The Trust me I’m a Doctor BBC TV show, which was on recently, had a 5 minute segment about balding men. Presented by a nearly bald doctor, it very briefly explained some of the choices. Generally it was accurate and helpful, mentioning Finasteride and Minoxidil, hair transplants and alternative medicine. It could easily have been a longer piece and it suggested that Minoxidil worked by blood flow, which is incorrect. However, at least it was fair and neutral and not jokey, unlike many TV shows.
Transgrafts in hair transplant terminology, means performing a high quality, densely packed hairline transplant – either FUE or FUT (strip) Only to the hairline zone. This can be seen more easily in the photo below, showing an initial session.
This then leaves space for a made to measure hairpiece to sit behind the transplants and then the transplanted hair brushed backwards over the hairpiece. The advantage of this is that the transplants hide the edge of the hairpiece, which otherwise can be a giveaway if the hair isn’t styled forward to cover it.
This transgraft technique is best used for patients who are happy with long term hairpieces but desire the ability to have more of a “quiff” hairstyle. eg.
Punchgrafts are the old fashioned method of hair transplants but in essence, very similar to FUE hair transplants.
Essentially the difference is that the punches used (sharp hollow metal tubes) are 4mm across instead of the very small 0.8, 0.9 punches we use now.. They do not give natural results: the difference is clear in the photos
A BBC website article poses this question, although the answer seems somewhat incomplete to our more expert eyes.
However, it is an important subject, so it’s good that at least it is getting taken seriously.
“For some people it may be the stuff of nightmares, but baldness isn’t just a male problem. Loose Women panellist Nadia Sawalha has posted an emotional video talking about losing her hair at the age of 52. But what is female baldness?
The TV presenter admitted her trademark curls were fake and that she was going through the perimenopause, which is the start of the menopause.
She revealed a doctor told her she had the balding gene.”
The news agency, Reuters, reports a trial from the John Hopkins School of Medicine in Baltimore, whether “hair transplants make men look more attractive” or not?
(Reuters Health) – Balding men who seek to look better or younger by undergoing hair transplants are on the right course, a small new study suggests.
People shown before-and-after pictures of hair transplant recipients rated men with more locks as looking more attractive and younger, researchers found. People also thought the men looked more successful and approachable after the procedure.
“In an attempt to get objective opinions on men’s appearances before and after the procedure, Dr Ishii and her colleagues asked 122 volunteers – 58 men and 64 women – to view 13 pairs of images. Seven pairs showed men before and after having had a hair transplant; the other six pairs were of men who didn’t have a hair transplant or any other significant cosmetic procedures between the two photographs.
The participants were asked to rate each image on age, attractiveness, successfulness and approachability.
The reviewers thought the men who’d had hair transplants looked about four years younger in their “after” photos. They also thought the men looked more attractive, successful and approachable after their procedures.
“It showed there were measurable improvements on measures that are meaningful to the patients,” she said.”
Hair cell jab could restore lost hearing, reports the Daily Mail.
Dr Robert Langer of MIT, explains how this breakthrough successfully regrew crucial inner ear hair cells in the laboratory. A drug combination helped create 60 times the number of hair cells than previously achieved. Although the hair cells are not the same as scalp hair cells, there will be biological similarities which could lead on to the “Holy Grail” of hair multiplication or even cloning.
James Nesbitt relates in a recent BBC interview, how having a hair transplant has really helped him keep working, getting more varied roles that he probably wouldn’t have got otherwise.
The Cold Feet, Murphy’s Law and Lucky Man actor, has gone on record to say how much having a couple of hair transplants has boosted his self confidence and attracting leading roles he may not have been chosen for.
Safety of Finasteride (Propecia) has been a hot topic for many patients, especially in the past few years. Although extremely rare, a label of PFS (post finasteride syndrome) was tagged onto various vague symptoms, mainly of a sexual nature but also including mood swings and depression. These are well known but uncommon and a recent study offers very strong evidence that these side effects are in fact, just as common in the general public who aren’t taking these drugs.
As reported in The British Medical Journal, September 2016, a group of 72,000 men who were taking Finasteride (Propecia) for prostate hyperplasia or male pattern (androgenic) alopecia, concludes there is no significant increased risk compared to those not taking the drugs.
Dr Rogers was asked to comment about five years ago, for a newspaper article regarding hair loss and exercise. At the time. there was a limited amount of information but further studies have been done since and there is now increased clarity about how exercise affects hair loss.
