed by pigment, it may not be suitable for people with darker complexions, because of the risk of too much energy being absorbed and damaging the skin. People with Mediterranean complexions can be treated, but with care. You should also avoid laser treatment if you are particularly sensitive to light or have any infection around the place to be treated. You should not have laser treatment if you have been treated for acne with Isotretinoin in the previous year. Treatment can be given by medical professionals, or by trained beauticians. Treatment starts at around £40 per session for a small area, rising to £400 for larger areas. Most people need a minimum of three sessions for good results. Shaving equipment, creams, bleaches and other preparations are widely available. Most of these are easy and quick to use, but regrowth is rapid. Hair can be waxed away, but this can be quite painful and has to be repeated regularly. Electrolysis is still offered by some clinics, but this is a painful treatment which can cause scars, and is best suited to small areas because each hair has to be treated individually. Channel 4 Television takes no responsibility for the content of any third-party sites. Organisation British Association of Aesthetic Plastic Surgeons (BAAPS) c/o The Royal College of Surgeons of England 35-43 Lincoln's Inn Fields London WC2A 3PE Advice Line: 020 7405 2234 E-mail: info@baaps.org.uk Website: www.baaps.org.uk Offers information about aesthetic plastic surgery; its website features a search facility for accredited surgeons. Links The Consulting Room www.consultingroom.org Good UK site that provides a wide range of impartial and independent cosmetic and medical information and demystifies the world of cosmetic treatments. Consumer Guide to Laser Hair Removal www.consumerlaserguide.com The American Institute of Laser Medicine offers a factsheet describing who would be suitable for laser hair removal. Hair Facts www.hairfacts.com/tips/laserchoose.html Excellent site with information on how to choose a light-based hair removal practitioner. Unwanted Hair: Treatments www.skincarephysicians.com/agingskinnet/unwanted_hair.html Website of the American Academy of Dermatology offers advice on long-term and permanent hair removal by laser. Books Milady's Hair Removal Techniques by Helen Bickmore (Delmar, January 2004) Explains the evolution of methods of hair removal, with anecdotal historical information; tells how each method works to remove hair, including the length of time before re-growth. Step-by-step procedures are shown with photographs and illustrations for each stage. Get this book from Amazon

Hair Restoration The Bernstein

Bernstein Medical Center for Hair Restoration in New York: Hair Transplant Surgery Hair Transplant, Hair Replacement, Repair New York and New Jersey Facilities Toll Free: 1-866-576-2400 Bookmark This Page Schedule FREE Physician Consult Bernstein Medical - Center for Hair Restoration The Bernstein Medical hair transplant facilities in New York and New Jersey are solely devoted to the treatment of hair loss. We provide our hair restoration patients with the most advanced medical and surgical therapies for hereditary baldness. All hair transplant surgery procedures are performed by Dr. Bernstein using his pioneering Follicular Unit Hair Transplantation and Follicular Unit Extraction techniques. Robert M. Bernstein M.D., F.A.A.D. is Associate Clinical Professor of Dermatology at Columbia University in New York. He is recognized world wide for developing Follicular Unit Hair Transplantation , the procedure that has revolutionized modern hair restoration surgery. Dr. Bernstein’s medical publications have provided the foundation for hair replacement techniques that are used by surgeons across five continents. Dr. Bernstein is renowned for his honest assessment of a patient’s treatment options, his keen aesthetic sense for hair transplants and his exceptional surgical skills. In the News Dr. Bernstein addresses scientific conference in Sydney, Australia Robert M. Bernstein, MD speaks to an audience of hair transplant surgeons at the ISHRS 13th Annual Scientific Meeting in Sidney, Australia on new instrumentation for surgical hair restoration. See abstract on New Instrumentation for FUE Press Release "Best Doctors" in New York Magazine – 2005 Robert M. Bernstein, MD is selected for New York Magazines Best Doctors for the sixth year in a row This year, Dr. Bernstein is the only hair transplant surgeon... Read More Dr. Bernstein on The "Today" Show Hosted by Matt Lauer, Today airs a special, three-day series on hair loss that examines... Read More Hair Transplant Questions and Answers Q: Ill be traveling from New York to Cincinnati the week after my hair transplant. Will I be able to get through airport security if I have staples? O.L. – Manhattan, NY A: Yes, the staples that we use to close the donor area after the hair restoration, although made of stainless steel, are too small to be picked up by the metal detectors. I generally prefer staples as this method is superior to sutures in preserving donor hair. Read More Q & A's Submit Your Own Question Follicular Unit Forum is a patient-to-patient resource where hair transplant questions are answered by actual patients. www.FollicularUnitForum.com Before & After View hundreds of photos of our surgical hair restoration patients and see their incredibly natural results. Before and After Hair Transplant Photos Open Houses Attend one of our upcoming Open Houses to observe a hair transplant procedure and meet patients whose hair restoration has been completed. Reserve Your Space Read Transcripts MD Publications Follicular Unit Hair Transplantation Dr. Bernsteins chapter on hair transplantation covers a wide range of subjects including the history of follicular unit hair transplants, patient evaluation, planning the surgery, setting-up the OR, and maximizing the cosmetic outcome of the hair restoration. Go to Medical Article The Patient's Guide William R. Rassman, MD, colleague and co-author with Dr. Bernstein of " The Patient's Guide To Hair Restoration " and many important hair transplant publications, practices in California. He can be contacted at 800-NEW-HAIR or www.newhair.com . Hair Transplants, Restoration and Repair in New York and New Jersey For more information about Bernstein Medical - Center for Hair Restoration in New Jersey, visit NJ Hair Transplant . For more information about Bernstein Medical - Center for Hair Restoration in New York, visit NY Hair Transplant . 125 East 63rd Street, New York, New York 10021 212-826-2400 2150 Center Ave., Fort Lee, New Jersey 07024 201-585-1115 Toll Free: 1-866-576-2400 contact@bernsteinmedical.com ©2005 Bernstein Medical, P.C. All Rights Reserved. Hair Transplant Home | Link Maps | Site Map | Top of Page New York Hair Transplant Facility | New Jersey Hair Transplant Facility HOME HAIR LOSS Men Women MEDICAL TREATMENTS HAIR TRANSPLANTS Overview of Procedure Follicular Unit Transplant Follicular Unit Extraction Transplant Repair Hair Cloning Hair Transplant History New York Facility New Jersey Facility PATIENT PHOTOS Portraits Hairlines Repairs Women, Eyebrows, Crown ABOUT US Our Practice Dr. Bernstein Letters from Patients RESOURCES Bernstein's Publications The Patient's Guide Hair Restoration Papers Hair Transplant News Information on the Web CONTACT US Free Physician Consult Photo Consult Open Houses Ask the Doctor Directions to NY Facility Directions to NJ Facility