Hair Loss Medicine

Concealing bald spots is for many patients affected with baldness the only existing option to regain the appearance of a full head of hair, as hair regrowth treatments only work for some hair loss conditions. Non-surgical hair replacement is another term used for covering bald spots by non-surgical means. The two main techniques of non-surgical hair replacement today involve the use of hair systems and hair loss concealers. Various types of hair systems exist, such as full wigs, hairpieces, toupees, hair extensions and weaves. They can all look very authentic and have been used for centuries to cover bald areas. However, their main weaknesses are high maintenance costs and, in many situations, the discomfort of wearing them.

Concealers are a relatively new invention, designed to overcome the difficulties associated with wearing and maintaining wigs, but many people think they are not capable of withstanding adverse external conditions and appear unnatural. This no longer seems to be true, as many of them have greatly improved recently, both in terms of their authentic appearance and their resistance to external influences. It pays to understand how different types of hair replacement products work, in order to estimate their suitability for your current condition and compatibility with your lifestyle.

HAIR SYSTEMS
As for hair systems, there are a number of factors determining the user experience, as well as their price, such as the type of hair, the technology used to make the wig, the foundation of the hair system and how it is attached to the scalp. As far as the type of hair goes, it can be artificial or natural. The latter can be of animal or human origin. Human hair requires more care than artificial hair but it looks more authentic, lasts longer and is more comfortable to wear. Its downside is its higher cost and the fact that it can lose its colour when exposed to direct sun for long hours, or break, as normal human hair does. Secondly, hair systems can be hand-tied or machine-tied. Hand-tied wigs happen to be the more expensive alternative and the more authentic-looking solution. In addition, the foundation of a hair system can be either a polymer or a mesh. The polymer foundation is the more affordable, though less comfortable, option but it lasts longer.

The method of fixing a wig to your scalp and blending it with your existing hair is an extremely important factor. The semi-permanently attached hair systems are either glued to your scalp or woven into your existing hair and can only be removed in a hair salon, once every five weeks for cleaning. The temporarily-attached hair systems use double-sided sticky tape or clips to attach the hairpiece to your scalp and existing hair. You can remove and clean them any time you like but they can also be easily and unexpectedly removed, which can lead to embarrassing situations.

One thing that can surprise many potential buyers is the price. Although you can get a wig for a few hundred dollars, the more authentic-looking pieces cost a few thousand dollars and require regular maintenance costing a couple of hundred dollars a month. In addition, you need to buy at least two identical pieces, one to wear while the other is being maintained by your hair salon.

HAIR LOSS CONCEALERS
Hair loss concealers, also known as hair thickeners, are an alternative to hair systems for people who have some miniaturised fine hair left in their balding area. They are more comfortable to wear than wigs but they can never give a full head of hair to a completely bald person. They also seem to be a less expensive solution compared with hair systems.

There are three hair loss-concealing techniques that do the trick by: a) painting your scalp to match your hair colour, b) thickening your hair by coating and penetrating the hair and trapping moisture and volume-building proteins inside the hair shaft and, lastly, c) there are microfibers that cling to your hair like branches to the trunk of a tree, increasing the hair density. Microfiber-based, hair loss concealers can be typically applied in as little as 30 seconds, as opposed to a minimum of five minutes for hair-thickening concealers. However, microfibers are less water-resistant and it is quite difficult to apply them precisely and, therefore, they are not very good at creating an authentic-looking frontal hairline. Their biggest advantage is that they are unrecognizable in your hair, even with a very close inspection.

Hair thickeners, especially those that also colour your scalp, are extremely water-resistant and excellent for frontal hairlines but they take longer to apply. Their greatest weakness, in comparison to microfibers, is that in direct sunlight it can be visible to a sharp eye that the scalp has been painted. Some hair loss sufferers use a combination of two products simultaneously to overcome the weaknesses of individual products and to achieve the most authentic shade and appearance. Most often a combination of a hair thickener and a microfibrous concealer is used. The results of such combinations are often excellent even in people with very thin hair.

It can be concluded that wigs are more expensive and less comfortable than hair-loss concealers but they can cover a completely bald head, so they can also be used with burn patients and patients affected by alopecia areata, where concealers are of little help. Hair-loss concealers are suitable mainly for special occasions, when you want to look your best but many people use them permanently with good success.

