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When coping with hair loss plus the bounty of possible restoration selections, it truly is encouraged that folks ask questions and do as considerably investigation as achievable. Numerous answers can come from a certified hair restoration physician, articles in medical journals, and credible Online sources. The following is often a series of frequent questions and answers concerning follicular unit extraction:

What exactly is follicular unit extraction?

Follicular unit extraction, or FUE, is really a micro-surgical hair transplantation approach wherein the surgeon harvests hairs from the donor region 1 follicular unit (natural groups of among 1 and 4 hairs) at a time. The donor location is frequently anyplace amongst the back and sides of the head, to incorporate finer hairs from the nape of the neck or behind the ears. This harvested hair is then implanted into the balding recipient location.

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The Harley Street Hair Clinic is a pioneer of follicular transfer, the latest innovation for the effective treatment of hair loss.

There are many different kinds of hair loss treatment in the market today, but few have proven as successful as follicular transfer, a minimally invasive, scar free, revolutionary technique that is now available in the UK at the Harley Street Hair Clinic.

The process begins with a free consultation, in which they conduct a thorough analysis of a client’s condition, explain the follicular unit extraction (FUE) process and the implications of surgery, as well as discussing the likely outcomes so that all the clients fully understand their options.

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Androgenetic alopecia (AGA) is the most common form of hair loss in men, and female pattern hair loss (FPHL) is the most common form of hair loss in women. Traditional methods of treating hair loss have included minoxidil, finasteride, and surgical transplantation. Currently there is a myriad of new and experimental treatments. In addition, low-level light therapy (LLLT) has recently been approved by the United States Food and Drug Administration (FDA) for the treatment of hair loss. There are several theories and minimal clinical evidence of the safety and efficacy of LLLT, although most experts agree that it is safe. More in vitro studies are necessary to elucidate the mechanism and effectiveness at the cellular level, and more controlled studies are necessary to assess the role of this new treatment in the general population.

South Med J. 2010 Sep;103(9):917-21.

Ghanaat M.

Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, NY, USA. mahyar.ghanaat@downstate.edu

PMID: 20689478 [PubMed - indexed for MEDLINE]

1. Joe Biden: The new Vice President's hair transplant surgery was a hot topic of discussion during the final months of the 2008 presidential election.
2. Nicholas Cage: This star's newly plentiful hairline speaks of a very well-done hair transplant surgery.
3. Matt Lauer: Longtime host of the Today Show, Matt Lauer's hairline has been under the spotlight for years; giving the public witness to his bald-to-beautiful hair makeover.
4. Matthew McConaughey: This female-friendly actor and his new-and-improved hairline have made him an inspiration to the hair loss community.
5. Wade Boggs: Baseball-Hall-of-Famer Wade Boggs has received attention lately for his successful hair transplant surgery, rather than for his former batting skills.
6. Dennis Miller: This comedian made sure his hairline was no longer a punchline, after transforming it with hair transplant surgery.
7. Mel Gibson: Heartthrob actor Mel Gibson probably chose hair transplant surgery to help maintain his A-list status as well as his formerly plentiful mane.
8. Burt Reynolds: Idolized since the 70s for being the epitome of swaggering, hairy masculinity, Burt Reynolds turned to hair transplant surgery in his later years to keep his thick locks up to par.
9. Mickey Rourke: This star and comeback artist has been under scrutiny in the past for the plastic surgery work he's had done. But now, a welcome addition to that list is hair transplant surgery, likely evidenced in recent pics of his subtly re-emerging hairline.
10. Kevin Costner: Actor Kevin Costner, now in his 50s, is reported to have used hair transplant surgery to supplement his previously thinning mane.

CLINICAL PRESENTATION OF ANDROGENETIC ALOPECIA

Alopecia is a general term for hair loss and requires further description. Androgenetic alopecia (AGA) is the most common cause of hair loss, presenting as loss of hair over the top (vertex) and the anterior mid-scalp area (receding hairline) in affected men. The term androgenetic alopecia denotes that both a genetic predisposition and the presence of androgens are necessary to cause expression. AGA is also referred to as male pattern hair loss and typically begins gradually in men in there 20s with incidence increasing 10% per decade.

