Study is the First to Measure Perceived Benefits of Hair Transplant Surgery

Study is the First to Measure Perceived Benefits of Hair Transplant Surgery

A recently published study ((Bater KL, Ishii M, Joseph A, Su P, Nellis J, Ishii LE. Perception of Hair Transplant for Androgenetic Alopecia. JAMA Facial Plast Surg. 2016 Aug 25. doi: 10.1001/jamafacial.2016.0546.)) is the first to measure the perceived benefit of hair transplantation on a patient’s age, attractiveness, successfulness, and approachability – key factors that play an important role in workplace and social success. The pilot study, published in the Journal of the American Medical Association Facial Plastic Surgery, found that hair transplant recipients were perceived by others to be 3.6 years younger following their hair restoration surgery. The data indicate that the person’s attractiveness, successfulness, and approachability also showed statistically significant positive changes as a result of hair restoration surgery.

Background

Half of men over 40 experience hair loss. This may be associated with significant adverse psychological effects including reduced self-esteem and self-confidence, plus the social consequences that follow. Prior studies have shown that men who are balding are rated poorly when it comes to attractiveness, likability, and personal and career success. ((Wells PA, Willmoth T, Russell RJ. Does fortune favor the bald? psychological correlates of hair loss in males. Br J Psychol. 1995; 86(pt3):337-344.)), ((Cash TF. Losing hair, losing points? the effects of male pattern baldness on social impression formation. J Appl Soc Psychol. 1990;20(2):154-167.)) This perception motivates men to seek hair restoration in order to improve how they are viewed by others. The new study attempted to quantify, for both patients and their surgeons, the actual benefit of hair transplant surgery on these key perceptions.

Methods

The randomized, controlled study involved 122 participants — 47.5% men, 51.6% women — each of whom were shown a series of 13 sets of before and after hair transplant photos. Of the photo sets, seven showed men before and then after a hair transplant of approximately 1,200 follicular unit grafts. The control group were of men who did not have a hair transplant or any facial cosmetic surgery. Each participant was asked to rate how much younger the “after” photograph appeared, on a scale of 1-10 years. For the other metrics — attractiveness, successfulness, and approachability — the participants used a slider bar to indicate a positive or negative change.

Results

On age, the data showed a range of about one year younger to about six years younger for the “after” photos, for an average of 3.6 years younger in people who had a transplant. The “after” photos for the control group were perceived to be an average of 1.1 years younger, confirming that the post-transplant group appeared younger than the control group. On attractiveness, successfulness, and approachability, study participants rated the “after” photos with scores of 58.5, 57.1, and 59.2, respectively. This amounts to a 17% improvement in attractiveness, 14.2% improvement in successfulness, and an 18.4% improvement in approachability.

Summary

Since the first hair transplants in the 1950s we have observed that surgical hair restoration can significantly improve one’s appearance. Now, for the first time, we have concrete data that shows the extent of the change of perception in the person’s age, attractiveness, successfulness, and approachability that is caused by the hair restoration procedure. This pilot study should be encouraging for prospective patients, as the purpose of hair restoration is not only to improve one’s own self-image, but to improve appearance, attractiveness, and successfulness to other people as well. This study shows that this effect exists in a way that is both measurable and statistically significant.

Posted by Robert M. Bernstein M.D.

Study Identifies A Possible Cause of Age-Induced Hair Loss

Hair follicle aging is driven by transepidermal elimination of stem cells via COL17A1 proteolysis

Researchers show how the normal hair cycle (left) is disrupted by DNA damage (center),
resulting in age-induced hair follicle miniaturization (right)

We have known for decades that the incidence of male pattern baldness increases with age. New research published in the February 2016 edition of the journal Science has shed light on why this is the case. Researchers examining the role of hair follicle stem cells (HFSC) in the hair growth cycle have found that accumulated DNA damage in these cells results in the depletion of a key signaling protein and the progressive miniaturization of the hair follicle (and eventual hair loss). ((Matsumura H, Mohri Y, Binh NT, et al. Hair follicle aging is driven by transepidermal elimination of stem cells via COL17A1 proteolysis. Science. 2016 Feb: Vol. 351, Issue 6273, p. 613.)) The study represents a breakthrough in our understanding of the cell aging process and could open new pathways for the treatment of not only hair loss but other age-related conditions as well.

