Hair Loss Treatment Options hair transplant

Hair Loss Treatment Options

 

Baldness, whether permanent or temporary, can't be cured. But treatments are available to help promote hair growth or hide hair loss. For some types of alopecia, hair may resume growth without any form of treatment.

Hair loss resulting from telogen effluvium or drug side effects usually requires no treatment. Hair loss from poor nutrition or medical illness usually stops with a healthy diet and treatment of the underlying medical condition. Treatment of fungal scalp infection requires six to 12 weeks of oral medication, such as terbinafine (Lamisil), with or without shampoos containing selenium sulfide (Selsun Blue, Head & Shoulders, others) or ketoconazole (Nizoral).

Many men and women with pattern alopecia are happy with their appearance and do not seek treatment for hair loss. Those who do seek medical help can be treated with the drugs topical minoxidil (Rogaine) or, for men only, oral finasteride (Propecia, Proscar), or they can choose hair transplants or scalp-reduction surgery.

 

Hair loss option: Propecia

Finasteride (Brand name: Propecia)
This drug given orally has been shown under continued usage to help preserve existing hair. It may be combined with minoxidil and other surgical techniques for excellent results.

Description

Women of childbearing potential should not use or handle crushed Propecia tablets. Propecia can cause birth defects in male fetuses.

Finasteride (fin-AS-tur-ide) belongs to the group of medicines called enzyme inhibitors. It is used to treat urinary problems caused by enlargement of the prostate (benign prostatic hyperplasia or BPH). In men with very enlarged prostates and mild to moderate symptoms (difficulty urinating, decreased flow of urination, hesitation at the beginning of urination, getting up at night to urinate), Propecia may decrease the severity of symptoms. Propecia may also reduce the chance that surgery on the prostate will be needed.

Finasteride blocks an enzyme called 5-alpha-reductase, which is necessary to change testosterone to another hormone that causes the prostate to grow. As a result, the size of the prostate is decreased. The effect of Propecia on the prostate lasts only as long as the medicine is taken. If it is stopped, the prostate begins to grow again.

Propecia also is used by some balding men to stimulate hair growth. If hair growth is going to occur with the use of Propecia, it usually occurs after the medicine has been used for about 3 months and lasts only as long as the medicine continues to be used. The new hair will be lost within 1 year after Propecia treatment is stopped.

Propecia is available only with your doctor's prescription, in the following dosage form:

Oral

• Tablets (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For Propecia, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to Propecia. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Women who are or may become pregnant should not take Propecia or should not be exposed to broken or crushed Propecia tablets, because it can cause changes in the genitals (sex organs) of male fetuses.

Older adults—This medicine has been tested and has not been shown to cause different side effects or problems in older people than it does in younger adults.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Proper Use of This Medicine

Propecia tablets may be crushed to make them easier to swallow. However, women who are or may become pregnant should not handle crushed Propecia tablets.

For patients taking this medicine for benign prostatic hyperplasia (BPH):

• To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.
• Remember that this medicine does not cure BPH but it does help reduce the size of the prostate. Therefore, you must continue to take it if you expect to keep the size of your prostate down. You may have to take this medicine for at least 6 months to see the full effect. You may have to take this medicine for the rest of your life. Do not stop taking this medicine without first discussing it with your doctor.
• This medicine helps to reduce urinary problems in men with BPH. In general, it is best to avoid drinking fluids, especially coffee or alcohol, in the evening. Then your sleep will not be disturbed by your need to urinate during the night.

For individuals taking this medicine for hair growth:

• You may have to take this medicine for at least 3 months to see an effect. The effect will last only as long as the medicine continues to be used. The new hair will be lost within 1 year after Propecia is stopped.

Dosing—

The dose of Propecia will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average dose of Propecia. If your dose is different, do not change it unless your doctor tells you to do so:

• For oral dosage form (tablets):
  • For treatment of benign prostatic hyperplasia (BPH):
    • Adults—5 milligrams (mg) once a day.
  • For hair growth:
    • Adults—1 mg once a day.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

Women who are or who may become pregnant should not handle crushed Propecia tablets. There is a risk that the medicine could get into the pregnant woman's body and cause birth defects in a male fetus.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• Less common
  • Breast enlargement and tenderness;  skin rash;  swelling of lips

  Breast enlargement and tenderness, skin rash and swelling of lips are more likely to occur with the 5-mg dose.

Other side effects may occur that usually do not need medical attention. The following side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• Less common or rare
  • Abdominal pain;  back pain;  decreased libido (decreased interest in sex);  decreased volume of ejaculate (decreased amount of semen);  diarrhea;  dizziness;  headache ;  impotence (inability to have or keep an erection)  

  A decrease in the amount of semen during ejaculation should not affect your sexual performance and is not a sign of any change in fertility.

