• Alopecia Areata: Patchy Hair Loss and How to Treat It

    Alopecia Areata

    Alopecia areata (sometimes referred to as“spot baldness”) is a medical condition that typically results in patchy hairloss or bald spots on the scalp, beard, arms and legs. Though the exact cause of alopecia areata is unknown, it is thought to be an autoimmune disorder causing the body’s immune system to attack its own hair follicles, resulting in hair loss.

    Roughly 2% of the world’s population suffers from alopecia areata and approximately 5% of these have a family history of "alopecia", the medical term for hair loss.

    Diagnosing Alopecia Areata

    Alopecia areata is normally diagnosed through the observation of symptoms. However, occasionally a scalp biopsy or blood tests may be performed.

    Treating Alopecia Areata

    There is no cure for alopecia areata and current treatments, while sometimes effective, offer limited success.  Current treatments for alopecia areata include; steroid injections, topical corticosteroids (steroid hormonesnaturally produced in the adrenal cortex of vertebrates), topical immunotherapy, Rogaine(minoxidil) and ultraviolet light therapy.

    Although permanent hair loss is a possibility, the course of the disease is unpredictable and varies from patient to patient. The good news is that, even without treatment and after many years,the hair follicles do remain viable and ready to resume normal hair production if and when they receive the appropriate signal. Hair regrowth may, and often does, occur in time.

    Are Alopecia Areata Patients Good Candidates for Hair Transplantation?

    Patients suffering from alopecia areata are rarely considered good candidates for hair transplant surgery because donor hair grafts harvested from the “safe” zone at the rear and sides of the scalp are still vulnerable to the effects of the body’s immune system once transplanted to the recipient sites. However, if the affected area is small, has remained unchanged for an extended period of time and if there is no sign of inflammation below the scalp, hair transplantation may be an option. This would require a thorough consultation with a skilled and experienced hair restoration surgeon and the patient would need to fully understand and accept the risks of such a procedure.

    Adapting to and Living with Alopecia Areata

    Depending upon the severity of the condition, hair loss concealers like Toppik, Nanogen and DermMatch may help disguise bald patches. In more severe cases, a hair replacement system or full wig may be necessary.

    Aswith all forms of hair loss, patients suffering from alopecia areata may experience emotional and psychological trauma. It’s important to reach out to family and friends, join an alopecia support group and/or seek the services of a mental health professional if you are experiencing intense, prolonged and overwhelming psychological effects.

  • Extreme Hair Therapy (EXT)

    Extreme Hair Therapy

    Extreme Hair TherapyIs this hair loss treatment effective?

    Extreme Hair Therapy (EXT) for thinning hair is a 5 "step" hair loss treatment solution created by Hair Club that claims not only to rejuvenate your hair, but "rejuvenate your life".  Making claims to be FDA approved, EXT claims to stimulate hair regrowth in thinning areas by keeping hair in the anagen (hair growth) phase longer.

    Balding men and women seeking hair loss solutions should be careful to do their due diligence in researching all products they are considering.   Is this one of the hair loss products that really works to treat baldness?  Can Extreme Hair Therapy really deliver what it promises?

    Below we take a look at each of the 5 “steps” and separate treatments and analyze whether or not EXT can remedy alopecia in men and women.

    What is the 5 Step Process of Extreme Hair Therapy?

    Step One: Moisturizing or Revitalizing Cleanser
    This moisturizing shampoo is rich with vitamins and works to cleanse the scalp. Though it claims to revitalize and strengthen thinning hair, the ingredients are not listed on their website. Many hair rejuvenators and thickening agents (commonly referred to as volumizing shampoos) help to make hair appear thicker as they take on hydration and swell. Unfortunately, these thickening agents do nothing to stop the progression of male pattern baldness, even if it temporarily makes the hair shaft appear fatter.

    Step Two: Enzyme Scalp Cleanser
    Claiming to be a “new breakthrough”, this organic formula removes sebum oils that can sometimes hinder hair growth. Though sebum buildup, excessive dandruff, and scalp dermatitis are sometimes responsible for certain non-genetic types of balding such as diffuse alopecia or telogen effluvium, it does not promote androgenic alopecia (hereditary male or female hair loss).

