The first study on topical finasteride was done in 1997 and showed a decrease in rate of hair loss at 6 months.
In 2009, another study compared topical finasteride to oral finasteride. This study was a double blind, randomized clinical trial. Both topical and oral led to increased hair counts, although the increase occurred 1 month earlier with oral finasteride. Another difference between the two groups was that the size of the area of hair loss decreased by the fourth month of treatment in the oral finasteride group, whereas there was no significant change in the topical group.
In 2018, Lee et al. reviewed 7 studies that looked at the use of topical finasteride for the treatment of pattern hair loss in men and women. They looked at several concentrations, including finasteride 0.005%, 0.25%, and 1%. The good news is that they all showed some efficacy with limited systemic effects. Overall, topical 0.25% finasteride solution applied once a day seemed to be the most effective. The downside is that topical finasteride did cause some scalp irritation in some participants, which could be a limiting factor for some patients. It is not clear if the irritation came from the finasteride itself or from one of the other components in the solution.
In a study by Ramos et al in 2019, oral minoxidil was investigated as an alternative therapy for female pattern hair loss. In the study, which was a 24 week, randomized, open study design, they compared 1 mg oral minoxidil to 5% topical minoxidil used for 24 weeks. The authors found that the increase in density with both treatments was very similar and there was no statistically significant difference.
Oral minoxidil was well tolerated and had very few side effects. Some of the reported adverse events included mild hypertrichosis in 27% of participants and increased mean resting heart rate.
Oral minoxidil at a dose of 1 mg daily may be an option, particularly in women who cannot tolerate topical minoxidil. However, this medication should probably be avoided in patients with pre-existing cardiac disease for the moment until it has been further evaluated.
Dr. Nakatsui does not use a multi-blade scalpel. FUT is an imprecise term and as a result, there are some gray areas. In Dr. Nakatsui’s opinion, a true FUT hair transplant requires a single blade scalpel to yield a single strip. One thing is certain–if Dr. Nakatsui were to use a multi-blade scalpel, he would definitely no longer be able to state he does Ultra-Refined follicular unit hair transplants.
Some physicians do use a multi-blade scalpel to extract multiple strips in one stroke from the donor area. If these strips are dissected into 100% follicular units, this could technically still be considered FUT. However, if the strips are also broken down into non-follicular unit hair grafts or multi-follicular unit grafts like slot grafts, minigrafts, or punch grafts, then it would no longer be considered FUT.
The main advantage to using a multi-blade scalpel is speed. With a multi-blade handle, multiple thin strips can be removed in one stroke of the scalpel, potentially saving hours of work. The disadvantage is that there is a much higher change of hair transection along one or more of the blades. The more blades on the scalpel, the higher the rate of hair follicle transection and damage.
