Hair Restoration Treatments: Hope or Hype?

Both men and women tend to lose hair thickness and amount as they age. Inherited or "pattern baldness" affects more men than women. Approximately 25 percent of men begin to bald by the time they are 30 years old, and about two-thirds are either bald or have a balding pattern by age 60. Women, on the other hand, generally have diffuse thinning that affects all parts of the scalp. In this situation, much of the hair remains, but the thickness of the hair shaft is smaller than normal.
There are a number of treatment options available designed to re-grow hair and to replace hair that's already been lost. Currently in the United States, there are more than 2,000 topical and oral products, about five surgical procedures and several hair restoration devices, but only a few that actually work. Out of all the topical and oral treatments available, only two are approved by the Food and Drug Administration (FDA). They are Propecia and Rogaine.
Propecia is an oral medication; its chemical name is Finasteride. It was developed nearly 40 years ago as a treatment for prostate hypertrophy (extended prostate). However, users found that the hair in their crown and bridge areas of their scalps was getting thicker, and they weren't losing hair at the same rate they once were. Propecia is known as a DHT-inhibitor, actually slowing or halting the conversion of testosterone into di-hydrotestosterone (DHT), a hormone that shrinks hair follicles as men age. Because DHT is known to be the primary cause of male-pattern baldness, stopping the conversion of DHT allows genetically susceptible hair follicles to remain intact, and in some cases increase in size. The side effects of Propecia are minimal and can include a reduced desire for sex (1% chance) and possible breast enlargement (less than .25% chance).
Rogaine is a topical treatment, the latest version being foam. Its active ingredient is Minoxidil, which was originally developed as a product to control blood pressure. But users found that they were growing hair in areas where hair didn't previously exist. Minoxidil comes in a number of strengths: the maximum non-prescription strength of five percent usually recommended for men, two percent formula recommended for women and prescription strength 12 ½ percent, which is seldom used.
Rogaine is a hair growth stimulator, meaning that when it is effectively applied to the scalp, it absorbs into the skin where it increases blood flow to the tissue and hair follicles underneath. It primarily benefits the crown and bridge area of the scalp, but some users have seen minimal benefit in the front and along the hairline. Rogaine is approved for use by men and women. It must be used twice a day, EVERY day. When used as directed, Rogaine has been reported to work in 60-70 percent of cases. Skin irritation is a side-effect and primary frustration for users.
Lasers are used with great success in a variety of medical specialties, but what about in improving hair density? The concept is simple; low-level lasers are known to increase blood flow to underlying tissue and can stimulate natural processes beneath the skin. If lasers are effective in stimulating blood flow to hair follicles and accelerating the hormonal process of hair regrowth, users should be able to realize slightly thicker hair and possibly more hair on the scalp at any given time.
In addition to the in-office laser treatment, there is a "laser comb" device that has been approved by the FDA. Reportedly, the laser comb, when brushed through the hair and over the scalp, administers phototherapy to the scalp. A six-month study reviewed by the FDA shows that men who used the comb grew an average of 19 more ‘thick' hairs per square centimeter than those who used sham devices. There are a variety of laser combs on the market, all for use three times per week. Prices range from $395 to $545, depending on the version.
Electro-magnetic stimulators claim to actually stimulate the hormones responsible for hair growth into growing new hairs in follicles that have long stopped. Small, acupuncture-type needles are injected into the areas of the scalp with thinning and loss. When the device is activated, slight electro-magnetic pulses are transmitted into the scalp. Supposedly, over time, the hormones responsible for hair growth and ultimately new hair are reactivated. While the product is receiving a lot of attention, there is virtually no clinical data to support its claims and very few medical doctors take it seriously.
Surgical hair transplantation is the fastest growing cosmetic surgery today. There are currently a few surgical procedures available: the ‘donor strip' hair transplant, ‘follicle unit extraction', and scalp reduction.
The donor strip method is the most commonly used, provides the best results and is considered the only viable surgical treatment by over 95 percent of hair restoration surgeons in the United States. The surgeon first removes a section of hair-bearing skin from the back of the head, right around the base of the skull. The removal area is sutured together, leaving a thin scar blended into the hair in the back of the head. The follicular units are extracted and placed in cool saline solution. Then, small incisions are made in the areas of thinning and loss and one-by-one the follicular units are implanted.
Follicular Unit Extraction is just that; instead of making an incision in the back of the head, each individual follicular unit is removed with a punch blade and then relocated to the areas of thinning and loss, all in one step. Unfortunately, it isn't as simple as it sounds. First of all, hair follicles do not grow straight up and down beneath the skin; they grow at angles. Not only that, but each follicle can be at a dramatically different angle than the follicle next to it. Clinical studies have shown that 25-40 percent of all follicular units being extracted are destroyed, simply cut in half. In addition, the punch blade will leave multiple scars throughout the donor area. Bottom line: follicular unit extraction procedures cost more, result in less density and compromise the donor area. This is why few surgeons employ this technique, and respected names in hair restoration caution against it.
Scalp reduction surgery involves removing an area of the scalp, eliminating part of the area affected by hair loss. The result can be a reduced bald spot and greater coverage by surrounding hair-bearing skin as it is pulled towards the spot where the skin was removed. However, there are risks associated with this procedure. Stretching is a likely possibility since the resulting scar has a great deal of tension on it. Another possibility is traction alopecia, which is the permanent hair loss caused by great stress on hair follicles. Also, reduction in scalp elasticity from a scalp reduction can compromise future hair transplant procedures.
The cost for hair transplant surgery? The average procedure is about $5,200, and depending upon the procedure, could rise to $10,000 or more.
If you are experiencing hair loss, only you can judge the procedure that is right for you. Be sure to do your homework and keep in mind the relative risks and benefits of each procedure.