For many hair loss sufferers, scalp "tinting" solutions are the most effective type of topical concealer. Tinting solutions like COUVRé, also commonly referred to as "masking lotions" or "concealing lotions," eliminate the contrast between thinning hair and the bald scalp by naturally darkening the skin and matching the tone to one's existing hair. By matching bald scalp to an individual's natural hair color, the harsh contrast of thinning hair is eliminated, and a fuller, denser appearance is achieved.

Although several types of masking lotions currently exist, one of the most popular and trusted is COUVRé. However, what makes COUVRé distinct from other masking lotions, or different types of concealers in general? Is COUVRé a quality concealer for both hair loss suffering men and women? Most importantly, what are other concelears users saying, and where can balding individuals purchase their own supply of COUVRé masking lotion?

COUVRé: What is it, and how does it work?

Unlike comparable "shaker" application products (such as Toppik – a popular topical applicator product from the same makers as COUVRé), COUVRé is a tinted lotion, meant to minimize the contrast between dark, thinning hair and the balding scalp. According to the manufacturers, COUVRé is applied to the scalp using a specialized sponge applicator. Once the masking formula is on the scalp and providing sufficient camouflage, users are instructed to simply style hair normally and go about their day.  The manufacturer of COUVRé assert that the application appears subtle, natural, will not appear "greasy or sticky," will not stain clothing or towels, and does not interfere with pores or affect natural hair growth.

The Benefits of COUVRé

According to both the manufacturers and satisfied users, COUVRé offers various benefits over comparable concealer products. First, because the makers of COUVRé are confident in the product, they ensure that, unlike some other concealers, COURVe will create a natural appearance without looking greasy or sticky, and does not clog scalp pores or interfere with existing hair shafts. Because of this, not only is COUVRé useful for those with thinning hair, but also for patients awaiting new growth from hair transplant surgery. What's more, COUVRé does not contain any harmful chemicals, can allegedly withstand perspiration, rain, wind, and even physical contact (such as touching the scalp).  COUVRé comes in 8 different colors/tones (to match all hair types) and is equally effective in both male and female hair loss sufferers.  Although COUVRé will withstand a variety of situations without smearing or smudging, it easily washes completely away with water and shampoo.

COUVRé Color Chart

Why COUVRé has Become Popular and Trusted within the Hair Restoration Community

While COUVRé does offer many benefits above other concealer products, its popularity and reputation within the hair restoration community is likely due to several important factors. First, unlike some other concealing products, COUVRé application is both simple and fast. For many individuals, the ability to naturally conceal thinning hair without spending an excessive amount of time "getting ready," is a huge benefit. Furthermore, because COUVRé contains natural ingredients and does not interfere with native or implanted hairs, it is safe to use with other proven hair loss medications (like Rogaine/minoxidil and Propecia/finasteride) and during the new growth phase of hair restoration surgery. Because of its ease of use, effective nature, and ability to conceal hair loss in a variety of situations, COUVRé has become a reputable hair loss treatment and remains popular within the hair restoration community.

What Real Hair Loss Sufferers are Saying About COUVRé

To read real reviews on COUVRé alopecia masking lotion from other hair loss suffering men and women, visit our hair loss forum and social community.

This hair loss product, meant for women, is a synthetic form of Progesterone, a hormone and steroid that occurs naturally in the ovaries. The body uses the Progesterone treatment to control a variety of functions. These include the regulating of the menstrual cycles, anticancer properties, the slowing and prevention of bone loss and ensuring the female sexual organs’ health. Another important function of Progesterone is to maintain the hormone balance of estrogen.

But in regards to hair loss, Progesterone treatment is an effective DHT-inhibitor. However, there has not been much research conducted as to Progesterone’s impact to male and female pattern baldness (MPB, FPB). What research was conducted showed that it may be effective at stopping hair loss, but not at hair regrowth.

