In a recent post, we discussed the use of topical finasteride (Propecia) and went through the benefits and limitations of this agent. A recent study published by Haber et al. in the Hair Transplant Forum International looked at 762 men (663 on oral finasteride and 99 not on oral finasteride) and assessed whether or not they experienced any sexual dysfunction. The short answer seems to be that there was no evidence of increased sexual dysfunction in this study, which supports a previous systematic review of the literature that also did not show any evidence of increased sexual dysfunction from the use of oral finasteride.
Based on these studies, it seems that we can be even more confident about the lack of sexual side effects from the use of oral Propecia in male pattern hair loss. We will therefore continue to prescribe Propecia in the management of male pattern hair loss.
There are many different types of punch designs and some of them offer advantages over previous designs. At the most recent International Society of Hair Restoration Surgery 2020 conference, Dr. Nakatsui came across several new advances that he is eager to implement. One new advance is a new punch design that incorporates a hexagonal blunt portion of the punch shaft that uses vibration to help release the follicular unit from the surrounding tissue. As well, it has tiny grooves cut into the distal shaft. These changes, while they may appear subtle, should allow us to produce better grafts with even lower transection rates. Our dermatologist, Dr. Nakatsui, is really looking forward to incorporating this new advance into our FUE hair transplant procedures!
Dr. Nakatsui also came across several other hair transplantation advances that are very intriguing and will add these to our hair transplant blog in the near future.
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.
This is a patient who came in and was concerned about the progressive thinning of his frontal scalp. He had definite miniaturization of the hair in the frontal scalp. His after photos were taken one year post surgery. Because we dense packed the area, he is even able to cut his hair really (more…)
This is an Asian man who was concerned about the progressive thinning of his frontal scalp. He had definite miniaturization of the hair in the frontal scalp, especially in the temples. In the after photos, you can see we lowered the hairline in (more…)
In this video, Dr. Nakatsui discusses a few of the instruments for Follicular Unit Excision (FUE) that he uses during hair transplant surgeries. Technology is always evolving and it is always important to stay at the forefront of technique and technology in order to provide the best possible experience and results for our patients. Please visit our Youtube channel for more informative videos!
Number of Grafts: 407 Areas Treated: Right retroauricular region, right temple, and mid frontal region Number of Procedures: 1 Type of Surgery:Follicular Unit Excision (FUE)
This friendly gentleman came to see Dr. Nakatsui regarding a bout of scarring alopecia that occurred over 20 years ago. He had no complaints or issues with hair thinning, rather just 3 areas of scarring alopecia. The patient advised us that he had surgery elsewhere where the surgeon excised a portion of scar. This led to a linear scar line. When dealing with hair transplants into a scar region, we know that approximately 80% of the hairs will grow and survive whereas transplanted hairs into virgin scalp will have a success rate of approximately 96-98%. The patient was made aware of the decreased survival rate and still proceeded with the surgery. Ultimately, the end result is very natural, thick, and blends in well with his surrounding hair.
Hairs come in different angles and directions all throughout the scalp. The angle the hair will be different in the front of the scalp compared to the back of the scalp. The in the retroauricular region (behind the ear), the angle of the hair is fairly flat and facing downward. If hairs were transplanted perpendicular to the natural angle of the hair, the end result will be very unnatural. For more of Dr. Nakatsui’s before and after results, please click here.
Number of Grafts: 3,000 Areas Treated: Hairline and Frontal Region Number of Procedures: 1 Type of Surgery: Follicular Unit Transplant (FUT)
This gentleman came in with progressive hair loss throughout his scalp. Dr. Nakatsui transplanted approximately 3,000 grafts for his final result. The nice thing about this patient is that he grew out his hair demonstrating that hair transplanted hairs grow just like regular hair because it is natural hair. To view more of Dr. Nakatsui’s before and after photos, please click here.