Background: The Hair Growth Cycle

At any point in time, a hair follicle exists in one of three phases:

Anagen Phase – this is the “growth” phase in which the hair follicle is actively producing living hair. Anagen can last from two to seven years.
Catagen Phase – this is a short transitional phase in which hair growth stops, the middle of the follicle constricts, and the bottom of the follicle begins to form the “club.” The follicle also separates from the bloodstream. Catagen lasts two to three weeks.
Telogen Phase – this is the “resting” phase in which the clubbed hair detaches from the dermal papilla and is susceptible to falling out. Telogen lasts three to four months before hair follicle stem cells initiate a new anagen (growth) phase and the cycle repeats.

Stem Cells and the Hair Cycle

Normally, hair follicle stem cells (HFSC) perpetuate the hair cycle by initiating a new anagen (growth) phase after the telogen (resting) phase. But HFSC, like all cells, age over time. Included in this aging process is damage to DNA strands inside these cells due to spontaneous errors in DNA replication or those due to exposure to sunlight and other insults. While it has been well understood that hair follicle miniaturization occurs as a person ages and that damage to genetic material contributes to the process, the exact mechanism that ties cell aging to the disruption of the normal hair cycle was unknown. The recent study examines miniaturization from cell aging and distinguishes it from miniaturization caused by the effects of DHT.

Results of the Study

The key finding in this new research is that as hair follicle stem cells (HFSC) accumulate genetic damage over time, their store of a signaling protein called COL17A1 is depleted. The depletion of this key protein forces HFSC to differentiate into a common type of skin cell called a keratinocyte. By differentiating into keratinocytes, the population of HFSC gradually shrinks, there are fewer HFSC to initiate the anagen (growth) phase, and the telogen (resting) phase is extended. With a gradually longer telogen phase and shorter anagen phase, the follicle progressively miniaturizes. Eventually, the hair-producing follicle disappears leaving a bald scalp and the keratinocytes, which no longer serve a purpose in the hair growth cycle, are ejected from the skin.¹ Click here to view the graphic that illustrates this process.

The authors of the study suggest that restoring COL17A1 levels, or halting their depletion, may prevent this aging-induced hair follicle miniaturization from occurring.¹

With perhaps much broader significance, the study confirms the tight linkage between the instability of genetic material in stem cells (that can be due to environmental factors) and the shrinkage and functional decline seen in many organs as they age.

Conclusion

Progressive hair loss is a pervasive problem for males as they age. However, current treatments deal, exclusively, with hormone-induced miniaturization. The discovery of the mechanism behind age-induced miniaturization may result in a new avenue for the treatment of hair loss. More research into methods of boosting levels, or preventing the depletion, of COL17A1 may yield a hair loss therapy that targets this cause of hair loss.

Further, developing a better understanding of the cell aging process may open up new avenues of research into the causes of, and potential solutions to, the age-induced decline of major organs in the body.

Image c/o Science

Posted by Robert M. Bernstein M.D.

What is the Incidence of Hair Loss in Adults?

Q: How common is hair loss in adult men and women? — N.F., Bronxville, NY

A: The incidence of androgenetic alopecia (common baldness) is quite high for both men and women. By age 50, 50% of men and 30% of women are affected. By age 70, that increases to 80% of men and 60% of women. Fortunately, in spite of significant thinning, women often preserve their hairline and have a diffuse pattern, so their hair loss can be camouflaged for many years.

Posted by Robert M. Bernstein M.D.

Early Baldness May Suggest Prostate Cancer Risk

A study of Australian men between the ages of 40 and 69 suggests that men who were mostly bald by the age of 40 were more likely to develop prostate cancer in their 50s or 60s. The Melbourne Collaborative Cohort study of about 10,000 men showed that men who have high levels of testosterone may be more vulnerable to cancerous prostate tumors.

