Once you have been evaluated by a physician and concluded you indeed have hair loss, you have several options for restoring your hair, slowing the rate of hair loss or camouflaging your hair loss. Many individuals accept and embrace their new appearance or temporarily try to disguise their hair loss. However, depending on the severity or type of hair loss and your lifestyle, there are many medical and non-medical treatments and solutions that may be right for you.
Surgical Hair Loss Treatments
All four of the surgical treatments for hair loss move active, hair producing follicles from one site on the scalp to another. Moving hair from an area where hair is more plentiful and less likely to be lost to areas where hair is thinning or missing. While all of these surgical treatments have shown proven success, achieving natural-appearing results has made Transplantation the most widely used surgical procedure for diminishing the appearance (or is the treatment of the condition of hair loss) of hair loss.
The four surgical treatments for hair loss are:
- Hair Transplant: Gone are the days of the “plugs.” Hair transplantation today achieves a natural look and is made possible by better understanding of the scalp and hair biology, refined surgical techniques and ever-improving surgical instruments.
- Scalp Reduction: Scalp (Alopecia) reduction surgically removes bald scalp skin in areas of hair loss and pulls adjoining hair-bearing scalp skin together to eliminate the bald spot.
- Scalp Expansion: Scalp expansion is a modification of alopecia reduction. A balloon-type device is placed under the scalp and slowly inflated and expanded over a period of several weeks to create a “dome” or “bubble” of stretched scalp skin. A series of surgical procedures reduces the area of hair loss by alopecia reduction surgery, removes the scalp expansion device, and completes closure of hair-bearing scalp to achieve complete alopecia reduction.
- Scalp Flap Transfer: Flap procedures are used in both cosmetic and reconstructive surgery. In the treatment of hair loss, a flap of hair-bearing scalp tissue is surgically raised from underlying tissue and transferred to a prepared scalp site with hair loss.
Non-Surgical Hair Loss Treatment
As long as people have been concerned about hair loss, there have been products that claim to stop or cure it. Until scientific research discovered the cause of androgenic alopecia (hair loss), medical treatments for hair loss were hit-or-miss.
Today there are products on the market that claim to reverse hair loss, but only two medications have FDA-recognized effectiveness – minoxidil and finasteride.
- Minoxidil: Minoxidil is available over-the-counter and applied topically to the scalp skin in areas of hair loss. Monoxidil is marketed under the brand name Rogaine®. Minoxidil is available in both 2% and 5% strengths. The 5% strength has been shown to be more effective in both men and women in slowing hair loss and promoting new hair growth. Results of Minoxidil’s effectiveness in slowing or halting hair loss to some degree in men have ranged from 50% to 80% of men treated. A lower percentage has reported new hair growth. Minoxidil is ineffective for some men and women who continue to lose hair. While it is available without prescription it is used most effectively in a physician-guided program of hair restoration, after the cause of hair loss has been diagnosed. Minoxidil’s mode of action is not completely understood. It appears to act to prolong the anagen (growth) phase of the hair follicle.
- Finasteride: Finasteride is available only by prescription and is taken orally daily. It is marketed under the brand name is Propecia®. Its mode of action is well understood thanks to research that documented the hormonal cause of hair loss in androgenic alopecia. Finasteride inhibits the enzyme that converts testosterone to dihydrotestosterone (the dreaded DHT everyone with hair loss is ware of) in the follicle. Finasteride has proven highly effective in clinical trials and in medical practice for slowing hair loss in almost all men and stimulating new hair growth in some men. It can be used alone or in conjunction with other hair loss treatments, including surgery.
- Pyrithione Zinc: Pyrithione zinc, an ingredient in some anti-dandruff shampoos, has been shown to improve hair growth in men with Hamilton-Norwood Type III or Type V hair loss. (see Androgenetic Alopecia). The improvement in hair count (hairs per square centimeter) was modest but sustained over a 26-week randomized clinical trial using a 1% solution of pyrithione zinc in an anti-dandruff shampoo. The finding is being followed up by further investigations. Pyrithione zinc or anti-dandruff shampoos have not been approved by the FDA as hair loss treatments.
Laser Hair Treatment
Low level laser light, when applied to the scalp, is one of the newest therapies to treat hair loss. Laser therapies for hair restoration are available through hand-held laser devices and may be used at home, or in a medical setting under a physician’s supervision.
What are the facts about laser therapy for hair loss? Let’s take a look through evidence-based facts and unsubstantiated claims to learn about this treatment option.
