Along with Propecia, Rogaine is one of the only proven hair loss medication options approved by the FDA for treating hair loss. Minoxidil, (Rogaine’s active ingredient), was originally created as a drug for treating hypertension (high blood pressure). It was then discovered that one of its side affects was growing hair. Minoxidil was then tested for use a topical application for regrowing hair. The results were sufficiently impressive that the FDA approved it as a treatment for hair loss.

Rogaine works by revitalizing shrunken hair follicles, thus increasing their size. When you use Rogaine every day, your follicles may increase in size, and the growing phase may become longer. This may then produce longer, thicker hairs.

Rogaine is a clear alcohol-based solution and should be applied to a person’s thinning area with its supplied dropper or spray twice a day.

The solution is approved and available in two strengths -- Regular (2%) and Extra Strength (5%). Individual users of Regular strength Rogaine have claimed success rates of 30-40%. Meanwhile, users of Extra Strength Rogaine have claimed success rates of 50-60%. Currently, the average price for a 2oz. bottle of Rogaine is about $20-30 per month. Minoxidil is also available as a generic and can be purchased over the counter without prescription.

It’s important to note that Rogaine (minoxidil) does not cure baldness and scientists have been unable to determine just how it works. What is known is that Rogaine increases the blood flow to the areas of the scalp that surround these balding areas. Currently some researchers believe that Rogaine (minoxidil) works by opening the follicle’s potassium channels located in the cells. It’s theorized that these channels, when opened, may regulate hair growth.

Rogaine can’t grow hair on completely bald scalps or in the frontal hairline areas. It has been found to be somewhat effective in maintaining or growing hair in the crown area (the top back of the head). However, Rogaine is only effective at delaying hair loss. It is also more effective in women than in men. And again, the reasons for this are not understood.

What can I expect with Rogaine?

Rogaine (minoxidil) generally only regrows hair in a minority of men and women. In most cases, the best case scenario for hair growth with these treatments is a thin coverage of thin hair.

The real benefits of Rogaine (minoxidil) is keeping what hair you have or slowing your thinning. Rogaine’s success depends on how advanced your hair loss has become.

You must apply it to your scalp twice a day for life to get and maintain any benefits. Research shows that using Rogaine (minoxidil) only once a day is ineffective. If you stop taking Rogaine (minoxidil) you will loose whatever hair you preserved or regrew within 2 to 4 months. And while Rogaine may stimulate hair growth, it may not prevent the hair follicles from their eventual deterioration.

It's also true that Rogaine's effects may diminish over time. Some doctors believe that patients can build up a tolerance after many years of use. But it's possible to fight this tolerance by taking a week or two off from the treatment every 3-4 months. However, it's not advised to take this break unless you've taken the hair loss medication consistently for at least 12 months.

Are there side effects from Rogaine?

There are only minor side effects with Rogaine. But some users do experience certain problems such as scalp irritation, itching, and dandruff. However, this can be treated with a good shampoo like Nizoral or Neutrogena T-Gel. There may also be an increase in hair shedding at the start of the treatment. You shouldn’t panic, as this may actually be a signal that the treatment is working.

Due to the medication’s alcohol content, some users may develop a contact rash or irritated skin. And with excessive doses, some users may experience dizziness or a rapid heartbeat. However, with normal use these effects are uncommon.

Rogaine users with severe, refractory high blood pressure experienced some problems. One such problem was “hypertrichosis,” hair growth on the face or other bodily areas. This side effect appears in about 3-5 % of women who use the 2% solution, and higher among women using the 5% solution.

Rogaine and Hair Transplants

Some hair restoration physicians have come to consider Rogaine to be instrumental right after surgery. This is especially true when grafts have been placed in and around existing hair.

The shock of surgery can result in temporary hair loss. Rogaine is thought to possibly help prevent this temporary loss of healthy preexisting hair. The 5% solution has been found to be more effective for men and women. However, some physicians believe that the hair loss medication should be stopped a week or two before surgery. They feel that Rogaine may increase bleeding, while dilating blood vessels.

After surgery, most patients wait a week or two before restarting Rogaine. This gives the graft areas time to heal. However, taking Propecia is not interrupted by surgery.

Click to learn more about DHT Blockers

Today's evolutionary high point - Ultra Refined Follicular Unit Transplantation

By relocating these carefully prepared bald-resistant follicular units, physicians doing "follicular unit hair transplantation" recreate a natural pattern of hair in the balding areas.

