Non-surgical Treatments for Baldness

Balding men and women seem to go to almost any lengths to regrow thinning hair. Until now, inherited balding in either sex has not responded well to any anti-balding stimulants, applications, injections, or other treatments.

Antiandrogen Therapy
In the United Kingdom, the most commonly used anti-androgen for women is CPA (cyproterone acetate) in combination with ethinyl-estradiol. In the United States, where CPA is not available, the aldosterone antagonist spironolactone has been given in dosages from 75 to 100 mg per day with some benefit. However, higher doses (150 to 200 mg per day) appear necessary to produce a significant increase in cosmetically useful hair, as occurs with CPA therapy. Anti-androgen treatment must be continued for at least 12 months. Often two years is required before a subjective improvement is observed. Complete reversal of the hair loss can never be achieved unless treatment is instigated within two years of its onset. This is probably due to the atrophy of the miniaturized hair follicles with time. The degree of benefit observed is dependent upon the subject’s age and the duration of alopecia; however, most patients are satisfied with the thought that no further hair loss will occur. Some improvement in hair quality should be expected in all cases, although withdrawal of therapy results in further progression of the alopecia. Nonhormonal aspects are critical to ensure an optimal therapeutic response is achieved. And, the need to maintain vitamin and serum ferritin levels above values previously thought adequate has recently been demonstrated. The side effects of oral CPA therapy in combination with ethinyl-estradiol are well documented and are similar to those associated with other oral contraceptive regimens. Spironolactone disrupts the menstrual cycle and increases menstrual bleeding in some patients; but, in general, it is well tolerated. To understand how these hormonal remedies work, you need to know a little science. DHT is one of several male hormones, called androgens, that compete for a berth on the hair follicle’s receptor sites. In principle, if you could keep the receptor busy metabolizing other hormones, like progesterone, DHT would never have a chance to move in and start shrinking the follicle. The researched based on this concept have made little progress over the past decade. The biggest hurdle: to limit the effects of the androgen blocker to the scalp only. If DHT is blocked at other sites around the body, a male will lose his sex drive and develop a vocal delivery that resembles a teenage girl’s. Blocking the activities of DHT in female who have hair loss is, of course, less problematic. Spironolactone or Aldactone does just that, and very effectively.

By far the most publicized medical treatment available for male pattern baldness is minoxidil (Rogaine). The idea of using minoxidil topically to grow hair was serendipitous. This drug was originally developed to treat high blood pressure and had the unanticipated side effect of stimulating hair growth, sometimes in unwanted areas. This observation led to the testing of topical minoxidil on balding areas of the scalp. Since its introduction in 1988, Upjohn, the manufacturer, sells about $150 million worth of the drug each year, even though its ability to grow back hair is, at best, modest. A large-scale clinical trial involved over 2,300 participants with male pattern baldness was carried out by having 1,547 patients apply 1 ml of 2% or 3% minoxidil and 779 patients apply 1 ml of placebo ( no active ingredients, only alcohol and propylene glycol) twice a day to the balding area. Actual counts of vellus hairs, indeterminate hairs, and terminal hairs in an one-inch patch were made before and after treatment. At 4 months, 5% to 8% of patients had moderate to marked hair growth on the balding vertex of the scalp. This figure is statistically no different from the number of men who regrow hair in response to a plcaebo. another 15% to 20% of patients had some growth of vellus hair on the balding area. At 12 months, 39% of patients had moderate to marked hair growth, while 11% of those using placebo reported an increase in hair growth. This result shows that you to used minoxidil for more than 4 months in order to decide whether this treatment works for you. Who is the best candidate for this drug? research showed that you have to be: 1) young man (20 to 30 years old), who only recently (within 5 years) had begun to bald 2) not completely bald, and 3) not bald at the temples This drug works best on small areas of vertex baldness (smaller than 1 square inch). There is no evidence that topical minoxidil could regenerate hair on the receding temple area. Topical minoxidil was as effective at a concentration of 2% as at 3%. A 1% formulation was less effective. Successful treatment, however, does require a lifetime commitment. The topical solution must be applied to the balding area twice a day, every day. Decreasing the dosage to once a day results in some hair loss, and discontinuing application causes regression to pretreatment baldness within 3 to 6 weeks. The cost? Anywhere between $600 to $1,000 a year, depending on the size of the area to be treated. Why minoxidil works remain a mystery. It is know to be a powerful vasodilator, but other drugs the dilate blood vessels do not promote hair growth. It is postulated that it delays or prevents some follicles’ entry into the next anagen phase for long periods of time and stimulate these follicles back into active production. But this theory remains to be vindicated. The disadvantages of minoxidil are: 1) lifetime commitment; 2) high cost : It is not covered by health insurance schemes as it’s considered a cosmetic; 3)Its side effects; including itching and prickling, headaches (in 40 per cent), dizzy spells and, in some, heartbeat irregularities. Although apparently safe when rubbed into the scalp – since little is absorbed into the bloodstream – it is a vasodilator and not recommended for anyone with heart trouble. Its safety in men over age 49 and its long-term safety remain unknown. Some scientists believe that minoxidil is more effective in preventing hair loss than in promoting regrowth, but no controlled trials are available. At the time of writing this book, the only away you can obtain rogaine is through a doctor’s prescription. That could be changed soon. Upjohn is confident it will obtain FDA approval to take the drug over the counter.