Definitions: Understanding the Terminology
Lasers are widely used in medicine, in industry, in the military, and of course, as weapons in science-fiction. The laser’s energy used to stimulate hair growth is visible in the red light spectrum. Their use in treating hair loss and other medical conditions is defined as low-level laser therapy (LLLT). LLLT is sometimes included under a broader definition of phototherapy called “low-level light therapy” where the light-emitting device may be a laser or a light-emitting diode (LED).
Only laser energy has been proven effective in the treatment of hereditary hair loss whereas phototherapy using lasers and LEDs have numerous uses in medicine.
How LLLT Works
Light from a laser has an effect on your body when the specific wavelength of light is absorbed by molecules of the target tissue. When light energy is absorbed by target tissue molecules, the energy level of the molecules is increased and the molecules respond by “working off” the excess energy with adaptive changes. These changes may be chemical or physical and they may have biological effects on the target tissue or surrounding tissues.
Because the changes in the molecules are brought about by phototherapy, chemical changes are said to be due to “photochemistry” and physical changes to “photophysics.” As a result, the biological effects on tissue are called photobiomodulation. See Laser Therapy (LLLT) for Treatment of Androgenetic Alopecia in Men and Women for more information.
LLLT Today: Delivery Systems
Hand-held devices are sold for home use in treating hair loss. While there are many products in this category, the market leaders in hand-held laser devices are Spencer Forrest’s X5 Laser® and the HairMax LaserComb®. These two devices have significant differences in their coverage area, total power, number of laser diodes, output, and cost, but share the same laser wavelength and laser class. Both devices are available for purchase from reputable online sites, directly from the manufacturer or, in the case of the Laser Comb, through a physician’s office.
There are many differences in hand-held laser devices, but the two market leaders make the following claims.
The X5 bypasses intervening hair by making direct contact with the scalp using diodes. The X5 Laser is marketed as a cosmetic device and needs no further clearances to be sold for this purpose, but the company continues to conduct ongoing clinical studies and research for FDA clearance.
The LaserComb provides lasers which are located in a vertical line along the center of the LaserComb device. As the LaserComb moves across the head, the hair-parting teeth push aside hair to create a direct path between the laser beams and the scalp. The LaserComb device was cleared by the FDA for use in promoting hair growth in males who have Hamilton-Norwood Type II to Type V androgenetic alopecia (hair loss) (see Hair Loss and Its Causes). It received FDA 510(k) Clearance for Marketing. The key component of the clearance was a clinical study proving efficacy and safety of the device.
LLLT in a medical setting may be delivered by a device that looks somewhat like a “hood” used in a beauty parlor. Panels in the “hood” deliver a measured LLLT dose to a specific area of the scalp for a precise period of time. The devices are classified under FDA standards for the patient’s safety, but these devices do not have FDA Clearance for Marketing.
Manufacturers of hand-held and “hood” devices offer recommendations for safe and effective use. Physician hair restoration specialists who offer LLLT as a hair restoration option also follow safety/effectiveness protocols they have found to be optimal.
LLLT Today: Who Will Benefit from Its Use?
Hair loss can be due to inherited, metabolic, autoimmune or infectious causes. Medical experts who specialize in treating hair loss agree that treatment should be based on the correct diagnosis of its cause. Inherited androgenetic alopecia is a common cause; however, hair loss due to a condition such as hypothyroidism will only be corrected only by adequate treatment of the metabolic disorder.
Medical experts also agree that LLLT should be considered as an option only for the treatment of androgenetic alopecia-inherited male and female pattern hair loss. There have been no studies showing that LLLT is effective in treatment of hair loss due to other causes.
Physicians who use LLLT in treating androgenetic alopecia have usually found that LLLT is most effective in persons with minimal to moderate hair loss but is less effective with major hair loss. Keep in mind, responses to LLLT is somewhat unpredictable and results vary from person to person.
People considering LLLT for the treatment of hair loss, at home, or in a medical setting, should not undergo treatment until a correct diagnosis of the cause of hair loss has been made by a physician specializing in hair loss treatment.
LLLT Today: Is It Effective in Hair Restoration?
Medical experts reviewing currently available data1 agree that LLLT can be effective in treating male and female pattern hair loss when either used alone or in conjunction with other medical therapies. Physicians have observed that the overall condition and health of existing hair may be improved in a LLLT treated area, even if no new hair growth is stimulated.
LLLT has been observed to improve outcomes of hair transplantation by improving patency of grafts and speeding healing time.
Data from the first randomized, double-blind, multi-center study was published in 20092. This was a double blind, multicenter study of treatment of male pattern hair loss comparing use of the LaserComb, with an inert “sham” device.
LLLT Today: How Do LLLT Results Compare with Other Treatments for Androgenetic Alopecia?
