“Will my hair grow back?” This is the most asked question at a Trichologist’s clinic. While there is no simple answer to this, the chances are better if you are following the right treatment. Right treatment follows as a corollary of right diagnosis. Right treatment does not necessarily mean years of treatment. When correctly treated most cases stabilize within a reasonable time frame. The various types of treatment options can be classified under 4 basic categories.
MEDICINAL TREATMENTS FOR HAIR LOSS
This category includes various medicinal treatments and external applications that help the patient to grow their own natural hair back. However there are a few limitations. One, it may work only in certain specific conditions like Telogen effluvium and Fungal infections. Secondly, the degree of hair loss will determine how much hair will grow back.
Oral medicines and external applications to grow hair usually consist of Tricho Active Supplements and hair boosting factors. Hair boosting factors can stimulate the roots to produce new hair roots.
This picture shows the process of hair fall.
The strand of hair miniaturizes as it moves
from the growing phase to the falling phase
and eventually falls off.
This picture shows the effect of hair boosting factors on hair.
NON-SURGICAL TREAMENTS FOR HAIR LOSS
Platelet Rich Plasma Therapy for Hair Loss
Platelet Rich Plasma is concentrated blood plasma. It has abundance of hair boosting factors and other bioactive proteins that aid in wound healing and restoration of hair.
Platelets play an important role in healing wounds and repairing damaged tissues. This fact is extrapolated to explain the use of PRP in hair boosting. By increasing the platelet count in the affected area, PRP can help stimulate the damaged hair follicles to produce better hair boosting.
In PRP, blood is drawn out from the patient like it is normally done for a blood test. The blood is then centrifuged at high speed to separate the Platelets from the rest of the blood. The highly concentrated platelet rich plasma is then injected into the scalp. The hair boosting factors in the injected PRP then stimulate hair boosting.
Platelet Rich Plasma being injected in the scalp
While in the early stages of scientific research, PRP is emerging as a promising non-surgical treatment option for patients with hair loss. It offers the opportunity for hair boosting to patients who are not candidates for surgery or those patients wanting a more aggressive nonsurgical approach to treatment.
PRP is contraindicated in patients with chronic liver disease, chronic skin disease, platelet dysfunction diseases and thrombocytopenias, metabolic or systemic disorders. People on blood thinning drugs, or those with a history of heavy smoking and alcohol use should also avoid PRP therapy.
Micro-needle Therapy or Derma Roller for hair loss
Micro-needle therapy uses a tiny cylindrical drum shaped device called a derma roller. The cylindrical drum comes fitted with stainless-steel micro needles, similar to the non-invasive use of needles in acupuncture.
The derma roller works by triggering the production of human hair boosting factors. When the needles are rolled along the skin they cause minor surface wounds. This injury activates the healing response of the scalp and stimulates the production of human hair boosting factor and other chemicals to aid the process of repair. These chemicals also then stimulate the damaged hair follicles and stimulate hair boosting of new hair.
Derma Roller treatment in process
Apart from stimulating the follicles, micro needling also facilitates higher absorption of external applications used to treat hair loss and re-grow hair. To understand this better, it is important to know the basic structure of the scalp skin. The scalp skin is made of several layers. The outermost layer is called the stratum corneum which is made up of dead skin cells. This layer acts as a natural barrier and protects the underlying tissues from infection, dehydration and from any chemical or mechanical trauma. When an external application is applied to the scalp the smaller molecules of the active ingredient penetrate easily through the stratum corneum, but the larger molecules often get blocked. This results in only a fraction of the active ingredients reaching the target area. Applying external applications would be useful only if the active ingredients can penetrate through this layer. Using the derma roller opens thousands of channels through the stratum corneum thereby increasing the absorption of the topical scalp medications and its efficacy.
Mesotherapy for Hair Loss
Mesotherapy works on the concept that a disease needs to be treated from as close a point as possible. Thus it employs the use of superficial microinjections into the mesoderm (middle layer of the skin) of the scalp. This brings the active ingredients of the medicines to the exact place where it is needed i.e. around the hair follicles so that it can stimulate hair boosting. When done professionally, it is virtually painless.
Mesotherapy in process
Apart from the active ingredients directly reaching the target site, micro perforations caused by the injections activate the healing process of the scalp. This stimulates the producing collagen and elastin which further aid in the repair of the damaged hair follicles and enable them to produce better and newer hair.
Stem Cell Therapy for Hair Loss – Hope & Hoax
Stem cells are the very first cells that form after the sperm and the egg meet, i.e. at conception. All of us start life as a single celled organism. Shortly after that, the single cell divides into 2 cells, which divide into 4, which divide into 16 cells and so on. These cells are known as stem cells and the reason they are given this name is because every cell of the body eventually “stems” from these cells.