Restoring the hair lost due to hereditary factors is the dream of many hair loss sufferers. Until not too long ago, the only effective and authentic-looking methods of reversing hair loss were non-surgical cover-ups. It was only with the advent of follicular unit transplantation and the discovery of the true cause of baldness - the harmful effects of dihydrotestosterone (DHT) on our hair follicles - that the hair-loss sufferer’s chances of reversing hair loss naturally have greatly improved.

The three best weapons in the fight against baldness today are the two FDA-approved medicinal drugs – finasteride (Propecia) and minoxidil (Rogaine) and hair surgery, the follicular unit transplantation and, especially, the follicular unit extraction technique. However, no ultimate cure exists yet as each of the three aforementioned hair restoration methods has its limitations. Minoxidil and finasteride work well only in the vertex area of the scalp, and finasteride cannot be used by women. Hair transplant surgery is suitable only for people who have sufficient hair density in the donor area, and many women, who typically suffer from diffuse thinning, do not make good candidates for hair transplantation.

Therefore, scientists around the world are relentlessly searching for new approaches to treating hair loss. There are presently several promising medications and new techniques under development listed below but progress seems to have slowed down a bit due to the global financial crisis, as some projects are finding it increasingly difficult to raise financing to further their research.

The greatest progress has been achieved on dutasteride. Dutasteride is an antiandrogen, in its chemical structure and mode of action it is similar to finasteride. It is used to treat benign prostatic hyperplasia and since it is a dual 5-alpha reductase inhibitor, it should be a more potent DHT blocker than finasteride. Therefore, it is thought to be more effective in treating hair loss, especially in the frontal area of the scalp. Dutasteride completed Phase III clinical testing this year and the study results are expected to be published soon.

NEOSH101 was originally developed by the US medical research firm Neosil and was until recently undergoing phase IIb clinical testing. At the end of 2008, Neosil was taken over by Peplin, Inc., a development stage specialty pharmaceuticals company and since then no information on the further progress of the clinical trials has been released. In previous clinical trials, NEOSH101 was shown to be a more powerful and faster-acting, hair growth stimulant than minoxidil and it only needs applying once daily. Though significantly improving the current hair-loss treatment options, NEOSH101 is not going to become the ultimate cure for baldness. The clinical trials seem to be advancing slower than most hair-loss sufferers would like and, hence, do not hold your breath waiting for it to hit the market anytime soon.

Another promising area of development is the telomerase research. Telomerase is an enzyme that is able to put natural caps on telomeres and thus protect them from shortening. Telomerase thereby maintains the genomic integrity. Shortened telomeres are associated with premature aging processes. However, the uncontrolled activation of telomerase can cause cancer. Cancer research is the main focus of the telomerase studies but scientists are also looking for other applications, such as anti-aging drugs and drugs against baldness and premature grey hair. Telomerase research could really change the world of medicine but its commercial application might be a good 15 years away.

Hair multiplication, often called hair regeneration or hair cloning, is the next hopeful treatment option being developed. This technique involves extracting hair follicles from the back of the patient’s scalp, culturing and multiplying them and injecting the newly-grown hair cells into the bald scalp area. The UK healthcare firm Intercytex appears to be the frontrunner in hair multiplication research. Intercytex has already completed phase II clinical study of ICX-TRC (a suspension of a patient’s own dermal papilla cells). The main benefit of hair multiplication would be solving the shortage of donor hair that is the main limiting factor in hair transplant surgery. However, Intercytex is currently facing financial difficulties and after failing to find an investor, it will have to continue operating on its own. Aderans, the main competitor of Intercytex, has also recently launched a Phase II clinical study on cell-based hair regeneration for men and women.

Generating new hair follicles in hair-free skin wounds is an entirely new approach to regrowing hair. It was discovered accidentally when wounded skin in mice started producing new hair. This technology is currently being developed by the US medical device company, Follica, which has licensed this technology from the University of Pennsylvania. Though this method may sound a bit weird, it is said to only use common instruments and drugs that have already been medically approved and thus it might not take too long for it to become commercially available.

This list of the undergoing R&D projects in the field of hair-loss research includes the most promising lines of development but it is not exhaustive. However, none of the new therapies, with the exception of dutasteride’s approval for treating hair loss, is expected to hit the market before 2013 and the immediate future of hair restoration lies in improving the surgical techniques, increasing the yields of the follicular unit extraction method and making it more affordable to a larger portion of the population.