In the United States, finasteride (Propecia®) and minoxidil (Rogaine®) are the only medications approved by the FDA for treatment of androgenetic alopecia. The effectiveness of these medications has been investigated in many well-designed studies over many years.
By comparison, data regarding effectiveness of LLLT is available only from small studies and one double-blind study published in 2009. Comparison of results on the basis of peer-reviewed evidence is difficult; however, physicians and hair restoration specialists have favorably assessed the efficacy of LLLT in everyday treatment of androgenetic alopecia based on global assessment of the patient’s hair loss and medical status.
LLLT Today: How Long Does Treatment Take to Be Effective?
Hand-held devices come with recommended protocols for home use. LLLT in a medical setting may require regular therapy sessions over a period of months. As with the medical treatment of androgenetic alopecia, hair restoration using LLLT is not a one-time “fix” for hair loss. It must be repeated at intervals to maintain results; medical treatment also must be maintained to retain results.
The only permanent “fix” for androgenetic alopecia is hair transplantation or other surgical hair restoration procedure.
LLLT Today: How Much Does It Cost?
The LaserComb costs less than $500 and the X5 Laser costs less than $199. The cost of LLLT administered in a medical setting is set by the physician’s practice and can cost from several hundred to several thousand dollars depending on factors included in the treatment and other fees.
Photobiomodulation in the Treatment of Male and Female Pattern Hair Loss:
Many hypotheses have been offered to explain how LLLT photobiomodulation may stimulate new hair growth. While LLLT’s chemical and physical effects have occurred with new hair growth attributed to LLLT, none of these effects has been shown as the primary effect in stimulating new hair growth. It is however, hypothesized that LLLT mediates new hair growth through either a direct or an indirect increase in proliferative activity within the hair follicle epithelial matrix.
Evidence also points out that laser energy reverses follicular apoptosis and from observations of wavelength stimulation of optimal hair growth and from an ex-vivo study, it has been precisely what wavelengths, power, intensity are necessary for optimal effect in stimulating new hair growth.
It is important to note that heat is not associated with the photochemical and photo therapeutic effects of LLLT. While there are visible red wavelengths and low wattage of LLLT, a “cold light” laser produces no sensation on the skin of persons undergoing treatment.
Hair Systems & Prosthesis
Hair additions include partial hairpieces and hair extensions. The term “hair addition” is preferred today for the partial hairpieces that used to be called by the jocular terms “toupee” and “rug”. The partial hairpiece provides hair replacement only over a defined area of hair loss. It is attached to the scalp with an adhesive, by suction cups or to surrounding hair with clips, hair weaving or bonding with a chemical sealant.Hair extensions are techniques for bonding human or synthetic hair to existing hair to provide coverage, more density or additional length to existing hair. Techniques include hair-to-hair bonding with an adhesive, sewing or bonding of braids or cornrows to existing hair, hot-bonding with a glue gun, braiding or corn-rowing on netting bonded to underlying natural hair and clip-on extensions. Hair extensions can be adapted to purposes of hair replacement, but the most common purpose is cosmetic enhancement.
Hair Pieces & Extensions
Unlike wigs, which are whole-scalp, long-term solutions for hair loss, hairpieces are partial-scalp products which frequently have a limited period of usefulness before they must be replaced. The most common reason for having a hairpiece is to cover a bald spot, which is usually due to androgenetic alopecia (male- or female-pattern hair loss). Because androgenetic alopecia is progressive, a bald spot changes in size and shape over time. A partial hairpiece that covers an area of hair loss today may provide inadequate coverage as hair loss progresses.Because areas of partial hair loss are unique to each person, there are few satisfactory ready-to-wear partial hairpieces. A hairpiece must usually be made to order to meet the esthetic and physical requirements of the individual man or woman. The fitting and creation of a high-quality partial hairpiece requires skill and experience. A physician specializing in hair restoration can refer patients to a trusted professional. Hairpieces may also be available directly from cosmetologists who have the requisite training and experience to properly fit a hairpiece and assure its quality and workmanship.
Spray-ons & Thickeners
Spray on Hair: Thickening spray is a moderate hold spray used by both men and women with or without hair loss to achieve volume, lift and control in hair styling.
Products such as colored powders, bonding powders, sprays or lotions which are used to conceal areas exposed by hair loss, hair transplants, to create the illusion of fullness or to cover gray and/or undyed regrowth hair. Blended to match your hair and scalp color, these products can be applied to coat each individual hair and your scalp to provide an instant and cost-effective solution to the appearance of hair loss.
Our overall health and diet are integrally linked to having healthy hair. A lack of any one of your body’s essential vitamins and minerals, weight gain or loss, a change in diet, or stress can change the growth rate of your hair, may affect your scalp health, and can cause hair loss.