Depending on their stage of development these stem cells are divided into various categories like – Embryonic stem cells, which are the stem cells formed within 7 days of conception and stem cells, which are formed after birth. Unlike their name, Stem Cells are found in both children.
The huge excitement about stems cells is due to the fact that these cells are like mother cells that have the potential to become any type of cell in the body. Stem cells can become cells of the blood, heart, bones, skin, muscles or brain.
Similarly in case of baldness if your hair roots are destroyed, using stem cells we can produce new roots, giving the patient a whole new crop of hair, something no treatment has so far been able to do.
In case of hair, the Stem Cells are located little above the hair root in an area called the hair bulge, where they remain silent for a long time. Under certain circumstances, when the hair root cells are destroyed, the Stem cells migrate from the hair bulge area to the hair root area and form new hair root cells. However what activates the Stem cells is unknown as they do not necessarily recognize the damage and migrate to form new cells in all the cases. Sometimes they do and sometimes they just don’t.
Thus, there is a growing need to tap the potential of the stem cells. If we can get the stem cells to behave and develop as directed, then in every case of hair loss, even in case of complete baldness, we can generate a whole new crop of hair roots and a head full of natural hair. Theoretically this sounds like the ultimate ‘Fountain of Youth’, an endless supply of hair.
This is the hope that we have from Stem Cells. But before we open the bottle of Champagne, let’s look at the other side of the story and find the answer to some questions. If stem cells look so promising, then why do we still see bald people around us? Why has baldness not been eradicated yet?
The reason, stem cell therapy has some limitations like:-
a) Technology not yet available
Theoretically we can remove a person’s hair root stem cells from the head, multiply it in a laboratory, inject them back into the scalp and make them grow hair. Theoretically yes but practically no. There is no technology available that allows us to do this in the present day. A few companies are carrying out experiments, but are yet to come out with concrete solutions. The technology may need some more time to develop. Some people are trying to overcome this problem by using stem cells from other sources like apples and other plants, which is completely rubbish. An apple stem cell can grow apples on your head, but not hair.
b) How to avoid recurrence of hair loss
The second concern is even if we manage to grow new hair using stem cells, how do we prevent them from suffering the same damage as the earlier ones? That is how do we protect them from the original triggers like heredity, stress, hormones or infection? Unless we can find a solution to this problem, we can grow an endless supply of hair and it would still keep falling off. One way to avoid this would be to maintain them through continuous medication, perhaps even lifelong. Thus even with stem cell therapy, medication would still be required to sustain hair, perhaps even more than before.
c) Long term side-effects
This is the biggest worry of all. Since research in this field is pretty new the data available is limited. The long term side effects are yet not fully understood. For example, in case of Embryonic Stem Cells, it was only after sometime of its use, the researchers realized that it can cause cancer and therefore a lot of research based on Embryonic Stem Cells has now been discontinued. Similarly the long term side effects of using Stem Cells will only be known after a while, and should not end up becoming a case of the cure being worse than the disease.
Gene Therapy for Hair Loss
Gene Therapy is in its infancy and current therapies are primarily experimental. Human trials are still in the research stages. However Gene Therapy carries the promise of cure for hair loss and eventually will be known as the ultimate treatment for hair loss.
What does Gene Therapy do? If you recall in Pattern Baldness even in the advanced stages of Baldness, hair loss always happens from the front and the vertex portion of the head, the rim and the back portion of the head are spared. This is because the hair roots on the rim and the back of the head are genetically programmed to withstand the hormonal damage and thus the hair in these areas remain intact even in advanced stages.
Gene therapy is the process by which these protective genes that prevent hair loss are identified. Once identified, they could be activated in the hair roots on the front and vertex of the head, preventing hair loss from that area too. As simple as it sounds, the real problem lies in identifying the right set of genes. But it is only a question of time before it happens, and when it does hair loss could become extinct for mankind.
SURGICAL TREATMENTS FOR HAIR LOSS
This category includes various forms of hair transplantation techniques like Follicular Unit Transplant (FUT) and Follicular Unit Extraction (FUE) methods. The results depend a lot on the surgeon’s skill and when done efficiently, the result can be very close to the natural look. The flip side however is that when not done correctly, or if the process of baldness continues even after the transplantation is done, it can lead to a lot of aesthetic hassles.
Follicular Unit Transplant (FUT)
Follicular Unit Transplant is a surgical procedure that moves hair follicles from a part of the scalp called the donor site to a bald or balding part of the scalp called the recipient site. In other words the persons own hair follicle is removed from the back of the scalp, the area which is known to be genetically resistant to baldness and reinserted into the other areas which are bald or balding. Furthermore post transplantation most patients need lifelong medication to maintain the hair density and to prevent the hairline from receding further.
During the transplantation procedure, the surgical area experiences a fair amount of trauma and bleeding. As a result of this the natural hair surrounding the area becomes liable to fall off. The degree of such damage depends on the method used for transplantation and the skill of the person performing the surgery.