New Treatments
One anti-androgenic drug now being tried as a baldness remedy is oral finasteride. It inhibits the 5-alpha reductase (enzyme) that transforms testosterone into the dihydrotestosterone (DHT) form responsible for hair loss. Blocking the action of DHT seems to stimulate growth of stronger, thicker and more pigmented hair. In one multicentre study, 200 males aged 18 to 35 with distinct baldness had a one-inch circle of scalp shaved and periodically examined for hair growth. The report states that “men taking 5 mg per day of oral finasteride had significantly increased hair growth. Side effects – such as impotence, loss of libido and reduced sperm counts – were not widespread, and often decreased with time, affecting about three per cent of the sample.” Ideal candidates for finasteride treatment are men who have already fathered all the children they wish, as its use for baldness might be lifelong and it could harm any fetus conceived (while taking it). Further studies are needed to assess the drug’s efficacy, dosage and long-term safety. Another dihydrotestosterone-inhibitor now being tested is a derivative of hyaluronic acid, the chemical at the tip of sperm that aids penetration of the egg’s membrane. Massaged into the scalp, this substance apparently blocks the androgenic action that causes hair loss, but more research is needed.

Surgical Treatments for Baldness
If you do not respond to medical treatments and If you have time, money, and a stoic attitude toward pain, Surgical hair restoration is the only truly permanent solution to baldness. It involves a series of operations that extract plugs of scalp from the sides an back of your head, where hair grows densely, and implant them on top and in front, where you’re going bald. The procedure, which usually isn’t covered by medical insurance, can cost as much as $15,000 and takes a year or two to complete. Despite the time and expense, an estimated 250,000 American men each year elect to have the surgery. Restoration is possible because the hair follicles on the sides and back of the scalp are insensitive to the hormones that cause androgenic alopecia, so the hairs are immune to fallout. During surgical hair transplantation, hair follicles are redistributed in balding areas, where they grow hairs that continue to grow for the rest of the individual’s life. Hair transplants are better than they used to be, for doctor can use a variety of techniques to make it look like natural hair. Here is a rundown of the major surgical treatment for baldness.

