Bernstein Medical Center for Hair Restoration - Hair Loss Treatment

Hair Loss Treatment

About Header Image

Q: In what cases do you think Scalp Micro-Pigmentation (SMP) is most useful?
— M.O., Greenwich, CT

A: Scalp Micro-Pigmentation (SMP) is used in patients who want to make their thinning hair look fuller and want to avoid the nuisance of daily application of cosmetic concealers, powders or fibers. It is for patients who want a permanent solution, but who do not want, or who are not candidates for hair transplant surgery. It can achieve a variety of looks such as a buzz cut by tattooing hundreds of microdots that appear like follicles or it can reduce the contrast between generalized dark hair that is thinning over a pale scalp. It can even give the appearance of hair over a scar that has now become noticeable.

Posted by

Q: How is Scalp Micro-Pigmentation (SMP) Performed?

How is SMP done? — B.P., Long Island, NY

A: Scalp Micro-Pigmentation (SMP) is applied with tiny microneedles that mimics the appearance of hair in an area of the scalp that looks thin. It requires the use of local anesthesia and is performed in a doctor’s office. SMP is typically performed over a series of three or more sessions spaced at least 2-4 weeks apart. The length of each session varies depending on the area to be tattooed and can last from a few hours to a full day.

To perform successful SMP, the hair length and color must be analyzed in consultation along with a discussion of cosmetic goals and the potential techniques that could be implemented for the patient’s hair type. The procedure is performed under local anesthesia and is generally well tolerated with very few post-op limitations.

Posted by

Q: What is Scalp Micro-Pigmentation (SMP)?

What is SMP? — M.O., Greenwich, CT

A: Scalp Micro-Pigmentation (SMP) is a medical-grade scalp tattoo. It is a form of permanent cosmetic camouflage that can mimic the appearance of hair in locations such as scars or balding areas. SMP gives the appearance of fullness of hair without actual hairs being present. Although permanent dyes are generally used, semi-permanent materials can be substituted that will purposely fade over time.

Dr. Shaver is our dedicated in-house physician for Scalp Micro-Pigmentation procedures.

Posted by

Dr. Robert M. Bernstein, a Clinical Professor of Dermatology at Columbia University and one of the leading pioneers in modern hair transplant surgery, is recognized for his leadership in the field of hair restoration with inclusion in his 18th consecutive edition of New York Magazine’s ‘Best Doctors of New York.’

Best Doctors 2017 - New York Magazine

New York, NY — Robert M. Bernstein, MD, MBA, FAAD, FISHRS, has been recognized by his peers with inclusion in his eighteenth consecutive edition of New York Magazine’s annual ‘Best Doctors in New York’ issue. Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University and founder of Bernstein Medical – Center for Hair Restoration, helped re-invent hair transplant surgery by pioneering the Follicular Unit Transplantation (FUT) procedure and by becoming an early proponent of robotic hair transplant surgery (Robotic FUE). He is the only hair restoration surgeon named to the prestigious “Best Doctors” list for so many consecutive years.

Dr. Bernstein said:

“New York has some of the finest doctors in the world, so to be considered among the best by my peers is quite an honor. It is equally satisfying when a patient tells us that we helped change their life.”

The ‘Best Doctors of New York‘ issue is an annual edition of New York Magazine that contains a more select version of the Top Doctors: New York Metro Area list published each year by Castle Connolly Medical, Ltd. New York Magazine’s list of 1,341 doctors represents about the top 2% of doctors in the region. In each list, the area’s top physicians are organized by specialty. Dr. Bernstein is listed under dermatology with expertise in robotic hair transplantation, surgical hair restoration, and hair loss treatment. To be included, doctors in New York, New Jersey, and Connecticut are nominated by their peers then subjected to a physician-led review of their skill in diagnosis and treating patients, qualifications, and reputation. Castle Connolly Medical also publishes the America’s Top Doctors directory, which has included Dr. Bernstein in all sixteen annual editions.

Dr. Bernstein has earned top accolades from the hair restoration industry, including the International Society of Hair Restoration Surgery’s Platinum Follicle Award, for his medical contributions to the field. Renowned for developing FUT hair transplants and introducing follicular unit extraction (FUE) procedures, Dr. Bernstein became one of the first in the world to incorporate the ARTAS Robotic Hair Transplant System into his practice in 2011. He has continued innovating through his collaboration with Restoration Robotics, Inc.; the company that developed the image-guided, physician-assisted robot. Recently, he announced a major upgrade to the robot with the release of ARTAS 9x. This latest version of the robot provides improved accuracy, quicker donor healing, and a faster overall procedure.

Dr. Bernstein’s hair restoration facility, Bernstein Medical – Center for Hair Restoration, is dedicated to the treatment of hair loss in men and women using the most advanced treatments and technologies. The state-of-the-art facility is located in midtown Manhattan, New York City and treats patients who visit from 58 countries and all 50 states. The board-certified physicians and highly-trained clinical assistants at Bernstein Medical take pride in providing the highest level of treatment and care for all patients.

About Robert M. Bernstein, M.D.

Dr. Robert M. Bernstein is a Clinical Professor of Dermatology at Columbia University in New York and is the founder and lead surgeon at Bernstein Medical – Center for Hair Restoration. He was the first to describe Follicular Unit Transplantation and Follicular Unit Extraction in the medical literature, and his more than 70 medical publications have fundamentally transformed the field of hair restoration surgery. Dr. Bernstein has appeared as a hair restoration expert on many notable television programs and in many news and lifestyle publications over the years. Examples include The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, GQ Magazine, Men’s Health, Vogue, Interview Magazine, Columbia Business, The Columbia Journalist, The Wall Street Journal, and The New York Times. He is a co-author of Hair Loss & Replacement for Dummies. Dr. Bernstein graduated with honors from Tulane University, received the degree of Doctor of Medicine at the University of Medicine and Dentistry of NJ, and did his training in Dermatology at the Albert Einstein College of Medicine. Dr. Bernstein also holds an M.B.A. from Columbia University.