The team of scientists that conducted the long-term study, which was published in the journal Cancer Epidemiology, Biomarkers and Prevention, reported that both baldness and prostate cancer are age-related and androgen dependent conditions, so these findings are not surprising. The statement said, “We found that baldness at the age of 40 might be a marker of increased risk of prostate cancer.”

Posted by Robert M. Bernstein M.D.

Propecia Causes No Statistically Significant Change in Sexual Function, Says 2004 Tosti Study

The central finding of a 2004 study led by Italian researcher Dr. Antonella Tosti, in which he and his team investigated sexual dysfunction in hair loss patients being treated for androgenetic alopecia, was that there was no statistically significant change in sexual function after four to six months of treatment with finasteride 1mg (Propecia).

The researchers used a questionnaire, called the abridged 5-item version of the International Index of Erectile Function (IIEF-5), to measure sexual function in the men in the study. The questionnaire, which is considered an internationally valid diagnostic tool for distinguishing between men with and without erectile dysfunction, asks the patients 15 questions on the topics of: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall sexual satisfaction. By administering the questionnaire both before and after treatment with finasteride, the researchers were able to determine if sexual function was impaired by the treatment.

The result of this investigation in the sexual function of 186 patients was that, “the erectile function of all patients remained stable after 4 to 6 months of treatment with finasteride 1 mg.”

Interestingly, the research team found that sexual side effects were actually less common than reported in the clinical trials of the drug. They suggest that this difference was potentially due to the fact that subjects in the clinical trials were made aware of the potential for sexual side effects, and were asked about these side effects upon each visit, which led to higher reporting of side effects than what would otherwise be the case.

Reference:

Tosti A, Pazzaglia M, Soli M, Rossi A, Rebora A, Atzori L, Barbareschi M, Benci M, Voudouris S, Vena GA. Evaluation of Sexual Function With an International Index of Erectile Function in Subjects Taking Finasteride for Androgenetic Alopecia. Arch Dermatol. 2004;140:857-858.

Download the Tosti study of erectile function and finasteride

Posted by Robert M. Bernstein M.D.

10-Year Finasteride Study: First to Investigate Long-Term Effects and Safety

The 2011 study published by a research team led by Dr. Alfredo Rossi, is the first comprehensive investigation on long-term safety and efficacy of finasteride 1mg (Propecia).

In “Finasteride, 1 mg daily administration on male androgenetic alopecia in different age groups: 10-year follow-up,” the Italian research team sought to fill a gap in our understanding of the long-term effects of treating hair loss with Propecia. The study tracked hair growth in 118 men between the ages of 20 and 61, with mild to moderate hair loss, who were treated with 1mg finasteride. These patients were evaluated before treatment and then again at 1, 2, 5, and 10 years on treatment.

The result of testing found not only that Propecia works and is safe for use, but there were some other interesting findings as well. Only 14% patients experienced a worsening of hair loss, while 86% benefited from the treatment over this extended time period and efficacy of the drug was found not to reduce over time for the majority of patients.

One of the most interesting findings is that patients who had hair growth in their first year of treatment are more likely than others to have better hair growth after 5 years. About half of patients experienced good hair growth in their first year, and about 53% of those patients went on to see improved growth over time. However, of the group with unchanged or worse results in their first year, only 25% saw improved hair growth after 5 years. After 10 years, almost 69% of patients who experienced growth in their first year experienced continued growth. Only 32% of those who saw unchanged or worse results after their first year had growth at 10 years.

The authors concluded that a patient’s response to finasteride in the first year is a pretty good indicator of how effective long-term treatment will be for the patient. The better growth he experiences in his first year, the more likely he will have continued growth beyond 5 years of treatment.

Among other findings, the age of a patient did have a statistically significant effect on the outcome, as patients older than 30 years had better hair growth in the long term. On the topic of side effects, 7 subjects (5.9%) experienced them, and some of those patients remained in the study because of what they perceived as the benefits of the treatment.

In conclusion, the authors found that Propecia is a safe and effective hair loss medication, even when used long-term. It is effective in patients older than 40 years and it is particularly beneficial for patients over 30 and who are in early stages of hair loss. Perhaps the most important finding is that a patient’s response to finasteride after the first year of treatment can be an indicator of the patient’s success with the drug in the long-term.