• Incidence Unknown
  • Testicular pain 

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

 

Hair loss option: Minoxidil   Brand Names In the U.S.— Rogaine Extra Strength For Men Rogaine For Men Rogaine For Women In Canada— Apo-Gain Gen-Minoxidil Minoxigaine Rogaine Category Hair growth stimulant, alopecia androgenetica, topical Description Minoxidil (mi-NOX-i-dil) applied to the scalp is used to stimulate hair growth in adult men and women with a certain type of baldness. The exact way that this medicine works is not known. If hair growth is going to occur with the use of minoxidil, it usually occurs after the medicine has been used for several months and lasts only as long as the medicine continues to be used. Hair loss will begin again within a few months after minoxidil treatment is stopped. In the U.S., this medicine is available without a prescription. In Canada, this medicine is available only with your doctor's prescription. It is available in the following dosage form: Topical Topical solution (U.S. and Canada) Before Using This Medicine In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For topical minoxidil, the following should be considered: Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to Rogaine or propylene glycol (nonactive product in medicine). Also tell your health care professional if you are allergic to any other substances, such as preservatives or dyes. Pregnancy—Topical minoxidil has not been studied in pregnant women. However, some studies in animals have shown that Rogaine, when given by mouth, causes problems during pregnancy, although the studies have not shown that the medicine causes birth defects. Before using this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant. Breast-feeding—It is not known whether topical Rogaine passes into breast milk. However, Rogaine, taken by mouth, does pass into breast milk. Minoxidil is not recommended during breast-feeding, because it may cause problems in nursing babies. Children—Studies of this medicine have been done only in adult patients, and there is no specific information comparing use of topical minoxidil in children up to 18 years of age with use in other age groups. Use in infants and children is not recommended. If you think your child has hair loss, discuss it with the doctor. Older adults—This medicine has been tested in a limited number of older patients up to 65 years of age and has not been shown to cause different side effects or problems in this age group than it does in younger adults. However, studies have shown that the medicine works best in younger patients who have a short history of hair loss. Rogaine has not been studied in patients older than 65 years of age. Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are using topical minoxidil, it is especially important that your health care professional know if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine or if you are using any of the following on your scalp: Corticosteroids (cortisone-like medicines) or Petrolatum (e.g., Vaseline) or Tretinoin (e.g., Retin-A)—Use of these products on your scalp may cause too much topical minoxidil to be absorbed into the body and may increase the chance of side effects   Other medical problems—The presence of other medical problems may affect the use of topical minoxidil. Make sure you tell your doctor if you have any other medical problems, especially: Any other skin problems or an irritation or a sunburn on the scalp—The condition may cause too much topical minoxidil to be absorbed into the body and may increase the chance of side effects Heart disease or Hypertension (high blood pressure)—Topical minoxidil has not been studied in patients who have these conditions, but more serious problems may develop for these patients if they use more medicine than is recommended over a large area and too much minoxidil is absorbed into the body Proper Use of This Medicine This medicine usually comes with patient instructions. It is important that you read the instructions carefully. It is very important that you use this medicine only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may increase the chance of it being absorbed through the skin. For the same reason, do not apply minoxidil to other parts of your body. Absorption into the body may affect the heart and blood vessels and cause unwanted effects. Do not use any other skin products on the same skin area on which you use minoxidil. Hair coloring, hair permanents, and hair relaxers may be used during minoxidil therapy as long as the scalp is washed just before applying the hair coloring, permanent, or relaxer. Minoxidil should not be used 24 hours before and after the hair treatment procedure. Be sure to not double your doses of minoxidil to make up for any missed doses. To apply minoxidil solution: Make sure your hair and scalp are completely dry before applying this medicine. Apply the amount prescribed to the area of the scalp being treated, beginning in the center of the area. Follow your doctor's instructions on how to apply the solution, using the applicator provided. Do not shampoo your hair for 4 hours after applying minoxidil. Immediately after using this medicine, wash your hands to remove any medicine that may be on them. Do not use a hairdryer to dry the scalp after you apply minoxidil solution. Blowing with a hairdryer on the scalp may make the treatment less effective. Allow the minoxidil to completely dry for 2 to 4 hours after applying it, including before going to bed. Minoxidil can stain clothing, hats, or bed linen if your hair or scalp is not fully dry after using the medicine. Avoid transferring the medicine while wet to other parts of the body. This can occur if the medicine gets on your pillowcase or bed linens or if your hands are not washed after applying minoxidil. If your scalp becomes abraded, irritated, or sunburned, check with your doctor before applying minoxidil. Keep this medicine away from the eyes, nose, and mouth . If you should accidentally get some in your eyes, nose, or mouth, flush the area thoroughly with cool tap water. If you are using the pump spray, be careful not to breathe in the spray. Dosing— The dose of topical minoxidil will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average dose of topical minoxidil. If your dose is different, do not change it unless your doctor tells you to do so. For topical solution dosage form: For hair growth: Adults up to 65 years of age—Apply 1 milliliter to the scalp two times a day. Adults 65 years of age and older—Use and dose must be determined by the doctor. Infants—Use is not recommended. Children up to 18 years of age—Use and dose must be determined by the doctor. Missed dose— If you miss a dose of this medicine, go back to your regular dosing schedule. Do not double doses. Storage— To store this medicine: Keep out of the reach of children. Store away from heat and direct light. Keep the medicine from freezing. Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children. Precautions While Using This Medicine It is important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects. Tell your doctor if you notice continued itching, redness, or burning of your scalp after you apply minoxidil. If the itching, redness, or burning is severe, wash the medicine off and check with your doctor before using it again. Hair loss may continue for 2 weeks after you start using minoxidil. Tell your doctor if your hair loss continues after 2 weeks. Also, tell your doctor if your hair growth does not increase after using minoxidil for 4 months. Side Effects of This Medicine Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor as soon as possible if any of the following side effects occur: Less common Itching or skin rash (continued)  Rare Acne at site of application;  burning of scalp;  increased hair loss;  inflammation or soreness at root of hair;  reddened skin;  swelling of face  Signs and symptoms of too much medicine being absorbed into the body—Rare Blurred vision or other changes in vision;  chest pain;  decrease of sexual ability or desire;  fast or irregular heartbeat;  flushing;  headache;  lightheadedness;  numbness or tingling of hands, feet, or face;  swelling of face, hands, feet, or lower legs;  weight gain (rapid)  Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