Nevertheless, topical Progesterone has been used by some European dermatologists in Europe to treat MPB and FPB. For this, they only used 1% or 2% topical concentrations, and no more than 40mg a day. Researchers believe that higher doses could cause menstrual irregularities.

Topical Progesterone is available as capsules, vaginal creams and suppositories. Patients use the medication by rubbing it into the body’s soft areas, such as the breast, abdomen, inner thighs and the palms of the hands (which is thought to be the most effective area).

It’s advised that women use about 1/8-1/2 teaspoon, once to twice daily, for 21days. Physicians also advise women to stop using the medication for 5-7 days each month. They also advise women to change the application areas periodically.

Childbirth may result in hair loss. It's common for many women to notice hair loss about 3 months after they've had a baby. This too, is caused by hormones. But this is not something to worry about. You see, during pregnancy, hair that normally falls out is kept in by high levels of hormones. Once the hormones have returned to pre-pregnancy levels, this extra hair falls out. The normal cycle of hair growth and loss then begins again.

Diffuse Hair Loss and How to Treat It

Unlike male pattern baldness (MPB) and female pattern hair loss (FPHL), which tends to follow one of the hair loss patterns defined by the NorwoodScale and the LudwigScale, Diffuse Patterned Alopecia (DPA) is characterized by diffuse thinning throughout the front, crown and vertex(crown) with no distinct pattern evident. However, like male and female pattern balding,Diffuse Patterned Alopecia patients typically preserve the stable "permanent zone" on the sides and back of the scalp and may sometimes retain a well-defined hairline. DPA is also a type of hereditary balding condition like and rogenetic alopecia (genetic hair loss).

Diffuse Patterned Alopecia (DPA) can be difficult to diagnose and, particularly in its early stages, may be confused with a similar condition known as Diffused Unpatterned Alopecia (DUPA). While both conditions are characterized by diffuse thinning, DUPA sufferers lack the stable permanent zone necessary for surgical hair restoration.

Treatment for Diffuse Patterned Alopecia

DPA often responds well to medical hair loss treatments like Propecia (finasteride) and Rogaine(minoxidil) and, due to the preservation of the permanent donor region, many DPA sufferers are candidates for hairrestoration surgery.

Conclusion

It’s essential that hair loss suffering men and women seeking medical and/or surgical treatment for diffuse thinning consult with a skilled and experienced hair restoration physician. Differentiating between DPA and DUPA is critical because Diffuse Patterned Alopecia patients frequently make good hair transplant candidates, whereas DUPA patients rarely do.

What Is DUPA?

Diffuse Unpatterned Alopecia (DUPA) is a form of genetic hair loss characterized by diffuse thinning over the entire scalp. Unlike Diffuse Patterned Alopecia (DPA), DUPA lacks the stable permanent zone associated with other forms of alopecia.

Dr. O'tar Norwood defined DUPA in his 1975 seminole publication "Male Pattern Baldness: Classification and Incidence" as:

Diffuse, Unpatterened Alopecia (DUPA). In this type, there is a general decrease in the density of hair without any definite pattern, although it is usually more marked over the top and front. This type is common in women.

Identifying DUPA

Diffuse Unpatterned Alopecia patients have a similar pattern of hair loss to DPA patients but the balding tends to occur more rapidly. DUPA patients are also more likely to achieve the “horseshoe” pattern commonly associated with Norwood class VII baldness. However, unlike other forms of alopecia hair loss, the DUPA “horseshoe” takes on a thin and transparent appearance.

It is important that patients suffering from diffuse hair loss are properly diagnosed. While DPA patients are often good candidates for surgical hair restoration, DUPA patients typically make poor hair transplant patients due to the lack of a stable zone in which to harvest donor grafts.

Treatment for Diffuse Unpatterned Alopecia

Not a lot is known about the cause and treatment of DUPA. However, about half of males who suffer from this form of balding benefit from Propecia (finasteride). Unfortunately, DUPA is about 10 times more common in females for whom Propecia is not a treatment option.

