Hair Restoration Surgery Paired with Approved Medical Treatments

In considering hair restoration to alleviate male hale loss new choices have become preferable in the past several years; hair transplant surgery and medical treatment. Each of these methods enjoys satisfactory level of success for some patients. Los Angeles based Mohebi Medical, US Hair Restorations Center’s medical director Parsa Mohebi, MD reviewsthe tandem use of medical treatment with hair restoration surgery.

An ethical hair transplant physician’s strives to make the patient look as good as possible within evaluated expectations. The primary objective is to help restore a person’s self image and thereby improve their quality of life. Having the patient maintain his preexisting hair with medicines is a smart approach in hair restoration. Repeated hair transplants, at some point will exhaust donor hair supply. Using one of the two FDA approved medications may allow the patient to maintain more of their hair and therefore lessen the extensiveness of the hair restoration surgery or future surgeries.

Male pattern hair loss typically progresses slowly and that makes determining whether they are effective difficult. A patient may use one of these medicines for at least six months before best determining the effectiveness of it. One may experience some regrowth, or simply not losing as much hair and then judging is easy. At times a patient may have difficulty determining if it is helping, and he should stick with it. If it is obviously ineffective one should consider switching to a different medicine.

If he does find a medicine that seems to work for him, he must understand that he cannot discontinue its use. It is a long term commitment because it will only work as long as he uses it. If he stops the medicine, he must expect his hair loss to resume. In fact, some experts feel the hair loss could accelerate and catch back up to where it would have been had he not been on the medicine at all.

In regards to regrowth of hair, this typically only occurs on the top or the back of the scalp but not in the front. This actually makes these medicines very complimentary with hair transplants, because I prefer to work on the front of the scalp before I consider working on the back.

The tow FDA approved medication such as Rogaine (minoxodil) and Propecia (finasteride). These are the only two that have currently been adequately studied and approved by the F.D.A. (Food and Drug Administration) for hair loss.

Minoxidil (Rogaine)

Minoxidil (Rogaine) is a medication known for its ability to slow down or prevent hair loss and promote hair regrowth. Rogaine was the first FDA approved medication that was used for hair loss prevention. It is available without prescription (over the counter) for treatment of hair loss in men and women, among some other baldness treatments such as finasteride or hair transplant, but measurable changes disappear within one to two years after discontinuation of treatment.

Minoxidil was first used exclusively as an oral drug for treatment of high blood pressure. It was, however, discovered to have the interesting side-effect of hair growth and reversing baldness, and in the 1980s a topical solution of it was produced contained 2% minoxidil to be used to treat baldness and hair loss, under the brand name Rogaine in the United States. Treatments usually include a 5% concentration solution that is designed for men, whereas the 2% concentration solutions are designed for women.

In 2007 a new foam-based formulation of 5% minoxidil was shown to be an effective treatment of male pattern baldness without the usual side-effects of the topical solution such as itching and skin irritation.

The mechanism by which minodixil promotes hair growth is not fully understood. Minoxidil is a potassium channel agonist. It contains the chemical structure of nitric oxide, a blood vessel dilator, and may be a nitric oxide. Studies show that minoxidil is less effective than finasteride but the combination of the two drugs can be more potent.

Side Effects of Minoxidil

As a drug to prevent hair loss, the most common side effect is itchy scalp. In some cases minoxidil may initially cause an increase in hair loss within the first few weeks. This is called shedding and is seen as a long-term positive effect during hair loss treatment since the shedded hair strands will regrow within a few months with renewed strength.

There have been cases of allergic reactions to minoxidil or some of its non-active ingredients, which is found in some forms of topical Rogaine. Large amounts of minoxidil can lower the blood pressure. If a person uses minoxidil to stop hair loss for a length of time and then stops taking the drug, hair loss will occur again. This phenomenon is called catch up hair loss.

Finasteride (Propecia)

Finasteride marketedas Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo,Prosteride, Gefina, Finasterid IVAX) is a medication with antiandrogen which acts by inhibiting type II 5-alpha reductase, the enzyme that converts the male hormone (testosterone to dihydrotestosterone (DHT). This medication is used as a treatment in male patterned hair loss and also in benign prostatic hyperplasia (BPH). Initially approved in 1992 as Proscar, finasteride use was as a treatment for prostate enlargement. A sponsor study demonstrated that 1 mg of finasteride promoted hair growth in male pattern hair loss. On December 22, 1997, the FDA approved finasteride to treat male pattern hair loss.

There are several studies on using finasteride for treatment and prevention of hair loss. In a 5-year study of men with mild to moderate hair loss, 48% of those treated with Propecia (finasteride 1mg) experienced some regrowth of hair, and 42% had no further loss. Average hair count in the treatment group remained above baseline, and showed an increasing difference from hair count in the placebo group, for all five years of the study. Propecia is effective only for as long as it is taken; the hair gained or maintained is lost within 6-12 months of ceasing therapy. In clinical studies, Propecia, like minoxidil, was shown to work on both the crown area and the hairline, but is most successful in the crown area.

Some hair loss patients who use finasteride, in an effort to save money, buy Proscar instead of Propecia, and split the Proscar pills to approximate the Propecia dosage. Doing so is generally considered unadvisable if women of pregnancy age are in the household; this is because finasteride, even in small concentrations, can cause birth defects in a developing male fetus. The birth defects involve the development of male genitalia. Propecia has been shown to be ineffective for treating hair loss in women.

Androgenetic alopecia or male pattern baldness is caused by the effects of the male hormone dihydrotestosterone (DHT) on genetically susceptible hair follicles that are present mainly in the front, top, and crown of the scalp (rather than the back and sides). DHT causes hair loss by shortening the growth, or anagen, phase of the hair cycle, causing miniaturization (decreased size) of the follicles. The effected hair becomes progressively shorter and finer until it eventually disappears.

DHT is formed by the action of the enzyme 5-alpha reductase on testosterone. Finasteride is a drug that works by blocking the enzyme 5-alpha reductase Type II that converts testosterone to dihydrotestosterone (DHT) in the hair follicle. Propecia, the brand name for finasteride, is the only FDA approved oral medication for hair loss. Finasteride causes a significant drop in both scalp and blood levels of DHT and its effect is felt to be related to both of these factors. Finasteride 1-mg/day decreases serum DHT levels by almost 70%. As serum testosterone level actually increased by 9%; but this is within the range of normal.

Side Effects of Finestaride

Side effects from finasteride at the 1-mg dose are uncommon, but reversible. The one- year drug related side effects were 1.5% greater than in the control group. The data showed that 3.8% of men taking finasteride 1mg experienced some form of sexual dysfunction verses 2.1% in men treated with a placebo. The five-year side effects profile included: decreased libido (0.3%), erectile dysfunction (0.3%), and decreased volume of ejaculate (0.0%).

Most reported cases of sexual dysfunction occurred soon after starting the medication, but there have been reports of sexual dysfunction that have occurred at later points in time. The sexual side effects were reversed in all men who discontinued therapy, and in 58% of those who continued treatment. After the medication was stopped, side effects generally disappeared within a few weeks. When finasteride is discontinued, only the hair that had been gained or preserved by the medication is lost. In effect, the patient returns to the level of balding where he would have been had he never used the drug in the first place. No drug interactions of clinical importance have been identified.

Hair restoration is increasing segment of elective cosmetic surgery because of its natural, proven and permanent results.