Hair Loss Treatment and Prevention

Are There Ways To Restore Hair?

Generalized hair loss - resulting from certain illnesses and infections, vitamin deficiencies, as a side effect of medication or medical treatment, and following exposure to toxic substances - is usually temporary. Because these processes do not damage the hair roots, hair will regrow in the vast majority of people.

Patchy hair loss caused by ringworm is easily reversed with anti-ringworm treatment. Patchy hair loss caused by alopecia areata cannot be cured, although the condition usually clears completely by itself within six months to a year.

Balding in men is normal, and no treatment is required if the person is comfortable with the appearance. Treatments for this condition are designed to reverse the normal and natural course of events. Ways to restore hair in men who are balding include:

• Camouflage techniques
• Plastic surgery techniques
• Drug treatments

Camouflage Techniques

Techniques for camouflaging (hiding) the hair loss include:

• Toupees and hairpieces
• Hair weaving

Toupees And Hairpieces

Toupees and hairpieces may be complete or partial, and they may be made of artificial fiber or natural hair. The overall cosmetic effect is dependent on the skill with which the color, thickness, and hair length are matched.

The goal is for the added hair to look natural, and this is difficult if the transformation is made all at once. A useful strategy it is use two or three hairpieces over the course of a few months, each slightly thicker than the previous one.

Hairpieces frequently look unnatural because they contain too much hair. A good hairdresser may be very helpful with careful positioning, trimming, and securely fixing of the hairpiece.

Hair Weaving

This technique allows artificial or natural hair to be anchored onto, or braided into, the remaining natural hair. Some of the natural hair is woven or braided together to act as an anchor onto which either artificial or natural hair tufts are sewn, woven, knitted, or glued.

The effect is semi-permanent, and the hair can be trimmed and styled to blend in with the natural hair. However, as the natural hair grows, the anchoring needs to be tightened every six to eight weeks, which can be expensive. Also, vigorous washing may loosen the new hair.

Need To Know: A camouflage technique used in the past was the implantation of synthetic hair directly into the scalp. This technique is not recommended because it can result in scars, infection, and abscesses of the scalp and brain. Abscesses are pus-filled cavities surrounded by inflamed tissue. Because of the high rate of infection, the use of hair implants made of artificial fibers has been banned by the U.S. Food and Drug Administration.

Plastic Surgery Techniques

Plastic surgery can help to lessen the visible effects of baldness. Techniques include:

• Hair transplantation
• Scalp flap transfer
• Skin expansion
• Serial excision

Hair Transplantation

This is the traditional method of resurfacing bald areas of scalp with hair. Plugs of bald scalp are removed and then filled with plugs of scalp containing several hair roots taken from hair-bearing areas. These grafts hear into their new locations, and the hair follicles eventually grow.

The number of grafts required and the length of a treatment session will vary, depending on the degree of baldness. Several operations may be required, and the procedure can be expensive. The technique does leave many small scars on the donor sites, but these are not usually apparent.

Scalp Flap Transfer

This technique is based on the fact that the sides of the scalp (above the ears) and the back of the scalp usually remain hair-bearing. A long thin "flap" of hair-bearing scalp is removed and replaced across a bald patch to create a dense band of normal hair growth. Parts of the bald scalp may be removed as part of the procedure. The donor site is closed by stretching the adjacent scalp.

This technique can replace hair across a large area of bald scalp. The thick hair growth looks normal. The very narrow scars are easily hidden among the hair.

Skin Expansion

In this technique, one or more inflatable bags are inserted in pockets under areas of hair-bearing scalp adjacent to the bald patch. These bags, or expanders, are connected to valves that are also implanted under the skin. After the scalp has healed following the surgery, saline is injected into the valves, causing the expanders to gradually enlarge and stretch the overlying hairy scalp.

After a number of injections, over a period of some weeks or months, the expanders are so large that they have stretched out the hairy scalp to a greatly increased area. At a second operation, the bald scalp can be removed and the expanded hair scalp can be stretched to take its place.

This technique can produce excellent results, but during the interim period, while the expanders are getting bigger, the appearance can be bizarre. In addition, any procedure involving implanted foreign material may be complicated by infection.

Serial Excision

In this technique, as much of the bald area as possible is surgically removed in the first operation. The adjacent hair-bearing areas of scalp are pulled in close to the bald area, accepting the fact that some bald scalp will remain. This process is then repeated one or more times at a later date, so that the bald area is eventually removed.

Need To Know: Q: Who is qualified to perform hair restoration surgery? A: In order to ensure maximum safety and the best-looking results, choose a board-certified dermatologic surgeon who is an expert in the causes and treatment of hair loss. Since the success of the procedure greatly relies on the physician's skill and creativity, it's important to see a dermatologic surgeon with training and experience. Dermatologic surgeons invented hair transplant procedures in the 1950s.