Posted by

Dr. Robert M. Bernstein, pioneer of modern hair transplant procedures and a Clinical Professor of Dermatology at Columbia University in New York, was selected for the 17th consecutive time to be included in New York Magazine’s annual ‘Best Doctors’ issue.

New York Magazine Best Doctors 2016New York, NY — Robert M. Bernstein, MD, MBA, FAAD, FISHRS, a Clinical Professor of Dermatology at Columbia University in New York and distinguished pioneer of modern hair transplant surgery, was included for the seventeenth consecutive time in the ‘Best Doctors’ edition of New York Magazine. Dr. Bernstein was selected by his peers as one of New York’s top doctors on account of his prominent work in developing Follicular Unit Transplantation (FUT), Follicular Unit Extraction (FUE), and Robotic Hair Transplantation (Robotic FUE).

Dr. Bernstein said: “It is exciting to be part of the continuing progress made in the treatment of hair loss as technological advances in both robotics and traditional surgery converge to improve the care of our patients.”

Bernstein Medical – Center for Hair Restoration, founded by Dr. Bernstein in 2005, is a center of innovation for the hair restoration industry. So far in 2016, Dr. Bernstein has patented a modified FUE procedure and published research on improvements to the ARTAS® Robotic Hair Transplant System. Each of these advances is designed to enhance surgical outcomes for hair transplant patients. Bernstein Medical is a beta-test site for Restoration Robotics, Inc.; the company that produces the ARTAS robot and Dr. Bernstein is a medical advisor to the company.

The ‘Best Doctors’ issue is a special annual edition of New York Magazine that contains a peer-nominated list of 1,300 of New York City’s top physicians. The list of doctors is cultivated by Castle Connolly, Ltd., through a survey of physicians in the New York Tri-State area, which includes New York, New Jersey, and Connecticut. Doctors who are nominated must pass a rigorous physician-led review of their qualifications, skill in diagnosis and treating patients, and reputation. Castle Connolly also publishes America’s Top Doctors, which has included Dr. Bernstein in all fifteen editions, and Top Doctors: New York Metro Area, which has included Dr. Bernstein in fifteen consecutive editions.

Posted by

A study published in the December 2015 issue of the Journal of Clinical and Aesthetic Dermatology suggests that Viviscal, an oral supplement designed for women with thinning hair, may promote hair growth. ((Ablon G, Dayan S. A Randomized, Double-blind, Placebo-controlled, Multi-center, Extension Trial Evaluating the Efficacy of a New Oral Supplement in Women with Self-perceived Thinning Hair. J Clin Aesthet Dermatol. 2015 Dec;8(12):15-21.)) The researchers noted a 79 percent increase in healthy, terminal hairs and an almost 12 percent increase in hair diameter in female patients who took the supplement for six months. The evidence suggests that Viviscal may be a useful supplement to current hair restoration treatments, or an alternative treatment in patients not indicated for hair transplant surgery or medical treatment with finasteride.

Background

Viviscal, produced by Lifes2good Inc., out of Chicago, Illinois, was launched in the U.S. in 2008. Its key ingredient is a proprietary mix of powders derived from sustainably-harvested shark and mollusk species. This “amino marine complex,” known as AminoMar C™, is blended with B and C vitamins, and minerals such as calcium, to make Viviscal “Professional Strength.” The active ingredients in the AminoMar complex are glycosaminoglycans (GAGs), a group of long-chain sugar molecules present in many living creatures. GAGs are especially adept at retaining water, and ingesting them may contribute to healthy hair and skin, although it is not clear if taken orally GAGs have any benefit in this regard. According to Viviscal, the beneficial effect on skin and hair of a fish- and protein-heavy diet was first observed in Inuit people in the late 1980s.

Dr. Glynis Ablon and her research team sought to determine if Viviscal “Professional Strength” tablets could successfully treat female hair loss. (The “Professional Strength” blend contains 25mg more of the AminoMar complex than the newer “Extra Strength” variety, as well as a different blend of extracts and additives.) If determined to be a viable treatment, Viviscal could be another option in an otherwise limited market of hair loss products for women. Many women with androgenetic alopecia (common genetic hair loss) are poor candidates for hair transplant surgery. Also, the use of Propecia (finasteride), the most effective hair loss medication available, is not indicated in women due to poor efficacy and the risk of potential side effects.

The Study & Findings

The study observed 40 women, aged 25-66, who self-reported some form of hair loss. An initial densitometry, to determine the progression of hair loss, was conducted on a 4cm2 target area of the frontal hairline. This was followed by the random distribution of either Viviscal or a placebo.

At 90 days on Viviscal, the researchers noted a 56% increase in terminal hairs in the target area and 10% increase in mean hair diameter. A nearly insignificant 1% rise was noted in the number of vellus hairs (non-mature or miniaturized hairs). Compared to the placebo group, the Viviscal group had 57% more terminal hairs, a 10% larger hair diameter, and 9% fewer vellus hairs.

At 180 days, compared to baseline, patients on Viviscal showed an almost 80% increase in terminal hairs, a hair diameter increase of 11.67%, and a 14% increase in vellus hairs. Compared to the placebo group at 180 days the Viviscal group had 77% more terminal hairs, an almost 10% larger hair diameter, and slightly more vellus hairs (1.5%).

Limitations of Ablon Study

The main limitation of the study lies in the potential conflict of interest between the researchers and Lifes2good. Dr. Ablon received a grant from Lifes2good as funding for the December 2015 study. In addition, no clear mechanism of action is proposed.  Finally, the cause of the volunteer’s hair loss was uncertain and probably represents several different diagnoses further confounding any explanation as to why the supplements might work.

Summary

Viviscal has the potential to supplement current treatments for hair loss or provide an alternative treatment for patients not indicated for hair transplant surgery or medical treatment. It would be especially useful for female patients who have relatively limited treatment options. It may also benefit men who are not good candidates for surgery. While the research findings are compelling, more investigation is necessary into the long-term efficacy of Viviscal and the effects of glycosaminoglycans on the hair growth cycle. Further study should be conducted by independent researchers in order to avoid the perception of a conflict of interest.