Presence of Androgens must be present for baldness to occur

For centuries, it has been observed that the presence of androgens was necessary for Androgenetic Alopecia to express itself. In 400 BC Hippocrates observed that eunuchs (castrated males) did not become bald. Aristotle noticed this also.(1) Through out history it was also observed that the Italian Castrati (boys that castrated in order to train them as adult soprano singers, a practice which was ended by Pope Leo XIII in 1878) never became bald. Researchers knew that AGA had to be associated with the male hormone testosterone. It comes as no surprise that current research shows that the balding scalp contains miniaturized hair follicles and increased amounts of DHT compared to a hairy scalp. This suggests that it is the excess presence of dihydrotestosterone in the scalp tissue that causes AGA in those patients genetically predisposed.

Pathophysiology of Androgenetic Alopecia

In the body testosterone is broken down by an enzyme call 5 alpha reductase to dihydrotestosterone. (DHT). DHT, a potent metabolite of testosterone causes a gradual, progressive shrinkage in the length and caliber of genetically programmed hair follicles. This process is called miniaturization. Miniaturization results from shortening of the anagen phase and a decrease in the sit of the dermal papilla and volume of matrix cells. Consequently, each succeeding hair cycle results in production of smaller, finer hairs which contribute less to the overall appearance and density of the hair. These biochemical events occur at the cellular level of the hair follicle. Because the dermal papilla is highly vascular, it is continuously bathed in circulating androgens. It has been demonstrated that the dermal papilla is rich in androgen receptors and is the primary target of androgen action. (Choudhry et al., 1996) Cells in genetically programmed hair follicles contain the enzyme 5 alpha reductase. 5 alpha reductase converts testosterone into the more potent DHT (Chen, Zouboulis & Orfanos, 1996). 5 alpha reductase is found in higher quantities in the scalp follicles of affected men. (Sawaya & Price 1997) Androgen receptors in the cells of the dermal papilla bind with circulating DHT, forming androgen receptor complexes. This results in the androgen effects of miniaturization on the hair follicle. (Randall et al., 1992)

In conclusion, by inhibiting the breakdown of testosterone to DHT, hair loss can be prevented or at least kept to a minimum.

Treatments for Androgenetic Alopecia

5 Alpha Reductase inhibitors

Drugs in this class work by inhibiting the enzyme 5 alpha reductase, which limits the conversion of testosterone to DHT (Chen et al., 1996) Finasteride (propecia) is the first drug in this class to undergo extensive clinical trials in men. Finasteride has selective activity against 5 alpha reductase. As a result, serum and follicular DHT levels are significantly reduced (Dallob et al., 1994).

Saw Palmetto extract

Studies have shown that saw palmetto is an effective anti-androgen. It acts in a similar way that propecia does. Firstly it lowers levels of DHT in the body by blocking 5 alpa-reductase. Secondly Saw Palmetto blocks receptors sites on cell membranes required for cells to absorb DHT. Although no studies have been carried out on saw palmetto and its relation to hair growth, studies have been performed on the use of Saw Palmetto in the treatment of benign prostatic disease, which is similar to androgenetic alopecia in that it also depends on the production of dihydrotestosterone. All of the studies that have been performed to date show that Saw Palmetto is an effective anti-androgen and has shown conclusively to be effective in the treatment of benign prostatic disease.

One may assume from this that since Saw Palmetto is an effective anti-androgen and is used in the treatment of prostatic disease then it may also be effective in the treatment of androgenetic alopecia.

Vitamins

Some vitamins have been show to inhibit the activity of 5 alpha reductase and subsequent production of DHT. These vitamins therefore may be of great benefit in the treatment of androgenetic alopecia or preventing baldness. There has been studies in which zinc is shown to inhibit 5 alpha reductase activity and it has therefore been concluded that zinc is beneficial in disease and disorders related to an excess in DHT. There has also been studies which have show that vitamin B6, Zinc and azelaic combined together even in low concentrations resulted in a 90% inhibition of 5 alpha reductase activity.

Recommendations

Propecia has been tested and found to be effective in the treatment of AGA. However, its list of possible side effects include sexual adverse experiences. It also affects PSA levels, which is the screening indicator for prostrate cancer.

Saw Palmetto has been proven safe to use. It has no known drug interactions and is well tolerated by most people. The only noted side effect in a very small percent of people is upset stomach. Saw Palmetto can be taken with zinc, vitamin b6, and azelaic acid for a synergistic effect.

Conclusion

Normal healthy hair grows about ½ inch per month. It may take several months before any effects are noticed. Where the area is completely bald, hair may not grow, if the follicles are dead. It takes years for the hair to thin, so one must assume that it will take time to also reverse the process. Keeping the hair from further thinning is success in itself.

