There are several hair restoration options for managing male and female pattern hair loss and they can be categorized as follows:
- Hair restoration surgery
- Scalp reduction
- Medications — finasteride, dutasteride, spironolactone, minoxidil
- Laser — low level laser therapy
- Camouflage — Toppik, hair piece
Hair Restoration Surgery
Recently, there has been a total revolution in the field of hair restoration, thanks to the advent of follicular unit transplantation. Current instrumentation and techniques have allowed us to reduce the size of our hair grafts to one to three hairs. With the recent use of high power dissecting microscopes, single hairs and tiny groups of hairs called follicular units can be dissected out and excess bald tissue can be removed without damaging the hair. As a consequence, the grafts are virtually undetectable and natural in appearance if implanted using our lateral slit technique.
Patients are no longer left with the option of either accepting their hair loss or having an artificial looking head of hair. Today we can achieve results that look as good as your original hair. If you are experiencing hair loss and thought hair transplants were not for you, look again! You will be pleasantly surprised.
The reason hair restoration surgery works is because hair at the back of the head and along the sides is considered permanent hair as these follicles continue to grow throughout a person’s lifetime, even if they have been transplanted. Hair transplantation is the relocation of these hair follicles to any other desired area, including the top of the head and even the eyebrows. The transplanted hairs, once established, will grow normally in their new location after a brief resting period of 4-6 months. The “new” hair will live and grow throughout the person’s lifetime just as if it were growing in its original position. It can be cut, styled, colored, or permed because it is real hair!
For an individual with sufficient donor hair, surgical hair restoration is the most effective and carefree answer to hair loss. In the past thirty years over two million men and women have undergone surgical hair restoration. Learn more about the procedure.
In the past, patients would also under scalp reductions, which involved removal of a section of scalp with subsequent closure and reduction of the balding area. The main problem was that with continued hair loss, the patient would sometimes be left with a slot deformity as the hair loss proceeded in a somewhat unnatural pattern. In addition, if the hair loss progressed enough, the scar line from the closure eventually became visible. As a result, very few of these procedures are done now.
Non-Surgical Hair Restoration Options
Besides surgical hair restoration, many topical treatments have been advocated for hair loss. These include prescription medications, over the counter medications, herbal treatments, and many shampoos, creams, and ointments. It turns out that very few of these have good evidence of efficacy even though every product will claim to have some evidence. The first two medications proven to have some benefit are minoxidil (also known as Rogaine ™) and finasteride (also known as Proscar ™ and Propecia ™).
In studies where hundreds of men used minoxidil, not everyone with male pattern baldness responded by growing hair. However, some did grow hair, and in others the balding process was delayed with growth of new hair equaling loss of old hair.
Finasteride has helped many men slow down their hair loss significantly, and some men do experience significant hair growth on this medication. Side effects of finasteride are few, but some of the potential side effects include decreased sex drive and gynecomastia. Finasteride is also known as Propecia and is a 5-alpha reductase inhibitor. We have found finasteride to be a useful adjunct to hair transplantation patients as it at the very least helps men retain the hair they have.
Some women have also been put on finasteride for their hair loss, although the studies to date have not conclusively shown reliable benefit. Nevertheless, some women may benefit from this medication.
Dutasteride (also known as Avodart) is also a 5-alpha reductase inhibitor and is a cousin to finasteride. It can also be used to help fight male pattern hair loss. Dutasteride can be used “off-label” for the treatment of male pattern hair loss, although there may be more side effects as compared to finasteride.
Another treatment that is sometimes used is platelet rich plasma, which is also known as PRP. The jury is still out on the effectiveness of PRP as some studies have shown benefit, whereas others have shown absolutely no benefit. One of the best studies that has been done so far did not show any benefit whatsoever. In addition, there are several different systems commonly in use for PRP, including Selphyl ®, Eclipse PRP ®, and Arthrex ACP (or Angel) ®. These systems are not identical, however, as these systems appear to concentrate platelets to differing degrees.
Low level laser therapy (LLLT) can also provide some benefit to hair loss sufferers. This involves the application of low level laser therapy to the affected area of hair loss. After several months, many patients do notice an improvement in their hair, although this treatment is not effective for everyone.
Hair pieces are an effective treatment for covering hair loss and some hair pieces can look very realistic. Many people, however, find that maintenance of these hair pieces is greater than anticipated, and that their lifestyle must be curtailed, especially if they are physically active. Most importantly, many men relate a constant feeling of anxiety that it will be discovered that they do wear a hair piece.
Both medications and hair pieces involve significant costs over the lifetime of an individual. This should be borne in mind when considering the alternative of surgical hair restoration, which, once complete, involves no further costs and can last a lifetime.
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