Posted by

A review of research on the efficacy of Viviscal, published in the September 2015 issue of the Journal of Drugs in Dermatology, suggests that the oral supplement may increase hair volume as well as the thickness of healthy, terminal hairs. ((Hornfeldt CS, et al. The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments. J Drugs Dermatol. 2015 Sep;14(9):s15-22.)) The article presented more than two decades of research on the hair regrowth product and also included a discussion with a roundtable of dermatology and plastic surgery experts.

Both the research review and roundtable discussion point to the benefits of Viviscal, however the article’s conclusions can be questioned due to the appearance of a conflict of interest between the researchers and Lifes2good, Inc., the company that produces Viviscal. Additional independent research needs to determine if Viviscal is a viable and effective hair loss treatment.

Background

Viviscal, was launched in the U.S. in 2008 by Lifes2good Inc., Chicago, Illinois. Its key ingredient is a proprietary mix of powders derived from sustainably-harvested shark and mollusk species. The resulting “amino marine complex,” known as AminoMar C™, is blended with B and C vitamins, and minerals such as calcium to make Viviscal. The active ingredients in the AminoMar complex are called glycosaminoglycans (GAGs), a group of long chain sugar molecules present in many living creatures. GAGs hold water, and ingesting them may contribute to healthy hair and skin – although this is still speculative. According to Viviscal, the beneficial effect on skin and hair of a fish- and protein-heavy diet was first observed in Inuit people in the late 1980s. Viviscal is marketed primarily to women because of the relative dearth of effective hair loss treatments for female patients compared to men.

Review Article

The summary article by Hornfeldt, et al., ((Hornfeldt CS, et al. The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments. J Drugs Dermatol. 2015 Sep;14(9):s15-22.)) notes that studies dating back to 1992 have suggested that Viviscal may treat hair loss to some degree. ((Lassus A, Eskelinen E, et al. A Comparative Study of a New Food Supplement, ViviScal®, with Fish Extract for the Treatment of Hereditary Androgenic Alopecia in Young Males. J Int Med Res. 1992 Nov;20(6):445-53.)) However, the more recent pivot to testing the supplement in women with thinning hair was pioneered by Dr. Glynis Ablon of the Ablon Skin Institute Research Center, Manhattan Beach, California. In a 2012 pilot study, Dr. Ablon found that Viviscal increased the number of terminal hairs by 211% and 225% after three months and six months, respectively. ((Ablon G. A Double-blind, Placebo-controlled Study Evaluating the Efficacy of an Oral Supplement in Women with Self-perceived Thinning Hair. J Clin Aesthet Dermatol. 2012 Nov;5(11):28-34.)) This was followed by a three month clinical study of women with self-perceived thinning hair; which the author attributed to poor diet, stress, hormones, or abnormal menstruation. In this study, published in early 2015, the mean number of terminal hairs increased by 32%, the count of shed hairs decreased by 39%, and subjects reported a significant increase in quality of life. ((Ablon G. A 3-Month, Randomized, Double-Blind, Placebo-Controlled Study Evaluating the Ability of an Extra-Strength Marine Protein Supplement to Promote Hair Growth and Decrease Shedding in Women with Self-Perceived Thinning Hair. Dermatol Res Pract. 2015; 841570.)) A similar randomized, placebo-controlled study, also led by Dr. Ablon and published in December 2015, found that female patients on Viviscal showed an almost 80% increase in terminal hairs and increase of 11.67% in hair diameter. ((Ablon G, Dayan S. A Randomized, Double-blind, Placebo-controlled, Multi-center, Extension Trial Evaluating the Efficacy of a New Oral Supplement in Women with Self-perceived Thinning Hair. J Clin Aesthet Dermatol. 2015 Dec;8(12):15-21.))

Some additional publications, such as Bloch’s 2014 study, ((Bloch L. Demonstrating the efficacy of a nutraceutical for promoting hair growth using a digital photography technique with posterior image analysis. Submitted for poster presentation at the 2015 World Hair Congress, Miami.)) suggest that Viviscal is effective in increasing patients’ hair volume and thickness. Another study published in 2014 suggests that Viviscal may improve scalp coverage and hair fullness in men with common baldness. ((Pinski KS. Patient satisfaction following the use of a hair fiber filler product to temporarily increase the thickness and fullness of thinning hair. Skinmed. 2014;12(5):278-281.))

In the roundtable discussion, which took place in August 2014, dermatology and plastic surgery physicians discussed findings of several clinical studies and reported a positive inclination to offer Viviscal as a treatment option. ((Hornfeldt CS, et al. The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments. J Drugs Dermatol. 2015 Sep;14(9):s15-22.))

Limitations of Hornfeldt Review

The main limitation of the Hornfeldt article lies in the potential conflict of interest with the researchers and Lifes2good. Dr. Carl S. Hornfeldt received honoraria fees as a consultant for Lifes2good and his co-author of the review article, Mark Holland, is an employee of Lifes2good. Members of the expert roundtable advised Lifes2good on Viviscal or received an honorarium for their participation.

Summary

Viviscal has the potential to offer a new avenue of treatment for treating hair loss or supplementing current therapies. The review article provides a review of research and presents compelling findings over a span of two decades. However, more research is necessary into the long-term efficacy of Viviscal and the effects of glycosaminoglycans on the hair growth cycle. Also, given the appearance of a conflict of interest between the researchers and Lifes2good, it is particularly important that further research be conducted by independent investigators.

Posted by

The 2015 hair restoration practice census, published by the International Society of Hair Restoration Surgery (ISHRS), showed that hair transplantation is an increasingly popular treatment for hair loss. The biennial survey found that 397,048 procedures were performed in 2014, an estimated increase of 28% over the previous survey, published in 2012. Three prior surveys found increases of up to 12%, so the rate of surgical hair restoration seems to be accelerating.

Since 2006, the number of procedures worldwide has increased 76%, with the estimated global hair restoration market now valued at approximately $2.5 billion annually.

Age
Over half of all men and women treated were younger than 50. Men aged 30-39 made up the biggest percentile at 31.7%, followed by those aged 40-49 (26.9%). It was the inverse for women, however, with those aged 40-49 making up the biggest percentile at 27.7%, followed by women in the 30-39 year old bracket (27.0%).

