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Strip vs FUE in hair transplantation: What was more commonly performed in 2013?

Follicular Unit Strip surgery more common in 2013

In 2013, strip surgery remained more popular than follicular unit extraction according to the 2013 ISHRS Practice Census Survey

In 2013, strip surgery remained more popular than follicular unit extraction according to the 2013 ISHRS Practice Census Survey

It comes as a surprise to many that strip surgery was more commonly performed than follicular unit extraction (FUE). A 2013 survey of over 900 hair transplant surgeon members of the International Society of Hair Restoration Surgery (ISHRS) showed that about 67 % of procedures were performed using strip surgery (FUSS) and 1/3 were by follicular unit extraction (FUE).

At Donovan Medical, both types of procedures are performed. Some individuals may be better candidates for FUE than strip and other individuals may be better candidates for strip than FUE.

 

Source:

International Society of Hair Restoration Surgery (ISHRS) - 2013 Practice Census Survey.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Fixing the "Pluggy" Hair Transplant: How do we do it?

Repairing the "Pluggy" Transplant

Many patients come to see us with hair transplants performed using older technologies from days gone by. These include the use of large plugs. Fortunately, hair restoration has evolved from large plugs to micrografts and minigrafts to the use of single follicular units. 

But what do we do when a patient comes to see use with concerns about an unnatural looking "pluggy" hair transplants that they had performed years ago? What are the options to create a natural looking appearance?

Video: Repairing the 'pluggy' transplant

In the accompanying video, Dr. Donovan outlines two strategies for repairing the 'pluggy' transplant.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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22nd Annual International Hair Transplant Surgery Meeting Announced

Hair Transplant Surgery Meeting Set for Kuala Lumpur 

Great news that the 22nd Annual Scientific Meeting of the International Society of Hair Restoration Surgery is set for Oct 8-11 in Kuala Lumpur, Malaysia. Looking forward to another great meeting!

 

The International Society of Hair Restoration Surgery (ISHRS)

The ISHRS is the leading authority on hair loss treatment and restoration with more than 1,000 members throughout 60 countries worldwide. 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Achieving appropriate densities in hair transplantation

The density of follicular units can be calculated by dividing the number of grafts placed in an area by the area. This patient with extensive thinning was transplanted at a density of 32 follicular units per square cm (32 FU/cm2).

The density of follicular units can be calculated by dividing the number of grafts placed in an area by the area. This patient with extensive thinning was transplanted at a density of 32 follicular units per square cm (32 FU/cm2).

What densities do we aim for in hair transplantation?

One of the most important parts of the hair transplant surgery is determining how close to place or 'pack' the grafts. A patient with a large area of hair loss to fill (such as a Norwood VI) with limited donor supply may want to use 3000  grafts at a density of 30-35 follicular units per square cm. Another individual with limited hair loss in the frontal scalp may want to use 1000 plus hairs packed at a density of 35-45 follicular units per square cm

 

 

Different follicular unit densities for different patients and different areas of the scalp

The frontal hairline is an area where decisions on target density are very important. A density of 40-45 follicular units per square cm was planned for this patient.

The frontal hairline is an area where decisions on target density are very important. A density of 40-45 follicular units per square cm was planned for this patient.

The density that is chosen for each patient requires careful thought. A patient with course curly grey-white hair will require less grafts for than a patient with fine straight blonde hair. A density of 30-35 FU/cm2 might be chosen for the grey haired patient whereas a target of 40 FU/cm2 or more may be required for the patient with fine hair.

In addition, different areas of the scalp often require different densities to achieve a good result. The frontal hairline might require 40 FU/cm2 to 50 FU/cm2 depending on the patient.

It's extremely important to think about the density of recipient sites in hair transplant surgery There is not magic formula or recipe - and each patient's procedure needs to be carefully considered and planned. 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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The Phototrichogram: A Powerful Tool in Assessing Hair Loss and Growth

The phototrichogram helps assess hair growth patterns & treatment responses

The phototrichogram is a clinical tool I generally only use in my research - when I want to understand if a specific treatment is helping or not and quantify just 'how much' it helps. However, sometimes I will use the phototrichogram in patients with complex hair loss patterns. The phototrichogram involves comparison of two small 1 cm x 1 cm areas on the scalp at an interval of three days.  On day 1, the hairs in the target 1 cm2 area are clipped to 1 mm and a photograph is taken. 2-3 days later the same areas is evaluated again

What information comes from the phototrichogram?