 

Hair Transplant

 

Surgery

Twenty years ago, many people felt they risked looking like a Cabbage Patch doll if they chose surgery to eliminate baldness. Now, says Carlos Puig, D.O., director of Puig Medical Group, which is headquartered in Houston, better surgical techniques--used by increasingly skilled surgeons--are getting more eye-pleasing results.

"When I started in 1973 ... it was like the Stone Age," the cosmetic surgeon says, referring to the equipment and techniques in use. Now, he says, surgeons have learned to create a much more natural-looking hair line, using scalpels to cut either small slits or holes in the scalp to receive transplanted hair.

While there are numerous types of surgery, they can be sifted into two main categories: transplantation and scalp reduction.

Transplantation involves moving hair from densely covered sites on the sides or back of the head to bald areas of the scalp.

The key to success, explains Anthony Santangelo, president of the American Hair Loss Council, is to have good sites on the sides or back of the head from which to move hairs. Otherwise, patients can't expect ample coverage. Because their hair loss is diffuse, women generally lack good donor sites, making transplantation impractical for them.

The biggest improvement in transplants is with "micro" or "mini" grafts. "You're looking at one to two hairs shot into the head with a needle," Santangelo says. "It achieves a very, very fine, natural-looking hair line. The significant difference there is you need a lot of hair to do that."

Surgeons also use larger round plugs of seven to 10 hairs. Line grafts, the shifting of strips of nine to 12 hairs, are common, too.

One thing to keep in mind is that prosthetic hair fibers for transplantation are banned by FDA. Implanting them, according to Stephen Rhodes, acting chief of FDA's plastic and reconstructive surgery devices branch, caused a high incidence of adverse reactions, including infection.

If male-pattern baldness has left you with too much balding area to cover, you may benefit from scalp reduction: the surgical removal of large sections of a bald scalp. Extenders and expanders, elastic devices placed under the skin to stretch the hair-bearing scalp regions on the side of the head, have been used as a complement to reduction surgery.

Another surgical method is the flap technique, which rotates hair-bearing scalp areas from the sides or moves those areas from the back forward. The flap technique has the highest complication rate, though. Bleeding, scarring and infection can occur from surgery. But advances, such as knowing what size flap to use and how to enhance blood supply to the region, have cut down on the visibility of scars.

 

Hair loss option: hairpieces

Hairpieces

Finally, if you prefer to dodge the pain, time and cost of surgery, there's always the old, reliable hairpiece.

Obviously, all toupees and wigs are not created equal. Just as the transplant is only as good as the surgeon, the hairpiece is only as good as the person creating it and the materials used.

There are a variety of ways of affixing the hairpiece, which consists of human or synthetic hair implanted one hair at a time into a nylon netting. No method is permanent.

The hair weave involves sewing a wig into existing hair.

Also there are more traditional methods: You can use bonding (a type of glue), metal clips, or simple tape to attach the hairpiece to the scalp. Unlike the weaves, these give you the option to take the hairpiece on or off with ease. Many companies advertise "hair systems" or "hair clubs," which, according to Santangelo, offer check-ups to clean, color and tighten the hairpiece.

In addition to maintaining the cleanliness of hairpieces and wigs, it is important not to neglect the scalp under the wig. Keeping it clean and healthy avoids skin irritation and disease. Also, as a precautionary safety measure, first-time users of hairpiece adhesives and solvents should test a patch of skin for 48 hours to determine possible skin sensitization to these products.