This article first appeared in the Fall 2019 issue of NewBeauty. Clickhereto subscribe.
Hair is way more than inanimate protein attachedto our heads. It highlights our personal style, acts as a security blanket and boosts confidence. Theres a reasonhashtag #goodhairday has been used nearly 1.5 milliontimes on Instagram: When someones hair looks good,they want to show it off. But for the millions sufferingfrom hair loss, there may be more bad hair days thangood. Thanks to cutting-edge products, devices and procedures, this doesnt have to be the case.
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WHY HAIR THINSThe average person has about 100,000 hairs ontheir head and loses about 100 of them every day (to thedetriment of shower drains and bathroom floors everywhere). But, if those hairs dont grow back at the same rate,or more than 100 hairs fall out, it may be a sign of thinning.And shockingly, the American Academy of Dermatologycites that a whopping 40 percent of women have visiblehair loss by age 40. The sooner you seek care, the betteryour chances are of successfully treating it, says BeverlyHills, CA hair restoration specialist Dr. Craig Ziering. Butin order to prescribe a treatment, we need to determinethe reason for the thinning. These are the most common:
GeneticsAndrogenic alopecia (AGA), or male and female patternhair loss, is the most common form of hair loss and affects nearly 50 million men and 30 million women in theU.S., according to the National Institutes of Health.Chances are, if sparse strands are common on either sideof your family, you will experience the same. Femalehair thinning shows up in three different ways: enlargingof the center hairline part, frontal hair line recession anda diffuse thinning pattern, says Beverly Hills, CA hairrestoration specialist Natalie H. Attenello, MD.
Although often hereditary and occurring in healthyindividuals, AGA has been associated with serious conditions such as hypertension, diabetes and polycysticovarian syndrome, so see your doctor if you have concerns, says Pittsburgh plastic surgeon Brian V. Heil, MD.
DietIn addition to taking the patients personal and familialhistories into account, doctors often suggest a blood test,which can reveal mineral and vitamin deficiencies thatmay be affecting hair. Low vitamin D and iron can beculprits, and its common to see depleted levels of themthese days, says New York dermatologist Dhaval G. Bhanusali, MD. In those cases, I generally prescribe a dailydose of 5,000 IU vitamin D and an iron supplement. Beverly Hills, CA dermatologist Rhonda Rand, MD saysvegetarians often have less hair because they dont eat asmuch protein. You need 40 grams a day, and most of myvegetarian and vegan patients arent getting that much.
HormonesA key hair loss offender is the DHT hormone (dihydrotestosterone), a derivative of testosterone that binds to receptors in hair follicles on the scalp and shrinks themuntil they can no longer function. Blood work can disclose testosterone levels, and if theyre elevated, medication can balance them out, says Dr. Rand.
Sharp hormone shifts after pregnancy are also commonly tied to hair thinning, although the effects are temporary. Women have some of the thickest hair theyllever have right before they give birth, and then two tofour months post-partum, many of them experiencetelogen effluvium, a dramatic, yet temporary change asthe hair goes into resting phase for two to four monthsand thins out, Dr. Rand explains. Around eight monthsafter childbirth, the hair should be back to normal.
Menopause can stir up hair issues too, as lowerestrogen levels are linked to thinning. Many women losesubstantial amounts of hair after menopause, says Dr.Ziering. Their hair tends to thin out all over, rather thandevelop a signature spot like men do at a similar age.
StressAlopecia areata is a form of sudden hair loss thats oftencaused by stress and shows up in circular bald patches.Its considered an autoimmune disease because the immune system gets stressed and attacks the hair follicles,causing them to weaken and fall out, Dr. Bhanusali says.Theres no cure yet, but Dr. Ziering says it can be treatedsuccessfully with injectable steroidstypically everythree to six weeksthat suppress the immune system.
IllnessAny auto immune disorder could cause hair loss, saysDr. Heil, but its most common with lupus and thyroiddisease due to the alteration of the bodys ability to function normally. Once the disorder is treated and the bodyis in remission, hair growth should return to normal.
MIRACLE GROW:The three stages ofthe hair growth cycle
1. The Anagen Phase (lasts 26 years)Also known as thegrowing stage, thisis when the cellsin the root of eachhair divide, pushingthe previous strandout to make room fora new one. Hairthats in anagen forless than two yearsis usually thinning,says Dr. Rand, andthe length of apersons anagenphase is geneticallypredetermined.
