Carlos K. Wesley, M.D.
Dr. Carlos Wesley
Dr. Carlos Wesley is a board certified diplomat of the ABHRS and performs high quality follicular unit hair transplants with excellent results in NYC.
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Hair Restoration Evolution
Hair transplant procedures have evolved a long, long way since they began in the early 1950's. The "corn row" or "doll's" hair look that was associated with hair transplantation has evolved into today's "follicular unit" procedure that, when done right, is undetectable even by a hair stylist.
The Concept of the Hair Transplant is Born
During the past several decades superstition, old wives tales, and guess work has gradually been replaced by science.
The early 1800's is renowned in hair restoration circles as the age of the con men. There were hundreds of hair restoration treatments released and many lasted well into the late 1900's. These "cures" were marketed by "doctors", whose only skills were those of fast-talking and nerves of steel (as well as bravery, considering they were conning hardened cowboys and outlaws!).
The salesmen hawked their products from the safety of their side shows and "Wild West" spectaculars. They used endless tricks to get people to buy their products, such as rubbing grease into people's hair, to make it look thicker.
In 1939, a Japanese dermatologist, Dr. Okuda, published a revolutionary method in a Japanese medical journal that would lay the ground work for modern hair transplantation.
This method involved using hair transplant grafts to correct lost hair from various areas, including the scalp, eyebrow, and moustache areas. However, this study didn't make an impact in the Western Hemisphere due to the interruption of World War II.
Hair Restoration Comes of Age
In the late 50's one physician in particular, Dr. Norman Orentriech, began to experiment with the idea of relocating or transplanting the hair on the back and sides of the head to the balding areas.
Dr. Orentriech's experiments showed that when bald resistant hairs from the back and sides of the head were relocated they maintained their bald resistant genetic characteristic regardless of where they were transplanted.
This principle, known as "Donor Dominance", established that hair could be transplanted from the bald resistant donor areas to the balding areas and continue to grow for a life time. This laid the foundation for modern hair transplantation.
The Scientific Era of Hair Restoration
During the 60's and 70's hair transplants grew in popularity. However, the standard of care used larger grafts that were removed by round punches and often contained many hairs.
This now outdated hair transplant technique could achieve good results with a full look if a patient completed all planned sessions. However, a patient was typically limited in the manner they could style their hair.
Patients who stopped short of completing all planned sessions were left with hair transplants that looked obvious and unnatural. Such uncompleted hair transplant results are some times referred to as "Barbie doll hair" or "corn rows".
Many who have had these older techniques now refine or complete their bad hair transplants with today's very refined techniques to achieve a natural look that they can style in any manner.
Continue reading Hair Restoration Evolution - Hair Loss Solution
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Female Hair Loss - Treatment and Restoration
Female hair loss, otherwise known as Female Pattern Baldness (FPB), affects 1 out of every 4 women in the United States. Recent findings have found that the incidence of FPB has been reported to be as low as 8% and as high as 87%. And, it does appear to be as common for women as for men. Most often, menopause is the most frequent time for hair loss in women to become apparent.
For a woman to lose her hair can be even more troubling than for men. A woman with thinning hair is not generally accepted as part of the normal aging process. Society has come to expect a thick, luxurious head of hair as part of the attractiveness in women.
While males and females can both experience thinning hair, they typically do not lose their hair in the same order or appearance.
Women with thinning hair compared to Men
Typically men observe their hair loss earlier, whereas women will first notice it in their late 20's through their early 40's. Female Pattern Baldness (FPB) is often seen during hormonal changes. These include the use of birth control pills, following childbirth, or during or after the time of menopause.
Top view of patient, showing excellent growth of transplanted hair.In addition, men typically have localized areas (patterns) of thinning, whilein women this usually occurs as thinning across the top, or over an even wider area. When women have very diffuse thinning over much of their scalp they are generally not good candidates for hair restoration surgery. However, women with localized hair loss, similar to the typical male pattern baldness, can successfully undergo hair restoration surgery.
Thinning hair in females is also characterized by an increase in the combination of normal thick hairs mixed in with finer, smaller hairs. This results in decreased density, and not total hair loss.
A woman's hair has also been proven to be more sensitive to the effects of stress than men's hair. Stress can result in hair loss in women and men. But this type of loss is not female pattern baldness. Rather, it is known as “telogen effluvium.” This type of hair loss is the shedding of hair in the resting phase when the body senses that it needs to divert its energies elsewhere. Therefore stress can temporarily changes the amount of hair that is shed. But the lost hair is likely to grow back.