FOLLICULAR UNIT TRANSPLANT (FUT)
The Surgeon marks anoutline where the new
hair line will be created.
The surgeon uses a scalpel to cut an elliptical
area of skin from the donor area.
The technicians take the strip of skin & cut it
into pieces.Each technician then uses
a microscope to extract the follicular
units out of the donor tissue.
The surgeon makes small incisions, along
the line previously drawn where the follicles
will be transplanted into.
Technicians do a final check to see that all
the follicles have been inserted correctly,
at the right depth, and are pointing in
the right direction.
The donor area at the back of the head
is shaved and anesthetized.
The scalp is then sutured or stapled closed.
The extracted follicles are then placed into
a saline solution for implantation.
The technicians carefully insert each follicle
into each of the incisions. This takes a long
time as each and every one has to be perfectly
Once the procedure is over the patient’s
head will have red dots all over where
the follicles were implanted. After a successful
transplant it takes between 6-12 months
for hair boosting to start.
Follicular Unit Extraction (FUE)
Follicular Unit Extraction involves the same process as Follicular Unit Transplant i.e. it also moves hair follicles from a part of the scalp called the donor site to a bald or balding part of the scalp called the recipient site. The only difference between the two procedures is the method used. In Follicular Unit Transplant, a strip of skin around ½ inch in width is cut out and the gap then stitched up. This often leads to a fair amount of pain, bleeding and scarring. In Follicular Unit Extraction, with the use of specially designed tools, each hair is removed individually. There is no stripping of the skin and thus the amount of pain and scarring in the FUE procedure is much less.
Follicular Unit Extraction (FUE)
The doctor isolates the hair he wants to extract.
The hair is extracted.
The extraction process is repeated.
The doctor microscopically removes each
follicular unit one at a time.
A special tool is inserted around the hair.
The process is repeated to other selected hairs.
The hair is implanted into the balding and/or
thinning areas of the scalp.
View of donor area immediately after removing the
An example of follicular units removed.
Follicular units are then implanted in the thinning areas especially frontal areas which do not respond well to medically induced hair boosting.
After a successful implantation procedure,
it may take between 3-6 months to see any signs of hair boosting.
ARTIFICIAL TREATMENTS FOR HAIR LOSS
This category includes procedures like weaving, bonding, hair replacement systems, non-surgical camouflaging etc. A lot of fancy names but ultimately they are all wigs which are worn on the scalp to conceal the baldness.
Hair Weaving & Bonding
In weaving the basic process is to first make a hair piece. Each hair piece consists of two parts – the first part is a base which is measured to fit snugly onto your scalp, and the second part is the hair, which can be either human or artificial hair, which is stitched onto the base. The hair piece thus made is then attached onto the scalp. When the attachment is done via clips it is known as weaving. Its main advantage is that it can be maintained by the person himself, which means the person can remove it every night and wear it again in the morning, almost like a cap. On the other hand the hair piece can also be attached via tape or glue, in which case it is known as bonding. Bonded hair pieces are not self-operated and they need to be maintained via salon services on a monthly basis. Both the processes are quite successful, but the degree of satisfaction depends on ones expectations. It is important to understand that while these processes are described in very sophisticated terms like weaving, hair replacement systems, and what not, at the end of the day, they are artificial procedures which are useful to cover the baldness and often involve continual maintenance. They have nothing to do with natural hair boosting. And therefore while we hear of so many celebrities like cricketers and film stars getting it done every other day, on them it may appear good, because they have the advantage of choosing the right camera angle and lighting, a luxury which most of us do not have in everyday life.
HAIR WEAVING & BONDING
Hair weaving or bonding is a type of hair extension or a hair wig.
A transparent or skin colored base is
The base is then measured and cut to size
depending on the individual requirements.
Into this either synthetic or human hair is woven.
This procedure is then repeated till the entire base is covered with hair.
The base can then be placed on the scalp by either weaving it
into the existing natural hair or stuck to the scalp using glue
which is then known as bonding.
Hair Camouflaging is the use of hair building fibers which temporarily conceal the appearance of balding or thinning areas. This technique is more popular in the show business by film personalities who use it to cover the thinning areas while shooting on camera. These hair building fibers are made up of microscopic keratin fibers, just like human hair. They are charged with electrostatic energy so that they bond tightly to the existing hair. When sprayed onto the thinning areas, these fibers help by physically coating each hair, making it look thicker and denser. For salt and pepper hair, these fibers are available in different shades like white, black & brown. These fibers are colorfast and therefore do not run or stain. And to remove they can just be washed off. Generally this procedure is quite safe but some people are known to develop allergy to the fibers.
FIBERS ADHERE TO YOUR HAIR
HAIR BECOMES THICKER