Several key pieces of information come from the phototrichogram. Hairs that grow over the 2-3 day period are deemed 'anagen' hairs. Hairs that don't grow or elongate are deemed 'telogen' hairs. Hairs that are not present at day 1 but present at day 2-3 are deemed anagen hairs. In addition, hair calibre can also be ascertained. Hairs greater than 40 um are terminal hairs.

Figure 1. The Phototrichogram. Hairs that do not elongate over a three day period are telogen hairs. The blue circle shows a telogen hair. The green circle shows one telogen hair and one anagen hair. The red circle shows a significant increase in hairs. Hairs that were not present at day 1 but present at day 3 are anagen hairs. 

Figure 1. The Phototrichogram. Hairs that do not elongate over a three day period are telogen hairs. The blue circle shows a telogen hair. The green circle shows one telogen hair and one anagen hair. The red circle shows a significant increase in hairs. Hairs that were not present at day 1 but present at day 3 are anagen hairs. 

In general, the following information can be ascertained from a carefully conduced phototrichogram:

1. hair density

2 terminal hair density

3. vellus hair density

4. anagen hair counts

5. telogen hair counts

6. mean hair thickness

 

Conclusion

The phototrichogram is a powerful tool. It's not routinely employed in the clinical setting because most patients don't want their hairs clipped (patients come to see me for help with more hair - not less).  Nevertheless, the phototrichogram remains a tool I call upon from time to time 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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What is the risk of balding if my father has hair loss?

What is the risk of developing male pattern balding if my father has hair loss?

It's challenging to 100 % predict any man's exact chances of balding. The genes for hair loss come from mom's side and dad's side and dozens of genes contribute to one's chances to develop hair loss. 

I'd like to tell you about two studies I often share with my patient's when they ask me about their chances of balding

 

Two Important Male Balding Research Studies

In a study of 572 men ages 16-91, young men with a balding father had a 5.5 times increased risk of balding than young men who did not have a balding father.

In another study, only 1 of the sons of 50 non balding men had Hamilton Norwood type III balding or worse. In contrast, 32 of 54 (60 %) of sons whose fathers were bald had Hamilton Norwood scale type III baldness or greater 

Having a father with balding greatly increases the chance a male with develop male pattern baldness or MPB.

 

References

Birch  MP Eur J Dermatol 2001; 11-16

Ellis JA. J Inv Dermatol 1998 110: 849-53


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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To caffeinate or not to caffeinate: What is the benefit of caffeine shampoos in men?

Are Caffeine Shampoos Helpful for Hair Loss?

This was a great week for discussions with my hair transplant patients about caffeinated shampoos.  Do they work?  What is the evidence? I thought this would be a good time to review this interesting topic. Previous studies have shown that caffeine can inhibit the negative effects of testosterone in a laboratory setting (i.e. in a petrie dish). How exactly it does this remains to be clarified, but caffeine is known to have many effects including blocking the cell death that occurs with androgenetic alopecia.

One of the best studies to date looking at the role of caffeinated shampoos was a study by Sisto et al and published in the Journal of Applied Cosmetology in 2013.

 

2013 Study of Caffeine Shampoos

Sisto et al from Italy set out to look at the benefit of a caffeine shampoo using a randomized controlled, double-blind study in 66 men with genetic hair loss. 33 received the test shampoo and 33 received the 'placebo' shampoo not containing caffeine. These two groups were matched to ensure that they were similar ages and had similar degrees of balding.

 

What were the results of the study?

Men using the caffeinated shampoo for 6 months were more satisfied with their outcome than men using the placebo (84.8 % vs 36.4 %, p<0.001). Men using the test shampoo were significantly more likely to feel that their hair loss had improved and were significantly more likely to report and improvement in strength and thickness of their hair.

 

Conclusions

This study supports a mildly beneficial effect of caffeinated shampoos. One of the limitations of the study is that it is predominantly survey based and the researchers relied on subject responses to survey questions to determine if a benefit present. Further studies are needed to quantify the benefit of caffeinated shampoos more precisely. However, this study does lend support to the notion that caffeinated shampoos may improvement the strength of hair follicles and slow the rate of balding.