Need To Know: Q: Is it safe to have surgery at hair treatment clinics? A: Many hair treatment clinics also offer surgery for baldness. But it is essential that anyone interested should be fully satisfied about the quality of the care offered, before agreeing to a costly series of operations that do involve some risk.

Drug Treatments

Two medications have been approved for the treatment of hair loss:

• Minoxidil (Rogaine)
• Finasteride (Propecia, Proscar)

Both of these medications also can be used preventively to help keep hair loss from happening.

Minoxidil (Rogaine)

Minoxidil (sold under the brand name Rogaine and also available generically) is applied to the scalp to stimulate hair growth in adult men and women. Medication applied to the body is called "topical" medication.

In the U.S., minoxidil is available without a prescription. The exact way in which this medicine works is not known.

Side effects of minoxidil are rare and include:

• Itching or skin rash on the scalp
• Headaches
• Dizzy spells
• Irregular heartbeat or chest pains
• Decreased sexual ability or desire

Need To Know: Minoxidil should not be combined with the topical application of corticosteriods (cortisone-like medicines), petrolatum (Vaseline), or tretinoin (Retin-A), because the use of these products on the scalp may cause too much minoxidil to be absorbed into the body. In addition, individuals with other skin problems or irritations, heart disease, or high blood pressure may not be able to take minoxidil, because more serious problems may develop.

Minoxidil does not work for everyone, and it does have some limitations:

• Minoxidil may help hair to grow in 10% to 20% of the population, and in 90% it may slow the loss of hair.
• If hair growth is going to occur with the use of minoxidil, it usually occurs after the medicine has been used for several months.
• When the use of minoxidil is discontinued, hair loss will recur.
• If minoxidil is not allowed to completely dry (which may take two to four hours), it may stain clothing, hats, and bed linen.

Nice To Know: Minoxidil originally was used as a treatment for high blood pressure and was found to cause increased hair growth all over the body in people taking it regularly. It was then prepared as a lotion for direct application to the scalp.

Finasteride (Propecia, Proscar)

Finasteride (sold under the brand names of Propecia or Proscar) is a medication taken by mouth. It belongs to a group of medicines called enzyme inhibitors. It is primarily used to treat urinary problems cause by enlargement of the prostate in men (benign prostatic hyperplasia, or BPH).

Finasteride has been found to stimulate hair growth in some men. Women, however, should not take finasteride. The medication is available only with a doctor's prescription. In clinical studies, it stopped hair loss in 83% of men.

If hair growth is going to occur with the use of finasteride, it usually will happen after the medicine has been used for about three months. The effect lasts only as long as the medicine is taken; new hair is lost within a year after finasteride treatment is stopped.

Side effects of finasteride are uncommon and include:

• Breast enlargement and tenderness
• Skin rash
• Swelling of lips
• Abdominal pain
• Back pain
• Decreased sex drive
• Decreased amount of semen that is ejaculated during orgasm (this should not affect sexual performance, however)
• Diarrhea
• Dizziness and headaches
• Impotence (inability to achieve or maintain an erection)

Need To Know: Finasteride tablets may be crushed to make them easier to swallow. However, women who are or who may become pregnant should not take finasteride or handle crushed tablets, because the medication may cause birth defects in an unborn child.

Can Hair Loss Be Prevented?

There are many reasons for the loss of hair. Prompt treatment of health conditions that can lead to hair loss, such as thyroid disorders, can help prevent the hair loss from occurring.

The most common cause of hair loss is balding in men. Until recently, male pattern baldness could not be prevented. Today, the two medications used to regrow hair can also be used to prevent hair loss:

• Minoxidil (Rogaine), which is applied to the scalp, may slow the loss of hair in 90% of men. Treatment is expensive, however - the cost is about $600 a year for the recommended use of twice daily. Any hair loss that is slowed by the medication will resume when its use is discontinued.
• Finasteride (Propecia, Proscar), is a hair-promoting drug taken by mouth that is approved for use in men only. In clinical studies, it stopped hair loss in 83% of men. However, the medication can have significant side effects.

How-To Information: Some everyday ways to help prevent hair loss include: Eating a balanced diet and taking vitamin and mineral supplements to avoid losing hair due to a vitamin or iron deficiency. Avoiding hair treatments that can damage hair; this includes bleaching, hot rollers, frequent perming, hot curling irons, and repeated brushing and combing under hot hair dryers. Alternate hairstyles that put tension on hair, such as ponytails and braids, with looser hairstyles to avoid a constant pull that causes some hair loss. When the hair is wet, avoid brisk rubbing with a towel; blot the hair dry instead. Avoid vigorous combing and brushing the hair when it is wet, because its structure is more fragile then. The old recommendation to brush hair 100 strokes a day should be avoided, as this damages hair. Use wide-toothed combs and brushes with smooth tips.