Hair Transplantation
The common method of implanting grafts is illustrated in figure 3. There are two type of donor grafts taken from the hair-bearing posterior scalp: cylindrical, elliptical (also macrografts) and micrografts or minigrafts. The most common type of Macrografts is cylindrical plug. Using a device like a hole puncher, the surgeon removes 1/8-inch-round graft containing about 12 to 20 hairs and placed into a smaller cylindrical hole in the anterior balding region of the scalp. Depending on the degree of baldness, 1 to 4 sessions of transplantation are required, with placement of 50 to 60 plugs at each session. Successive transplantation sessions are scheduled with at least a 3-month interval between procedures. Average cost: $12,000 per 50 grafts ( one session). The number of grafts depends on the hair coverage desired. Elliptical grafts are used for large posterior areas of baldness. Nowadays macrografts are no longer used by most surgeons, since these techniques tend produce artificial appearance. Micrografts (1 to 2 hairs) or Minigrafts (3 to 4 hairs) are implanted along the anterior hairline to mask the “doll’s hair” look of the cylindrical plugs and give a natural appearance to the hairline. A narrow two-inch section of scalp is removed from the back of the head. It is then divided into 1 to 2 millimeter grafts and implanted in tiny incisions made in the bald area. Average cost: $1,200 per 50 grafts (one session). When used with other procedures, at least two sessions may be required. After transplantation, the recipient area is covered with a scab for several days, the donor hairs fall in 2 to 4 weeks, and new definitive hairs grow within 3 months. one study (19) showed that if topical minoxidil is applied twice daily beginning within 48 hours after hair transplantation, the hair in the grafts will stay and regrowth of hair begins immediately. Typically, men with hair loss limited to the frontal area of the scalp are the best candidates for hair transplantation. However, the patient’s age and the potential for more extensive baldness must be considered carefully. These factors may dictate that other procedures should be performed in addition to hair transplantation. Certain hair characteristics make it easier for surgeons to re-create truly outstanding hairlines. Individuals with blond, gray or light brown hair usually require the transplantation of fewer grafts because there is less contrast between hair color and skin tone. Generally, if a patient has darker hair, more single-haired grafts are blended into the frontal hairline area. Men who have at least some natural wave in their hair have an advantage over individuals with straight hair because the natural curl provides extra volume. Sometimes patients with straight hair opt for a permanent wave once their newly transplanted hairs grow to a sufficient length.

Scalp Reduction
Scalp reduction, also referred to as galeoplasty, male pattern reduction or bald area reduction is performed on patients with well-defined bald spots in the crown area of the scalp. It is sometimes done in conjunction with hair transplantation to reduce the size of the bald scalp, especially in patients who do not have enough donor hair to cover the bald areas. A section of bald scalp (up to 2 by 7 inches) is removed, and the sides of scalp are lifted and sutured together. Small hair grafts fill in the remaining bald areas. For patients with large area of baldness, successive scalp reductions are performed to reduced progressively the bald area. Average cost: 1,600 per procedure. Scalp reduction is recommended for men with bald spots smaller than 3 inches in diameter. This technique is not suitable for patients with little or sparse donor fringe.

A large horseshoe-shape piece of scalp is partially detached from the donor fringe area. The free end is positioned over the bald spot where a corresponding patch of hairless scalp has been removed. Additional small grafts are needed to create a natural look. Average cost: $2,700 to 8,000 per flap, depending on the size. There are some disadvantages associated with this procedure. First, the resulting straight frontal hairline does not appear natural, and a scar along the hairline can sometimes be detected. Second, the hairs of the flap grow in a direction different from the natural hairs, giving an artificial look. Discuss with your surgeon about your concern.

Tissue Expansion
Silicone bags are inserted beneath an area of hairy scalp and gradually inflated with a saline water over a six-week period. This causes the hair-bearing skin to stretch, thus increasing the amount of hair-bearing scalp. After removing the bags, expanded hair-bearing skin is lifted and moved to an adjacent bald area where a similar-sized patch of scalp has been excised. The major disadvantage is that patients have to tolerate the strange appearance of balloons in their heads for several weeks. Though men can camouflage this, most find it embarrassing. The procedure is even less suitable for smokers, whose blood supply to the scalp may not be sufficient to allow normal healing, and for diabetics, who are more susceptible to infection. Average cost: $4,000.

Before Making Any Decision
In US any licensed physician can perform hair the surgery, it is easy to end up with Unsatisfactory results–scarring, patches of thin transplanted hair over scalp sections that continue to grow bald, a “doll’s hair” look, or loss of hair that leaves the scars from transplantation visible–are no longer as likely as they once were, but they are still a risk. If you decide to go this route, choose your surgeon with care, and beware of seductive advertising brochures showing “after” photos of men with thick, way hair. Ask to see some real people whom the doctor has treated. The best way, actually, to find a surgeon is through a referral from a satisfied customer, but even then you should be sure the doctor’s credentials check out. Check with the department of plastic surgery or dermatology at your nearest university medical school. You can also call or write to the American Hair Loss Council or the American Academy of Facial Plastic and Reconstructive Surgery

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