 

Reference

Efficacy of a Cosmetic Caffeine Shampoo in Androgenetic Aloepcia Management. J Appl Cosmetol 2013;

Fischer TW et al. Effect of caffeine and testosterone on the proliferation of human hair follicles in vitro. Int J Dermatol 2007; 46: 27-35.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Is genetic hair loss in women the same as in men?

Genetic hair loss in women: Is it the same as in men?

I'm not asked this question very often by patients, but it's a question that I think about nearly every day. Genetic hair loss in women is not the same as genetic hair loss in men. In fact, most hair specialists, including myself, steer away from using the term "androgenetic alopecia" for women and use the term "female pattern hair loss (FPHL) instead.

 

FPHL vs male AGA: A few of the important differences:

1. In men, androgen hormones are essential in driving the process of baldness.  Without androgens there is no baldness. This is not quite so clear cut in women and blocking androgen hormones doesn't always have a benefit. In fact, increasing androgen hormones may actually help some women.

2. The genetics of hair loss in women is more complicated as well. A proportion of women develop genetic hair loss without strong family histories

3. Alterations in estrogen signalling may have an important role in FPHL.

4. In men with AGA, the drug finasteride seems to be more effective in those men with specific findings in the androgen receptor gene (i.e. shorter CAG repeats of the AR gene).  In women with FPHL, the efficacy of finasteride can’t be predicted with the same degree of certainty.

5. The patterns of hair loss are different as well with women losing hair in the central scalp and men losing hair in the temples and crown. 

6. A much lower proportion of women are good candidates for hair transplant surgery on account of genetic hair loss affecting the donor area.

7. Females have 3 to 3.5 times less 5 alpha reductase than men 

8. Female have higher aromatase levels than men. This enzyme converts testosterone to estradiol and estrone which reduces the conversion to DHT. The levels of aromatase are 6 times higher in the frontal hairlines of women than men. These differences in aromatase may explain why retention of the frontal hairline is a typical feature of FPHL but not male balding

9. Furthermore, even though androgen receptor levels are greater in the frontal scalp than the occipital scalp in both men and women, the total receptor level is 40 % less in women.

10.  The above points 7-9 may explain why the oral medication finasteride does not help as many women as it does men.

 

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Conclusion

It's a mistake to think of FPHL as simply the female equivalent of male balding. 

 

References

Sawaya et al J Inv Dermatol 1997; 109: 296-300


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Does FUE leave a scar? Does ARTAS leave a scar? OF COURSE!

Hair transplants with FUE and ARTAS: Does it leave a scar? 

One of the biggest sources of confusion in the public is that hair transplants done via follicular unit extraction or "FUE" is a scarless procedure. This is wrong. 100 % wrong.  Any time an incision is made in the skin, below a certain level, a scar wants to form.  There is no changing the laws of nature. We have to deal with the laws of nature and work around them. Such is life.

 

FUE leads to small circular micro scars.

Yes, FUE leads to small circular micro scars. Any form of FUE, whether robotic FUE with ARTAS or manual FUE or motorized FUE or Neograft. They all lead to tiny circular scars. There is a lot of interesting research going on to try to figure out how to reduce the appearance of these scars -  but scars do form. 

Fortunately, or unfortunately, there is no changing the laws of nature. We have to deal with the laws and work around them.  Anytime an incision is made into the skin, a scar wants to form. In 2014, a scar does form. Someday we might be able to block this process of scarring or reduce the formation of a scar, but not right now.  FUE is not a scar-less procedure.

 

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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New study of HairMax LaserComb shows benefit in men and women

Men and women benefit from HairMax LaserComb according to new research study 

As my patients know, I'm a stickler for good scientific evidence and data on hair loss treatments. If I'm going to recommend a treatment, there has to be evidence it helps. Why would anyone want to spend time or money on a useless treatment?

photo-4.JPG

There has been emerging data over the past years on the potential benefits of low level laser therapy (LLLT). A number of LLLT devices are on the market now and are being used in patients with hair loss and in some patients after hair transplants. Few LLLT devices have been subjected to rigorous testing.

 

What is considered rigorous testing for LLLT?

A good scientific study involves testing of a drug or product in a randomized, double-blind manner and multiple different centers. Randomized means that some patients would receive the real medication or treatment device and some would receive a placebo or 'fake' treatment. Double-blind means that both patients and doctors don't know who is getting the real treatment and who is getting the placebo.

 

So, are there any randomized, double blind multi-center studies of any low level laser therapies? 

