The recent Annual meeting of the International Society of Hair restoration Surgery saw discussion of upcoming medications to treat male pattern hair loss. In particular we were intrigued to understand that different versions of prostaglandins (chemicals involved in inflammation) have opposite effects on hair growth! Some prostaglandins have recently been shown to inhibit hair growth, whereas others are well known to stimulate hair growth. Perhaps the most exciting part of the research is that some medications currently being developed to treat asthma via inhibiting specific prostaglandins could have an unexpected benefit in stimulating hair regrowth in balding males. These new compounds are still a couple of years away but may turn out to be the next generation of medicines that positively affect balding.
Hair Transplant Blog - The Knudsen Clinic
I just recently came back from the Asian Association of Hair Restoration Surgery Annual Meeting in Seoul – Korea. The meeting was well attended with 250 surgeons there to find out the most up to date information concerning hair loss treatments.
Of particular interest to me were the talks referencing the influence of the recipient site on the growth rate of the transplanted hair. Original research was performed in Korea more than 10 years ago and showed the surprising result that, contrary to our initial belief, the body site where the transplanted hair is placed influences and changes the future growth rate of the hair.
The relevance of this result is that hairs in different areas of the body grow at different rates. When using scalp hair to reconstruct eyebrows the transplanted hairs initially grow at the scalp hair rate (three times faster than the eyebrow rate of growth). This means that the new transplanted eyebrow hairs need to be trimmed regularly because they grow much longer and quicker.
Over time the surrounding eyebrow skin influences the transplanted hairs and they slow down a lot to more match the growth of normal eyebrow hairs. More interestingly, if the transplanted hairs are removed from the eyebrow and then re-transplanted in to the scalp again, they begin to speed up their growth rate again! Simply amazing!
Another benefit from this research is that it proves that certain body hair can successfully be used to replace lost hair in the scalp and over time these body hairs will resemble natural scalp hairs in their appearance and the hair regrowth rate. Despite these compelling results, body hairs should only be considered as a last resort when there aren’t any more usable scalp hairs available to use as donor hairs.
A large amount of internet and media interest has recently focused on claims of persistent sexual side-effects long after discontinuing the use of Propecia (finasteride) hairloss medication. A study published by Irwig in 2011 suggested the occurrence a high incidence of long-term sexual side effects in some Propecia users. It should however be noted that this study was not a study of Propecia users in the general population, but a sample of men already claiming to have long-term side effects.
While not wishing to cast doubt on these patient claims, I do find them somewhat surprising. In over 14 years of prescribing Propecia/Proscar, to well over 4000 of my patients, I have no reported case of permanent sexual side-effects. Those few patients who reported these side-effects recovered fully after stopping taking the medication. In most cases recovery occurred within 4 weeks, in a couple of cases it was about 2-3 months until full recovery. A couple of recently published medical studies from Japan and Italy support the previously published lower incidence of side-effects and the long term effectiveness of Propecia. The Japanese study by Sato followed 3177 men for 3 years and the Italian study by Rossi followed 113 men for 10 years. In both studies, over 80% of patients show long-term growth and stability on the medication without any significant side-effects.
Another factor, largely unknown, is that the frequency of sexual side-effects depends upon the dose used. In my hands, I have consistently recommended a dosing of a 1 mg tablet three times a week for the last fourteen years. This is because Propecia lasts much longer than 1 day in your system. In fact, the enzyme is blocked for up to 1 month! This means that you can maintain the effectiveness of Propecia without having to use it every day. The other great benefit is that, the frequency of sexual, or other, side effects drops dramatically if you only take the tablet every 2-3 days.
I believe that my frequency of patient sexual side effects is approximately 1 per 200 patients on 3 tablets per week and even less frequent on 2 tablets per week. All my patients have fully recovered after stopping therapy. Some who could not tolerate 3 tablets per week were able to be re-introduced to 2 tablets per week without any side effects.
With regards to altered mood (depression) whilst on Propecia, I have seen this in a handful of patients. It occurred quickly after starting the medication and resolved quickly on stopping the Propecia tablets. In summary, Propecia remains a very effective and also very safe treatment for male pattern hairloss. It has demonstrated clear superiority compared to other treatments for hairloss and side effects can be significantly reduced with adjusted or lower doses.
Recently an international conference heard an in-depth panel discussion about Finasteride and sexual side-effects. It was again emphasized that Finasteride is a safe medication, side-effects were largely dose-related and disappeared upon stopping the medication. It was felt that recently media reports about the incidence and severity of side-effects was significantly overstated and that it remained the medication of choice for treating male pattern hair loss. In my hands, side effects are quite uncommon and only a small intermittent dose of Finasteride is required to achieve long-term stability of the hair loss in most balding men.
A recent trend for male patients is the desire to wear short hair after surgery. With this we have received many enquiries at our Sydney Hair Loss Treatment Clinic about whether this is possible. The good news is that this can be achieved because the modern donor technique overlaps the donor area skin edges while stitching allows hair to grow back through the scar. This is called the trichophytic technique and almost always creates an excellent result that is almost undetectable, even with a very short number 2 cut!
Some patients request the ability to shave their head after the transplant. This is a bit unrealistic however no matter which technique is used for the hair transplant. All surgery creates scarring to a certain degree but the modern techniques that we use minimise the visibility in both the recipient hair area (the balding area) and the donor hair area. Our website has more information about Hair Loss Treatments and Hair Transplant Surgery. If you have any questions about this or would like to chat to us, please feel free to visit our Sydney Hair Loss Clinic or call us on 02 9363 9308.
There has been a lot of interest in low powered laser devices and their effect on hair loss. Recent research suggests that it has a stimulatory effect on hair follicles. This could be an effective secondary (i.e. additional) treatment for hair loss in patients who are balding or thinning. It certainly also may be effective in seasonal increased hair shedding (a moult).
However, the delivery system and amount of laser exposure is critical to the chances of success. A new device called the Lasercap, applies 224 laser lights continuously to the scalp in the comfort of your own home. It uses rechargeable batteries, can be worn under a cap or hat and can be used at your convenience. Suggested dosage schedules is 15-30 minutes every second day.
The major advantage of this device, compared to hand held devices, is that the correct energy level is continuously applied to the scalp. Hand held laser devices only apply energy for a very short period of time if used to the manufacturer’s instructions. If you would like to know more about this additional treatment for hair loss, please call our Sydney Hair Loss Clinic on 1800 685 399. The Lasercap can also be ordered directly from our Sydney Clinic.
Many patients are reading about the supposed superiority of Follicular Unit Extraction (FUE) over Strip Harvesting during hair transplant surgery. Please be aware that it is very important to separate the marketing from the science. Both techniques involve cutting the of the skin. There is no such thing as a scarless technique.
Both techniques produce the same size graft. Both techniques leave scars which may, or may not, be visible to the naked eye. The difference is that FUE produces circular, small, dot scars that may also have a white appearance. Strips produce linear scars that may have hair growing through them and be very difficult to see. Short haircuts are usually possible with either technique but shaving the head will probably demonstrate scars with either technique.
We will provide regular updates on new information relevant to hair loss treatment. The latest news for people with thinning hair is that Minoxidil is now available in a foam solution (Rogaine Foam) from the chemist or our Clinic in Sydney. It is less irritating than the lotion and just as effective! Our Sydney Hair Loss Treatment Clinic will be closed from December 24 till 10th of January. Merry Xmas to our patients. Dr Knudsen will be available on his mobile for existing patients.