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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