Reference:

Rossi A, Cantisani C, Scarnò M, Trucchia A, Fortuna MC, Calvieri S. Finasteride, 1 mg daily administration on male androgenetic alopecia in different age groups: 10-year follow-up. Dermatol Ther 2011; Jul-Aug;24(4):455-61.

Download the Rossi study of finasteride long-term effects

Posted by Robert M. Bernstein M.D.

Sato Finasteride Study Points to Long-term Safety, Efficacy in Use of Propecia

Led by Dr. A. Sato, a Japanese team of medical researchers published the largest finasteride study ever performed, “Evaluation of efficacy and safety of finasteride 1mg in 3,177 Japanese men with androgenetic alopecia.” It investigated the effects of finasteride over a 3 1/2 year period in men with androgenetic alopecia, or common baldness.

The study found that patients who had experienced hair loss for an extended period of time and were treated with finasteride exhibited notable hair growth. While a fairly small proportion of patients with a hair loss duration over 10 years exhibited “greatly increased” growth, 85% of patients with hair loss duration of more than 15 years experienced “moderate” or “slightly increased” growth. Physicians have thought that people with advanced hair loss do not respond as well as patients in the early stages of hair loss. However, in light of the results of this study, that determination should be reconsidered.

Further, the same study found that the initial age of a hair loss patient at the time of commencing treatment has little to no effect on the outcome. While the efficacy studies that are included in the Propecia package insert were conducted in men 18 to 41 years old, men over 41 appear to respond as well as the younger group. Adverse reactions occurred in only 0.7% of the study population and the Sato study found no increase in adverse safety events over time.

In summary, the Sato study showed an increased response rate to finasteride 1mg with increasing duration of treatment. In addition, it is effective in a larger portion of the male population with androgenetic alopecia than previously thought.

Reference:

Sato A, Takeda A. Evaluation of efficacy and safety of finasteride 1mg in 3,177 Japanese men with androgenetic alopecia. J Dermatol 2012; 39: 27–32.

Download the Sato study on finasteride

Posted by Robert M. Bernstein M.D.

When To Assess One’s Donor Supply?

Q: I am 24 years old and just starting to thin. I was told by another doctor that it was too early to have a hair transplant, but the hair on the back and sides of my scalp seems really thick. Shouldn’t I have a hair transplant now, just in case I am not a candidate in the future? — A.S., Cherry Hill, NJ

A: The most important criteria in determining who will be a candidate for a hair transplant is the presence of sufficient permanent donor hair. When hair loss is early, it is often hard for the doctor to determine this, since early on the donor area can appear very stable. It is not until the front and/or top of the scalp has significant thinning that the donor area may also show thinning. Therefore, it is only at this time that the stability of the donor area can adequately be assessed.

It has been argued, that one should have a hair transplant early, before the donor area can thin. This is not a reasonable argument, since doing a hair transplant early, does not make the donor hair more permanent. If the donor area is not stable, the transplanted hair will continue to thin after it has been moved to the new location. This will cause the hair transplant to gradually disappear and also risk the donor scar from becoming visible as the hair covering it continues to thin. This problem can affect patients undergoing both FUT and FUE procedures.

Age itself is another factor to consider. The donor area in young people almost always appears adequate. However, the older a person is, the more likely he/she will show donor changes. Therefore, the older a person is, the more confident we are of donor area measurements being accurate. In very general terms, it is very difficult to assess the permanency of one’s donor area in patients under 25 year of age.

Posted by Robert M. Bernstein M.D.

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Hair Loss Age

Study is the First to Measure Perceived Benefits of Hair Transplant Surgery

Background

Methods

Results

Summary

Study Identifies A Possible Cause of Age-Induced Hair Loss

What is the Incidence of Hair Loss in Adults?

Early Baldness May Suggest Prostate Cancer Risk

Propecia Causes No Statistically Significant Change in Sexual Function, Says 2004 Tosti Study

10-Year Finasteride Study: First to Investigate Long-Term Effects and Safety

Sato Finasteride Study Points to Long-term Safety, Efficacy in Use of Propecia

When To Assess One’s Donor Supply?

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