To do this properly is a very time consuming and exacting process. It requires a team of meticulous medical technicians working hand-in-hand with the hair transplant surgeon in a very lengthy surgical procedure.

Ultra Refined Grafting - Smaller Blades, Smaller Incisions, Smaller Grafts

Today's micro surgical blades, like the size of hair grafts, have become ever smaller and now enable hair transplant surgeons to safely make more tiny graft incisions in a given area then ever before. Surgeons are then able to "dense pack" select areas with as many as 40 to 60 follicular unit grafts per square centimeter. This graft density is as much as twice that of the standard follicular unit hair transplant procedure.

Such high densities of transplanted hair typically produce the appearance of fullness even after only one surgical session. Patients also experience rapid healing and no visible skin distortions due to the tiny size of these incisions.

Ultra Refined Follicular Unit Grafting - Hard on the clinic but easy on the patient.

Ultra refined follicular unit grafting raises the bar for physicians and their staff. This delicate and demanding hair transplant procedure requires more skill and careful attention to be performed properly. The smaller and more tightly packed incisions require more closely dissected follicular unit grafts that are carefully trimmed under microscopes. These small and densely packed incisions are also more difficult to place the grafts into.

This procedure also requires more careful patient selection, as "dense packing" of grafts is not appropriate for all patients.

Ultra Refined Follicular Unit Transplantation - the new "Gold Standard"

In the hands of a highly skilled physician and staff the Ultra refined follicular unit hair transplant procedure can achieve excellent new hair growth that is so natural that it is undetectable even under close scrutiny.

While the standard micro "follicular unit" hair transplant does produce natural looking results, its ability to achieve high density in only one surgical session is limited. Thus patients may have to do subsequent surgical sessions in a transplanted area to achieve a full look.

The many patient benefits of this new ultra refined procedure are significant and include:

• The ability to get excellent hair density in only one surgical session.
• Minimal trauma in the graft recipient area with rapid post surgical healing.
• Little or no visible pitting or distortions in the transplanted areas.
• More natural direction and angulation of the transplanted hair.

All physician members of the Coalition perform Ultra Refined Follicular Unit Hair Transplantation.

While many hair transplant physicians perform quality follicular unit hair transplants, only some of them are capable of performing large sessions of ultra refined follicular hair transplantation. However, all members of the Coalition of Independent Hair Restoration Physicians perform ultra refined grafting with excellent results.

The Future of Surgical Hair Restoration

The amount of hair you can transplant is ultimately limited by the amount of hair follicles you can safely relocate from the bald resistant donor area at the back and sides of your head.

Some day it may be possible for physicians to create multiple hair follicles from one original follicle. This process typically called Hair Multiplication or more incorrectly Hair Cloning is currently being investigated by several research scientists and hair restoration physicians.

If and when this process is successfully developed patients would no longer be limited by the finite amount of bald resistant hairs that can be relocated from their donor area. Hair multiplication would result in a virtually limitless supply of hair available for hair transplants.

This would be especially good news for men or women with extensive baldness and a very limited supply of donor hair. Even those with extensive baldness would theoretically be able achieve thick full heads of hair.

However, experts believe that we are at least ten years away from hair multiplication being available, if even then. But perhaps some day scientists will be able to use gene therapy to halt the balding process without drugs or surgery.

Learn about modern hair loss drug treatments that work.

While hair restoration surgery is now a proven treatment for restoring hair where it has been lost, Hair loss medication such as Rogaine (minoxidil) and Propecia (finasteride), have made real contributions toward stopping and even reversing hair loss.

During the late 70’s and early 80’s it was discovered that minoxidil, used as a heart medication, had hair growing side effects. Minoxidil was tested for use as a topical scalp treatment for hair loss and proved to inhibit hair loss in many test subjects.

It has proven to be effective to some degree in slowing the hair loss process. For a minority of people it can even grow back lost hairs in the crown area (back of the head). However, Rogaine (minoxidil) does not slow or reverse the balding process in the frontal hairline area.

Rogaine is typically applied topically on the scalp twice a day, morning and evening. But once usage is discontinued the hair loss which had been inhibited will resume and the hair that was saved will be lost.

Rogaine originally required a prescription, but in 1995, it became available in 2% strength Rogaine over-the-counter. Today, men and women can buy 5% strength lotion over-the-counter as Rogaine or as generic minoxidil.

