By Dr. Emilia A. Ripoll
Bald is beautiful
Think about how different the world would we be without the contributions of these great bald men: Hippocrates, Leonardo da Vinci, Galileo, William Shakespeare, Charles Darwin, George Washington, Ben Franklin, Winston Churchill, Dwight Eisenhower, Pablo Picasso, Mahatma Gandhi, Mikhail Gorbachev, or The Dalai Lama.
Although I’ve never polled my patients, it’s a safe bet that men would prefer to keep their hair if they could — or Rogaine sales would not be pushing $50 million a year. For better or worse, there’s a global stigma about hair loss that makes many men feel diminished, emasculated, self-conscious, or just plain old. Have you ever heard a man say, “I can’t wait until my hair falls out so I can start shaving my head”?
Neither have I.
Bald may be beautiful, but it’s not for everyone — especially women
Although I have seen some women who look good with very short hair, like most women, I have a strong attachment to my hair. It’s part of what makes me feel feminine. So why on earth would I want to lose it?
Imagine my delight as a doctor at discovering a new application of PRP (platelet rich plasma) therapy that not only reverses hair loss (alopecia), but actually stimulates the growth of new hair. It’s a blessing to be able to offer this breakthrough treatment to my male and female patients who suffer from hair loss — and at a huge savings over the cost of hair transplants.
Before I jump into how PRP therapy regrows hair, allow me to explain what happens when hair loss occurs.
What causes hair loss?
Hair loss is part of everyday life. According to the American Academy of Dermatology, most people lose anywhere from 50 to 100 strands of hair every day.
All your hair follicles, including the ones on your head, go through a three-phases cycle:
- Growth (anagen)
- Resetting (catagen)
- Resting (telogen)
At any given time, different follicles are in different phases. Usually, about 90 percent of your follicles are in the anagen, or growth, phase.
“Hair loss” occurs when you start losing more hair than you grow back. “Baldness” happens when hair loss becomes noticeable. Both hair loss and baldness occur in men and women.
Male pattern baldness and female pattern baldness also have a genetic hormonal component. (You can thank your parents, and their parents, and their parents….) And you inherit it from both sides of your family — not just your mother’s side — so you can stop blaming your mom.
Male pattern baldness, which starts with a receding hairline at the temples, can begin during teenage years; whereas, female pattern baldness (thinning hair at the front, sides, and crown of the head) usually starts after menopause. Although, female pattern baldness may start as early as mid-20s, these cases are rare.
There are five basic types of hair loss (alopecia)
1. Androgenetic alopecia: male pattern hair loss in men, and female pattern baldness in women
2. Alopecia areata: This condition is considered an autoimmune disorder because white blood cells attack the hair follicles, causing hair to fall out in a circular pattern. Typically, the hair grows back within a couple of months. A sudden increase in stress (death of a loved one, financial instability, a sick child, and so on) can be a factor in Alopecia areata.
3. Telogen effluvium: In this condition, the hair follicles get stuck in the contracted resting (telogen) phase and have trouble returning to the expansive growth (anagen) phase. Telogen effluvium often occurs after major surgery (a reaction to anesthesia), dramatic weight loss, extreme stress, and pregnancy.
4. Other Medical Conditions: Diabetes, lupus, thyroid disorders can all cause/contribute to hair loss.
5. Nutrition: Diets that are low in protein, iron, zinc, and certain vitamins (A, B6, B12, C, and D) can all cause hair loss. Too much insulin in the blood (hyperinsulinemia) and insulin resistance (when increased amounts of insulin are required to move sugar from the blood into the cells) can contribute to alopecia. These conditions are frequently the result of eating a high-carbohydrate diet.
Restrictive hairstyles like cornrows and tight braids, hair dyes, chemical treatments, even blow drying can all cause temporary hair loss. Fortunately, the hair usually grows back once you stop torturing it to death.
DHT is the culprit
As I mentioned earlier, both male and female pattern baldness have a strong genetic component. These types of baldness are caused by individual hair follicles responding to dihydrotestosterone (DHT). DHT is a more potent form of testosterone that is responsible for body and facial hair in men and women and prostate growth in men. (Yes, women have testosterone in their bodies, just like men have estrogen in theirs.)
The reason female pattern baldness usually doesn’t occur until perimenopause or menopause is because women have enough estrogen circulating in their bodies to offset the presence of DHT. As a women’s estrogen levels decline, however, hair follicles are “unprotected” and DHT has more of an unwanted impact.
Although the exact biochemical pathway by which DHT adversely affects hair follicles in genetically prone scalps is poorly understood, DHT attacks the hair follicle and contracts the follicle and it’s opening to the point of turning a normal strand of hair into peach fuzz.
DHT also shortens the anagen phase of hair growth until the follicles switches first to the catagen and then to the telogen phase. The follicle curls up like a puppy in its bed and goes to sleep — and stays asleep. Essentially, PRP wakes the puppy up.
PRP restores hair loss
Instead of reversing the effects of DHT on the hair follicles of the scalp, PRP rejuvenates the surrounding tissues via the introduction of various platelet-derived growth factors.
These growth factors (a special group of proteins that the body uses in wound healing) stimulate stem cells in the scalp to produce new tissues (Dermal Papilla Cells), which in turn signal the hair follicles to return to the anagen phase of the hair growth cycle. Once in the anagen phase, the follicles begin to produce hair again.
In studies on mice and humans, and tissue studies from both animals, PRP jump-starts hair growth in dormant follicles (telogen phase) and increases hair thickness (diameter) of the individual shafts. Both of these findings support the idea that PRP returns hair follicles to the anagen (growth) phase.