    Step Three: Energizing Conditioner
    Adding nutrients such as proteins and wheat amino acids, this conditioner helps to promote a healthy scalp and hair growth. It should be noted that nothing in this step claims to stop hair loss or stimulate hair regrowth.

    Step Four: Hair Revitalizing Complex
    This dietary supplement containing Vitamins B3, D, and E, Biotin, saw palmetto and nettle root is taken twice daily, once in the morning and once at night. Some of these ingredients can also be found in several other hair loss products such as Provillus, Procerin, and Avacor.

    Though some of these ingredients work to treat benign prostatic hyperplasis (BPH) in men by inhibiting DHT (the hormone responsible for female and male pattern baldness), no formal clinical studies have been performed on successful hair loss treatment. It should be noted that tocotrienol molecules in Vitamin E may effectively treat alopecia but its counterpart tocopherol (commonly found in alternative herbal hair loss treatments such as HairMax MD), is not supported.  Additionally, because there are no regulations on herbal medications in the United States, the daily recommended value and dosage in Extreme Hair Therapy is based on something other than FDA regulation.

    Step Five: Minoxidil (2% or 5%)
    Minoxidil (the active ingredient in Rogaine and Xandrox) is an FDA approved hair regrowth formula and is used by many balding men and women with great success. Because Extreme Hair Therapy includes this, they are legally allowed to claim it to be FDA approved.

    Costs:

    Unfortunately, this information is not available on the Hair Club website. Upon calling the toll free number for this information, we are told that we must schedule a consultation with a Hair Club specialist. Customer service representatives are apparently not provided with this information.

    Side Effects and Warnings:

    No EXT side effects are reported on the Hair Club website however, Minoxidil may cause scalp irritation or redness, chest pain, a rapid heartbeat, faintness, swelling of the hands and/or feet, and unwanted facial hair growth.  Be sure to discuss the use of herbal medication with your physician before taking them. Saw Palmetto should be avoided by pregnant women with hair loss.

    Conclusions:

    The only FDA proven ingredient in Hair Club’s Extreme Hair Therapy hair loss treatment is Minoxidil.  Though Saw Palmettoand nettle root may be effective in treating men with an enlarged prostate by inhibiting DHT, no formal tests have been performed on them.

  • Procerin for Hair Loss: Product Review

    Procerin

    Procerin is one of the top selling “all natural” hair loss products on the market today and is often an attractive alternative to drugs like Propecia (finasteride)and Rogaine (minoxidil). Procerin comes in both a tablet and topical form that can be ordered together or separately depending on your hair restoration goals.

    Men and women suffering from androgenic alopecia (genetic female hair loss / male pattern baldness) have elevated levels of the hormone DHT (dihydrotestosterone) in their body.   Procerin’s claim to fame is that it naturally blocks this DHT without reacting with testosterone like the drugs Propeciaand Avodart (dutasteride).  This allegedly allows Procerin to stop hair loss and stimulate hair regrowth without unwanted sexual side effects.   Procerin is so convinced their product works, that they offer a 90 day money back guarantee if you don’t receive your desired hair growth results.  But how many balding men and women have successfully restored their hair with Procerin?

    In order to fully evaluate the efficacy of this product, we must further explore each ingredient to determine whether or not this hair loss treatment delivers what it promises.  Below you will find a list of ingredients and information that will help you determine whether or not Procerin is right for you.

    Oral Ingredients:

    The Procerin tablet includes a number of alleged “all natural” DHT blockers including saw palmetto for hair loss, zinc sulfate, pyroxidine, magnesium, and a proprietary blend of gotu kola, nettles, pumpkin seed, eleuthero root, muira puma root, and uva ursi.  Many, but not all of these ingredients are also found in the highly popular hair loss treatment Provillus.

    Oral saw palmettoand nettle root extracthave been used as “all natural” alternatives to treat benign prostatic hypertrophy (BPH) or enlarged prostates.  Theories have thus been produced that they might also effectively treat baldness and alopecia.

