Hair Loss Part 3: Treatment Options

When treating hair loss, there are a variety of options that range from the simple to complicated procedures. Regardless of the treatment, we often have to undergo a journey to get from where we are (hair loss) to where we want to be (healthy hair).

If we were planning a vacation or trip, the vehicle we would choose to get us from point A to point B would depend on the circumstances of that trip. For example, we wouldn’t want to buy a plane ticket to get us to the next town over just like we wouldn’t use a car to drive a city block when walking would be much better. Hair loss treatments are much the same way. I will often have patients wanting to do a “jet boat” treatment when in actuality a “scooter” treatment would be much more effective. With this analogy in mind, I tend to break down hair loss treatments into three categories: Bicycles, cars, and airplanes; or Tier 1, Tier 2, and Tier 3 treatments.

Tier 1, the Bicycle

These treatments are often the simplest treatments, but just because something is simple does not make it less effective. Tier 1 treatments will often include treatment of underlying medical conditions. In the previous blog we described several medical conditions that cause hair loss, and by treating these conditions we can correct the problem. For example, in male pattern baldness we have medications that can block a testosterone byproduct called DHT. DHT damages hair on the crown of the head, and by
blocking that hormone the hair follicle is preserved. Treating hypothyroidism is another example. Sometimes the “bicycle” treatment is as simple as a lifestyle change. Stress can literally make your hair fall out, and by decreasing the stressors of life we can see an improvement in the health of our hair.

There are alternative treatments out there as well. Light therapy can help promote blood flow to the scalp. Certain shampoos can stabilize hair as well. There is some science that shows certain nutritional supplements can help. Although there is limited research showing the effectiveness of these alternatives, in practice I see compliance or cost being an issue and rarely recommend them.

Tier 2: the Car

When the “bicycle” treatment fails, I will often have my patients try other options. We call these options Tier II, or another way of looking at it is a “car” treatment. In this Tier, we trick the scalp into a healing, more youthful state. We do this through three mechanisms: Platelet Rich Plasma (PRP), Platelet Rich Fibrin (PRF) or microneedling.

With PRP, we have specialized equipment designed to harvest and concentrate platelets and growth factors from the blood. When injected into the scalp, these growth factors prompt a healing cascade to occur in the skin reverting the skin, in a sense, to a more youthful state. PRF works much the same way, but we also include a fibrin matrix into the product which keeps the platelets and growth factors around for longer…lengthening the healing time. Both PRP and PRF tend to thicken up the hair. As hair follicles get healthier, the shaft of the hair increases in diameter, and the hair shaft tends to live longer. Add those two together and we get a scalp with thicker hair.

Microneedling can also improve the health of the scalp. With a microneedling device, we slightly damage the skin which causes a healing cascade to occur promoting blood flow to the region. We can also pair this therapy with PRP/PRF for an additional bonus as well.

Tier 3, the Airplane

Once a follicle on the scalp dies, it will never grow back no matter what treatment we do. While Tier 1 and Tier 2 treatments are designed to keep follicles healthy and living longer, a Tier 3 treatment is designed to create a new hair follicle in an area of the scalp that no longer has one. This is done through hair transplantation, where a healthy hair follicle is transplanted from the portion of the scalp with thick, healthy hair, to an area that needs new follicles.

Traditionally this was done through the “strip” method or follicular unit transfer. In this procedure, a large strip was surgically removed from the back of the head. This left a gap in the back of the scalp, so the surgeon would stitch this gap back together. The harvested strip was then processed for hair grafts, and individual grafts were then transplanted to other areas of the head. The strip method has the advantage of being able to harvest a large number of grafts. However, patients were left with an unsightly scar on the back of the head, and as such had to wear their hair long to cover it up. Patient downtime is also significant requiring the patient to take several weeks to fully recover.

A newer technology that accomplishes a similar result to the strip method is through follicular unit extraction (FUE). With FUE, instead of harvesting a large strip, only single follicles are extracted from the back of the scalp for transplant. This leaves the patient without the linear scar that is found through the strip method. In my clinic, this is the only type of hair transplantation that we do. We do our extractions with the NeoGraft system which is a quick and effective way of transplanting hair.  A great advantage of FUE is that patients have very little downtime, usually about 2-3 days.

There are several other treatment options available for hair loss. In my practice, we focus on the ones mentioned above. If you are interested in any of the above treatment options, please set up a free consult. We would love to discuss your treatment options.