The production of the hair loss-inducing androgens is also different among men and women. A woman produces a small quantity of androgens in the adrenal glands and the ovaries. The ovaries also produce pre-hormones, which are then converted to androgens on the outside of the ovaries or adrenal glands.
Generally speaking, a woman with hair loss will probably not experience total balding in a given area. But if there is total hair loss, this is most likely a sign of a previously hidden disease. For this reason, it’s important for females to have their hormone levels checked by a physician if they are experiencing heavy hair loss.
Finally, men and women react differently to various hair loss treatment options. In men, hair loss may be halted or even reversed by finasteride (brand named "Propecia"). However, Propecia is not safe for females or children. Minoxidil (Rogaine) can be effective for both men and women in treating hair loss.
However, for some women the causes of their hair loss are much more complex than the classic "male pattern baldness". Thus proper diagnosis of the underlying cause is vital before any hair loss treatments are attempted.
The following physicians are nationally well known experts in female hair loss. Feel free to contact them.
David Whiting in Dallas, Texas - 214 824-2087
Vera Price in San Francisco, California 415 353-4163
Maria Hordinsky in Minneapolis, Minnesota 612 625-1493
Wilma Bergfeld in Cleveland, Ohio 216 444-5722
For a web community that is dedicated to female hair loss visit HerAlopecia.com -
Superoxide Dismutase (SODS)
Excessive DHT in the hair follicle causes specific immune responses. These responses cause the cells to release a substance known as Superoxide. This substance combats against any viruses, cells, or foreign tissues. SOD's claim to fight hair loss by reducing the presence of Superoxide.
As a result, the body is less prone to reject any offending hair follicles, which helps to ward off hair loss. SOD's actually treat hair loss in more than one way. Besides reducing Superoxide, they also stimulate growth and they have anti-inflammatory properties. SOD’s are topical, as well. They include Tricomin, Proxiphen, Proxiphen-N and Folligen.
Click to learn more about Anti Inflammatories -
Nizoral Shampoo (Regular Strength) for Hair Loss
While Nizoral 2% shampoo is more effective at inhibiting DHT production and its binding to hair follicles, Nizoral regular strength offers a smoother, gentler approach to treating hair loss while minimizing scalp irritating effects from other topical treatments such as Rogaine 5% liquid.
This product includes 1% 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". Alternatively, you can obtain a prescription from your medical practitioner for the more concentrated 2%.
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.
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Diffuse Patterned Alopecia (DPA)
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.
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Victor Hasson MD
Dr. Victor Hasson
Dr. Victor Hasson exclusively performs Ultra Refined Follicular Unit Hair Transplantation with outstanding results. -
Laser Treatment
Is it Effective in Stopping Hair Loss?
Use of low level laser therapy (LLLT) devices for treating hair loss has been heavily debated for some time by reputable hair restoration physicians and patients on our hair loss forum. While some physicians reject its use entirely, others use laser hair treatment as a regular part of their practice. Additionally, some physicians believe that laser light therapy can assist with postoperative healing after hair transplant surgery.
History of Laser Light Therapy
Shortly after the first working laser was invented in 1964, a researcher from Semmelweis University of Budapest named Andre Mester developed a theory that exposure to cold laser light (similar to UV radiation emitted by the sun) may eventually lead to cancer. To test his theory, Mester shaved a group of mice and trapped some of them in a cage with constant cold laser light exposure leaving the other half unexposed as a control group. To his surprise, the light didn’t cause cancer in any of his animal subjects. Instead, mice that were exposed to the laser light therapy grew back their shaved fur much faster than the control group. Mester named his discovery photo-biostimulation. His theory was that somehow, the laser light had stimulated the hair cells into an accelerated state of hair growth.
Laser Therapy as a Hair Loss Treatment
Today, low level laser therapy is being used as a hair loss treatment. To treat baldness with laser light therapy, laser rays are directly applied to the scalp by a mechanical device so that red blood cells are stimulated. Lasers are said to work by converting ATP (Adenosine Triphosphate) to ADP (Adenosine Diphosphate), releasing energy and causing cellular metabolic changes. During this process, additional nutrients and oxygen are provided to the scalp assisting the normal chemical processes performed by those cells, increasing overall blood circulation. Lasers, when applied to the scalp and hair, have been said to improve overall hair quality, promote hair growth, and increase hair shaft diameter.
Laser treatment devices have a similar appearance to a hood hair dryer which is placed over top of your head. The low level laser toll will rotate allowing laser rays, usually red in color, to be discharged into your scalp. Hand held devices such as the Hairmax comb have also been developed and resemble a brush in appearance.
