Hair loss treatment

The first hair transplantations were performed in Japan in the 1930s. In the early days of hair transplant surgery relatively large pieces of skin of four millimetres in diameter, the so called punch grafts, were transplanted from the back of the scalp to the frontal receding area. Hair transplantation techniques have evolved tremendously since then and today’s hair transplantation can give you a genuinely natural look. This is due to the miniaturisation of hair transplants, which now contain only one hair follicle (holding between one and four hairs) and are less than one millimetre in diameter. These tiny, single follicle grafts are then implanted into the needle-made incisions in the balding area. Today’s technology enables dense packing of hair follicles, which gives you a truly natural-looking frontal hairline. Gone are the days of ‘pluggy’ grafts that made you look like a toothbrush.

The two leading technologies that are used today are called Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). The main difference between them is in harvesting hair follicles. The FUT is the older method, using strip harvesting, when a linear strip of skin of up to 20 centimetres long and 1.5 centimetres wide is removed from the back of the scalp and the opening is then sewn closed. This strip is then placed under special dissecting microscopes and dissected into small grafts, containing just one follicular unit each. Such follicular grafts are then implanted into the receding area. The advantage of this method is its high yield, measured as a percentage of the follicles that are successfully transplanted into the balding area. This yield is around 98%. The weakest point is that it leaves the patient with a linear scar at the back of the head. The FUT is less expensive than the FUE and is used when a large area needs to be filled with transplanted hair in one single session.

The FUE method uses a micro-extraction technology to harvest individual follicles that can be directly implanted into the small needle-poke holes in the balding area. The FUE method is the latest technology, introduced only a few years ago. Its greatest benefit is the fact that it leaves the patient with only minuscule scars at the back of the head, which are hardly visible, and the healing time is significantly shorter than with the FUT, due to the small size of the wounds. However, this technique cannot be used to cover large areas in one session and it is more expensive than the FUT. Additionally, its yield is much lower, due to the transaction of many follicles, and since the supply of donor hair is limited, it cannot be used in patients whose hair loss has progressed above NW4 level.

Currently explored surgical hair restoration technologies, such as hair cloning and the generation of new hairs in wounds, should in the future help solve the constraints of the limited amount of donor hair. It seems that hair transplants will in the long future only be used for frontal hairlines and, therefore, the follicular harvesting should manage to provide a sufficient number of hair implants. However, none of the aforementioned potential future techniques is expected to become commercially available before 2013. Hence, the immediate future probably lies in improving the harvesting methods of the FUE in order to improve its yields and make it financially more affordable to customer. The FUT with its strip harvesting, which started a revolution in the hair transplant industry less than two decades ago, may become history in the not too distant future.

When it comes to combating hereditary hair loss, it is medicinal pills and topicals that spring to most peoples’ minds as the options holding the greatest promise. There also happen to be other available treatment options, such as surgical as well as non-surgical hair replacement, but to date only oral and topical medicinal treatments have been proven to reduce and reverse hair loss naturally. Hair transplantation, though providing the best cosmetic results, cannot slow or reverse hair loss. Natural and herbal hair loss treatments seek to mimic medicinal treatments in their mode of action but their effectiveness in treating hair loss has never been confirmed in any significant clinical study and many of them are associated with hair scams.

The two medicinal treatments that have been approved by the FDA (Food and Drug Administration) in the US for treating hereditary hair loss are topical minoxidil (trade name Rogaine/Regaine) and oral finasteride (Propecia). These two hair loss drugs have been also approved by national health supervisory authorities in many other countries. Topical minoxidil is suitable for both sexes, whereas finasteride can only be prescribed to male patients. Minoxidil is a vasodilator, originally used to treat high blood pressure, which was later found to stimulate new hair growth when applied topically to the scalp. Its exact mechanism of action is not known, though.

Finasteride is an antiandrogen that was initially applied to treat benign prostatic hyperplasia (BPH), also known as prostate enlargement. It works by inhibiting conversion of the male hormone testosterone to the follicle harming didydrotestosterone (DHT). The discovery of finasteride’s positive influence on hair growth led to finding the true cause of hereditary baldness, which are the harmful attacks of DHT on our hair follicles. Since making this discovery, a quest for other alternative DHT inhibitors has begun, especially amongst antiandrogen drugs and herbs that have, in the past, been used to treat urinary problems.

Dutasteride (trade name Avodart) is a medicine similar to finasteride and has been studied extensively for treating hair loss. It is currently undergoing phase III clinical testing. It has been approved for treating BPH and is therefore available in pharmacies in many countries around the world. Although it has not yet been approved for treating hair loss by any national health supervisory authority, it is being prescribed by some clinics and doctors to male patients who no longer respond to finasteride. Dutasteride is believed to be a more powerful hair loss drug than finasteride but also with more severe side effects.

Flutamide (trade name Eulexin) is an extremely powerful antiandrogen used to treat prostate cancer. It acts by binding to the androgen receptors and thus competing with DHT. Oral use of flutamide can cause serious side effects but it is believed that topical applications might have less adverse side effects and could be, in the future, used to combat hereditary hair loss. More research is needed to verify such claims.

Spironolactone (trade name Aldactone) is another antiandrogen that works by binding to androgen receptors, competing with DHT. It is used in women to treat acne, excess body hair and hair loss and although there are some generic topical applications designed for treatment of male pattern baldness containing spironolactone, it has never been approved to treat hereditary hair loss in men and should better be avoided.

Aminexil, was developed by L’Oreal to treat baldness in men and women and its molecule is very similar to minoxidil. Its mode of action is not exactly known and it is believed to be a less powerful weapon in the fight against hair loss than minoxidil.

NEOSH101 is one of the most promising novel hair loss drugs under development. It is in phase II clinical trials and is supposed to be a hair growth stimulant, distantly related in its mode of action to minoxidil. Although not expected to become an ultimate cure for baldness, it could improve the chances of many hair loss sufferers of regrowing some of their lost hair.

The above list of medicinal treatments for hair loss is not exhaustive. There also happen to be other drugs though to help treat hereditary baldness, such as superoxide dismutase, fluridil, ketoconazole, alfatradiol, etc. but none of them has ever been proven in any serious clinical study to promote hair growth and further studies will be needed to evaluate their actual effects on hair loss. Therefore, for the time being, minoxidil and finasteride remain the main weapons in the fight against genetically-determined hair loss conditions in male patients.