The take home message is that relatively short bursts of high intensity exercise, such as HIIT and weightlifting, bodybuilding etc, can significantly increase levels of natural anabolic and androgenic hormones in men and women. The principal one of course, is testosterone which is metabolised to DHT (dihydrotestosterone) well proven to cause hair loss.
Low intensity but prolonged aerobic cardio exercise, such as long distance running, reduces the levels of testosterone. It makes sense when looking at the physiques of marathon runners vs 100m sprinters.
Finally, as an aside, couch potatoes who become obese, may experience less hair loss. Fat cells metabolise testosterone into estrogen, so reducing the amount of DHT.
This update is about the options for female genetic hair loss – for other causes of female hair loss, please click here:
It has always been assumed until recently, that female pattern hair loss is a distinct genetic pattern of hair loss, inherited differently to men and not treatable with male medications. Hair transplants did help of course but it would be better still if further hair loss could be prevented.
However, at the ISHRS conference in Las Vegas, Dr Rogers attended a number of specialist lectures demonstrating a change in thinking about female pattern hair loss:
Essentially, there is more and more clinical, experimental and genetic evidence to suggest that male, androgenic pattern hair loss is the root cause of female pattern also. There is still a lot to elucidate yet as it is unclear why male pattern hair loss looks different to female pattern hair loss. Additionally, some men exhibit a female type pattern of hair loss and some women a male type of hair loss.
There have been a number of trials treating women with medications but they were inconclusive or contradictory. However, since the trials have increased the prescribed doses, it seems more women do respond to these hair loss drugs. It’s very specialised but includes:
spironolactone and cyproterone acetate
estrogels
Finasteride and Dutasteride
and a few more esoteric drugs as well. As can be seen, they are hormonally acting drugs, unlike Minoxidil
In addition stem cell treatments have also shown promise.
At the ISHRS Las Vegas conference, an interesting lecture suggested that from their case studies, there is additional benefit from combining Propecia and Avodart (Finasteride and Dutasteride respectively).
Specifically, those patients that had some response (i.e. it slowed hair loss but didn’t stop it or regrow hair) and those that previously had good regrowth of hair from Finasteride (but after five years noticed some deterioration again) did get improvement by adding just one 0.5mg capsule of Dutasteride once weekly whilst continuing their existing Finasteride dose.
This is interesting because it does demonstrate crossover benefits whilst keeping the dose very low, probably helped by the fact that Dutasteride has a long half life and adds just enough extra DHT suppression synergistically, to regain hair. It correlates with the known effect that for some men, the Finasteride effects do wane after five years – clearly lowering DHT is effective but some patients do need lower levels than others to completely stop the process.
We shall be recommending patients consider this option as it is a very cost effective treatment, especially now prices for Finasteride and Dutasteride have come down.
Dr Rogers was guest speaker at this year’s prestigious SKN conference 2016, presenting “the history, techniques and state of the art hair transplantation” to approximately 150 delegates attending the all day event.
There were many questions from the practitioners regarding hair transplants. Although now popular in the press, detailed knowledge of hair transplant surgery is less well known, even amongst other healthcare professionals. But Dr Rogers soon enlightened them and it was a very well received presentation.
To recap, modern hair transplants were actually invented in the 1930’s by Dr Okuda in Japan. A dermatologist, he researched transplanting hair in bald men to see if it worked. It did! He soon improved the technique to cover all aspects of a natural cosmetic result.
This international hair loss conference took place in Caesar’s Palace hotel over four days. It was very well attended, covering beginner’s workshops and more advanced courses. In brief;
Female hair loss treatments are now greater in number, especially since the evidence is now suggesting it has an androgenic basis in many cases and can be treated by hormonal and non hormonal methods.
FUE versus FUT (strip) is again a hot topic. Although FUT is still the majority choice (52/48%), clearly FUE is very popular. Notes of caution were made however, even by those strongly in favour of it in their own practice – “there is a danger that less well trained doctors see FUE as a simple skill that can be learned for extra income, without the experience in hair transplant planning to go with it.” Additionally, not all of a patient’s needs can be met with just one technique so FUE only doctors could be blinkered from the advantages of strip.
There are many FUE devices out there but no consensus as to which is best and possibly it actually depends on the patient characteristics.
Stem cell treatments such as the Stemvita clinic are at the accepted forefront of new hair loss restoration technology. Other researchers are backing up the good results now getting documented by Dr Khan at Stemvita: by using th e patient’s own stem cells to reactivate the repair pathways, miniaturising hairs can be strengthened again – to at least the same level as Finasteride achieves.