Gender
In 2014, 84.7% of surgical patients were men and the rest (15.3%) were women. The number of women receiving a hair transplant increased by 12% since 2012. There was also a 21% increase in non-surgical female patients.

Procedure
While Follicular Unit Transplant (FUT) procedures accounted for over half of all hair transplants, Follicular Unit Extraction (FUE) is gaining rapidly, with a 51% increase over the 2012 results (from 32.2% in 2012 to 48.5% in 2014). See the chart:

FUT vs FUE (2004-2014)
Posted by

A study published in the British Journal of Dermatology suggests that subcutaneous placement of testosterone pellets may boost hair regrowth in some women. ((Glaser RL, Dimitrakakis C, Messenger AG. Improvement in scalp hair growth in androgen-deficient women treated with testosterone: a questionnaire study. Br J Dermatol. 2012 Feb;166(2):274-8.))

This retrospective analysis examined patients who had androgen deficiency. Of the 285 patients studied, 76 had some degree of hair loss prior to beginning treatment. At one year on testosterone replacement 63% reported an increase in hair regrowth on the scalp.

Traditionally, elevated levels of androgens, such as testosterone, are felt to be the primary cause for common hair loss in both men and women. This is due to the seemingly adverse effect of androgens on hair follicles. This has held true for most men with patterned hair loss in whom DHT-blockers, such as Propecia (finasteride) and Avodart (dutasteride), have proven to be a potent remedy.

Given this, it was surprising that none of the 285 women in the study who had been treated with testosterone reported any hair loss after one year. In fact, of the 76 women who initially reported hair loss before the study, 63% reported positive hair regrowth at one year.

The researchers noted that patients with a “significantly higher body mass index (BMI)” were in the subset of those who did not regrow any hair. This suggests that a higher dose might be needed in some patients. ((Kapp N1, Abitbol JL2, Mathé H2, Scherrer B2, Guillard H2, Gainer E2, Ulmann A2. Effect of body weight and BMI on the efficacy of levonorgestrel emergency contraception. Contraceotion. 2015 Feb;91(2):97-104. doi: 10.1016/j.contraception.2014.11.001. Epub 2014 Nov 8.)), ((Lopez LM, Grimes DA, Chen M, Otterness C, Westhoff C, Edelman A, Helmerhorst FM. Hormonal contraceptives for contraception in overweight or obese women. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD008452. DOI: 10.1002/14651858.CD008452.pub3)), ((Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, Gainer E, Ulmann A. Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011 Oct;84(4):363-7. doi: 10.1016/j.contraception.2011.02.009. Epub 2011 Apr 2.))

Summary

By correlating higher levels of testosterone with more hair growth and/or retention in women, the study bolsters the idea that hair loss in men and women is caused by different mechanisms. Though not conclusive, the study opens the idea that testosterone implantation can effectively treat hair loss in women.

Posted by

Q: Hi. I am 52 years old and wish to know if Propecia will work for people my age. I have started losing some hair a couple of years ago and it’s thinning out. Thank you very much for your help. — K.E., Boca Raton, FL

A: Propecia (Finasteride 1 mg) can hold on to hair at any age, but works best to re-grow hair in those who are younger.

The reason is that finasteride works to reverse miniaturization (the thinning and shortening of hairs due to DHT). Younger patients, with early hair loss, generally have more hair in the early stages of miniaturization where the changes are readily reversible.

Older patients are more likely have more advanced miniaturization or areas that are totally bald and will thus not regrow with medical therapy.

Posted by
International Journal of Trichology - Oct-Dec 2012

Research published in the International Journal of Trichology in 2012 found that the antiandrogen ((Alonso R, Prieto L, Hernandez C, Mas M. “Antiandrogenic effects of the pineal gland and melatonin in castrated and intact prepubertal male rats.” J Endocrinol. 1978 Oct; 79(1):77-83.)) and antioxidant ((Tan DX, Chen LD, Poeggeler B, Manchester LC, Reiter RJ. “Melatonin: A potent, endogenous hydroxyl radical scavenger.” Endocr J. 1993;1:57–60.)) properties of the hormone melatonin could be made into a topical solution for the treatment of early stage androgenetic alopecia, or common male and female pattern baldness. Four different study designs observed that daily application of the melatonin solution to the scalp reduced hair loss and, in some cases, caused new hair growth. ((Fischer, Tobias W et al. “Topical Melatonin for Treatment of Androgenetic Alopecia.” International Journal of Trichology 4.4 (2012): 236–245. PMC. Web. 25 Mar. 2015.))

Background

Melatonin is primarily known as a neurohormone that is produced in the brain’s pineal gland and is involved in regulating the body’s physiological response to natural cycles of light and darkness, called circadian rhythms. ((Lerner AB, Case JD, Takahashi Y. “Isolation of melatonin, a pineal factor that lightens melanocytes.” J Am Chem Soc.1958;80:2587.)) More recent research showed that not only is melatonin produced by other organs, including the skin, ((Slominski A, Pisarchik A, Semak I, Sweatman T, et al. “Serotoninergic and melatoninergic systems are fully expressed in human skin.” FASEB J. 2002 Jun;16 (8):896-8. Epub 2002 Apr 23.)) but melatonin is produced by, and melatonin receptors are found in, hair follicles. ((Fischer TW, Slominski A, Tobin DJ, Paus R. Melatonin and the hair follicle. J Pineal Res. 2008 Jan; 44(1):1-15.)), ((Fischer TW. “The influence of melatonin on hair physiology.” Hautarzt. 2009 Dec; 60(12):962-72.)), ((Kobayashi H, Kromminga A, Dunlop TW, et al. “A role of melatonin in neuroectodermal-mesodermal interactions: the hair follicle synthesizes melatonin and expresses functional melatonin receptors.” FASEB J. 2005 Oct; 19(12):1710-2.)) In year 2000, a low dose of melatonin was found to stimulate hair follicle growth in a laboratory setting. ((Fischer TW, Fischer A, Knöll B, Hipler UC, Elsner P. “Melatonin in low doses enhances in vitro human hair follicle proliferation and inhibits hair growth in high doses.” Arch Derm Res. 2000;292:147.))