Promoting healthy hair growth however, is not the same as the regrowth of miniaturized hairs brought on by genetic female hair loss or male pattern baldness (MPB). So what clinical evidence exists, if any, that laser therapy is an effective treatment? Below we take a closer look at the available data including exclusive interviews of leading hair restoration physicians.
Varying Opinions of Well Respected Physicians
Physicians have long shared varying views on whether or not laser treatment is viable. While some well respected physicians reject its use entirely, some believe that LLLT can provide marginal benefit for men and women suffering from androgenic alopecia (genetic baldness). Additionally, some physicians believe that laser hair treatment can assist a hair transplant patient’s postoperative wound healing process and expedite hair growth.
Dr. Charles (one of our well respected members of the Coalition of Independent Hair Restoration Physicians) believes it may provide similar hair loss prevention benefit to Rogaine in the mid vertex area and crown. Benefits in the frontal area include an increase in overall hair quality rather than hair loss prevention.
Dr. Charles believes LLLT works better when combined with Propecia (finasteride) and Rogaine (minoxidil). Like Propecia and Rogaine, he believes low level laser therapy may help some patients more than others and works better in patients with only minimal thinning hair.
Dr. Charles believes in helping balding men and women develop and maintain realistic expectations and he doesn’t oversell its benefits. Because lasers are free from side effects, he always tells his patients that the biggest risk is the money. Dr. Charles believes more research on laser hair treatment is needed.;
Dr. Williams of the Coalition has been using laser hair treatment as a regular part of his practice for over 2 years and feels quite confident in its success in some patients. In his experience, LLLT promotes healthy hair growth and can increase hair shaft diameter of miniaturized hair affected by genetic female hair loss and male pattern baldness in some patients.
Dr. Williams offers 16 free laser therapy sessions to local males following hair transplant procedures and encourages his female transplant patients to undergo laser light therapy for one full year at a highly discounted rate. Dr. Williams usually notices faster transplanted hair regrowth and a quicker resolution of postoperative telogen effluvium or “shock loss”, if it occurs.
Because androgenic alopecia is a progressive condition, Dr. Williams encourages male patients to use Propecia while encouraging out of town females to use the Hairmax laser comb to help maintain their existing hair. Dr. Williams would like to see more formal studies defining the benefits of lasers as a hair loss treatment, but he is encouraged by his experience with it to date.
Dr. Alan Feller (also a member of the Coalition) is one doctor who remains skeptical. "Medical lasers work in only one way, and that is to deliver energy to a target. When it strikes the target the energy is absorbed and converted to heat. That's it". Dr. Feller believes that more compelling evidence is needed to promote low level laser therapy (LLLT) as a hair regrowth solution or to stop hair loss.
Recent Scientific Studies
study presented at the last International Society of Hair Restoration Surgery (ISHRS) meeting in Las Vegas (2007) by Maria A Muricy, MD, confirms increase in hair shaft diameter, fullness, and overall quality with laser hair treatment alone. Additionally, some statistically significant evidence reveals that low level laser therapy when combined with 5% minoxidil (the active ingredient in FDA approved Rogaine) provided noticeable cosmetic benefits for women in particular. However, this study also showed that laser hair loss treatment alone produced no statistically significant new hair growth in both men and women.
Laser Hair Therapy and FDA Approval
Another important issue to consider is the significance and meaning of the FDA clearance (not approval) of the Hairmax laser comb. Though some have proposed the Hairmax laser comb was only approved for safety, apparently the FDA did require Lexington International (who funded the study) to provide it with a study on its efficacy (effectiveness) in treating baldness. But this study and its results have not been released to the public since Lexington International had the option of submitting the study to the FDA privately. The obvious question then is – why would Lexington hide their study from the public if it proved the efficacy of laser hair regrowth?
While the Hairmax laser comb device was found by the FDA to be safe based on its “substantial equivalence” to previously approved laser light therapy devices and thus “cleared” (not “approved”), it was unclear to what extend the FDA reviewed or cleared it based on its effectiveness in treating hair loss. To learn more about the FDA standards for “approving” food and drugs and for “clearing” medical devices visit www.fda.gov
It appears that much of the laser hair treatment industry is now promoting their devices as “FDA Approved for Hair Loss” as if they are on par with the two only FDA approved hair loss solutions Propecia (finasteride) and Rogaine (minoxidil). However, until laser hair treatment provides compelling public evidence of its effectiveness in treating hair loss, it is quite possible that the effectiveness of low level laser therapy may be oversold by some companies. We expect that time will tell.
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Dr. Özlem Biçer MD
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. -
Folexen (S-equol)
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.