Trends in hair restoration don’t just affect the physicians who offer it in practice, but also consumers who might not have considered themselves candidates in the past. Among those trends: better instrumentation for follicular unit extraction; more donor sites, opening the door to new candidates; an option for transplanting hair to scarred skin; and the possibility of a treatment alternative that might halt progression or help increase growth in early hair loss.
Two physician experts who participated in hair restoration sessions at the April 12 - 15 American Academy of Facial Plastic and Reconstructive Surgery’s “Facial Rejuvenation: Master the Techniques” meeting in Chicago, share what they say colleagues need to know about what’s new in hair restoration.
Focus on Follicular Unit Extraction & Replacement
Hair restoration experts agreed that there’s no question that follicular unit extraction and replacement is the procedure of choice today for hair replacement, according to Vail, Colo., facial plastic and reconstructive surgeon Devinder S. Mangat, M.D., who moderated three panels on hair restoration at the meeting.
“It was a panel discussion with a couple of other panel members, including Jeffrey S. Epstein, M.D., who is considered one of the authorities on hair replacement,” Dr. Mangat says. “Everybody agrees follicular unit extraction and replacement is the best way because it gives you the most natural result and, uniformly, these patients are very happy with the outcome.”
Follicular unit extraction and placement has become state-of-the-art, allowing providers to transplant hair in mega sessions, with 1,500 to 3,000 follicular grafts at a time.
“You can do almost do the entire hair replacement in one session, which is better for the patient,” he says.
But what about follicular unit extractions that are done by the physician and his or her team, versus by grafting technicians employed by the device company, who go to individual practices and do the same work?
“You have two schools of thought: One where the physician, who has his own team of technicians, does these procedures manually. The second alternative is to use the NeoGraft system, where the follicular units are extracted mechanically with a powered system, and they’re placed in the same manner,” Dr. Mangat says.
When using the NeoGraft device, Dr. Mangat explains, one or two company technicians typically assist the physician or the practice in performing the procedure. The physician plans the new hairline and administers local anesthesia for the procedure, which is done in the surgical facility or office. The technicians basically do the rest, under the physician’s supervision.
Panel members agreed that whether providers do follicular unit extraction and replacement manually or mechanically, the results are identical, Dr. Mangat said.
To achieve optimal results from follicular unit extraction and replacement, providers should focus on accurately extracting units, so that the hair follicle is left intact and undamaged. Dr. Mangat says putting these patients on Propecia (finasteride, Merck) helps with new hair growth and avoids the telogen phase. Use of ultraviolet light after treatment also helps new hair growth and reduces hair loss, he says.
A Question of Candidacy
“We have an even deeper appreciation for how outstanding the results from hair restoration are these days, in a variety of circumstances,” according to Lisa Ishii, M.D., MHS, professor of otolaryngology, head and neck surgery and director of research, facial and plastic reconstructive surgery, at Johns Hopkins Medicine, who presented on hair restoration at the meeting.
Today’s candidates include men and women experiencing pattern hair loss, patients with scars, as well as men who don’t have substantial numbers of hair roots on their scalps but have a lot of hair on other body parts, such as the beard, mustache, chest and back, according to Dr. Ishii.
“Sometimes the beard hair, because of its texture, is more amenable and gives a more significant hair density look than scalp hair. Patients who have very fine scalp hair but relatively denser beard hair would benefit from that kind of procedure,” Dr. Ishii says.
Experts at the meeting also talked about use of platelet-rich plasma (PRP) for hair loss.
“In patients who have pristine skin, PRP probably is not adding much. But for patients who have scarred skin, for example, it can make a tremendous difference in the take of the individual hair grafts,” Dr. Ishii says. “We’re hoping that for patients who are very early in their progression of pattern hair loss, that beginning treatment with PRP can either halt that progression or perhaps contribute to increased growth — restoring density in the area that is starting to show some loss. There’s more to come on that, but it’s an exciting new innovation in hair.”
Looking at the future of hair restoration, Dr. Mangat says it’s entirely possible that topical drugs will replace procedures.
“I personally think that we will get to the point where you can use topical treatments that will grow hair much like we already have with the Latisse (bimatoprost ophthalmic solution, Allergan) system for eyelashes,” he says. “I believe that, within the next decade, hair replacement may become a thing of the past and topical application of drugs will cause the hair to grow.”