    Some studies suggest that Zinc when combined with Vitamin B6 may be able to inhibit the conversion of testosterone to DHT in the skin.

    Pumpkin seed oils contain the ingredient delta-7-sterine that has been said to protect the prostate by competing with DHT.  Therefore, it’s suggested that this ingredient might help reduce the risk of genetic hair loss.

    Eleuthero, uva-ursi, muria puma, and horsetail are said to promote healthy hair growth, hair expansion, and a clean scalp.  However, promoting healthy hair growth is not the same as stimulating new hair growth, hair regrowth, nor does it indicate they’re effective hair loss treatments.

    Topical Ingredients

    The Procerin topical solution contains saw palmetto extract, gamma linolenic acid, grape seed extract, azelaic acid, avocado oil, and nettle extract.

    Azelaic acid when applied topically has been conjectured to inhibit DHT.  Some anecdotal evidence suggests oral saw palmettomay inhibit DHT however; no such evidence exists for topical use.  Though nettles are typically consumed orally, some speculate nettle root extract may help fight alopecia areata when applied topically.

    Possible Side Effects

    One false assumption is that “all natural” hair loss products don’t have potential side effects.  Procerin reports directly on their website that reported side effects include mild stomach discomfort and from the topical formula, skin irritation.  Additionally, be sure to research each ingredient carefully as some side effects are possible in larger quantities.

    Dosage

    Currently there are no standards on dosages of herbal medications in the United States.  In addition, no formal clinical studies have been performed on them for treating baldness.  Therefore, the suggested daily value listed on the ingredient package is based on something other than government regulation and scientific study.

    Costs

    The discounted cost of the combined formula for a 1 month supply of Procerin is about $50 and is discounted when you buy in bulk.  It is also cheaper when you buy in bulk.

    Conclusions and Our Opinion

    Though we can appreciate the aspiration for balding men and women to use herbal products as an “all-natural” replacement for Propecia to treat androgenic alopecia, we’ve seen no third party clinical studies that support the ingredients in Procerin can successfully stop hair loss or stimulate hair regrowth.  Due to the lack of compelling evidence in these other conjectured hair loss solutions, it may be more beneficial and cost effective to spend your money on Propecia (finasteride) for men only and Rogaine (minoxidil) that has helped balding men and women worldwide for years.  For men who have experienced sexual side effects with Propecia, Procerin may at the very least, be worth trying as an adjunct treatment to Rogaine.

  • FUE – a new way of doing Follicular Unit Hair Transplantation

    FUE – a new way of doing Follicular Unit Hair Transplantation

    Follicular unit extraction is a minimally invasive procedure for performing follicular unit hair transplantation. However, unlike the predominant follicular unit transplant procedure, in which a strip of donor tissue is removed and dissected under magnification, the FUE procedure uses a small punch to extract each follicular unit one by one.

    Both the strip excision and FUE procedures create 1, 2, 3, and 4 hair follicular unit grafts that are then transplanted into the balding area in the same manner. The primary difference between these two procedures is the technique used to harvest the follicular unit grafts.

    Comparing the Strip Excision procedure to the Extraction (FUE) procedure

    The common strip excision method of performing follicular unit hair transplantation involves surgically excising a thin horizontal strip of bald resistant skin from the donor area.

    Strip Excision Procedure 

    Donor strip being excised
    Donor strip being excised

     

    Incision sutured together
    Incision sutured together

     

    Hair combed down after suturing
    Hair combed down after suturing

     

    This donor area is then sutured together. These sutures (either stitches or staples) are then typically removed about ten days after surgery. Some physicians use dissolvable sutures so that no removal is needed.

     

    Patient’s donor area 2 months after surgery
    Patient’s donor area 2 months after surgery

     

    Once this linear incision is fully healed the patient is left with a thin horizontal scar in the back of the head. This scar is typically hard to detect since the surrounding hair conceals it, even when the hair is cut short.

    To view a video of an actual strip excision surgery.