A hair system can be any type of borrowed hair in the form of a full wig, hairpiece, weave, hair extension or a toupee, which replaces your own missing hair. Hair systems are for many people the only available option to replace the lost hair and to regain the original appearance of a full head of hair. The quality and the price of hair systems depend on a variety of different factors, such as the type of hair used, the production process used to make the wig, the foundation of the hair system and how it is attached to the scalp.

The type and quality of hair is the first thing many buyers will ask about. Both natural and artificial hair can be used. The natural hair can be of human or animal origin. Some hair systems blend human hair with animal hair to save on cost. The human hair can be of Asian origin (the least expensive option), Indian origin or European origin (the most expensive option). Asian and Indian hair must be often bleached, which makes it brittle and less durable. Considering the harvesting methods, virgin hair is the most expensive and hair gained from combs and hairbrushes the least expensive option. Human hair requires more care than artificial hair but it looks much more authentic, lasts longer and is more comfortable to wear. Its downside is its higher cost and the fact that it can lose its colour when exposed to direct sunshine for long hours or break, as normal human hair does.

As far as the manufacturing process is concerned, hair systems can be hand-tied or machine-tied. Hand-tied wigs can also be custom made, which happens to be the most expensive alternative. The foundation of a hair system can be either a polymer or a mesh. The polymer foundation is a more affordable but also a less comfortable option. A mesh structure breathes better than polymer structures and is therefore more comfortable to wear but, besides being more expensive, it is also a less durable alternative and more difficult to maintain. Mesh is suitable for creating authentic-looking hairlines, so many wigs combine both technologies, mesh for the hairline and the polymer structure for the inside of the wig.

The method of attaching a wig to your scalp and blending it with your existing hair is an extremely important factor. There are semi-permanently attached hair systems that are either glued to your scalp or woven into your existing hair and these can only be removed in a hair salon once every five or six weeks for maintenance. These systems cling tightly to your scalp but can be unhealthy and uncomfortable to wear after a couple of weeks of use. The temporarily-attached hair systems use double-sided sticky tape or clips to fix the hairpiece to your scalp and existing hair. They can be removed and cleaned any time you like but can also be easily and unexpectedly removed, leading to embarrassing situations.

The final, determining factor when deciding on buying a hair system is obviously the cost. Any hair system is temporary in nature, it will not last for ever like hair transplants do. Nevertheless, they can be also quite expensive. Hair transplants can cost as much as ten thousand dollars or more. Although you can get a wig for a few hundred dollars, the more authentic pieces cost a few thousand dollars and require regular maintenance costing a couple of hundred dollars every month. In addition, you have to buy at least two identical pieces, one to wear while the other is being maintained by your hair salon. Though not inexpensive, hair systems are often the only option to replace the lost hair for many alopecia areata patients, as well as a large percentage of female hair loss sufferers.

The principal methods of non-surgical hair replacement today involve the use of hair systems and hair loss concealers. Various types of hair systems such as full wigs, hairpieces, toupees, hair extensions and weaves can look very authentic and have been used for ages to cover bald areas and typically with good rates of success. However, their main weaknesses are high maintenance expense and, in many situations, the discomfort of wearing them. Hair loss concealers on the other hand have been around for a shorter period of time and have often been looked down upon for being incapable of withstanding adverse external conditions such as heavy rain or wind and for appearing unnatural. This is no longer true as many of them have greatly improved recently, both in terms of their authentic appearance and their resistance.

There are three basic types of hair loss concealers: those that simply paint your scalp to match your hair colour, then there are hair thickeners that thicken your hair by coating and penetrating the hair and trapping volume-building proteins and moisture inside the hair shaft and, lastly, there are concealers that use microfibers that cling to your hair like branches to the trunk of a tree, increasing the hair density. Some products combine two of the aforementioned approaches and paint your scalp and thicken your hair at the same time. All of these products come in various forms, such as a powder, cream or a spray. Hair loss concealers do not contain any active ingredients that would combat hair loss but some of them allow you to continue with a topical hair loss treatment such as minoxidil.

Microfibre-based hair loss concealers can be typically applied in as little as 30 seconds versus a minimum of five minutes needed for hair thickeners. However, microfibres are less water-resistant and it is quite difficult to apply them precisely and, therefore, they are not too good for creating an authentic-looking frontal hairline. Their greatest advantage is that they are unrecognisable in your hair, even with a very close inspection. Hair thickeners, mainly those that also colour your scalp, are extremely water-resistant and excellent for frontal hairlines but they take longer to apply. They cover your scalp with a layer of colouring substance, which makes it difficult to effectively apply any topical hair loss treatment. Their greatest weakness in comparison to microfibres is that in direct sunlight it can become visible to the sharp eye that the scalp has been painted.