Fortunately, there is ! I was pretty excited to share with my patients this past week a new study published in the American Journal of Clinical Dermatology last month. The study was a randomized, sham device-controlled, double-blind clinical trials conducted at multiple US centres.

 

How was the LLLT study designed?

Investigators set out to determine whether treatment with the HairMax Lasercomb® was helpful for men and women with pattern hair loss. A total of  128 male and 141 female subjects were randomized to receive either a lasercomb (one of three models) or a sham device in concealed sealed packets, and were treated on the whole scalp three times a week for 26 weeks. Terminal hair density of the target area was evaluated at baseline and at 16- and 26-week follow-ups, and analyzed to determine whether the hypothesis formulated prior to data collection, that lasercomb treatment would increase terminal hair density, was correct. 

 

What were the results?

The HairMax LaserComb was found to increase in terminal hair density and this was independent of the age and sex of the subject. Additionally, a higher percentage of lasercomb-treated subjects reported overall improvement of hair loss condition and thickness and fullness of hair in self-assessment, compared with sham-treated subjects. No serious adverse events were reported in any subject receiving the lasercomb in any of the four trials.

 

Conclusion

The key limitation in LLLT becoming more accepted in the world of hair loss is solid scientific data. This is one of the first high quality independent multi centre studies in LLLT done.  These results suggest that the HairMax LaserComb low-level laser treatment may be an effective option to treat pattern hair loss in both men and women.   

 

Reference

Jimenez JJWikramanayake TCBergfeld WHordinsky MHickman JGHamblin MRSchachner LA.  Efficacy and Safety of a Low-level Laser Device in the Treatment of Male and Female Pattern Hair Loss: A Multicenter, Randomized, Sham Device-controlled, Double-blind Study. Am J Clin Derm 2014 Jan 29. 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Hair Transplant Donor Area Scars: Options for Further Camouflage

Options for Camouflage Hair Transplant Donor Area Scars:  

 

Consider the following scenario.

A patient has had a previous hair transplant by the strip procedure (follicular unit strip surgery, FUSS). He enjoys wearing his hair short. At times he notices that when he wears his hair quite short the scar is a bit more visible. He wants to reduce that visibility.

 

What are the options to camouflage the scar even further if he wants to wear hair short?

 

1. FUE into the scar

Screenshot 2014-02-09 08.36.15.png

In some patients, we can remove 25-200 grafts from surrounding areas and place them into the scar. This can help camouflage the scar. Because so few grafts are needed, we can perform this procedure with minimal downtime for the patient. 

 

 

2. Scalp Micropigmentation  (SMP)

Scalp micropigmentation is proving to be a very useful technique to tattoo scars.  SMP allows small circular dots to be placed into the scar in a manner than resembles hair follicles cut in cross section. The dots are the same color as the patient's hair and this creates a nature look.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Proper Selection is Essential for Hair Restoration in Black Men and Women

Hair Restoration in Black Men and Women: Proper Selection is Essential

 

In general, there are three ways to remove hair from the back of the scalp in the course of a hair transplant:

1. Follicular unit extraction (FUE) 

2. Robotic follicular unit extraction (R-FUE or ARTAS)

3. Follicular unit strip harvesting (FUSS)

Each method can give great results and there are advantages and disadvantages of each. Men who plan to shave their scalp in the future prefer the FUE method because a linear scar is not seen.  

 

What is the best method of donor removal in Black Men and Women?

For most black women in my practice, strip method is superior. The grafts are easily removed and in the properly selected patient, the area heals very nicely. Shaving of the back of the scalp is not required and we have access to 500-2500 healthy grafts.

For most black men in my practice, a preference for FUE is seen. However, not all black men are good candidates for FUE. There are several factors that influence whether someone is a good candidate for FUE.  One of these is the shape and curl of the patient's hair follicles.  It is much easier to extract hairs by FUE in men with straighter hair than men with curly hair.  The curlier the hair, the more difficult it is to predict the path that the hair follows under the scalp and the more likley these hairs are to be damaged by FUE.  We call this damaged 'transection.' Curlier hair is much more likely to be transected during FUE.

If I'm ever not sure if a patient is a good candidate for FUE, I will do a small test session and extract a few grafts and then examine the grafts under the microscope for evidence of 'transection.' If I can't be sure that I'll have nice grafts, I won't do an FUE procedure.  It doesn't happen very often, but certainly there are a small proportion of black men who are not good candidates for FUE by either manual FUE or ARTAS.