    How the FUE Procedure is performed

    With the Follicular Unit Extraction or FUE procedure 1, 2, 3, and 4 hair follicular unit grafts are carefully extracted one at a time using a tiny punch of one millimeter or less. Often the surgeon requires the patient to buzz cut a portion of their donor area so that they are able to see the patient’s scalp.

    The follicular units are extracted
    The follicular units are extracted

     

    The follicular units are extracted by placing the punch around a single follicular unit and cutting a small circle through the skin around that follicular unit. The follicular unit is then gently pulled up and away from the loose tissue underneath the skin.

    The small hole left behind after the follicle is extracted then heals over the following week. Normally this small round incision contracts as it heals making the resulting round scar smaller than the size of the 1mm punch that made the incision. The FUE patient ultimately ends up with hundreds of small round white scars, which are normally not detectable once the patient’s hair grows out.View a video of an actual FUE surgery.

    To Extract or to Excise, that is the question.

    Advocates for the relatively new FUE procedure claim that this procedure produces less noticeable scarring and no tightness or numbness in the donor area since no donor tissue has been pulled together and sutured. Many patients and physicians find the claim that FUE produces less visible scarring to be debatable.

    Some physicians and patients also have concerns about the relatively new FUE procedure, such as the lack of formal studies regarding the percentage of follicles that may or may not be transected during the sight unseen extraction process.

    In addition, since the physician must personally extract all follicles, one by one, the FUE procedure is very physician dependent and thus very expensive. The FUE procedure also requires considerably more time in surgery to move a given amount of hair to the balding area.

    The standard strip excision procedure has the advantage of utilizing a collaborative team to carefully create the grafts once the donor tissue is removed in a strip. This collaborative approach enables a well trained staff to do sessions of 2,000 to 3,000 all follicular unit grafts in a single day. This team approach enables a patient to get a much larger number of grafts/hairs in one sitting at a much lower cost per hair than with the FUE procedure.

    However, some believe that despite being relatively costly the FUE procedure may be appropriate for patients who have very limited elasticity in their donor area or who only need a small number of grafts.

  • Recoverup: A Revolutionary Stem Cell Treatment or Hair Loss Hype?

    Female hair loss

    It seems that lately, new hair loss treatments based on “revolutionary scientific research” hit the rumor mill on a monthly basis. Some of these treatments come to light via reputable scientific journals while others, like Recoverup, materialize one day with a flashy website, a lot of promises and very little verifiable data. Recoverup is a UK based company that claims to offer stem cell treatments for hair loss through clinics in Taipei, Taiwan and Penang, Malaysia. According to their website, this treatment is so quick and easy it can be performed in a single day with startling results visible in only one month. Does this sound too good to be true?

    Recoverup’s baldness treatment process claims to rely upon Autologous Adipose Adult Stem Cells (AAA). Unlike controversial embryonic stem cell treatments, Autologous Adipose Stem Cells are derived from the patient’s own fat cells through a small liposuction procedure and are then grown into a culture to increase volume. These stem cells are then “differentiated” with “growth factors” and injected into the scalp in order to induce new hair growth. This multistage process from extraction to injection can be performed in two appointments scheduled in the same day.

    The question is, does Recoverup’s baldness treatment really grow hair? They state that “Empirical data indicates patients would expect to see at least 40% of all treated areas showing one of four results; (1) darker hair (2) thicker hair (3) faster growing hair or (4) more hair per follicle. Overall the effect is of more volume, and density, in those areas which were treated.” However, the Recoverup website offers very little in the way of photo documentation. The few photos that are presented are of poor quality and covered in text making them very difficult to evaluate.