The most commonly criticised weakness of all chemical substances used for concealing hair loss is the limited choice of available shades. Some hair loss sufferers use a combination of two products simultaneously in order to overcome the weaknesses of individual products and to achieve the most authentic shade and appearance. Most often a combination of a hair thickener and a microfibrous concealer is used. The results of such combinations are usually excellent. If you want to try any such combinations, make sure that you apply the scalp-painting, hair loss thickener first and then use the microfibres to mask the remaining imperfections. There are many products in all three categories of hair loss concealers and you may need to test several of them in order to identify those that best match you hair colour and style of application.

The existing medical options for regrowing lost hair in patients suffering from hereditary forms of hair loss are limited to relatively few treatments which are most effective in the early stages of baldness. Once you have lost a substantial portion of hair due to hereditary factors or an accident, such as a burn, the only remaining option is to replace the missing hair. Your options can be either of a temporary nature, such as the use of wigs and hair loss concealers, or a permanent surgical solution. Hair transplantation happens to be the most effective way of surgical hair replacement and the only permanent solution that offers satisfactory results.

Hair transplant surgery consists in transplanting your own hair from the back of your scalp to the frontal, balding area. The major limiting factor of hair transplantation is the shortage of donor hair and, hence, many patients do not make a good candidate. The ideal hair transplant candidate should have a high hair density in the back of the scalp, his hair should be thick and wavy, his scalp flexible and the contrast between the colour of his hair and scalp should not be too great, and he must be in good physical condition. Women usually suffer from a diffuse form of hair loss and, therefore, do not make very good hair transplant candidates. Hair transplantation also cannot be performed on patients suffering from unpredictable forms of hair loss such as alopecia areata.

Given the chronic shortage of donor hair, the hair restoration surgeon must be able to utilise the little hair he can use to create the optical illusion of a full head of hair. This is one of the biggest risks in hair transplantation, as it can sometimes happen that the patient does not like the final result. Although you can arrange for another hair transplant session, some damage can be irreparable. Other risks and side effects occurring during and after hair transplant surgery include excessive bleeding and scarring, the lengthy healing of wounds, the transaction and eventual death of many implanted hair follicles, post transplant shock hair loss, which, though usually only temporary, can affect your newly-implanted hair as well the hair in the donor area, scalp numbness and tension and the further progression of hair loss post surgery, which can lead to unnatural patterns of baldness. In a recent study, which analysed the experiences of 425 hair transplant patients who had undergone 533 hair transplant procedures in total, it was determined that about 5% of the patients experienced complications either during or after surgery.

Hair transplantation can cost ten thousand dollars and more, depending on the technique used, the location and reputation of the clinic, the extent of hair loss and the number of hair transplant sessions needed to achieve the desired effect. However, sometimes it is impossible to estimate the final cost, which is another risk you take when deciding on hair transplant surgery. Given the pain, time and cost involved, it pays to educate oneself prior to signing up for hair transplant surgery. The hair transplant industry is a fast-growing sector and the quality and affordability of hair surgeries are improving, so do not let anybody push you into hasty uninformed decisions.

The first hair transplants were performed in Japan eighty years ago. In the old days of hair transplant surgery relatively large pieces of skin of four millimetres in diameter, the so called punch grafts, were transplanted from the back of the scalp to the frontal balding area. Hair transplantation techniques have evolved tremendously since then and today’s hair transplants can give you a completely natural look. This is due to the miniaturisation of hair transplants, which now contain only one hair follicle (holding between one and four hairs) and are less than one millimetre in diameter. These tiny, single follicle grafts are then implanted into the needle-made incisions in the bald area. Today’s technology enables dense packing of hair follicles, which gives patients a completely natural-looking frontal hairline. Gone are the days of “pluggy” grafts that made you look like a toothbrush.

