Hair Loss Treatment Options
There are many options for treating hair loss from non-surgical methods to surgical methods. The first step in determining the right treatment for a patient is to determine the cause of the hair loss. Some causes of hair loss are related to medical conditions that must be treated for the hair loss to resolve. Failure to treat these conditions can cause worsening and permanent hair loss. Therefore a consultation with a hair loss physician, dermatologist, or a primary care physician is necessary before any treatment is undertaken. Once the cause of hair loss is determined, there are surgical and non-surgical methods for hair loss treatment, depending on the cause.
Nutrition plays a big role in keeping hair healthy and growing. Some of the important vitamins, minerals, and diet considerations include:
As always, moderation is key as taking some vitamins and minerals in excess can lead to hair loss. For daily recommendations of intake, visit the US Department of Agriculture's nutrition website at http://www.nutrition.gov.
People for thousands of years have been looking for treatment for hair loss. Ancient Chinese and Indian medical systems have herbs which were and still are used to treat hair loss. It is reported that the father of medicine, Hippocrates, even used a mixture of chemicals including bird dung to treat hair loss. While some of these herbs have science and studies to indicate that they may help to treat hair loss, it is always adviseable to speak with a physician before undertaking any treatment plan. Some of the treatments can interfere with other medicines which are taken.
There are currently three medications approved by the US FDA for treating hair loss: minoxidil, finasteride, and bimatoprost.
Topical minoxidil (Rogaine®) and oral finasteride (Propecia®) are the only treatments for male patterned baldness that have been approved by the US FDA. Their use is indicated in men older than 18 years with mild to moderate hair loss. Several well controlled studies have proven the efficacy of these medications. After 3-6 months of use, slowed hair loss, stabilization, or increased scalp coverage can be appreciated with either medication and results are clearly evident by 1 year. Dense regrowth is uncommon and neither medication can regrow hair in completely bald areas. Early intervention, when thinning is first noticed and hairs are incompletely miniaturized, produces the best results. Treatment must be continued indefinitely to maintain the benefits. Stopping treatment results in a return to pretreatment status by 6 months with minoxidil and by 12 months with finasteride. Minoxidil is available as both an oil and foam. Both are available over the counter. Finasteride is only available by prescription.
For female pattern baldness, 2% topical minoxidil is the only FDA-approved medication. Its use is indicated in women older than 18 years with mild to moderate hair loss. Women who are pregnant or nursing should not use minoxidil.
The latest treatment approved for hair loss by the US FDA is bimatoprost (Latisse™). The medication was originally approved as a treatment for glaucoma under the trade name Lumigen®. Latisse is approved for growing eyelashes of the upper eyelids. Currently, Latisse is only available by prescription from a physician. Side effects are mild and include irritation and redness. Discoloration of the skin have been reported but usually resolve after the medication is stopped. Discoloration of the iris has been reported with Lumigen® but not in the initial studies with Latisse™ but can be permanent. It can take several months to see results and once the medication is stopped, the results will disappear. For more information, consider a consult with Dr. Verret.
Low Level Laser Therapy
Recently, low level laser therapy (LLLT) has gained popularity as a non-surgical treatment for hair loss. The technology has been used for quite some time with success to aid in wound healing and treat chronic pain. Some of the initial studies into LLLT 50 years ago showed that it could cause hair growth but the side effect was forgotten for many years. There are several LLLT devices in use including those for home application and those which can be used in a physician's office. Though several studies have demonstrated improvement in hair growth with the technology, none to date have demonstrated the increase in hair growth in placebo controlled studies (comparing using the technology to doing nothing). For more information about LLLT, please check out Dr. Verret's article on LLLT or the chapter in his book, Patient Guide to Hair Loss & Hair Restoration, on LLLT.
Hair Replacement Systems
Hair replacement systems, often referred to as toupee's or wigs, can be a good option for patients with extreme hair loss, those with a temporary hair loss, or those wishing a quick solution. Hair systems can appear very natural but can often cost large sums of money. It must be remembered that hair systems will require replacement at regular intervals (often every 3-6 months), routine maintenance, and require specialized fitting. For more information about hair replacement systems, please read Dr. Verret's articles on hair replacement systems, the chapter in his Patient Guide book, or view the video on hair replacement systems.