Conclusion

Anyone suffering from diffuse hair loss should consult with a dermatologist or hair restoration physician for a proper diagnosis. This is especially true for balding men and women considering hair transplant surgery.

Over the past several years surgeons have used various techniques to perform follicular unit hair transplantation. One such technique is the Lateral Slit Technique, also known as Coronal or Perpendicular Grafting. This technique’s name is derived from the angle and direction in which the graft incisions are made.

While there are other techniques for performing densely packed and highly refined follicular unit transplantation, the lateral slit technique offers a high degree of control over the angle and direction in which the transplanted hairs will ultimately grow.

The lateral slit technique has been used both intuitively and systematically for years by hair restoration physicians. However, it has recently gained popularity as a systematic and precise way of performing follicular unit hair transplantation.

How our member physicians use the Lateral Slit Technique.

Many of our physician members use the Lateral Slit Technique exclusively or in combination with other techniques for creating graft incisions. The lateral slit technique enables a surgeon to create graft incisions at varying angles (ranging from 10 to 90 degrees to the scalp), including very acute angles that will make the transplanted hair grow out lying flatter to the scalp. The ability to create incisions at very acute angles is particularly useful in areas such as the front temples and sides where the hair normally grows out lying flat on the scalp.

The graft incision determines the direction of the hair growth

The lateral slit technique also helps enable a surgeon to determine the direction of the graft incisions. This then determines the ultimate direction of the transplanted hairs growth. Thus a surgeon can use this technique to control and vary both the direction and angle at which the transplanted hair will grow in order to mimic the subtle changes in hair direction that occur naturally.

Each graft incision is created by analyzing the neighboring hair so the surgeon can reproduce the correct hair pattern. As a result, as each transplanted hair emerges from the scalp it will grow and lay in a similar direction as its neighboring non-transplanted hairs.

Lateral slits can enable denser packing of grafts

Lateral slit incisions also tend to be more parallel to the scalp and thus more superficial and less invasive to the scalp’s underlying vascular structure. This parallel alignment also enables a physician to place more grafts per square centimeter with out the grafts compressing or popping up since the pressure exerted on the grafts does not push them upward from the scalp.

Using blades cut to the size of the grafts

Some of our members use custom blade cutters to create tiny blades to make incisions that match the size and depth of each follicular unit graft being transplanted. This enables a surgeon to safely dense pack more grafts into a given area during a surgical session. Healing time is also more rapid, with minimal scarring.

Typically most clinic’s blades range from 1.5mm to 2mm in size. However, by using the custom blade cutter our physicians can create blades as small as .7mm for a single hair graft and .9mm for a multi hair graft.

In addition, the blades created by the custom cutter are squared off to match the shape of the bulb end of a hair follicle. Non custom cut blades are typically spear pointed which requires them to be inserted deeper thus causing more trauma to the scalps vascular structure.

The ability to control the depth of the incision each blade makes is also critical. Each blade is placed in a blade holder that is set to not allow the blade to go any deeper than required for the graft to being placed in the incision. This minimizes unnecessary trauma to the deep vasculature of the scalp, thus enabling close tight incisions, minimal tissue swelling, and quick healing that leaves no visible scaring, pitting, or cobble stoning of the scalp.

Placing grafts to maximize their aesthetic result and coverage

The plane and direction in which each follicular unit graft is placed on the scalp can also impact the ultimate appearance of density that can be produced with a given number of grafts. This is because hairs within a follicular unit are typically next to each other inline.

Therefore by arranging each multiple hair graft on the scalp in a linear fashion to the line of sight, each follicular unit will provide the maximum appearance of fullness and scalp coverage. This also mimics how hair is normally aligned on the scalp.

Special thanks to Dr. DeYarman, Dr. Sharon Keene, Dr. Jerry Cooley, Dr. Alexander, and Dr. Glenn Charles for contributing their expertise and photos for this section.

A Viable Alternative to Propecia in Treating Hair Loss?

