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.
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…)
Areas Treated: Hairline, mid scalp, and vertex (crown)
Number of procedures: 2
Type of surgery: Strip (FUT)
This friendly patient experienced slow gradual thinning to throughout his scalp. The angles in which the grafts are transplanted is incredibly important for the end result. The frontal aspect of the scalp will have a different angle than the vertex. All of these angles and directions need to be followed in order to achieve a natural end result.
At the very front of the hair line, only singles are used. Immediately behind those singles, only double grafts will be used. This provides a natural appearance. If grafts larger than 2 hairs are used at the very front of the hair line, it will be easily detected that was something done. Even in close up photos, the end result are undetectable. For more of Dr. Nakatsui’s before and after photos, please click here.
This gentleman came in with progressing hair loss all throughout his scalp. The hairline, temples, mid portion, and vertex thinned out significantly. Dr. Nakatsui transplanted just under 5,000 grafts in one surgery. What was interesting about this patient’s case was that his widows peak is slightly off centre. A few singles were transplanted into the section. The end result is completely undetectable and incredibly natural looking.
The image of the close up of the hairline shows a completely natural appearance. There are no detectable grafts and one of the most important features is that the hairline itself is not a laser beam line. Rather, the hair line is irregular, very similar to that of a natural hairline.
For more of Dr. Thomas Nakatsui’s results please click here.