Careful quality control is important to grafts, particularly keeping them hydrated before efficiently reinserting them, although storage solutions weren’t the most important factor.
What is the difference between generic Finasteride 1mg tablets and genuine Propecia 1mg tablets?
In theory, none at all. Both should contain exactly the same amount of pure Finasteride (the chemical name of the drug). However, some doctors believe that small differences do occur between manufacturers, partly down to quality control and partly due to differences in the excipients i.e. the stuff that the tablet is made from.
We prescribe high quality generic Finasteride from a reputable pharmacy and don’t believe that there will be significant clinical differences in most patients but do leave the choice to the patient.
Our Propecia (finasteride & dutasteride) consent form has now been updated and placed in the download section.
Technically speaking, it is really a request for treatment form, not a consent form. It is your choice to ask for and take the treatment, rather than you agreeing to it. Sounds like a technicality but really it makes sense.
Lucky Jim 9 months HT update, demonstrating more vigorous growth of good quality hair and how well his strip (FUT) scar has healed, nearly invisible as can be seen in the short video.
This is probably the first thought that goes through the mind of most men when they first realise that something is happening to their crowning glory.
It is common to see that a lot of men go bald but not everyone knows the science behind it. Although factors such as stress and poor diet do make a difference, they are not the main culprits.
Hormones and genetics
Dihydrotestosterone (DHT) is a male sex hormone and is the main cause of hair loss. The reason that balding occurs is due to the hair follicle’s sensitivity to DHT, which causes them to shrink, or ‘miniaturize’. Miniaturization causes your hair to grow for shorter periods as well as becoming lighter and finer. This type of hair is often referred to as ‘peach fuzz’.
The amount of DHT produced in the body varies from one individual to the next. There is a certain “trigger” level reached at puberty which switches on the hair loss gene but the exact level for each man isn’t exactly correlated with the speed of hair loss although the lower the level of DHT, the better.
The most widely used drug to treat hair loss – finasteride, is essentially a DHT inhibitor. It works by reducing the production of DHT at a systemic level and therefore halting the advancement of male pattern balding.
Other causes of hair loss
Genetic hair loss due to sensitivity to DHT is responsible for the vast majority of cases of male pattern balding but is not the only reason why men lose their hair. Other causes of hair loss include:
Traction alopecia – this often occurs as a result of wearing a ponytail or other tight hair styles such as cornrows/braiding.
Medication – There are a number of medications that can cause hair loss, especially those for blood pressure, heart disease and diabetes.
Nutrition – It’s been shown that poor nutrition can cause hair to become weak and thin, however complete balding usually doesn’t occur.
Hair transplant techniques
Hair transplant techniques have advanced a huge amount over the last few decades. Doctors are now able to perform hair transplants in a way that offers a completely natural looking head of hair.
However, some patients are more suitable for a hair transplant than others. The ideal patient should:
Have mild to moderate hair loss – Although it’s possible to perform a hair transplant for guys with severe balding, the best results are achieved in those who have mild to moderate hair loss. This is because there is typically more donor hair and less coverage is required
Have a good amount of donor hair – A good amount of donor hair is vital for a successful hair transplant. This usually isn’t a problem since the donor hair is taken from the back and sides of the head and hair in these regions is genetically programmed to be permanent. This means that even those with severe hair loss usually have enough donor hair.
Have realistic expectations – Realistic expectations are always important when getting a hair transplant. For most men, the ideal would be to have a completely thick head of hair with no receding hairline. While this is possible for some men, it’s not always realistic, especially for those with more severe balding. A good surgeon will always explain exactly what results can be expected.
Be certain that they want a hair transplant – Getting a hair transplant is a big decision so you should be certain it’s something you want to go through with. Hair loss affects all men differently and some are able to adjust to life without hair without it severely affecting their self- confidence. For such men, a hair transplant might be more trouble than it’s worth.
Have tried treatments first – This is very important. It’s surprising how many people are still under the illusion that there are no effective treatments available for dealing with hair loss. Before considering a hair transplant you should first start a course of treatment that involved finasteride and minoxidil. This way you can assess how well treatments work for you and then make a decision as to whether a hair transplant is necessary. You should give treatments at least 6 months to see if they’re going to work for you.
Be certain that their hair loss has stabilised – All men tend to bald at different rates. Some only thin out very slightly over a number of years while other men can lose much of their hair within a few years. Before getting a hair transplant, it’s important that your hair loss has stabilised. The reason being is that although the transplanted hair is permanent, this doesn’t mean that you won’t lose any existing hair that would have started thinning anyway. This can create a patchy look that is far from desirable.
