August is National Hair Loss Awareness Month. While most people experiencing hair loss don’t want to bring attention to the issue, talking about it is the only way to learn about potential solutions. There’s a wide range of solutions for hair loss, from supplements to surgical treatments.
“Hair loss can be a challenging condition to treat for both men and women, and there is no one-size-fits-all solution. There are different types of hair loss caused by various reasons such as medical conditions, medications, hormonal changes, and life events,” Charlotte, NC dermatologist Gilly Munavalli, MD and Rachel Yang, NP say. “Therefore, it is imperative to have a comprehensive assessment and evaluation by a board-certified dermatologist in order to have a management plan specifically for you to get the most effective results.” Before you head to a doctor, learn about your options.
The simplest solution for improving hair growth, and where many people start their journey, is via supplementation. Wayne, NJ facial plastic surgeon Jeffrey Wise, MD suggests supplements that are specifically formulated for hair. He recommends Viviscal Professional ($120) and Nutrafol ($79-$141 a month).
Nutrafol is one of the most popular doctor-recommended supplements for hair loss. Washington, D.C. dermatologist Tina Alster, MD, Dr. Munavalli and Yang also suggest giving the brand a try. “The supplements for women are targeted for common hormonal changes in women’s lives leading to hair loss including postpartum and post-menopausal as well as a general supplement for women,” explain Dr. Munavalli and Yang. “Nutrafol also has a combination supplement and topical available for men. The topical solution contains a plant-based exosome to help stimulate cell renewal.” He adds that results from daily use can be expected within three to six months.”
Pittsburgh plastic surgeon Brian V. Heil, MD explains that although the “pathophysiology of androgenic alopecia is quite complicated, with numerous different pathways leading to shorter hair cycles and miniaturization, the main causative agent is believed to be a naturally formed bodily compound known as dihydrotestosterone (DHT).” Many prescription solutions for hair loss focus on suppressing DHT production. One such medication is Propecia (finasteride).
“Finasteride may prevent further hair loss but can only partially reverse balding,” says Dr. Heil. It’s only FDA-approved for men due to pregnancy warnings but can be used “off label” in most post-menopausal women, he notes. The medication “must be used indefinitely to maintain a response,” according to Dr. Heil. “Adverse side effects including sexual dysfunction (decreased sex drive and erectile dysfunction) are uncommon and most often resolve without discontinuing treatment. Side effects occur in less than one percent of men taking the medication.”
Dr. Wise says Dutasteride is also commonly prescribed. He claims that both of these medications “are taken once a day and do an extremely effective job at maintaining the existing hair and significantly slowing down hair loss and slightly improving hair density.”
Topical products can also be effective solutions in slowing hair loss, especially when used in tandem with an oral product. Dr. Heil suggests minoxidil (Rogaine) which is used to treat hair loss, but like finasteride, it can only partially reverse balding. “Minoxidil is available in two percent and five percent topical solutions and is to be applied to the scalp twice daily,” advises Dr. Heil. “Cosmetically acceptable hair growth is seen in about one-third of cases.”
Dr. Heil warns that a temporary shedding may occur within the first two to eight weeks. Other side effects include itchy scalp, dandruff and redness. He notes that foam formulations without propylene glycol may result in fewer side effects. “Maximal response to minoxidil is seen in the first six months of treatment. Regression of results occurs after three months of stopping minoxidil,” says Dr. Heil. “Minoxidil must be used continually to maintain a response.”
Dr. Munavalli and Yang advocate for Skin Medicinals, a “digital-based compounding pharmacy that delivers cost-effective medications directly to you.” The HAIRSTIM line features topical solutions for both men and women. “Although available only by prescription, this allows your dermatologist to create a personalized topical solution specific to your needs.”
Dr. Munavalli and Yang explain that “There are in-office noninvasive treatments that utilize lasers to maximize the absorption of topical solutions into the scalp to stimulate hair growth.” One laser is the LaseMD Ultra + KeraLase which employs a non-ablative thulium laser and serums that contain growth factors and skin proteins. “The LaseMD Ultra laser creates superficial, tiny channels into the scalp for better penetration of the KeraLase serum. This treatment has no downtime, has minimal discomfort and is a series of six treatments every two weeks.”
Dr. Wise uses products like the LaserCap, “which uses diode lasers to stimulate blood supply to follicles.” Patients are instructed to use the light therapy every other day for approximately half an hour. “Treatments have been proven to further stop hair loss in addition to strengthening existing hair.”
Platelet-rich plasma therapy
Dr. Alster calls platelet-rich plasma (PRP) scalp injections the “MiracleGro for hair.” Dr. Wise explains that “During this procedure, we spin the patient’s blood in a centrifuge to extract platelets that contain growth factors. Their PRP is then injected into their scalp, stimulating hair growth and keeping follicles viable, thus slowing down hair loss.”
The growth factors “act on various cellular receptors to stimulate cellular growth and differentiation as well as new blood vessel formation in the scalp, effectively reversing the miniaturization process,” explains Dr. Heil. The procedure is generally performed in an initial series of three treatments one month apart and is followed by a single maintenance treatment annually. He notes that “Results may vary, but those who do respond can expect an improvement in hair quality, texture, pigmentation, scalp coverage and a decrease in shedding.”
It’s essential for experts to ensure the patient is a candidate for PRP before performing the treatment. “Those with severe hair loss should consider other options. Once hair miniaturization reaches its end stage, growth factor treatments derived from PRP are typically not sufficient to correct balding,” says Dr. Heil. Although it is not currently an FDA-approved treatment option for hair loss, it’s becoming very popular.
Follicular unit extraction
Colloquially referred to as a hair transplant, follicular unit extraction (FUE) is the most drastic treatment option for hair loss. “This hair transplant procedure is ideal because it doesn’t require any linear scars with stitches. Another reason it’s an optimal treatment is the downtime is fairly minimal,” says Dr. Wise. He recommends patients spend at least one week avoiding public settings to keep recovery more private.
“During this procedure, we take each follicular unit out, one at a time, and then transplant it to the recipient area. In my practice, we use the smallest punch available (a 0.6 millimeter tool), which allows the most minimal amount of trauma to the donor area and promotes rapid healing,” says Dr. Wise. “The results for this procedure are fantastic. Patients typically see significant growth within three to six months. The final result of an FUE procedure is usually seen at one year.”
Dr. Heil cites using NeoGraft Automated and ARTAS robotic FUE to achieve permanent hair restoration. This is the future of combating hair loss. “Antiquated techniques of strip method/follicular unit transplant hair restoration have become a thing of the past, eliminating the stigma of bald donor scars, less natural (doll’s hair) grafts, and prolonged painful recovery,” he says. “With these cutting-edge technologies, hair loss has become a choice rather than a destiny.”