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Traction alopecia : Should I get a hair transplant or not?

Traction alopecia : Is a hair transplant a good option?

 

Traction alopecia is due to pulling of hairs, usually along the front of the scalp. Traction alopecia affects women much more than men.  There are many treatments for traction alopecia including steroid injections, minoxidil and hair transplantation. How do we know which to recommend? Is one better than the other?

 

Sudden Traction Alopecia may grow back; long standing does not

In general, if hair loss has been present for a short period of time (weeks or months), then medical treatment with steroid injections or minoxidil is worth trying. If the hair loss has been present for an extended period (a few years or more), then the hair loss is generally permanent and the only means to restore hair in the area would be to do a hair transplant.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Hair Loss in the Crown: What are the options for men under 35?

Screenshot 2014-02-07 10.30.07.png

Hair Loss in the Crown: Do we transplant men under 35?

I rarely perform a hair transplant in men with hair loss in the crown prior to age 35. Most hair transplant surgeons around the world have similar cut-offs, and a few of my colleagues would even push this to 40 years of age. The area of hair loss can expand leaving an unnatural look if the area is transplanted too early.

 

So what, then are the non-surgical options that can be considered to treat hair loss in the crown? 

 

OPTIONS FOR TREATING HAIR LOSS IN THE CROWN PRIOR TO AGE 35.

 

1. Finasteride.

Finasteride (sold under name Propecia as well as generics) helps about 90 % of men stop hair loss. A proportion of men improve their hair as well. Side effects include decreased libido, erectile dysfuntion, mood changes, enlargement of breast tissue. read more.

 

2. Minoxidil

Minoxidil (sold under many brands including popular Rogaine) helps 20 % or more of men maintain their hair. A small proportion will also see improvement. It works best in the earliest stages of hair loss, especially in men with less than a 10 cm diameter area of hari loss. read more. 

 

3. Platelet rich plasma

Platelet rich plasma involves removing one's own blood and injection that nutrient rich PRP back into the scalp. The procedure is safe and helps up to 50-70 % of men. Platelet rich plasma therapy is emerging as an important treatment consideration for young men with hair loss who may not yet be surgical candidates. Some of US colleagues are also investigating the use of ACell/Matristem with PRP, but unfortunately ACell is not approved in Canada. read more.

 

4. Low level laser therapy (LLLT)

LLLT involves use of red light lasers to stimulate hair growth. Studies show that they  promote improvements in some users.  read more. 

 

5. Copper peptides.

Viewed as an alternative to minoxidil, phase 2 FDA studies showed that copper peptide based technology (including products like Tricomin) promote hair growth in some users. I encourage patients to use with minoxidil.

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Platelet rich plasma for treatment of alopecia areata: How good is it?

Platelet rich plasma (PRP) for treatment of alopecia areata

 

Platelet rich plasma or “PRP” treatment has been around since the 1990’s, but is increasingly finding application in various parts of medicine. PRP to treat hair loss is increasingly popular and current evidence suggests it helps 50-70 % of patients with genetic hair loss. Hair transplant surgeons are increasingly interested in using PRP during surgery.  We too are now offering PRP as a means to augment currently available treatment modalities for hair loss.

PRP involves obtaining a patient’s blood and isolating a component of the blood cells called platelets and the rich nutrients that surround the platelets called platelet rich plasma. It’s this platelet rich plasma that can stimulate hair growth in some patients.  PRP is known to contain over 20 different growth factors.

 

Does PRP also help patients with alopecia areata?

Although PRP has been studied in genetic hair loss, it’s role in alopecia areata had not been carefully studied. Researchers from Italy and Israel set out to study the benefit of PRP in patients with alopecia areata and compare how well the treatment worked compared to the standard treatment – that being steroid injections.

The researchers studied 45 patients with alopecia areata. After 12 months of observation, 60 % of patients treated with PRP had complete remission compared to 27 % of patients treated with steroid injections. Furthermore at 6 months after treatment, 38 % of patients receiving steroid injections had relapse compared to none of the patients form the PRP group. At 12 months, 71 % of patients in the steroid injection group had a relapse compared to only 31 % in the PRP treatment group.