In the 2012 study commissioned by ASATONA AG; out of Zug, Switzerland; a solution consisting of a 0.0033% concentration of melatonin, along with the antioxidant ginkgo biloba and important micronutrient biotin, was tested for its efficacy in slowing hair loss and its safety and tolerability. This was the first attempt to confirm the in vitro year 2000 findings in a clinical setting.

Findings

From January 2003 to October 2006 the melatonin solution was subjected to five rounds of testing, each with a different study design. The first study tested the safety of the solution in a double-blind, placebo-controlled cross-over study on four fertile and four postmenopausal healthy women. This test found a slightly elevated, but not significantly different, serum melatonin level after 14 days of treatment compared to placebo. There were no safety or health impacts of the treatments.

The second phase of the study found a significant reduction in severity of hair loss in 30 patients with early hair loss after 30 days of treatment, with a further significant drop after 90 days. The importance of the study is limited, however, due to the fact that there was no placebo employed to act as a study control. Also, the results were, in part, obtained through subjective questionnaires completed by the patients.

Phase three was a more reliable and objective open-label, clinically controlled study involving 35 men with androgenetic alopecia. In this study, researchers used TrichoScan, a sensitive software and hardware package that uses epiluminescence to measure hair loss. Hair density was found to increase in over half of the subjects. The average increase in density was 29% after three months and 41% at six months.

In study four, hair stylists at four salons performed a standardized before-and-after comparison on 40 male and 20 female patients with early stage hair loss who applied the treatment for 90 days. Female patients experienced significant reductions after 40 days and further significant reduction after another 40 days. Hair loss in the male patients was stable throughout the treatment.

Study five was a large-scale, open-label, multi-center study involving 1891 female and male patients with early stage androgenetic alopecia. After 90 days of treatment, the proportion of patients with a positive hair pull test (which indicates ongoing hair loss) fell from 61.6% to 7.8%. Negative hair pull tests, which indicate no hair loss, rose from 12.2% to 61.5% in the same period. Using standardized examination forms, investigators found significantly reduced hair loss in two-thirds of patients. New hair growth was measured in 22.5% of patients. Further, the proportion of patients with moderate to severe presentation of the skin condition seborrhea dropped by over 30%.

Summary

Topical application of the solution containing melatonin, ginkgo biloba and biotin was found to reduce hair loss, and in some cases grow new hair. Incidence of seborrhea was also reduced by the treatment. While the exact mechanism for this result is unknown, if effective, it is likely related to the antioxidative effect of melatonin and/or a melatonin receptor-mediated antiandrogenic effects. More research on melatonin needs to be conducted, but this study acts as a proof of concept for the use of melatonin as a treatment for early hair loss in men and women and potentially as a treatment for seborrhea. Currently, only two medications are approved by the Food and Drug Administration (FDA) for the treatment of hair loss, finasteride and minoxidil, and so the addition of a third type of medical treatment might be beneficial for patients who are not indicated for those drugs or would prefer an alternative treatment.

Posted by

Q: How does laser therapy work?

A: The actual mechanism by which Low Level Laser Therapy (LLLT) stimulates hair growth (i.e., increases the anagen phase of the hair cycle) is still unknown. Possible mechanisms include the following:

  1. Stimulating the production of various growth factors (insulin-GF, vascular endothelial-GF, fibroblast-GF)
  2. Dilating the blood vessels of the hair follicles
  3. Increasing the production of ATP (molecular energy) in the cells through its effects on mitochondria.
Posted by

New York Magazine’s 2013 ‘Best Doctors’ issue includes Dr. Robert M. Bernstein, a pioneer of modern hair transplant procedures, making this the 14th consecutive year Dr. Bernstein has appeared in the special annual issue.

New York Magazine 'Best Doctors' 2013New York, NY — Robert M. Bernstein, M.D., F.A.A.D., Clinical Professor of Dermatology at Columbia University in New York and a pioneer of modern hair transplant procedures, was included in the ‘Best Doctors’ issue of New York Magazine for the fourteenth consecutive year.

Dr. Bernstein earned his placement in the Best Doctors issue, and his reputation as world-renowned hair restoration physician, through a 20 year career of developing surgical techniques and adopting and guiding technological advances in the industry. His more than 60 medical publications on Follicular Unit Transplantation (FUT), Follicular Unit Extraction (FUE), and Robotic FUE (R-FUE) have revolutionized the field of hair restoration and provide the foundation for hair transplant surgeons worldwide.

The New York Magazine ‘Best Doctors’ issue is an annual issue of the magazine that contains a directory of the New York area’s best physicians. The directory is based on the results of a peer-reviewed survey that is conducted by Castle Connolly, Ltd. The company also publishes the guidebook “Top Doctors: New York Metro Area,” based on the same survey of doctors. As part of the survey, physicians are nominated from across the New York metropolitan area including Manhattan, Brooklyn, Queens, The Bronx, Staten Island, Westchester County, Long Island, and counties in New Jersey and Connecticut. The recommendations are based on the nominated doctor’s qualifications, reputation, skill in diagnosis, skill in treating patients, and other criteria. A physician-led research team at Castle Connolly tabulates and vets the nominations and compiles the final list.

Bernstein Medical – Center for Hair Restoration, the facility Dr. Bernstein founded in 2005, is a state-of-the-art hair loss treatment facility in New York City that serves men and women from around the world. The center specializes in FUT, FUE and R-FUE hair transplants, and also performs corrective hair transplants and offers medical treatments for hair loss patients who are not indicated for a transplant. In 2011, Bernstein Medical became the first hair restoration facility on the East Coast to offer Robotic FUE procedures using the ARTAS Robotic System. Dr. Bernstein has worked closely with Restoration Robotics, Inc. to improve both the robotic technology and the R-FUE procedure protocol.