To date Rogaine (minoxidil) and Propecia (finasteride)are the only hair loss medications with FDA approval. Propecia’s active ingredient, finasteride, was originally used to treat enlarged prostate glands. It was discovered that, like minoxidil, it had the “side effect” of stopping male pattern baldness and for some even regrowing hair.

Propecia is taken as a pill once daily and acts to inhibit the body’s ability to create dyhydrotestosterone or “DHT”. DHT acts as the active ingredient or catalyst in the balding process.

Rogaine and Propecia

The 90’s brought great advances in hair restoration, both surgical and non surgical. Now most people can realistically halt and reverse their hair loss with truly natural results.

In 1988 minoxidil, Rogaine, became the first hair loss medication to be approved by the FDA for the treatment of hair loss.

In 1998 the FDA approved Propecia for the treatment of hair loss. Propecia (finasteride) should NOT be taken by woman or children for any reason.

Learn about all your hair loss treatment options.
 

A Cosmetic Tattooing Procedure to Conceal Hair Loss

Scalp Micropigmentation, the process of tattooing thinning or bald areas of the scalp to resemble shortly cropped hair, has been met with high amounts of enthusiasm from patients seeking alternative ways to mask and conceal their hair loss. This artistic and minimally invasive procedure, also referred to as SMP, provides men and women suffering from hair loss with an illusion of fullness or the appearance of thick, shortly cropped hair. SMP results (not the procedure) are often compared to topical concealers such as Toppik, DermMatch and Nanogen, because they also help conceal baldness and make thinning hair appear thicker and fuller.

Although scalp micropigmentation is increasing in popularity, it is still a new and evolving practice and its mystique may leave interested patients asking several important questions.

How does scalp micropigmentation work? What are the benefits, limitations and potential risks associated with the procedure? Who is a suitable candidate? What are the costs associated with SMP? What happens if consumers don't like the results? Is the ink associated with scalp micropigmentation permanent? Are all SMP practitioners equal or do some produce better, more natural looking results?

Scalp Micropigmentation is the artistic application of tattoo-like ink or pigmentation "dots" to bald or thinning areas of the scalp to recreate the appearance of shortly cropped hair (or "stubble") by a trained practitioner. SMP practitioners are typically experienced in the art but often aren't medical professionals or hair restoration physicians. Scalp micropigmentation is typically used for one of three purposes. These include:

• Creating the illusion of fullness or density to thinning hair by applying cropped, hair-like tattoos in between and around thinning hair.
• Creating the appearance of closely cropped or shaved hair on an otherwise bald scalp.
• Camouflaging a pre-existing hair transplant scar. Typically, this is a rare, but stretched, linear scars from follicular unit hair transplantation procedures via strip harvesting (FUT) can sometimes require revision.

Scalp micropigmentation ink is normally placed in the superficial dermis, a layer of skin between the epidermis (the outer layer of the skin) and subcutaneous tissues that consists of connective tissue and cushions the body from stress and strain. However, SMP practitioners often place ink at varying depths. Some practitioners are now beginning to use a “sweeping” technique when tattooing, in order to create a more three-dimensional appearance on the scalp.

Depending on the size of the balding/thinning area and the desired appearance, the procedure can take anywhere from 1-8 hours, and can now be completed with both permanent and temporary SMP ink.

According to Coalition hair transplant surgeon Dr. Robert Bernstein, the key to further achieving a natural result with SMP lies in holding the inking tool at an appropriate angle, controlling the depth at which the ink is placed, monitoring the amount of ink deposited at each site, and selecting appropriate ink tones.

To read more of Dr. Bernstein's input and discussion related to SMP at the 2012 annual ISHRS Scientific Meeting for hair restoration physicians, visit "Scalp Micropigmentation (Scalp Tattooing)at the 2012 ISHRS (International Society of Hair Restoration Surgery) Scientific Meeting".

Permanent Versus Temporary Scalp Micropigmentation (Advantages and Disadvantages)

Defining and understanding the difference between permanent and temporary ink is important for any consumer considering the procedure.

Permanent scalp micropigmentation is performed with micropigmentation ink that is not designed to fade or change over time. The ink is placed slightly deeper in the scalp tissue, and the procedure can be performed with ink containing both colored and black pigment.

Advantages of permanent SMP include the ability to undergo a single SMP treatment without frequent “touch ups" and potentially lower long-term costs.

Disadvantages include the possibility that the ink will eventually fade to a green or blue hue (due mainly to the black pigment used in permanent SMP ink) and the inability to reverse the procedure without laser pigment removal (i.e. “laser tattoo removal”) if the work is unsatisfactory.

