Treatment Options
The medical community’s knowledge of the cause of hair loss and hair loss treatments available has evolved exponentially over the last 20 years. Unfortunately, there is no present “Magic Bullet” to cure hair loss, but there are some very legitimate and good hair loss treatments, be it surgical, medical, or cosmetic. At times, it is difficult to differentiate between the legitimate treatments, such as hair transplants, and the gimmick treatments (i.e.- snake oil vendors), so be very wary.
Surgical Treatments
There are many different surgical techniques to correct androgenetic alopecia:
Hair Transplants
Scalp Reductions
Scalp Flaps
Medical Treatments
There are presently 2 medications that are FDA approved for male pattern hair loss:
Finasteride (Propecia)
Minoxidil (Rogaine)
There are no other medications on the market that can claim that their product causes clinically significant hair growth.
Cosmetic Treatments
There are a variety of cosmetic treatments, such as:
Hair pieces
The natural look has greatly improved over the years to the point where it is hard to tell normal hair from a hairpiece. The biggest down side is the continual maintenance that is involved in keeping it looking natural. Hair transplants and the present medications will never give you back the head of hair you had as a youth. I recommend hairpieces for my patients that will not be satisfied with anything less than a dense, full head of hair (like they were when they were 18 years old).
Cosmetic concealers
There are many sprays and powders that give the illusion that there is less baldness, some are much more cosmetically elegant than others are, but none look like natural hair. All of these products need to be applied daily.
Micropigmentation (tattoo)
Although this option allows the look of fuller density by tattooing dots directly on the balding area, mimicking a shaved scalp; as in any cosmetic approach, there is maintenance needed to continue the appearance of a natural looking shaved head.
Gimmick Treatments
One needs to be aware that there are many companies and doctors that play on the vulnerability of people with hair loss. There are numerous unethical companies that make claims that their products cause “fuller and thicker looking hair” and hope you interpret that as causing clinically significant hair growth. However, you will never get these companies to put in writing that their product “cause clinically significant hair growth” because they do not!
See blow for a partial list of unsubstantiated and/or false claims:
“Balding men have poor vascular supply to the balding area.”
Numerous studies have shown that the vascular supply to the balding scalp is just as good as the non-balding scalp.
“Balding men have plugged follicles.”
A plugged follicle will not stop a hair from growing.
“Balding men have diseased scalps.”
There are a few rare diseases that can cause hair loss, but hair loss caused by disease is not in the same pattern as male patterned baldness.
“Lack of vitamins causes hair loss.”
Hair loss due to a vitamin deficiency is rare in the United States. It is more common to see vitamin toxicity as a cause of hair loss.
“Some companies use electrical stimulation to the scalp or massage therapy.”
No studies have been shown that this causes clinically significant hair growth.
“The Demodex mite (a normal human mite) causes hair loss.”
This is completely unsubstantiated. The Demodex mite is found in most hair follicle in adults, not in just the hair follicles of balding men. And if the Demodex mite truly did cause hair loss, why doesn’t it cause hair loss of the eyebrows, of the beard region, or of the sides of the head where it is also found?
Dr. McAndrews M.D. is a Board-Certified Dermatologist specializing in the treatment of hair loss. He is a Clinical Professor at USC School of Medicine, teaching the residents the latest advances in medical and surgical treatments of hair loss. The single most important lesson he teaches all residents is to make sure a patient with hair loss has realistic expectations about what the various treatment options can achieve.
Surgical Treatments
Dr. McAndrews has been interviewed many times by television news programs and national newspapers about the latest advances in hair loss and hair restoration technology.
Hair restoration clinics are springing up as quickly as 24-hour mini-marts and fast food restaurants. Unfortunately, the patient is left to determine if a particular procedure is the right match or if a doctor has adequate training to perform that procedure.
We believe that an informed patient is the best patient. There are many different surgical techniques to correct androgenetic alopecia and it is important that our patients understand the risks and benefits of each and make an informed decision.
Hair Transplants
Hair transplants have evolved dramatically since Dr. Norman Orentriech, a Dermatologist, first developed the surgical procedure in 1959. Dermatologists have made huge strides over the past several years, creating hair transplant techniques that are undetectable and look completely natural. Please follow this link for a detailed description of Hair Transplants.
Scalp Reductions
Scalp reduction is a technique where a portion of the bald scalp is surgically removed and the hair-bearing scalp is stretched over that area. In theory it sounds logical, however in reality it is highly illogical. The downside to scalp reduction surgery is many:
It has a higher complication rate than hair transplants.
It leaves a scar in the balding area, which usually necessitates 2-3 hair transplants to hid. (It would be more logical to do 2-3 hair transplants in the first place instead and avoid the complications of scalp reductions.
Many times the scalp stretches back, which leaves the patient with the same amount of bald scalp and a visible scar that can be difficult to mitigate.
When a patient has a limited “hair bank,” it is far more important to use that “hair bank” to create a frontal forelock to frame the patients face. Unfortunately, scalp reductions only reduce the bald scalp in the vertex and on the sides of the patient’s scalp. Scalp reduction often does a patient a disservice by using most of the “hair bank.” Eventually, the patient will need this “hair bank” (that will no longer be available) to frame the face.
Dr. McAndrews no longer performs scalp reductions because he believes that there is no discernable benefit when compared to current hair transplant techniques.
Scalp Flaps
There are several different techniques used to create scalp flaps. Scalp flaps were developed to shift hair from the sides and back of the scalp to the balding front of the scalp. These methods address the issue of using the limited “hair bank” to frame the face, unfortunately they are fraught with complications and produce an unnatural look:
It is a very complex procedure that is performed in stages over several weeks.
The complication rate is much higher than that of a hair transplant and potentially devastating (i.e.- necrosis or tissue death, of the whole scalp flap).
It usually looks quite unnatural.
It usually crosses over the frontal -temporal triangle (an area that is naturally bald in most men) creating a very unnatural look, resulting because the face is not framed correctly in relation to the hairline.
The hairs along the hairline are directed in the wrong direction, creating an unnatural look (usually hairs on the hairline naturally point forward, in the flap all the hair along the hairline is usually directed sideways.
The flap creates an unnaturally dense look right on the hairline.
The flap creates a scar in front of the hairline, which now needs to be hidden with hair transplants. (Why not just have a hair transplant instead?).
It is an inefficient use of the “hair bank.” Dermatologic studies have shown that the naked eye cannot distinguish the difference between a scalp that has 50% hair density versus 100% hair density. The flap method shifts a large portion of the “hair bank” to the frontal hairline at 100% density. A Hair Transplant could have used this same donor area and spread it over twice the area as the flap at a 50% hair density, with the appearance of the same density to the naked eye.
For all the above reasons, Dr. McAndrews will not perform scalp flaps.