Dr. Bernstein has appeared on many notable media programs and publications over the years. Some of these include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, The Early Show, Fox News, National Public Radio, NY1, New York Times, Wall Street Journal, Men’s Health Magazine, GQ Magazine, Telemundo, “O” the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies and has received the Platinum Follicle Award, Surgeon of the Month, and Pioneer of the Month honors from the International Society of Hair Restoration Surgery (ISHRS).

Posted by

Q: I am interested in trying home laser therapy for my androgenic alopecia? Which handheld laser device do you recommend? — N.M., Northfield, NJ

A: There are several handheld lasers currently marketed as a home use treatments for androgenic alopecia. To my knowledge there has never been a clinical study comparing different laser devices. Most of the devices use diodes to emit a narrow band red light. This wavelength of light is actually similar to those that are used in hair removal lasers, except they are at a much lower intensity. The theory is that high intensity laser damage hair follicles causing hair loss, but low level laser energy can have a bio-stimulation effect and actually induce hair growth.

If you would like to try laser therapy for hair loss, I suggest using a HairMax laser comb. This is the only device that is FDA approved. They sell a few different “strengths” of lasers for different costs. They have not shown any clinical evidence supporting one laser comb versus another. The more expensive ones have more diode lights so it would be reasonable to conclude that they are “stronger” and require less frequent use. I have patients who have used the “mid tier” laser comb, the Premium Lux 9 successfully, so that is the one I recommend to other patients.

Read more about Laser Therapy.

Posted by

Dr. Robert M. Bernstein, pioneer of the follicular unit transplantation and follicular unit extraction hair transplant procedures, was selected as one of New York metropolitan area’s top physicians.

NY Magazine - Best Doctors - 2011

New York, NY — Robert M. Bernstein, M.D., F.A.A.D., world-renowned pioneer of the Follicular Unit Transplantation and Follicular Unit Extraction hair transplant techniques and founder of Bernstein Medical – Center for Hair Restoration, was included in New York Magazine’s Best Doctors issue for the twelfth consecutive year.

Dr. Bernstein, a Clinical Professor of Dermatology at Columbia University in New York, said that he is honored to be recognized again for the Best Doctors issue. He said, “My inclusion in the Best Doctors issue for the twelfth year in a row is a testament to the hard work and dedication of my staff, our consistently high quality of care, and our passion for treating patients who are struggling with hair loss.”

The New York Magazine Best Doctors issue is an annual compilation of physicians that is based on a peer-review survey conducted by Castle Connolly Medical Ltd., a research company that publishes Top Doctors: New York Metro Area. Each year, medical professionals in the New York metropolitan area nominate their choice of the best doctors in a field. The physicians make their recommendations based on several criteria including: professional qualifications, reputation, skill in diagnosis, and skill in providing treatment for patients.

Dr. Bernstein, a New York native, is a true innovator in the field of hair restoration. His medical publications on follicular unit transplantation (FUT) and follicular unit extraction (FUE) have revolutionized hair transplantation and provide the foundation for techniques in use by hair transplant surgeons across five continents. His medical practice has been solely devoted to the treatment of hair loss since 1995 and he has provided hair loss treatments and hair restoration surgery at his state-of-the-art hair restoration facility in New York City since 2005. The Bernstein Medical – Center for Hair Restoration, located in midtown Manhattan, is dedicated to the diagnosis and treatment of hair loss in men and women and specializes in both restorative and corrective hair transplants.

Dr. Bernstein has appeared on a wide variety of notable media programs and publications. Some of these include: The Oprah Winfrey Show, The Dr. Oz Show, The Today Show, Good Morning America, ABC News, CBS News, Fox News, National Public Radio, New York Times, Men’s Health Magazine, GQ Magazine, Univision, Telemundo, “O” the Oprah Magazine, and more. He is co-author of Hair Loss & Replacement for Dummies and The Patient’s Guide to Hair Restoration.

Posted by

Sometimes an “accident” in the laboratory can lead to a remarkable breakthrough. Penicillin, Botox, Viagra, and Minoxidil — the active ingredient in Rogaine — were all unintended discoveries that led to treatments for a variety of conditions.

A similar twist of fate, this time by researchers at UCLA, could lead scientists to a new hair loss treatment.

Mice had been bred to overproduce a stress hormone that causes them to lose their hair. The scientists’ intention was to study the effects of a chemical compound, called astressin-B, on blocking the effects of stress on the mouse colon.

What they saw, however, surprised them. The mice that were treated with the chemical had fully regrown their hair. After repeating the results, the researchers injected the chemical into young mice, which were similarly genetically altered but had yet to lose their hair. Those mice never lost their hair despite the fact that they, too, were bred to overproduce the stress hormone.

Whether this discovery will lead to a drug that cures common baldness in human beings, or whether such a cure will only affect hair loss due to stress, is unknown at this early stage.

For further reading on this discovery, see articles in Dermatology Times and the New York Times, as well as the primary scientific publication in the journal PLoS ONE.

Posted by

Latisse, the brand name for the drug bimatoprost, is commonly used to promote eyelash growth in women who want their eyelashes to be longer, thicker, and darker, typically for cosmetic reasons. It is also used to promote growth of eyebrow hair.

In a publication on ClinicalTrials.gov titled, “Safety and Pharmacokinetics Study of New Formulation of Bimatoprost in Patients With Alopecia,” Allergan, the pharmaceutical company that produces Latisse, has announced a new study on the safety and efficacy of a new formulation of bimatoprost for use as a topical hair loss treatment for general baldness.

The study, based out of Tempe, Arizona, will test two different formulations of bimatoprost in men who suffer from moderate male pattern baldness and women who have moderate female patterned alopecia.

According to the details of the study, the test involves, “One mL dose applied evenly onto pre-specified balding area on scalp – single dose in the am followed by multiple doses daily in the am for 14 days.” The goal of the testing is to measure the results of a single dose of bimatoprost, as well as multiple doses over time. The completion date of the study is February 2011, so we will look for the results and share them with you when they are available.

Update:

The results of the study have been published and it did not result in the FDA approving Latisse for hair loss on the scalp. Latisse was found to be not nearly as effective in treating hair loss as the control group that used minoxidil 5% solution. See the results of the study on ClinicalTrials.gov.