    The estimated cost for the one day hair loss treatment is between $8,000 and $13,000 depending upon the area to be treated. However, if the area to be treated is sufficiently large enough to merit a second day of treatments then this fee increases. Recoverup states that the long-term effects of the treatment are unknown and are dependent upon such factors as the patient’s age and quality of the source stem cells. “However, as a general guide, in other areas of stem cell treatment, data indicates approximately 3-5 years of positive results from each treatment.”  Recoverup does offer a 30-day money back guarantee if a patient experiences no new hair growth but is also quick to point out that the results will vary. One can imagine quibbling over whether or not a single follicle that didn’t appear to exist prior to treatment would constitute success under their definition. In summary, assuming Recoverup’s AAA stem cell treatment does stimulate hair regrowth, a patient can expect to pay upwards of $13,000 plus travel expenses to Asia for a treatment that is, by their own estimates, about 40% effective and may last between 3 and 5 years. This hardly sounds like an attractive alternative or even supplement to today’s state of the art, ultra-refined follicular unit hair transplantation combined with the clinically proven medical treatments Propecia (finasteride) and Rogaine (minoxidil). It is recommended that patients approach all unproven, “revolutionary” medical treatments with cautious optimism. Androgenic alopecia is progressive and avoiding proven surgical and medical treatments in favor of experimental procedures may lead to further hair loss.

  • Jerry Wong, MD

    Dr. Jerry Wong
    Dr. Jerry Wong
    Dr. Jerry Wong exclusively performs Ultra Refined Follicular Unit Hair Transplantation with outstanding results.
  • Dr. Ted Miln

    Dr. Ted Miln
    Dr. Ted Miln
    Dr. Ted Miln is performing refined follicular unit grafting with incredible density, with results that are undetectable from his patient's native hair.
  • Dr. Özlem Biçer MD

    Dr. Ozlem Bicer
    Dr. Ozlem Bicer
    Dr. Biçer provides ultra-refined follicular unit extraction (FUE) at an exceptionally low-price. Dr. Biçer's practice combines quality with affordability with a patient-centered focus and attention to detail.
  • Stemcelex – A Revolutionary Stem Cell Hair Loss Treatment?

    Stemcelex – A Revolutionary Stem Cell

    Stemcelex is the newest product in a long line of hair restoration therapies claiming to “cure” hair loss via stem cell therapy. Given the recent onslaught of news regarding stem cell based hair loss treatments, injectable baldness cures, and research breakthroughs, it’s not surprising to see new therapies claiming to aggressively fight hair loss through these same mechanisms. However, is Stemcelex truly a stem cell based, regenerative hair loss cure, or is it another therapy simply riding the recent wave of interest in these types of non-invasive, revolutionary treatments?

    At first glance, Stemcelex seems quite impressive. The product website is filled with scientific explanations, graphs, charts, and diagrams explaining the science behind stem cell based hair restoration. Stemcelex even states its affiliation with Dr. George Cotsarelis, a researcher at the University of Pennsylvania Medical Center who, along with a talented research team, recently discovered that the bald scalp does not suffer from a lack of stem cells, but rather a dysfunction in the pathway to properly activating stem cells to produce hair. The finding was significant and Dr. Cotsarelis’ involvement and the seemingly detailed science look promising, but what about Stemcelex itself? Does it utilize these scientific breakthroughs and offer an effective treatment for hair loss?

    Unfortunately, despite the impressive name recognition and detailed explanations, Stemcelex doesn’t appear to live up to its lofty hair restoration claims. Despite claiming to “activate” the dormant stem cells described by Dr. Cotsarelis, Stemcelex does not offer any sort of feasible molecular/stem cell based therapy. The website cleverly explains the science behind stem cell inactivation and the promise of reversing the dysfunctional pathway, but instead of reinforcing Dr. Cotsarelis’ view that cures for reversing the inactivation pathway are not yet understood, Stemcelex claims to actually fix the stem cell inactivation through a series of unproven homeopathic and herbal treatments for hair loss.

    So, what is actually inStemcelex? The treatment involves a three day cycle of different lotions and topical treatments for baldness applied twice a day.

    Day1: On the first day of the hair restoration cycle, a topical lotion made from Jaborandi Pilocarpus is applied twice after washing and thoroughly drying one’s hair. According to Stemcelex, Jaborandi Pilocarpus is a parasympathetic activator (it excites the nerves that cause the body to “rest and digest” during periods of relaxation) that rids the scalp of excess oils and dandruff that impede healthy follicular hair growth. Furthermore, Stemcelex claims that Pilocarpus naturally darkens and thickens existing, native hairs. According to the experts, Pilocarpus has no reproducible pharmacological applications and any evidence that it actually thickens and darkens hair is anecdotal.