This is an tremendously exciting study. PRP has very little side effects because it is the patient’s own blood.  PRP not only has growth promoting effects but has anti-proliferative effects as well. Both of these effects are likely extremely important for effective treatment of alopecia areata

Further large studies are needed to better understand the role of PRP in alopecia areata.  This initial study gives us new hope that this indeed may be a good treatment modality.

 

Reference

Trink A et al.  A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet rich plasma on alopecia. British Journal of Dermatology 2013; 169: 690-94


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Alzheimer's drugs and hair loss

Do Alzheimer's drugs  cause hair loss?

Today, I had a great conversation about Alzheimer's medications with a fellow passenger in the airport so I thought I'd share a few interesting points about these drugs.

In the year 2014, there is no cure for Alzheimer's disease. However, there are five drugs approved by the FDA to treat the symptoms of Alzheimer's. Donepezil, galantamine, tacrine and galantamine are called "cholinesterase inhibitors" and the fifth drug memantine is an NMDA receptor antagonist.  According to Litt's Drug Eruption Reference Manual - a key reference for drug side effects -  these drugs cause hair loss in approximately 1 % or less of users. So they are not common causes of hair loss, but they are on the list.  Hair loss typically starts 3-6 months after starting and the individual experiences an increase in noticeable hair shedding. 

 

The five FDA approved Alzheimer's drugs

1. Donepezil (marketed under brand name Aricept, approved to treat all stages of Alzheimer's disease) - causes hair loss is less than 1 % of users.

2. Rivastigmine (marketed under brand name Exelon, approved to treat mild to moderate Alzheimer's) - causes hair loss in 1 % of users

3. Galantamine (marketed under the brand name Razadyne, approved to treat mild to moderate Alzheimer's disease) - incidence of hair loss not clear

4. Tacrine (marketed under Cognex was the first cholinsterase inhibitor but rarely presribed today) - causes hair loss in less than 1 % of users

5. Memantine (marketed under Namenda, approved to treat mild Alzheimer's disease) - cuaes hair loss in less than 1 % of users.

 

Conclusion

Overall, hair loss is an uncommon side of these new Alzheimer's drugs, but can occur. Hair loss typically starts 3-6 months after starting the drug.  Stopping the drug can reverse the hair loss, but sometimes this is not practical if it is thought that the drug is helping with memory and cognition.

 

 


 

 

 


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Smoking and hair transplantation

Smoking and hair transplantation

 

There are many ways to do a hair transplant. At meetings, we debate about which ways are best. Donor harvest with strip methods, FUE, ARTAS.  Recipient site creation with needles, blades.   However, there's one thing we don't debate about: smoking is detrimental to hair transplants.

Of course lots of patients who smoke have successful hair transplants.   However, a small proportion have poorer growth. Nicotine decreases blood flow to the scalp by constricting blood vessels. The ability of blood to carry oxygen is reduced on account of the carbon monoxide in the blood. These factors increase the chance of poor wound healing and increase the chance of infection, scarring and overall poor growth. 

 

Minimal recommendations for hair transplant patients who smoke.

When it comes to stopping smoking, it's clear that the longer one abstains the better. Stopping one month before is better than one week before and two months is probably even better. The optimal times have yet to be thoroughly studied. In general, stopping smoking at least 1 week prior to hair transplant surgery and restarting no sooner than 2 weeks after the procedure provides appears to provide significant benefit.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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Testosterone therapy in men considering hair transplants : Do I worry about more than just hair loss?

Testosterone therapy in men considering hair transplants : 

 

There is a marked rise in the number of my male hair loss and hair transplant patients using testosterone therapy, especially men over 50.  Testosterone is also used at increasing rates in younger men as well.  Testosterone therapy is used in healthy men to counteract age-related reduction in serum testosterone and the diminished strength and physical function that accompanies the reduced testosterone.

 

Testosterone therapy and hair loss

In men with genetic hair loss, testosterone, as well as other androgen hormones (like anabolic steroids), have the potential to accelerate genetic hair loss. Some men notice increased hair shedding en route to developing worsening hair loss.  In my patients who use testosterone, we need to carefully plan for possible future hair loss. A hair transplant patient using testosterone may need a more conservative approach than a hair transplant patient not using testosterone.  A careful discussion and plan needs to be put in place. 

