hair restoration: prescription or procedure
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Hair restoration: prescription or procedure?

Individuals who experience hair thinning and baldness inevitably look at the medications available and also at the possibility of having hair transplants. But which is best – a prescription or a procedure? Marc R. Avram, MD, and his colleagues have suggested that both are needed to ensure a natural look. They wrote, “The Potential Role of Minoxidil in the Hair Transplantation Setting,” a paper prepared for the Roundtable Consensus Meeting of the 9th Annual Meeting of the International Society of Hair Restoration Surgery and published in an October 2002 issue of Dermatol Surg. The paper offers the details of their study, objective, methods, and conclusions. The goal of this article is to present the results of the collaboration and to present the key findings of the group.

The objective of the research, as presented in the article, "was to gain a better understanding of the regulation of the hair-growth cycle and its resulting advances in the treatment of gradual balding with medication."

The researchers state that, currently, there are two U.S. Food and Drug Administration (FDA)-approved medications that promote hair regrowth: over-the-counter topical minoxidil solution for men and women and prescription oral ministered tablets for men. In October 2001, eleven experts on hair loss and transplantation met to discuss, and to come to a consensus on the use of minoxidil solution as a component of the hair restoration process. Other medications were also discussed.

There are a variety of reasons that an individual might loss their hair. The following reasons for were offered in the article: medication, hair styling, chemotherapy, exposure to chemicals, hormonal and nutritional factors, generalized or local skin disease, chronic disease, and stress. Yet, it is explained that the most common reason that individuals - men and women - lose their hair is pattern hair loss. As a matter of fact, it is so common that half of all men and women by will have to deal with it before they reach their 50th birthday. Hair transplants are the most effective and permanent solution to this often distressing problem.

Hair transplants, as explained by the authors, “…involve surgical removal of a strip of hair-bearing scalp tissue from the “donor dominant” hair-bearing areas on the back and sides of the head where the hair follicles are not susceptible to the DHT [hormones that cause baldness] and continue to cycle normally for life.”

Avram and his colleagues state that there are some specific characteristics that determine how successful a hair transplant procedure will be. These include the following:

  • Thickness of donor hair
  • Donor hair quality
  • Reasonable patient and doctor expectations

Since baldness as a condition is not actually affected by the hair transplant procedure, it is important that a patient find a doctor who will work to create a permanent, natural hairline with an even distribution of transplanted hair. If medication is not taken as a supplement to hair restoration surgery, the researchers report that the density of hair after a transplant will equal the number of hair follicles added in surgery minus the loss of existing hair. What does this mean? Simply that without medication in addition to a hair transplant, only those sections with transplants will grow, giving a patient natural appearing hair in those specific areas, but producing an overall uneven look to the hair. Topical minoxidil enlarges the previously shrunken hair follicles and also increases the diameters of the hair shafts that had shrunk as baldness crept up on an individual. As a result, hair loss slows and the growth phase is lengthened. Minoxidil also adds density to the hair.

Members of the expert panel at the Chicago conference clearly had confidence in the abilities of minoxidil in the hair restoration process. Avram and his colleagues report that panel members discussed specific advantages of minoxidil use for certain groups: “…female patients, whose hair is thinning; younger male patients with diffuse thinning and a family history for extensive loss, whose [baldness] will continue to progress without treatment following the hair transplant; and patients desiring reconstruction of the [back area] of the scalp.”

Avram and his colleagues further report that most surgeons ask patients to stop taking minoxidil a few days before hair restoration surgery and to start taking it again a few days after. This reduces the chances of related complications. The researchers recommend that hair transplant patients use the product for up to one year to reach their hair’s full potential for growth. In support of their recommendation, they site studies of minoxidil topical solution demonstrating significant increases in hair count for men and women who used the product for the duration of the recommended time. Hair weight also increased. When the same studies included participants taking placebos - the equivalent of sugar pills - the results continued to demonstrate a positive response.

Finasteride, another drug examined, differs from minoxidil. Finasteride produces a reduction in circulating and skin levels of damaging body chemicals that are known to cause baldness, without reducing important testosterone levels. As a result, hair loss stops and new growth begins. The drug is for men only as it causes complications for women how are, or who want to become, pregnant. According to the study, “The greatest benefit with regard to hair counts occurred within the first year of therapy with finasteride. Scalp coverage, however, may progressively increase with a longer duration of use.”

In their article, the researchers discuss other prescription products that work in favor of hair growth, but that could have side effects. Herbal treatments get a mention with a note that the safety of the majority of the natural products for treatment of pattern hair loss has not been established. In addition, many of the ingredients or products have not been approved by the FDA. Minoxidil and finasteride however are proven, safe, and effective medications that compliment hair transplant procedures well.

The researchers concluded that, based on their own experiences and their research, minoxidil works in both men and women as an effective partner to hair restoration procedures. They wrote that it, “increases hair density, speeds regrowth, and slows or stops further hair loss.” In their conclusion, they re-emphasized that finasteride, while effective as a medication for hair loss, should be used only by men because of the potential devastating effects it could have on any children born to a woman who takes the drug.


Hair restoration: prescription or procedure references

  • Avram MR, Cole JP, Gandelman M, Haber R, Knudsen R, Leavitt MT, Leonard RT Jr, Puig CJ, Rose PT, Vogel JE, Ziering CL; Roundtable Consensus Meeting of The 9th Annual Meeting of The International Society of Hair Restoration Surgery. The potential role of minoxidil in the hair transplantation setting. Dermatol Surg. 2002 Oct;28(10):894-900. PMID: 12410672
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