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Severity of hair loss, patient preference determines type of restoration procedure

Article-Severity of hair loss, patient preference determines type of restoration procedure

Key iconKey Points

  • Two main goals in treating patient with hair loss are slowing or stopping progression of loss and improving hair growth
  • Pharmacological regimens and low-level laser light therapy are noninvasive treatment options
  • Follicular unit transplantation allow

Whether using a surgical or a nonsurgical technique, male hair restoration procedures in today's state-of-the-art medicine work. The choice of procedure depends in part on the patient's preference, as well as the severity of the hair loss already experienced by the patient, according to one surgeon.

The two main objectives when treating the male hair loss patient are to slow down — and possibly stop — the progression of hair loss and improve hair growth. These goals can be achieved surgically using various techniques, and/or nonsurgically with the help of oral and/or topical medications, says Edwin S. Epstein, M.D., past-president of the International Society of Hair Restoration Surgery, diplomate of the American Board of Hair Restoration Surgery and Bosley associate surgeon, Virginia Beach, Va.

"In hair loss patients, the most important goal is to first stop the progression of the hair loss. In my opinion, it is best to proceed with conservative treatments particularly in younger men just starting to experience hair loss, as these approaches can be very successful in halting progression," Dr. Epstein says. "Surgical techniques could be employed should conservative approaches fall short of set treatment goals."

Though surgical techniques can be used in both male and female hair loss patients, with males constituting the majority of candidates, approximately 10 percent of these procedures are conducted in females, Dr. Epstein says. The majority of female patients usually are not good candidates for these procedures due to the nature of female-type hair loss, which is much more diffuse throughout the scalp and typically extends into the usual donor area, limiting the amount of hair available for transplant, he says. Therefore, female hair loss patients largely must turn to nonsurgical options.

NONSURGICAL OPTIONS Medical treatment approaches used in male hair loss patients consist of pharmacological regimens such as oral finasteride, oral and/or topical minoxidil and low-level laser light applied to the scalp via a brush or a helmet-like device. According to Dr. Epstein, the laser light devices locally stimulate protein growth factors in the scalp, which is likely similar to the mechanism of action of topically applied minoxidil.

Of the nonsurgical treatments, finasteride is the most effective in terms of stopping hair loss progression, Dr. Epstein says. As with any at-home treatment, however, compliance is a major issue. The more motivated a patient is, the more likely he will adhere to treatment protocol.

"Some patients may initially get discouraged with conservative approaches because of the gradual process of hair growth. A hair cycle lasts three months, which means that the initial results of treatment for minoxidil or light therapy may be first realized four to six weeks after the initiation of therapy, and four to six months after the initiation of finasteride treatment," Dr. Epstein says.

According to Dr. Epstein, conservative treatments should be tried for at least one year in order to make an accurate assessment of therapy success or failure. In patients who are hair transplant candidates, a combination approach is the optimum for restoring hair loss, he says.

SURGICAL TECHNIQUES Varying surgical techniques are available, including follicular unit transplant (FUT) using strip linear harvesting; follicular unit extraction (FUE) using motorized handheld machines or robotic technology; scalp reduction/extension; and scalp flaps. The latter two approaches are rarely used today, Dr. Epstein says.

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