Temporary scalp micropigmentation is performed with ink that is specially designed to gradually fade and disappear within 6 to 24 months after the procedure. The ink is placed into a superficial layer of the scalp, which allegedly helps to define the pigmentation and decrease the probability of “blurring” ink. Temporary SMP is performed with ink containing no black pigment. Because black pigmentation can eventually fade into a blue or green tone, it would inevitably produce an unnatural looking result as it gradually fades and disappears, and should be avoided.

Advantages of temporary SMP include: the ability to redesign or discontinue the process (when the ink fades after 6-24 months) if the results are not satisfactory; the decreased rates of ink blurring, running, and definition loss with the superficial placement into the scalp; and the ability to use the three-dimension technique (which was designed by Beauty Medical in Milan, Italy, and is now utilized by several leading clinics recommended by this patient community).

Disadvantages of temporary SMP include ongoing maintenance and costs associated with undergoing subsequent SMP applications every 6 to 24 months, and the possibility of discoloration as the ink fades (though the temporary ink is purposely designed to fade evenly and without discoloration).

To learn more about the advantages and disadvantages of permanent and temporary SMP, visit "Temporary Scalp Micropigmentation: Advantages, Disadvantages, and Clinics Currently Offering the Procedure".

Scalp Micropigmentation Costs

The cost of SMP is variable and depends upon the type of procedure (temporary versus permanent), size of the procedure, and the practitioner/clinic performing the micropigmentation. While rates typically vary and change, permanent SMP can cost anywhere from $800 for a small procedure and $6000 for a large one. The cost of temporary SMP is approximately half the cost of permanent SMP and typically ranges from $500 to $2500 depending on the size of the procedure. Subsequent procedures, which are needed 6 to 24 months after the initial results fade are typically 50% of the original costs.

What Makes a Good SMP Candidate?

Although a wide variety of men and women are interested in scalp micropigmentation, the procedure is actually only ideally suited for a small, select number of hair loss consumers.
SMP is likely best suited for individuals interested in aiding the appearance of density in shortly cropped, diffusely thinned hair, and for patients trying to camouflage a hair transplant scar. It may also be suitable in creating a greater illusion of fullness in those who've already undergone surgical hair restoration.

SMP consumers should also consider a naturally asymmetrical hairline design and “fading” effect (from decreased pigmentation in the hairline to denser, increased pigmentation in the middle scalp) if hairline restoration is performed. This approach will likely create a more natural result in eligible candidates.

Creating Realistic Expectations

While scalp micropigmentation may be a useful adjunct therapy for a select group of consumers interested in concealing their hair loss, it should be approached with realistic expectations and performed by a trusted clinic. Individuals considering the procedure must remember that SMP is a two-dimensional process and cannot provide the texture and growth of real hair. Undergoing SMP without respecting its limitations may create unrealistic expectations and disappointing results.

Evolving Procedure or Just a Fad?

Is SMP just a fad or will it continue to evolve and cultivate additional interest from hair loss sufferers and hair restoration physicians?

While some hair loss experts are quickly embracing the procedure, others are more resistant, and liken scalp micropigmentation to less popular "niche" treatments like hair systems, laser caps, and topical concealers. Whether or not it will continue increasing in popularity and retain its momentum is not yet clear.

Hair restoration is a rapidly changing field and new and evolving therapies may eventually render scalp micropigmentation and other hair loss treatments obsolete.  Altogether, only time will tell whether SMP is a lasting adjunct therapy or a passing fad.

Clinics Currently Offering Scalp Micropigmentation

As of January 2013, the following hair restoration clinics recommended by this website are offering some form of Scalp Micropigmentation: Hasson and Wong (Drs. Victor Hasson and Jerry Wong), and Shapiro Medical Group (Drs. Ron and Paul Shapiro).

Dr. Feller, Dr. Lindsey, Hasson and Wong, and Shapiro Medical Group trained with Beauty Medical and offer the temporary SMP procedure; Dr. William Rassman performs his own variation of Scalp Micropigmentation with permanent ink.

Note that in many cases, a trained technician and not the physician will be performing scalp micropigmentation.

This website does not currently recommend one SMP clinic over another. Those considering scalp micropigmentation as a tool to conceal hair loss and create an illusion of hair are encouraged to do their own diligence in researching each technique, practitioner and clinic.

To discuss scalp micropigmentation with hair loss sufferers and other interested parties and to view results showing before and after pictures, visit the Scalp Micropigmentation Forum.