Treatment of Hair Loss in Men
Hair loss can be treated both medically and surgically. Surgical techniques include Follicular Unit Hair Transplantation (FUT), performed though the microscopic dissection of a donor strip, and Follicular Unit Extraction (FUE), where follicular unit grafts are removed directly from the donor area through tiny round incisions. The latter procedure is now performed robotically (R-FUE).
There are two FDA approved medications for hair loss; the oral medication Propecia (finasteride) and topical Rogaine (minoxidil). Other medical therapies include Low Level Laser Therapy (LLLT) and Platelet Rich Plasma (PRP).
If you are interested in treating your hair loss, the necessary first step is to have a Physician Consultation with a board certified Bernstein Medical physician.
Surgical Hair Restoration
In hair transplant surgery, hair is harvested from the donor area or “permanent zone,” in the back and sides of the scalp, and then implanted into recipient sites made in the balding areas. Hair follicles from the donor area are genetically resistant to the miniaturizing effects of DHT and maintain this resistance after being transplanted. This is why the cosmetic benefits of a hair transplant are long-term.
The modern hair transplant techniques of Follicular Unit Transplantation (FUT), Follicular Unit Extraction (FUE), and Robotic Hair Transplantation (R-FUE, or Robotic FUE) were pioneered by Dr. Bernstein and are now performed by hair transplant surgeons around the world. These procedures, which produce completely natural results, are minimally-invasive and require only local anesthesia. They allow the patient to resume his or her normal activities after a brief recovery period.
The Hair Transplant Photos section of our website has over 1,400 photos of more than 220 different surgical patients. Visit our before and after galleries to see results in some of our hair restoration patients. You can also browse our patients’ photos by their Norwood Class balding pattern, the number of hair transplant sessions, or other hair characteristics.
Follicular Unit Transplantation (FUT)
Follicular Unit Transplantation (FUT) was first described in medical literature in a landmark publication by Dr. Bernstein in 1995.
In FUT, a strip of hair and skin, called the donor strip, is surgically removed and dissected into naturally-occurring follicular units containing from one to four hair follicles. These are implanted in the balding areas where they grow permanent hairs.
FUT generally allows the surgeon to obtain a greater number of follicular units than FUE procedures. It is especially beneficial for patients who wear a longer hair style because the typically fine linear scar that results from the removal of the donor strip can easily be covered and camouflaged with hair. Click here to learn about FUT Hair Transplants.
Follicular Unit Extraction (FUE)
Follicular Unit Extraction (FUE) was first described in medical literature by Drs. Bernstein and Rassman in 2002.
In FUE, follicular units are extracted, one at a time, from the donor area using special instruments. At Bernstein Medical, all FUE procedures use the speed and precision of the ARTAS® Robotic System.
FUE leaves small, round scars in the donor area that are more cosmetically desirable than the linear scar from FUT, particularly in those who wear their hair very short. Click here to learn about FUE Hair Transplants.
Robotic Hair Transplantation
Robotic Hair Transplantation (R-FUE or Robotic FUE) is the latest advance in surgical hair restoration technology. In robotic transplants, individual follicular units are extracted from the donor area by a physician-assisted robot, the ARTAS Robotic System.
Introduced in the fall of 2011 by Restoration Robotics, Inc., the ARTAS robot extracts follicular units with accuracy and speed that is impossible with manual FUE instruments. The robot can also utilize its high-tech optical guidance system to create recipient sites according to a plan designed by the surgeon.
Bernstein Medical is one the first hair restoration facilities in the world to use the ARTAS robot, and is a beta-test site for improvements to the system. Dr. Bernstein has collaborated with Restoration Robotics to introduce numerous procedural and technological upgrades for the robot. He is a medical adviser to the company. Click here to learn about Robotic Hair Transplants.
Hair Loss Medication
The primary medications used to treat hair loss in men are finasteride and minoxidil. Both drugs act by reversing the miniaturization process (where hair follicles shrink and hairs become progressively finer until they eventually disappear). While the effects are similar, the two medications work by different mechanisms, so the combination of the two will generally give the best results.
Treatment with minoxidil: before (left) and after (right)
Treatment with both finasteride and minoxidil: before (left) and after (right)
Propecia is the brand name of the oral medication finasteride 1mg. Finasteride also comes in 1mg and 5mg generic tablets.
Finasteride blocks the enzyme 5-alpha reductase Type II from converting testosterone into dihydrotestosterone (DHT), the hormone most responsible for miniaturization, the process that leads to baldness.
As a result of blocking DHT production, finasteride enables follicules to continue to produce healthy, thick terminal hairs. Propecia, introduced in late 1997, continues to be the most effective medication for re-growing hair.
Rogaine, the brand name of the topical medication minoxidil, counteracts the miniaturizing effects of DHT by lengthening the growth phase of the hair cycle, called anagen. As a result, follicles continue to produce healthy terminal hairs.
Rogaine was introduced as a hair loss treatment in 1982. While it is typically effective in blocking miniaturization in its early stages, it is not as effective as oral finasteride in this regard. Minoxidil is available as a 5% solution, 5% foam, and a 2% formulation (for women). Although the 5% solution is the most effective, it contains propylene glycol which makes it greasy and occasionally irritating to the scalp.
Other Medical Therapies
Low Level Laser Therapy (LLLT)
Low-Level Laser Therapy (LLLT) in hair restoration utilizes cool lasers to stimulate hair growth and reduce hair loss. LLLT is based on the scientific principle of photo-biotherapy which occurs when laser light increases cell metabolism and protein synthesis. Although the exact mechanism by which laser light promotes hair growth is still unknown, it appears to stimulate the follicles on the scalp by increasing energy production and reversing miniaturization.
Recent studies have shown that Low Level Light Laser Therapy (LLT) appears about equal to the benefits of the hair loss medication minoxidil used over the short term. At present, its long-term benefits are less clear.
Platelet Rich Plasma (PRP)
Platelet Rich Plasma (PRP) is concentrated blood plasma containing approximately five times the number of platelets found in normal circulating blood. In addition, it contains biologic growth factors and other bioactive proteins that aid in wound healing and possibly hair growth. Recently, studies have suggested that PRP may serve as a safe and effective treatment option for common genetic hair loss.
In the medical treatment of male pattern baldness (androgenetic alopecia), PRP can be injected into the balding scalp to potentially stimulate thin (miniaturized) hair to grow into thicker (terminal) hairs. Patients with thinning, but not totally bald, areas would be the best candidates.