References

Chen, W., Zouboulis, Ch.C., & Orfanos, E.E. 1996) the 5-reductase system and its inhibitors. Dermatology, 193, 177-184

Choudry, R., Hodgins, M.B., Van der Kwast, T.H., Brinkmann, A.O., & Boersma, W.J.A. (1992) localization of androgen receptors in human skin by immunohistochemistry: implications for the hormonal regulation of hair growth, sebaceous glands and sweat glens. Journal of Endocrinology, 133 467-475

Dallob, A.L., Sadick, N.S., Unger, W., Lipert, S., Geissler, L.A., Gregoire, S.L., Nguyen, H.H., Moore, E.C., & Tanaka, W.K. (1994) The effect of finasteride, a 5-reductase inhibitor, on scalp skin testosterone and dihydrotestosterone concentrations in patients with male pattern baldness. Journal of Clinical Endocrinology and Metabolism, 79(3), 703-706.

Sawaya, M.E., & Price, V.H. (1997). Different levels of 5 alpha reductase type I & II, aromatase, and androgen receptors in hair follicles of women and men with androgenetic alopecia. The Journal of Investigative Dermatology, 10(3), 296-300.

Male pattern hair loss (MPHL) is a condition that affects as many as 50 percent of men by the age of fifty, but according to a new study, baldness may soon be a treatable condition.

Using pairs of identical twins, the study assessed the efficacy of dutasteride, a particular enzyme inhibitor, as a means of reducing hair loss and encouraging new growth, finding it to be an effective means of combating baldness.

In the study, one of each pair of twins was given 0.5 mg/day of the medication, the other receiving a placebo, with the results monitored over the course of a year. After both 6 and 12-month intervals, hair loss was found to not only have been halted in twins using dutasteride, but hair growth was actively improved. The rate of growth increased between the 6 and 12-month evaluations, while hair loss continued steadily in the placebo group.

MPHL is thought to be genetically controlled. As identical twins share the same genetic code, the study provides particularly convincing evidence of the efficacy of dutasteride.

Laser therapy for hairloss has been an idea researched for several years with a variety of products currently available. The first laser therapy devices were large bulky devices that were sold to salons and hairloss clinics for in-store use. Now a portable, personal device for this type of therapy is available.

Laser stimulation of the follicle and surrounding skin is used to increase energy and cell health of the treated areas as well as increase circulation. Usage is 1 or 2 times per week.

The LaserComb complies with FDA requirements as a cosmetic laser device for hair, meaning it meets the FDAs safety standards for a laser device and has a cosmetic effect to strengthen, thicken, or improve existing hair. The company that makes the LaserComb says they will be initiating clinical trials for FDA approval for the device as a hair regrowth treatment.

Initial observation are very encouraging.

None known. FDA approved for safety as a laser device. Low level laser is used in a wide range of healing applications.

$645. Payment options available.

Introduction

Alopecia or hairloss is a chronic skin disorder characterized by loss of some or all of the hair from the scalp and sometimes from the other parts of the body as well. It occurs in various patterns and affects both males and females. The most common type of baldness is male-pattern baldness, also called androgenetic alopecia. It is characterized by a defined pattern of hairloss from the top of the scalp and regression of the hairline. It affects a large proportion of the population. It might start as early as adolescence and increase with age. In the white population, males in their fifties have a 50% chance of exhibiting some degree of androgenetic alopecia as against an overall average of 66%.¹

Genetic and endocrinal factors play an important role but the exact cause and mechanism of hairloss is not clearly understood.² Alopecia, except for mild itching in some cases, is not a painful or life threatening condition. It may affect the psychological wellbeing of the victim. Studies in this regard are not very exhaustive. They suggest that baldness is psychologically damaging and can cause intense emotional disturbance. It can lead to personal social and job-related problems.³ Hair has always been an important aspect of one's image or identity particularly for women.⁴ Among the women suffering from alopecia, around 40% experienced marital problems and 63% suffered career related problems.⁵ Over all such people feel more social discomfort, and suffer from low self-esteem. In more than 30% of the cases specific problems are attributed to hairloss.⁶

A study revealed that males who had more profound hairloss were more dissatisfied with their appearance and were more concerned with their older look than those with minimal hairloss. This effect cut across all age groups but was more prominent in the younger age group.⁷

Difficulties in treatment

Androgenetic alopecia is a poorly understood progressive condition. Androgenic hormones are involved in its pathophysiology. This renders treatment difficult and complex. The androgen receptor antagonists used to treat women are not suitable for men because of the potential risks of gynaecomastia, feminisation, and impotence. In the absence of an understanding of the pathophysiology, it is not possible to attack specific areas.