2. The Catagen Phase (lasts 23 weeks) Hair takes a breakfrom growing andprepares to shedso it can eventuallyrenew. This isreferred to as thetransitional phase,during which clubhair (hair that hasstopped growing)begins to form.
3. The Telogen Phase (lasts 3 months) This is the restingphase, during whichclub hair is fullyformedif one ispulled from the root,youll see a hard,white substance onits tip. Dr. Rand saysabout 10 percent ofhair is usually in thetelogen stage.
HOW TO TREAT ITThinning hair isnt a quick-fix conditionoftentimes a multipronged approach withchanges to diet, products and treatments delivers the best results. Some nonsurgicalsolutions are both preventive and effective,providing reasonable improvements," saysDr. Ziering, but its important to have realistic expectations, as results can take monthsto manifest.
Essential OilsWhether theyre applied solo or infused into hair-care products, essentialoils are praised for their stimulating,balancing and calming properties that havebeen shown to spur healthy hair growth.Tea tree and cypress are proven to improvemicro-circulation deep in the scalp and increase blood flow to each follicle, saysFranois Hourcastagnou, CEO of hair-carebrand PHYTO and Als Group, USA. Rosemary can gently but effectively exfoliate thescalp, sage can help calm irritation andlemon oil can balance sebum production sofollicles dont get clogged. According to integrative medicine specialist Dr. Elizabeth Trattner, one study on 84alopecia areata patients revealed that massaging a mix of cedarwood, lavender, thymeand rosemary oils with either jojoba or grapeseed carrier oils into the scalp for sevenmonths produced significant hair growthimprovement in 44 percent of the group,compared to 15 percent of patients who usedjojoba or grape seed alone. Another studyshowed 3 percent peppermint oil appliedtopically helped facilitate hair growth bypromoting circulation in the hair dermalpapilla [cells at the base of hair follicles], sheadds. (Note: Applying essential oils directlyto the scalp could be too strong and cause irritation, which is why most are mixed withcarrier oils. Doing a patch test at the nape ofthe neck to check their compatibility withyour skin is recommended.)
Diet + NutraceuticalsTo strengthen brittle hair, Dr. Attenello says its best to follow a balanced diet that includes protein and foodssuch as eggs, fish and nuts that contain omega-3 fatty acids. We also recommend zinc,iron and biotin supplements, all of whichhave been shown to improve hair texture andcaliber, she adds.Dr. Ziering likes Viviscal, a daily supplement that contains a marine complex calledAminoMar that helps promote existinghealthy hair growth from within, but is notan option for patients with shellfish allergies. Another expert favorite is Nutrafol,which New York plastic surgeon Jennifer Levine, MD says is good for both thinninghair and anti-aging. It neutralizes free radicals, rebalances stress-producing hormones and contains botanicals that promote theabsorption of hair-boosting nutrients, sheadds. With the majority of hair supplements,some users can see results after one month,but experts say three months is standard.
AcupunctureIn Chinese medicine, acupunctureis often used as a remedy. Needlesare placed on the face, body andscalp to promote blood and energy circulation to the scalp, stimulating hair growth,says Dr. Trattner. Studies show it can helptreat female thinning better than male, although reasons for this are undetermined. Aseries of treatments need to be done weeklyor biweekly to restore balance, and thenmaintenance depending on individual results. Some people get better outcomes thanothers, but when combined with Chineseherbal medicine, results are synergistic andalmost always better, Dr. Trattner adds. It isalso important to find a licensed practitionerwho is familiar with hair loss.
Hair CareThinning hair demands extra TLC,so any products used on it shouldhave scalp health and hair growthproperties. Some brands tout biotin as astrand booster, but Dr. Rand says minoxidilknown over-the-counter as Rogaineisthe only FDA-approved OTC ingredient thathas been clinically proven to increase the diameter of the hair follicle, producing thickerhair. Results may take months to exhibit,and side effects associated with topical minoxidil can include scalp itching and flaking,so it's not an option for everyone. For those going the natural route, botanical-based topicals can also be effective:French hair-care brand Ren Furterer formulates with follicle-energizing pfaffia extract (aka Brazilian ginseng) and sebumreducing curbicia (a patented extract fromsquash seeds) to promote growth. No matter the product used, Dr. Rand notes:If you stop using it, the results will stop too.