Visit our page on Latisse/Bimatoprost for more information on the drug and its off-label use. View the publication on ClinicalTrials.gov for more specifics on the study. Read about other medical hair loss treatments on our page on medications.

Posted by

Dr. Christiano Interviewed on Alopecia, Hair Loss by New York TimesDr. Angela Christiano, a colleague of Dr. Bernstein’s at Columbia University, has been studying the causes of alopecia areata and genetic hair loss for many years. She, in fact, suffers from the disease as well.

The New York Times has published a question and answer interview with Dr. Christiano which covers her own struggle with alopecia, her research into the causes of genetic hair loss, and where she sees the field going in the future. Here is one exchange that offers a window into how her research is breaking new ground in the field of hair loss genetics:

Q. When were you able to actually do the study?

A. In 2008. We published our findings this past July. Ours was the first study of alopecia to use a genome-wide approach. By checking the DNA of 1,000 alopecia patients against a control group of 1,000 without it, we identified 139 markers for the disease across the genome.

We also found a big surprise. For years, people thought that alopecia was probably the stepchild of autoimmune skin diseases like psoriasis and vitiligo. The astonishing news is that it shares virtually no genes with those. It’s actually linked to rheumatoid arthritis, diabetes 1 and celiac disease.

Continued discovery by Dr. Christiano and others in the field of hair loss genetics will lead to clues like these, which will shape the future of hair loss treatment. The hope for hair loss sufferers around the world is that a medical treatment can be developed which will effectively cure androgenetic alopecia, or common baldness. There is a lot of ground to be covered and there are many studies yet to be conducted, but progress is being made.

You can read more about Dr. Christiano’s research on our Hair Loss Genetics News page.

Read the article and listen to a two minute audio stream of the interview at the NYT.

Photo c/o Ruth Fremson/The New York Times

Posted by

Hair Loss & Replacement for DummiesHair Loss & Replacement For Dummies, written by internationally renowned hair transplant pioneers Dr. Robert M. Bernstein and Dr. William R. Rassman and published in 2008, is one of the best hair loss and hair transplant resources available for the layperson.

Now it is also one of the best resources for the layperson… who owns a Kindle wireless reading device.

The digital Kindle edition of Hair Loss & Replacement For Dummies is available for purchase and download at Amazon.com.

The book dispels the many hair loss myths that proliferate on the internet, runs the gamut of hair loss treatment options, and includes crucial tips on how to avoid unscrupulous hair transplant doctors and potentially harmful products.

For more on the book, visit the Hair Loss & Replacement For Dummies page in the Resources section of our website.

Posted by

WABC-TV Eyewitness News; channel 7 in New York, NY; featured Dr. Bernstein in a special report on hair loss and hair loss medications. In particular, the report, by ABC correspondent Kemberly Richardson, asked Dr. Bernstein about the effectiveness of and Rogaine/Minoxidil in the treatment of male pattern hair loss.

The report also featured the new Consumer Reports consumer survey on the same hair loss treatments. Consumer Reports Health & Family Senior Project Editor Tod Marks details how the more than 8,000 consumers who took part in the survey rated the performance of the medications.

Watch the report:

For more on the Consumer Reports survey, visit Baldness remedies at Consumer Reports Health. Note: a subscription to ConsumerReportsHealth.org is necessary to view the complete findings of the survey.

Posted by

Our friends at the Hair Transplant Network have posted a 3-part video interview with Dr. Bernstein on YouTube for your viewing pleasure.

Watch the videos below (all three will play in order):

You can also view the videos individually on YouTube by visiting these links:

If you like the videos, visit the YouTube pages above and share them via email or a social media website like twitter or facebook. Or, log in to YouTube and add a comment.

Posted by

Q: I have been using Rogaine and Propecia, but recently purchased a bottle of Nioxin Cleanser/Shampoo. However, I am reluctant to apply it because I have noticed that the Nioxin website recommends against mixing Nioxin products with Rogaine products. The website does not give a chemical/medical explanation, and I have read that the admonishment may be a function of the fact that the two brands have competing products. Do you think that it is safe or advisable to use the Nixon shampoo? Is there any indication that this product is even effective? Also, I have biotin supplements but I’m also reluctant to take them because I’m beginning to feel like a human pharmacy laboratory. Any advice?

A: Nioxin has no active ingredients that can grow hair. There is an increased incidence of scalp irritation when used with Rogaine – i.e., the likely reason for their warning. I would stick with the medications that are proven to work, i.e. finasteride and minoxidil.

Posted by

Q: Is using Minoxidil combined with Retin-A better than regular Minoxidil for Hair Loss? — L.W., Gowanus, New York

A: Minoxidil has been prescribed (off-label) in combination with other medications, such as topical retinoic acid (Retin-A), to enhance its penetration into the skin and thus increase its effectiveness. This combination of medications can increase the absorption of minoxidil into the bloodstream and may increase the risk of potential side effects, including changes in blood pressure and scalp irritation. It is important to use combination therapy under the supervision of a physician.

If person wants to add Retin-A to the minoxidil regime, the Retin-A should be applied only once a day, since the Retin-A will bind to the skin and will last for at least 24 hours.

Applying Retin-A more frequently will not increase its effectiveness (in facilitating the absorption of minoxidil); it will only increase the incidence of side effects. Retin-A can be applied to the scalp at the same time as Minoxidil, or by itself.

Explore the pro’s and con’s of Minoxidil — also known by its over-the-counter product Rogaine — at the Rogaine/Minoxidil page or by viewing posts tagged with Rogaine (minoxidil).

Posted by

Hair Loss & Replacement for Dummies

Hair Transplant Surgeons Author Hair Loss for Dummies Book

An authoritative guide explaining the causes of hair loss and the newest ways to treat it.

Hair Loss & Replacement for Dummies

New York, NY (PRWEB) December 1, 2008

Renowned hair restoration surgeons Robert M. Bernstein, M.D., F.A.A.D., and Dr. William Rassman, have co-authored the first authoritative, but user-friendly guide, to help both men and women understand hair loss, its prevention, and their medical and hair transplant options. The book, published by John Wiley & Sons, Inc., is set for a December 3 publication date. Titled Hair Loss & Replacement for Dummies, the book follows in the tradition of the other informative books in the popular For Dummies series.