There are four options for androgenic alopecia available to the patient:

⁸

1. no treatment
2. medical therapy
3. using a wig
4. surgical treatment

Each of these has its own advantages and disadvantages. As far as medical treatment is concerned, the two that are approved by the FDA in the USA for the treatment of androgenetic alopecia in men are:

1. Topical minoxidil
2. Oral finasteride

Minoxidil is an oral antihypertensive drug which has a side effect of excessive hair growth. It is used topically to treat baldness. Though it results in hair growth in most patients, the hair grown is generally indeterminate rather than true terminal hair. The hair sheds when treatment is stopped.9 Its main benefit is in arresting the progression of balding.

Finasteride is a potent 5á reductase type 2 inhibitor.10 Its main action is to lower circulating dihydrotestosterone by inhibiting its production by the prostate, rather than affecting the metabolism of the androgen in the hair follicle. Loss of libido is one of the important side effects of this oral therapy.

Synergistic effect of the local application of minoxidil finasteride

1. view of the different mechanisms of action, it was hypothesized that the simultaneous administration of both the molecules should have a synergistic action.
2. The side effects associated with the oral administration would also be reduced.
3. If the dosage of the individual drug could be reduced, it will further improve the safety profile of the therapy.

Clinical Study

The effect of the novel combination was observed in a study. The subjects were divided into three groups.

• Group I (Placebo Group) plain lotion was applied
• Group II (Minoxidil Group) 5% Minoxidil lotion was applied
• Group III (Combination Group) 5% Minoxidil lotion, 0.025% Tretinoin and 0.1% Finesteride were applied.

The important aspect of the study was the fact that none of the parties involved viz. the clinical / research staff, the study sponsors or the subjects in the three groups were aware of the various groups until the data was collected in the verified database. The subjects were evaluated every six months with the help of a subjective questionnaire, objective examination and close-up photographs.

Results

In the Placebo Group, there was neither any improvement nor deterioration. In the Minoxidil Group 25% of the subjects showed hair growth. In the Combination Group as much as 75% of the subjects showed improvement. Further, the quality of the newly grown hair was also better in the combination group.

Study Participant:

Discussion

This study indicates that topical application of Minoxidil and Finasteride leads to better hair growth. Combination therapy was thrice as effective as any one of them. These results were documented in a triple-blind clinical trial using a subjective questionnaire, objective examination and close-up photographs. The findings are statistically significant. The study design and objective evaluation rule out observer bias, a common source of error in clinical trials. The two drugs have different route of action and combined use allows for a dual action. It may also be possible to reduce the dose of each drug, decreasing their individual side-effects.

Conclusion

A combination therapy of Minoxidil and Finasteride shows great promise in the treatment of hitherto difficult condition Alopecia androgenetica. It may potentially become the main stay therapy in this condition.

References

1. Hamilton JB. Patterned loss of hair in man: Types and incidence. Ann NY Acad Sci 1951; 53:708-11.
2. Anjiki T, Suzuki S. An injection-corrosion study on the angioarchitecture of the rat skin. Jikken Dbutsu. 1991; 40(4):439-46.
3. Hunt N, McHale S. Reported experiences of persons with alopecia areata. J Loss Trauma 2005;10: 33-50.
4. Weitz R. Rapunzel's daughters: what women's hair tells us about women's lives. New York: Farrar, Straus, and Giroux, 2004.
5. Hunt N, McHale S. Understanding alopecia. London: Sheldon, 2004.
6. Passchier J, Donk JV, Dutree-Meulenenberg PO, Verhage F. Psychological Characteristics of Men With Alopecia Androgenetica and Effects of Treatment With Topical Minoxidil An Exploratory Study. International Journal of Dermatology.1988:27(6):441-446.
7. Girmana CJ, Rhodesa T, Lillyb FR, Guob SS, Siervogelb RM, Patrickc DL, Chumleab WC. Effects of Self-Perceived Hairloss in a Community Sample of Men. Dermatology 1998;197:223-229
8. Sinclair R. Fortnightly review: Male pattern androgenetic alopecia. BMJ. 1998;317;865-869
9. Olsen EA,Weiner MS. Topical minoxidil in male pattern baldness: effects of discontinuation of treatment. J Am Acad Dermatol 1987;17:97 101.
10. Olsen E. Finasteride (1 mg) in the treatment of androgenetic alopecia in men . Aust J Dermatol 1997;38;A316.