The two techniques that are used today are called Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). The main difference between them is in harvesting hair follicles. The FUT is the older method, using strip harvesting, when a linear strip of skin of up to 20 centimetres long and 1.5 centimetres wide is extracted from the back of the scalp and the opening is then sewn closed. This strip is then placed under microscopes and dissected into small grafts, containing just one follicular unit each. Such follicular grafts are then implanted into the balding area. The advantage of this method is its high yield, measured as a percentage of the hair follicles that are successfully transplanted into the balding area. This yield is around 98%. The greatest weakness is that it leaves the patient with a linear scar at the back of the head. The FUT is less expensive than the FUE and is used when a large area needs to be filled with transplanted hair in one single session.

The FUE method uses a micro-extraction technology to harvest individual follicles that can be directly implanted into the small needle-poke holes in the balding area. The FUE method is the latest technology, introduced only in 2002. Its greatest benefit is the fact that it leaves the patient with only minuscule scars at the back of the head, which are hardly visible, and the healing time is much shorter than with the FUT, due to the small size of the wounds. However, this technique cannot be used to cover large areas in one session and it is more expensive than the FUT. Additionally, its yield is much lower, especially in the hands of inexperienced staff, due to the transaction of many follicles, and since the supply of donor hair is limited, it cannot be used in patients whose hair loss has progressed above NW4 level.

Potential future surgical hair restoration technologies, such as hair cloning and the generation of new hairs in wounds, are expected to solve the constraints of the limited amount of donor hair. It seems that hair transplants will in the long future only be used for frontal hairlines and, therefore, the follicular harvesting should manage to provide a sufficient number of hair implants. However, none of the aforementioned potential future techniques is expected to become commercially available before 2013. Therefore, the immediate future probably lies in improving the harvesting methods of the FUE in order to improve its yields and make it financially more affordable to customer. The FUT with its strip harvesting, which started a revolution in the hair transplant industry less than two decades ago, may become history in the not too distant future.

Conquering baldness and restoring lost hair is to many of us a distant dream. However, there are existing options for replacing lost hair and some of them may seem surprisingly effective even to the most sceptical hair loss sufferer. The three principal methods of hair restoration include surgical hair restoration, non-surgical hair replacement and therapies for regrowing hair using pills and topicals. The main technique of surgical hair restoration today is hair transplantation, whereas wigs, hairpieces, hair thickeners and hair loss concealers are the most popular aids used to replace the lost hair by non-surgical means. The non-surgical cover-up is obviously the quickest and the least expensive method of replacing lost hair, though not tremendously popular, as many people believe that wigs and concealers cannot withstand rain and wind and do not look natural. In spite of this common belief, some of them are extremely resistant to external influences and can appear very authentic. Wigs and concealers are usually the only option of restoring lost hair for people suffering from non-hereditary forms of hair loss such as unpredictable alopecia areata.

Surgical hair restoration is the most expensive method of restoring lost hair but also the most elegant and lasting solution. It can only be used in people suffering from hereditary baldness and burn patients. Candidates should have sufficient hair density at the back of their scalp and many women suffering from female form of hair loss with its typical diffuse balding pattern do not meet this condition. Hair restoration surgery has made great advances in the past twenty years with the introduction of the two main techniques used today - follicular unit transplantation and, more recently, follicular unit extraction. These improvements in hair transplantation techniques enable the grouping of hairs very close together, which gives modern hair transplants a completely natural look. The main weakness of hair transplant surgery, besides the high cost and the pain involved, is the limited supply of donor hair and the need for multiple surgeries to achieve the final change. Furthermore, patients have to commit themselves to the use of finasteride or any other adequate medicinal hair loss therapy for the rest of their lives to prevent further loss of hair in areas adjacent to their hair transplant.

Pills and topicals do not, despite great scientific advances and the discoveries of recent years, provide satisfactory hair restoration results yet. The two most frequently prescribed hair loss drugs, finasteride and topical minoxidil, can be effectively used to manage hair loss but their ability to regrow lost hair is relatively weak. Their effectiveness typically declines sharply in the later stages of the balding process. There is no existing medicinal or natural hair loss cure that can deliver adequate visual results comparable to either hair transplant surgery or non-surgical hair replacements such as wigs and hair loss concealers. Although there are some promising medicinal hair loss drugs currently under development, especially in the area of genetic research, the ultimate pill for baldness is not expected to emerge within the next fifteen years. Other advances in hair science, such as hair multiplication, often called hair cloning or the generation of new hair follicles in wounds, also hold out some promise but it appears that hair transplant surgery will in the next ten to fifteen years remain the most satisfactory method of hair restoration.