    Day 2: The second day of the cycle involves Veratrum Lobelianum, a family of herbs commonly used in Chinese medicine.  Stemcelex claims these herbs can penetrate the scalp and activate the necessary molecular signaling to “regenerate” the hair follicle stem cells. Furthermore, Veratrum allegedly down-regulates or prevents the production of Dihydrotestosterone (DHT), the hormone directly responsible for male pattern baldness. According to the research, members of the Veratrum family have been used in everything from a Native American poison to a drug researched in human blood pressure.  Currently, they are used in cancer treatments. Although the science behind cancer therapies indicates that the drug could have some molecular benefit in signaling cell activation and inactivation, there has been no research or evidence suggesting that Veratrum is useful in fighting, reversing, or preventing the effects of male or female hair loss.

    Day 3: During the third day of the Stemcelex cycle, a kelp based topical extract is applied twice daily to provide nutrients to the “new hair growth” and also ensure that the scalp remains clean and healthy. This step of the treatment doesn’t claim to be more than a simple dose of nutrients useful in good scalp hygiene.

    After reviewing the active ingredients behind Stemcelex, there is no evidence to suggest that Stemcelex is an effective hair loss treatment at this point in time. The idea of activating the dormant stem cells is important to finding a molecular cure to hair loss, but despite understanding this importance, Stemcelex doesn’t offer any concrete stem cell reactivation agents. It’s possible that Veratrum may prove useful in cell signaling and reactivating dormant cells, but the current research and evidence simply don’t support its use at this time.  Furthermore, Stemcelex charges a hefty $99.85 for a month supply of the treatment which may keep even the most curious and enthusiastic hair loss suffering men and women away.

    Altogether, the idea of reversing dormant hair follicle stem cells is important, but therapies for effectively stopping and rewiring this pathway do not seem to exist at this point in time. Unfortunately, this seems to nullify the claims made by Stemcelex and prevent it from becoming a stem cell hair loss cure.

  • Nizoral 2% Shampoo (Extra Strength) for Hair Loss

    Nizoral 2% shampoo

    Nizoral 2% is magnificent shampoo and a significant part of what's referred to commonly as the Big 3. The other two are the FDA approved and proven treatments Propecia (finasteride)and Rogaine (minoxidil). To date, Nizoral is the only shampoo on the market that can make the unique claim that it's proven to stop the formation of DHT. Its active ingredient ketoconazoleat 2% concentration has proven to be a moderate DHT inhibitor and has growth stimulating properties about as effective as Rogaine 2%.

    This product includes 2%, the highest concentration of the active ingredient ketoconazole. To view the clinical abstract proving the effectiveness of ketoconazole in the treatment of androgenetic alopecia, view "Ketoconazole as a hair loss treatment". There is also a less concentrated 1% of Nizoral. To learn more, visit Nizoral regular shampoo.

    We strongly suggest using Nizoral shampoo in addition to other proven treatments. Nizoral should be used 2 or 3 times a week to avoid dry hair and a flakey scalp.

    On the off days, you may want to consider rotating Nizoral with other excellent shampoos designed specifically for thinning hair. See the recommended treatments section below for other shampoos we recommend.

    Developing Realistic Expectations:

    Men and women sometimes suffer from hair loss for different reasons. Thus, diagnosing its cause is necessary to facilitate and promote proper treatment.

    Don't expect immediate results. It's recommended to use Nizoral in conjunction with other proven treatments for at least 6 to 12 months before determining its effectiveness. Documenting your progress with bi-monthly photos can help you determine whether or not Nizoral has been successful in helping you maintain existing hair.

    To date, only surgical hair restoration is proven to grow hair in completely bald areas. You are invited to have a free virtual consultation with one of our prescreened hair restoration physicians.