 

Testosterone therapy and heart attacks

Several studies have addressed the concern that testosterone therapy might lead to adverse cardiovascular outcomes.  In fact,  a small randomized trial of testosterone gel on muscle function in men 65 years of age or older was discontinued in 2010  because there were too many cardiovascular events in the group of men using testosterone.  A review of a number of  trials in predominantly older men also showed that men using testosterone had increased risk of cardiovascular problems. In addition, a recent study of men average age over 60 reported an excess of death and cardiovascular disease in those being treated with testosterone therapy.  In two studies, it appears that the risk of heart events (heart attacks, etc) starts very soon following starting therapy. 

 

Study findings of a new research study

A new study published this week in the Journal PLOS ONe showed that  older men, and in younger men with pre-existing diagnosed heart disease, the risk of having a heart attack after starting testosterone therapy is  substantially increased.

In fact, in men 65 years and older, the researchers observed a two-fold increase in the risk of heart attacks in the first three months after starting testosterone therapy. The risk actually  declined to baseline from month 3 to 6 in those who stopped therapy again.  The researchers also showed that among younger men with a history of heart disease, there was a two to three-fold increased risk of heart disease in the first three months after starting testosterone and no increased risk in younger healthy men without history of heart disease. 

 

Conclusion

While my main focus is on my patient's hair, I consider it critically important to be aware of the broad scope of medical research. My patients often need to make decisions about starting testosterone therapy for their physical health vs not starting on account of hair loss. At least 2-3 times daily in my hair transplant practice I have these important discussions. The scientific data are showing us time and time again that testosterone therapy increases the risk of heart attacks and other cardiovascular problems in men with a history of heart disease.

 

    REFERENCES

    1. Finkle et al. Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Therapy Prescription in Men. PLOS one. Published Jan 29

    2. Hensen LG, Chang S (2010) Health research data for the real world: The Thompson Reuters Marketscan Databases. White paper. Ann Arbor, MI.

    3. Baillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS (2013) Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Internal Medicine: 1–2.Page ST, Amory JK, Bowman FD, Anawalt BD, Matsumoto AM, et al. (2005) Exogenous testosterone (T) alone or with finasteride increases physical performance, grip strength, and lean body mass in older men with low serum T. J Clin Endocrinol Metab. 90: 1502–1510.  

    4. Xu L, Freeman G, Cowling BJ (2013) Schooling CM (2013) Testosterone therapy and cardiovascular events among men: a systematic review and meta-analysis of placebo-controlled randomized trials. BMC Med 11: 108. doi: 10.1186/1741-7015-11-108.

    5. O'Connor A (2013) Men’s use of hormones on the rise. New York Times.

    6. Basaria S, Coviello AD, Travison TG, Storer TW, Farwell WR, et al. (2010) Adverse Events Associated with Testosterone Administration. New England Journal of Medicine 363: 109–122. 

    7. Seeger JD, Walker AM, Williams PL, Saperia GM, Sacks FM (2003) A propensity score-matched cohort study of the effect of statins, mainly fluvastatin, on the occurrence of acute myocardial infarction. Am J Cardiol 92: 1447–1451.

    8. Vigen R, O’Donnell CI, Barón AE, Grunwald GK, Maddox TM, et al. (2013) ASsociation of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA 310: 1829–1836. doi: 10.1001/jama.2013.280386.

    9. Bremner WJ (2010) Testosterone Deficiency and Replacement in Older Men. New England Journal of Medicine 363: 189–191.

    10. Jackson G, Montorsi P, Cheitlin MD (2006) Cardiovascular safety of sildenafil citrate (Viagra): an updated perspective. Urology 68: 47–60. doi: 10.1016/j.urology.2006.05.04


    Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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    Hair loss treatment: another giant step forward

    New hair loss research findings

    This week a major breakthrough was announced by researchers at the University of Pennsylvania and published in one of the world's top research journals, Nature Communications.   

     

    How do you make a hair follicle anyways?

    As a bit of  background, it's important to understand how to make a hair follicle. You need to mix several specific cells together and then let nature do the rest. To make a cheese sandwich, you need cheese and bread. The more cheese and bread you have, the more sandwiches you can make. To make a strawberry sundae you need strawberries and ice cream. The more strawberries and ice cream you have, the more sundaes you can make.   To make a hair follicle, you need 2 things - epithelial stem cells (ingredient number 1) and dermal papillae (ingredient number 2).  And if you find a way to generate massive amounts of each, you'll find yourself with massive amounts of hair follicles - and a potential ability to treat hair loss.

