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Q: There are various types of hair rejuvenation methods such as pills, lasers, transplants, etc. Can you briefly explain what these treatments are supposed to do?
A: Hair rejuvenation is divided into medical and surgical.
Medical hair rejuvenation includes tonics and oral medication for hair restoration. All these are evidence-based medicine and have been approved by the dermatological associations from around the world.
After excluding any medical causes of hair loss, the commonest cause of hair loss is actually male pattern baldness or androgenetic hair loss, which has a genetic preponderance, but affects men and women.
Men manifest hair loss via a grading system called the Norwood scale. This grading system outlines the different stages and extent of hair loss in men. In women, the Lockwood scale is used.
The standard treatment of hair loss for men with androgenetic hair loss is oral Propecia tablets - 1 mg once a day. This acts to suppress the male hormone, testosterone. Testosterone is usually converted to Di-Hydrotestosterone, which is the culprit hormone for attacking the hair follicles on the head, causing a shrinking of the hair follicle, regression, and a cessation of hair growth, eventually leading to hair loss in genetically susceptible individuals.
The tablet suppresses the production of the hormones, and hair loss is suppressed. Propecia can only be taken by men, not by women.
A topical application of hair growth/hair loss suppression is Minoxidil 5% hair tonic, which is medically-proven to halt hair loss by opening up ion channels in the scalp and encouraging hair growth. It is a twice-a-day application, and is a lifelong treatment.
Laser hair rejuvenation uses diode laser - a medium wavelength laser - as an adjunct with other methods of hair rejuvenation. It works poorly on its own. Its results are extremely variable and inconsistent.
Oral supplements for hair growth are available freely over the counter and in clinics. These include Pantogar, which contain potent anti-oxidants, vitamin B complex, biotin, etc to encourage hair and nail keratin development.
Surgical hair transplant
Q: I understand that there are some machines for hair transplant. Can you tell us a bit more about them and who can operate them?
A: Surgical hair transplant is the foolproof way of hair restoration. Its success rate is 95-97%.
It uses a donor graft from the patient's scalp, which is usually the area at the back of the head. This area is surgically excised, and hairs from this strip graft are planted into the area of hair thinning or hair deficiency. These areas are genetically programmed to lose hair but when they receive the hairs from the back of the scalp, the hairs there will retain their characteristics and continue to grow on the transplanted recipient sites.
This is known as the strip graft method and is my preferred method.
Another way is the Follicular Unit Extraction method, which uses a machine to extract hairs from the scalp and plant them to other areas. This is done without removing a strip of skin of the scalp.
This has a disadvantage of causing multiple pitted scars - salt and pepper or a moth-eaten appearance - of the donor area, and hence may be unsightly and uneven in appearance. This method is suitable only for small areas such as eyebrow transplant, but is not my preferred choice.
High transection rates are prevalent with the machine - hairs are broken and divided during extraction - and only trained aesthetic physicians/dermatologists/plastic surgeons can use the machine. No nursing staff or beauticians or the like can operate the machine.
Choosing a doctor
Q: What kind of advice would you give to someone who is seeking a reputable doctor for hair loss treatments? Are there any tell tale signs that a patient should leave as soon as possible if he/she sees/feels or senses something amiss?
A: My advice to them would be:
- Avoid anything that sounds like a hard sell.
- Avoid any centre that does not underscore the premise of evidence-based medicine
- Avoid any centre that does not have trained staff
- Avoid any centre which subscribes to alternative theories of thought that are manned by non-medical personnel
Do seek professional help for hairloss from a qualified and reputable medical practitioner.
Dr Vanessa Phua is a Physician with an interest in Aesthetic Medicine & Beauty. She practices at Asia HealthPartners at 304 Orchard Road, Lucky Plaza, #05-06. Tel: 6235 7888