Though medical treatments for hair loss have been around for centuries, advances in surgical treatment have only occurred within the last 50 years. The current state of the art in hair transplant technology involves follicular unit grafting. Mention of the progression of technologies is important as some types of hair loss are not amenable to treatment with follicular unit grafting techniques.
Scalp Reduction Surgery
Scalp reduction surgery was a technique initially pioneered to reduce the amount of bald area on the scalp. This alone or in combination with other hair restoration techniques was used to correct hair loss. While the concept is sound, the natural elasticity in the scalp meant that over time, the excised area would relax and the bald area would recur. As a long term solution to hair loss, this did not prove to be a good option.
Classically, one of three different incisions is made to remove skin in cases of diffuse hair loss. In some cases, patients also undergo tissue expansion in the hair bearing area so that larger areas of hair loss could be removed. Tissue expansion involves placing a plastic balloon under the skin which is slowly filled over several weeks with water to cause the overlying skin to grow. Unfortunately, additional hair follicles are not created and as such the expanded area will have a decreased density of hair follicles.
Scalp reduction surgery runs the risk of scarring, long term recurrence of the bald area, and creation of an unnatural football shaped area of balding as the skin stretches over time. This is termed the vertical slot defect. Several excisions separated by several weeks may be necessary to remove the entire area of hair loss. The resulting hairlines can appear unnatural because of the direction of growth of the hair when it is brought together. Though taught for classical reasons, this technique is not generally used for hair restoration in patients with androgenic alopecia. It is appropriate for patients with small areas of hair loss, for instance due to an accident which caused a scar and bald spot.
Though not used for androgenic alopecia, flap procedures are used for patients who suffer full thickness areas of hair loss such as after cancer removal or trauma. Flap procedures are those which take hair and the underlying skin and tissue from one area of the scalp and move it to another area of scalp. The temporoparietal-occipital, or Juri, flap was once used for patients who had androgenic alopecia. The procedure took a strip of hair and skin from the side and back of the scalp and moved it to recreate the frontal hair line. The process took three operations separated by several weeks each.
Complications from the Juri flap included swelling, bruising, and cosmetic imperfections of both the donor and recipient areas. Poor hairline creation because of misdirected hair follicles was common. The flap was also technically challenging for the surgeon and was difficult to obtain reproducible results. It has been mostly abandoned for patients with androgenic alopecia.
In patients undergoing reconstruction of the scalp after trauma or cancer removal, flaps may be necessary to provide the appropriate depth of tissue and blood supple for hair growth. While not a good option anymore for classic androgenic alopecia, scalp flaps are often used in these other situations.
The next evolution in hair restoration surgery involved punch grafting. In this technique, a 4mm round punch was used to harvest donor hair from the back and sides of the hair. These grafts contained 4-20 individual follicles with surrounding tissue. The same size punch was used to make recipient sites in the bald area of the scalp. Since the donor hairs do not have DHT receptors, when transplanted, they will not be susceptible to the natural androgenic alopecia progression. The vast majority of the hair would survive and create a lasting head of hair with the patient’s own hair. Unfortunately, this technique produced an unnatural appearance to the hair line, often referred to as a doll’s head as the hair appeared as the hair on the head of a doll. Though the hair would grow as if it were in its original position, the appearance was less than optimal.
Follicular Unit Hair Transplantation
The latest evoluation in hair restoration surgery and the state of the art is termed follicular unit grafting. For more information, visit the section on follicular unit hair transplantation.
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D.J. Verret, MD | Hair Restoration Surgery | 6545 Preston Road | Suite 200 | Plano | Texas | 75024 | email@example.com
For more information about the latest in Dallas hair restoration, Texas hair transpalnt, and hair loss, visit Dr. Verret on the web at http://drverret.com