Product Picks: Ren Furterer Triphasic Strengthening Shampoo ($32); PHYTO Phytopolline Botanical Scalp Treatment ($40); Nutrafol Core for Women ($79); Viviscal Advanced Hair Health Supplements ($50).
However, a new platform called HairStim is now being offered by dermatologists around the country, who can customize products to include a mix of prescription-strength ingredients such as topical finasteride and spironolactone, depending on the patients concerns. Weve seen impressive results so far on both men and women, Dr. Bhanusali says.
Oral finasteride (you may know it by its brand name Propecia) is commonly prescribed in a 1 milligram dosage for men, and sometimes for post-menopausal women as well"its not advised for childbearing women because of its hormone interference, says Dr. Attenello. This also applies to oral spironolactone. A double-blind study in 2014 revealed that 400-milligram capsules of pumpkin seed oil could mimic the effects of oral finasteride in men, but there hasnt been much research since, and no studies that included women.
Light TherapyLow-Level Laser Therapy (LLLT)technologiesusually in theform of laser headbands and hatsthat can be worn at home or in a doctorsofficeare designed to improve folliclefunction and reverse the effects of thinninghair and hereditary hair loss. LLLT is anoninvasive, pain-free and FDA-clearedsolution that uses diodes that emit infraredor red light, says Dr. Ziering. It increasesblood circulation to the scalp and helps thefollicles produce thicker, longer, healthierhairs with improved pigment.
Dr. Rand says there are many doctorswho use LLLT, and while the devices cangrow some hair in carefully selected patients, they tend to work better on thosewho are balding (or quite thin) rather thanthose with moderate thinning. The issue isthat the lights cant penetrate down to thescalp tissue if theres hair in the way, whichis why I prefer combs rather than caps forwomen because they separate the hair, sheexplains. In general, these devices tend towork better on men; however, as technology evolves and more hair loss studies aredone on women, this may change.
Product Pick: The most high-tech headband weveever seen, HairMax LaserBand 41 ($549) delivers follicle-stimulating energyto the scalp via 41 medical-gradelasers and is super easy to use. Justput it on your head, press the buttonand voila. Wearing it three times aweek for just three minutes treatsthe entire scalp.
Platelet-Rich Plasma (PRP)Platelet-rich plasma (PRP)is a newer biotechnologyused to treat early androgenic alopecia or thinning hairand involves drawing a smallsample of the patients bloodfrom the arm before puttingit through a centrifugation process to extractthe blood plasmarich in proteins andgrowth factorsand eliminate the red bloodcells. The plasma is then injected into thehair follicles in thinning regions of the scalp,and the platelets bond to receptors in thestem cells of the scalp tissue," says Las Vegasplastic surgeon Julio L. Garcia, MD, an earlyadopter of PRP treatments. "This activatesthe active hair growth phase and allows hairto grow back where it has been lost.
Dr. Attenello says the treatments are best served for patients with hairthinning, where the hair bulbsstill exist for the PRP to nourish them, rather than thosewith hair loss that has beenpresent for more than a year,where the hair bulb is likelynot intact anymore. Preliminary studies have shown favorable results interms of hair count and density, but larger-scale trials are warranted, she adds.
Most PRP protocols involve treatmentonce a month for three months, and then awaiting period of an additional three monthsbefore results are visible; maintenance treatments every three to six months followingmay be necessary depending on the needsof the patient.
There is also a next-generation form ofPRP called PRF, or platelet-rich fibrin, whichis extracted similarly to PRP, but containsmore growth factors. Dr. Levine prefers PRFbecause it allows the platelets to remain viable while releasing growth factors in a controlled manner that can last hours to days;PRP growth factors only last a few minutes tohours. The benefits of longer-lasting growthfactors, she explains, are that they promotemore hair growth.