In addition to re-growing hair, no significant or systemic side effects have occurred from PRP hair restoration therapy, or as Kang et al. put it, “PRP preparation has a positive therapeutic effect on male and female pattern hair loss without remarkable major side-effects.”
The cost of PRP versus other hair loss therapies
PRP hair restoration therapy: $1,000 – $2,500 per treatment
PRP therapy for hair restoration and rejuvenation involves injecting platelet rich plasma into the scalp.
At Great Alchemy, we perform three treatments about a month apart to ensure maximum follicle activation. Each treatment involves a series of PRP injections into the scalp. (Don’t worry. We anesthetize the scalp first.) We also add a vasodilator to the PRP to enhance its absorption into the skin.
These injections are followed by a topical application of PPP (the remaining portion of the plasma, called “platelet poor plasma”), which penetrates the upper dermal layers thanks to a device called a dermal roller. This micro-trauma invigorates the scalp and recruits the body’s natural healing response, which further activates the PRP. The entire procedure takes about an hour.
Although the effects of PRP hair restoration therapy are not immediate, patients begin to notice a substantial difference after about a month. At first, the new hair is light-colored fuzz, but gradually each hair shaft becomes thicker, darker, and longer, until the follicles begin producing their own natural hair — without surgery and at a fraction of the cost.
The beauty of using PRP for hair restoration is that this type of therapy is regenerative: It continues working for months — even years — after the initial injections. In other words, once the PRP stimulates hair follicles into the growth (anagen) phase, the follicles often return to their youthful growth cycle.
I suggest that my patients return once a year for a PRP booster treatment to reinvigorate their scalp and keep their hair looking young and healthy.
Hair Transplant (follicular unit extraction): $4,000 – $15,000 depending on the number of grafts
PRP hair restoration therapy works best in areas where hair is thinning but not absent. When hair follicles become severely atrophied after being dormant for many years, they are often beyond PRP’s power to regenerate. In these cases (mostly bald men who have not had hair growth for a long time), follicular unit extraction (FUE) is considered the gold standard for hair restoration.
Interestingly, for years, hair transplant surgeons have been using PRP to increase the survival rate of transferred follicles and aid in the healing process.
The barrier of entry for hair transplants is usually the cost. We all want to look young and beautiful; however, $10,000 or $15,000 buys a really nice used car or covers a year of in-state college tuition. Even for those who are blessed with the means to afford a hair transplant, I recommend trying PRP therapy first because you may get the results you’re looking for and save yourself a lot of money.
Finasteride (Propecia, Proscar): $60/month ($720/year)
Finasteride is an oral prescription medication that helps regrow hair by interrupting the conversion of testosterone to dihydrotestosterone (DHT). Finasteride does this by inhibiting the 5-alpha-reductase enzyme necessary for the conversion of testosterone to DHT.
Finasteride’s hair growing properties were discovered during clinical trials for men with enlarged prostate. (DHT also has a powerful effect on prostates.) When the drug started regrowing hair for the men in these trials, the researchers at Merck realized they had an even bigger market for this new medication in male hair loss.
For 85 percent of the men in these clinical trials, finasteride stopped hair loss, and 65 percent reported new hair growth. The American Hair Loss Association recommends Finasteride as a first line of defense against hair loss.
In addition to regrowing hair and reducing enlarged prostates, Finasteride also carries a 30 percent reduction in prostate cancer for men who take a 5mg daily dose.
Although rare, side effects of finasteride include erectile dysfunction, ejaculation disorder, decreased libido, anxiety, and depression. In 2012, the FDA added to warning labels that these side effects may continue indefinitely after a man discontinues taking finasteride.
So men need to weigh the potential loss of sexual potency and their sense of drive against hair regrowth and a decreased chance of developing prostate cancer.
Women who are pregnant or may become pregnant should NEVER handle finasteride tablets because of the potential risk of birth defects in a developing male fetus if this medication is absorbed through the skin. This concern is not an issue for women who do not wish to have children or are past their childbearing years.
Rogaine (minoxidil): $50/month ($600/year)
Rogaine is effective at stopping hair loss, especially if used early enough. According to WebMD, minoxidil enlarges hair follicle diameter and stimulates new hair growth. Seven out of 10 men who use Rogaine say that they regrow some hair. The downside of Rogaine is having to use it twice a day. In some cases, Rogaine irritates the scalp and causes itchiness, flaking, and redness.
Rogaine also takes from four to six months to show results. Many men become discouraged and give up on Rogaine before it actually starts to work. In some cases, Rogaine initially promotes the transition from the telogen phase to the anagen phase — so hair follicles release their hair strands before starting to grow new ones. This transition may appear as if Rogaine is causing hair loss, when it is actually stimulating the growth of new hair.
Rogaine does not regrow hair in bald spots or replenish receding hairlines.
Bald can be beautiful, but beauty is in the eye of the beholder. If hair loss doesn’t fit the look you want or the lifestyle you have — don’t worry, you have options:
- PRP provides long-term hair re-growth and restoration — without side effects or draining your bank account.
- Hair transplants are very successful and very expensive.
- Finasteride also works well (and protects against prostate cancer) but in rare cases can cause sexual and psychological side effects.
- Rogaine works if you want to keep the hair you have or thicken it slightly.
If you’re concerned about hair loss (or know someone who is), please contact me at 303-554-4444 for a complimentary consultation so we can design a hair restoration plan specifically for you.