Folexen S-equol , produced by Australian manufacturer Eclipse Nutraceuticals is considered an "all natural" hair loss treatment that boasts an impressive 87% success rate for preventing and reversing the effects of male pattern baldness with virtually no side effects.  Folexen S-equol has also been a hot topic of discussion on our popular hair loss forum. But, does this self-described "nutraceutical" live up to its hair growth hype?  Is Folexen a viable alternative to Propecia for treating the effects of male pattern baldness?

What is Folexen S-equol?

According to the FAQ on Folexen's website, the active ingredient S-equol is "a metabolite of a natural isoflavone called daidzein, which occurs in soybeans and some other food products".

Isoflavones are an organic compound produced almost exclusively by various bean types. In populations that consume large quantities of soy protein, studies have shown a lower incidence of breast cancer and other common cancers because of its role in influencing sex hormone metabolism and biological activity.

As a metabolite, S-equol is the product that remains after the isoflavone is broken down or "metabolized" by the body.

In addition to its active ingredient, Folexen contains the following GRAS (generally recognized as safe) inactive ingredients: starch, maltodextrin, allantoin, propionic acid. It may also contain hypromellose (vegetarian capsule).

But is there any evidence that S-equol  works to treat hair loss?

How Folexen S-equol Allegedly Works to Treat Baldness

In the body, testosterone is converted to the hormone dihydrotestosterone (DHT) via the enzyme 5-alpha-reductase (5AR). It's widely known that androgenic alopecia (genetic hair loss) results when genetically vulnerable hair follicles are exposed to DHT which then binds to the receptor sites of these follicles causing them to weaken and shrink over time. This shrinking process is known as miniaturization.

The recognized leader in the battle against the balding effects of DHT is the clinically proven and FDA approved drug Propecia (finasteride). Propecia works by inhibiting the conversion of testosterone to DHT, potentially slowing or even reversing the effects of androgenic alopecia. However, approximately 2% of males who take Propecia experience debilitating sexual side effects.

Unlike finasteride, Folexen's rumored ability to suppress hair loss and potentially regrow hair is based on the theory that S-equol can bind strongly to free DHT molecules, prohibiting them from binding to the hair follicles' receptor sites. Because Folexen does not suppress the conversion of testosterone to DHT, there is no resulting increase of testosterone in the body and therefore, no sexual side effects. But are there any clinical studies supporting that S-equol can truly prevent DHT from binding to hair follicle receptor sites and prevent hair loss?

Clinical Studies

Folexen's website references four articles in peer reviewed journals. Two of these studies center on S-equol's effect on prostate health while the other two don't appear to reference S-equol at all.

At this time, there appears to be no scientific data presented supporting Folexen's efficacy as a hair loss treatment.

Side Effects

The company claims that the product is virtually side effect free: specifically noting that it does not cause gynecomastia (enlarged breasts), erectile dysfunction or any of the other side effects that are experienced with some other treatments.

Some users however, did report mild diarrhea that dissipated within one week of commencing treatment.

What is the Recommended Dosage?

The recommended dosage of Folexen is 4 capsules per day (two every 12 hours), totaling 10mg of the active ingredient. Eclipse claims that the product has been tested safe at much higher concentrations (up to hundreds of milligrams) and there is some speculation based on available data that it may, in fact, require a dose as high as 100mg to match the Propecia's hair growth results.

Where to Buy Folexen S-equol

Folexen is only available by mail order from Australia. A bottle of 100 2.5mg capsules (25 day supply) costs approximately $40 USD + shipping but there is a discount for purchases exceeding 4 bottles and again for 9+ bottles. However, it's easy to see that even in bulk this treatment is several times more expensive than purchasing generic 5mg finasteride and quartering the tablet, as many finasteride users do.

As a natural product and not a drug, there are no shipping restrictions. Estimated delivery time is two weeks.

Conclusion

Time will tell if Folexen S-equol proves to be an effective weapon in the fight against androgenic alopecia or simply another product in a long line of expensive disappointments.