Critics point to the treatments lack ofFDA-approval and regulation: Dr. Garciasays there are numerous PRP preparationsystems on the market today with FDA clearance for PRP used in bone graft procedures,but not those for hair. Therefore, the use ofPRP outside this setting is considered off label and scrutinized by the FDA, he explains. Nevertheless, it is widely consideredsafe. Pasadena, CA plastic surgeon GordonSasaki, MD and a team of doctors are currently conducting the first randomized-controlled clinical trials to study the safety andefficacy of low versus high amounts of PRPfor hair regrowth in patients with androgenetic alopecia. By four months, an increasein both terminal [longer, darker hairs] andvellus [shorter, thinner hairs]have been documented withminimal to no side effects orcomplications, Dr. Sasaki notes.Ian Sanderson, president ofskin-care brand AnteAGE, isdedicating his efforts to a newerarea of researchthe topicalapplication of growth factors to battle thinning hairwhich, he hopes, will one daymake PRP injections obsolete.
PRP is mostly effective by deployinggrowth factors like VEGFvascular endothelial growth factorand other stem cellby-products like cytokines to restart dormanthair follicles. Weve been able to engineer atopical treatment solution containing allthose hair growth factors in precise dosages,along with several bio-signals that go beyondwhats possible with PRP alone, he says, adding that its also an alternative to minoxidil.Its been recently understood that one ofminoxidils key mechanisms of action is up regulation of VEGF. Using this growth factortopicallyits a key ingredient in our hairtreatmentswe may make minoxidil obsolete, along with its potential side effects."
THE PRP DEBATENot all doctors see eye to eye when it comes to PRP.PRO: I advocate the use ofPRP for androgenicalopecia in men andwomen. Excellentclinical outcomes areseen after a series offour monthly injections.Diminished hair lossand noticeable newhair growth is typical.Washington, D.C. dermatologist Tina Alster, MD
CON:There is some evidencethat it can benefit thosewith hair loss, but itsstill very controversialbecause theres nota wealth of good data orresearch done underappropriate FDAguidelines. There havealso been some issuesof PRP being done insalons and spas withcatastrophic outcomessuch as contaminationand the spread of HIV.La Jolla, CA plastic surgeon Robert Singer, MD
SURGICAL SOLUTIONWhen nonsurgical solutions have beenexhausted without success, hair restoration surgery can dramatically improveones appearance and self-confidence. Thegold-standard surgical option for hair loss isa hair transplant, which entails surgicallyremoving hair from the back of the headthe area thats most resistant to DHTandimplanting it into thinning areas, says Dr.Attenello. It can be done on both men andwomen, but because women have a differentpattern of hair loss and hair thinning, not allfemale patients are ideal candidates.
The Two Main TypesFollicular Unit Transplantation (FUT): Astrip of hair is removed from the back of thehead, and then the hairs are separated andimplanted into the areas that need to beaddressed, says Dr. Levine. The advantageto FUT is that youre able to cover a largersurface area of baldness, but the downtimeis typically five to seven days.
Follicular Unit Excision and Extraction(FUE): The surgeon (the procedure can beperformed robotically or manually) cutsaround each individual hair follicle, removing and implanting it back into thinning areas. Many surgeons use handheld motorizeddevices to enhance the hair extraction process. These procedures are lengthy and cantake five to eight hours, depending on thesize of the treatment area, says Dr. Levine.But, the recovery time is fastertwo to fivedaysthan with the FUT method and thereis no linear scar on the head.
Power PlayNo matter how skilled the surgeon, robotscan offer exactness human hands cantthey also dont tire after hours in an OR. Themost advanced surgical technology currently available to treat hair loss is the ARTASrobotic system, which utilizes state-of-the-art technology to assist physicians with difficult, manual placements of grafts that require repetitive and precise movements,says Dr. Heil. ARTAS was developed withleading hair transplant physicians and researchers, and offers a clinically proven, permanent solution that provides natural results without stitches, staples or linear scars.Regardless of how the grafts are placed,Dr. Ziering says the hair will continue togrow and function like it normally would,although some routine maintenance maybe needed. Post-procedure, patients cantcolor their hair for four weeks and need toavoid direct sun exposure for at least threemonths to reduce risk of hyperpigmentation, therefore many patients opt to havetransplant surgeries in the winter. Dr. Ziering adds, Noticeably thicker, natural-looking hair growth begins around six months,and the final outcome is seen one year following treatment.
Medically reviewed byLa Jolla, CA plastic surgeon Robert Singer, MD,Eugene, OR plastic surgeon Mark Jewell, MDand Montclair, NJ dermatologist Jeanine B. Downie, MD
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