BACKGROUND: The field of hair transplantation has evolved considerably over the last quarter century. Performed correctly, the cosmetic results of contemporary hair transplantation are virtually undetectable in women and men. Large, pluggy "punch grafts" have been replaced with natural-appearing follicular unit grafts, which maintain their existing anatomy and with proper technique can match the orientation of surrounding hair follicles.

OBJECTIVE: To review all of the steps involved in hair transplantation surgery and to provide an overview of medications used in conjunction with transplantation to help prevent hair loss.

MATERIALS, METHODS, AND RESULTS: The authors review key aspects of the consultation, physical examination, selection of appropriate candidates, excision of donor area, hairline design, graft creation and placement, and postoperative instructions. The role of medications such as minoxidil and finasteride in preventing ongoing hair loss is an essential part of the treatment plan. For nonsurgical candidates, other treatments such as wigs, hairpieces, and camouflages are reviewed. Future trends may involve the use of low-level laser light therapy, dutasteride, and cloning of follicles.

CONCLUSION: Patients and physicians alike are pleased with the results of contemporary hair transplantation, and physicians can now recommend the procedure without reservation. The authors have indicated no significant interest with commercial supporters.

With so many products on the market claiming to stop hair loss, it’s no wonder that confusion abounds. And with the high stakes involved in this multi-billion dollar industry, the public is constantly being bombarded with marketing messages ranging from pills and topical applications to hair transplants.

Now entering into the ring is relative newcomer, FDA approved Caproxen, offering a viable solution to waning confidence and self-esteem due to hair loss for those on a tight budget.

According to Caproxen, “Now you don’t have to spend thousands of dollars on hair transplants, worry about wigs, or take those pills that simply don’t work. Order today if you want our professional grade formula to start growing your hair and confidence back.”

Among the 40 million men suffering from hereditary hair loss in the US alone, Caproxen users claim to have experienced noticeable results shortly after using the product and Caproxen is apparently backing up their claim with an unheard of offer.

Caproxen is currently offering to send a bottle, for the $5.95 cost of shipping, to anyone wanting to experience the results for themselves.

So if you’re among the 40 million men in the US currently suffering from male pattern baldness, consider taking advantage of Caproxen’s $5.95 offer before you make an appointment for an expensive hair restoration operation or other alternatives.

Leavitt M, Charles G, Heyman E, Michaels D.

The use of low levels of visible or near infrared light for reducing pain, inflammation and oedema, promoting healing of wounds, deeper tissue and nerves, and preventing tissue damage has been known for almost 40 years since the invention of lasers. The HairMax LaserComb(R) is a hand-held Class 3R lower level laser therapy device that contains a single laser module that emulates 9 beams at a wavelength of 655 nm (+/-5%). The device uses a technique of parting the user's hair by combs that are attached to the device. This improves delivery of distributed laser light to the scalp. The combs are designed so that each of the teeth on the combs aligns with a laser beam. By aligning the teeth with the laser beams, the hair can be parted and the laser energy delivered to the scalp of the user without obstruction by the individual hairs on the scalp. The primary aim of the study was to assess the safety and effectiveness of the HairMax LaserComb(R) laser phototherapy device in the promotion of hair growth and in the cessation of hairloss in males diagnosed with androgenetic alopecia (AGA).

This double-blind, sham device-controlled, multicentre, 26-week trial randomized male patients with Norwood-Hamilton classes IIa-V AGA to treatment with the HairMax LaserComb(R) or the sham device (2 : 1). The sham device used in the study was identical to the active device except that the laser light was replaced by a non-active incandescent light source. Of the 110 patients who completed the study, subjects in the HairMax LaserComb(R) treatment group exhibited a significantly greater increase in mean terminal hair density than subjects in the sham device group (p < 0.0001). Consistent with this evidence for primary effectiveness, significant improvements in overall hair regrowth were demonstrated in terms of patients' subjective assessment (p < 0.015) at 26 weeks over baseline. The HairMax LaserComb(R) was well tolerated with no serious adverse events reported and no statistical difference in adverse effects between the study groups. The results of this study suggest that the HairMax LaserComb(R) is an effective, well tolerated and safe laser phototherapy device for the treatment of AGA in males.

PMID: 19366270 [PubMed - in process]