     

    Key Research Findings

    The researchers from the University of Pennsylvania have shown, for the first time,  a method to generate large numbers epithelial stem cells - ingredient number 1 in the two part mixture to make a hair follicle.  When the epithelial stems cells were mixed with other cells they formed skin cells and hair follicles. The next goal now is to figure out a way to make massive amounts of dermal papillae (ingredient number 2)

     

    Conclusions:

    These are exciting studies for everyone to pay attention to - be they individuals with hair loss, hair loss specialists or hair transplant surgeons.  These studies provide a potential recipe or approach to generate massive large numbers of human epithelial stem cells for new treatments for hair loss. It's important to be aware that this study was done in mice and it's not clear if this an be easily replicated or translated to humans, but it's a (very, very, very) big leap.  Stay tuned.

     

    REFERENCE

    Yang et al. Generation of folliculogenic human epithelial stem cells from induced pluripotent stem cells. Nat Commun. 2014 Jan 28;5:3071. doi: 10.1038/ncomms4071.

     

     


    Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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    Treating seborrheic dermatitis in androgenetic alopecia: Make it a part of the plan

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    Treating seborrheic dermatitis in male pattern balding 

    Seborrheic dermatitis is a common flaky scalp condition that affects about 1 out of every 15 people. I describe the condition 'seborrheic dermatitis' to my patients as being a distant cousin of 'dandruff.' Individuals with seborrheic dermatitis have red, flaky, greasy scalps. The flakes may be yellow or white. When it's mild, most don't even know they have seborrheic dermatitis. Others notice a bit of itching, especially if they don't wash their hair every day. Seborrheic dermatitis, like dandruff, is influenced to a large degree by a yeast that lives in our scalp called Malassezia. But this yeast isn't the whole story, and a variety of genetic, environmental and hormonal factors seem important. 

    Is seborrheic dermatitis harmful? If not, why treat it?

    For the most part, seborrheic dermatitis is not harmful.   I pay attention to seborrheic dermatitis in both my hair loss patients and my hair transplant patients and treat it if the condition is present. I do this for a couple of reasons:

    1. Poorly controlled seborrheic dermatitis increases the proportion of hairs that are in the resting phase of the hair cycle (telogen phase). If we want to build density and drive improvement, we need growing hairs!  While seborreheic dermatitis usually doesn't cause hair loss or shedding, poorly controlled seborrheic dermatitis can. In patients with many miniaturized hairs undergoing hair transplant procedures, I believe that encouraging these hairs to be in the growing phase rather than the telogen phase, reduces 'shock loss.' I advise using an anti-dandruff shampoo (see below) three or four times per week for 6 weeks leading up to the transplant and then resuming 2 weeks after the hair transplant

    2. Treating seborrheic dermatitis with anti-dandruff shampoos may actually help hair growth. I am reminded of two studies  - one from 1998 and one from 2003 - which showed the zinc pyrithione shampoo as well as ketoconazole shampoo actually helped promote hair growth in men with androgenetic alopecia.  Whether the ingredients themselves are hair growth promoting or whether getting rid of the yeast reduces inflammation that helps drive hair growth is not 100 % clear, but it seems that the latter is more likely.  Regardless, I recommend treating seborrheic dermatitis aggressively when it's present. 

     

    Treatment of seborrheic dermatitis

    Fortunately, treating seborrheic dermatitis is usually simple, with any of the commercially available shampoos:

    a) zinc pyrithione (i.e. Head and Shoulders and others)

    b) selenium sulphide (i.e. Selsun Blue and others)

    c) ketoconazole (i.e. Nizoral and others)

    d) tar-based shampoos (i.e. T-gel and others)

    e) ciclopirox olamine (i.e. Stieprox and others)

     

     

    References

    1. Pierard-Franchimont et al. Ketoconazole shampoo: effect of long term use in androgenetic alopecia. Dermatology 1998; 196; 474-7

    2. Berger et al. The effects of minoxidil, 1 % pyrithione zinc and a combination of both on hair density: a randomized controlled trial. Br J Dermatol 2003; 149: 354-62

     


    Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing in hair transplantation. His research has been published in national and international medical journals and presented at scientific meetings around the world. To schedule a hair transplant consultation, please call 416-921-HAIR or toll free 1-855-921-HAIR.
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