Dr. Bernstein is the author of numerous medical publications on hair restoration, which can be found at www.bernsteinmedical.com.

Those who follow the current trends in hair restoration and hair transplant procedures know Dr. Bernstein for his pioneering work in the development of the Follicular Unit Transplantation procedure which has revolutionized the treatment of hair loss. Recently awarded a certificate of achievement from Columbia University, he has been named one of New York Magazine’s “The Best Doctors in New York” for the ninth consecutive year.

“Dr. Rassman and I felt it was necessary to write this book because we wanted to dispel many of the myths about hair loss and give men and women basic, easily understandable information about their hair loss,” Dr. Bernstein explained. “We feel that this book will provide men and women suffering from common baldness and other types of alopecia with the tools necessary to make informed decisions about their condition. There are a lot of options when it comes to the treatment of hair loss and we want to make certain that consumers are making the decisions that are the best fit for them as individuals – whether it is medical therapy or a hair transplant.”

In addition to providing readers with information about the latest trends in hair loss medications and hair transplants, the book also aims to caution against potentially harmful products that are currently on the market for treating hair loss. Finally, the text also gives tips for maintaining a healthy head of hair: from washing and drying correctly, to caring for children’s hair.

About Dr. Bernstein
Dr. Bernstein is Clinical Professor of Dermatology at the College of Physicians and Surgeons of Columbia University in New York. He achieved worldwide recognition for pioneering Follicular Unit Hair Transplantation. He is founder of Bernstein Medical – Center for Hair Restoration in Manhattan which is devoted to the treatment of hair loss using his state-of-the-art hair restoration techniques.

Dr. Bernstein has been chosen as one of “America’s Top Doctors,” by Castle Connolly Medical and New York Magazine’s “The Best Doctors in New York” for nine consecutive years. He has been selected to be among New York Magazine’s “Best Beauty Docs in New York” for his pioneering work in Follicular Unit Transplantation and Follicular Unit Extraction and is the most widely published author on these subjects. He is the founder of Bernstein Medical -Center for Hair Restoration in New York City (www.BernsteinMedical.com).

About John Wiley & Sons, Inc. /For Dummies Series
John Wiley & Sons, Inc. was founded in 1807 during the Jefferson presidency. In the early years, Wiley was best known for publishing the works of Washington Irving, Edgar Allan Poe, Herman Melville, and other 19th-century American literary giants. By the turn of the century, the company was established as a leading publisher of scientific and technical information.

In recent years, Wiley has focused its efforts on delivering its deep reservoir of “must-have” content to global communities of interest, forming collaborative relationships with such significant partners as Dow Jones/Wall Street Journal, CNBC and PricewaterhouseCoopers, among others. In 2001, Wiley acquired Hungry Minds, Inc., including the latter company’s wildly popular For Dummies series of books. Cleverly written, packaged and marketed, all For Dummies books utilize a lighthearted approach and down-to-earth style (often including cartoons and humorous icons) to dispel fears, inspire confidence and educate the public. For more information on John Wiley & Sons, Inc., visit wiley.com.

For further reading see the Hair Loss & Replacement for Dummies summary, the transcript of an interview with Dr. Bernstein about the book, or purchase the book at Amazon.com.

Posted by

Q: I have thinning hair and have heard about Low Level Laser Therapy (LLLT) for hair loss. I know that I can either buy a machine over the internet or go to a doctor’s office or medical spa for treatments. Which one should I do?

A: The advantage of the in-office LLLT systems are that the units are more powerful and that the delivery of the energy is the same each time. The treatment is also not dependent upon the patient having to remember to do the treatment and does not require the person to spend 15 minutes each time concentrating on using the hand-held machine correctly. It also had the important advantage of requiring an initial evaluation by a physician who can diagnosis the hair loss and make sure that it is the genetic type that may respond to this type of therapy. And the effectiveness of the treatment can more readily be monitored over time.

The disadvantage of the office- or medispa- based system is that the treatments are significantly more costly than the home machine and require periodic visits over an extended period of time – a nuisance for working people, or for those who do not live close to a facility offering this service.

The advantage of the hand-held system is that it is much less expensive than the office based machine and it is much more convenient to do the treatment at home than to go to a doctor’s office several times a week. There may also be a potential advantage for patients that still have a significant amount of hair. In these people, the hand-held system (that is able to part the hair) may allow the laser light to more effectively reach the scalp.

The major disadvantage of the hand-held device seems to be with patient compliance as people get tired of having to run the instrument through their hair for 15 minutes several times a week. It is also hard for the person himself to judge if the treatments are working, how to taper the treatments and if, and when, to stop.

Read more about Laser Therapy

Posted by

Q: The makers of the HairMax LaserComb have claimed that it will “revolutionize the hair growth industry.” What do you think?

A: This claim is obviously overstated.

Since the Low Level Laser Therapy (LLLT) doesn’t affect the action of DHT on hair follicles, it doesn’t affect the underlying cause of genetic hair loss, and thus would be expected only to have limited effectiveness. The company’s own studies show that this is, indeed, the case.

It was also predicted that Rogaine would revolutionize the field of hair restoration and it had little impact.

In my opinion, only finasteride has made a significant impact on the long-term course of hair loss, particularly in its ability to postpone the need for surgical intervention such as hair transplants.

Posted by

Q: Can the laser comb grow hair back in bald areas of scalp?

A: The HairMax LaserComb only works in areas where there is still some hair.

It will not bring back hair that has been lost. You need hair transplantation to do this. The laser comb works by thickening fine, miniaturized hair.

Posted by

Q: How effective is the HairMax Laser Comb?

A: It is difficult to tell since there are no long-term studies using the LaserComb.

From the data we have available, it seems to be about as effective as Rogaine (Minoxidil). As most who have used Minoxidil know, it only works in areas where there is a fair amount of miniaturized hair and over time loses its effectiveness.

The HairMax LaserComb is not as effective as Propecia (Finasteride) and, of course, is not a substitute for surgical hair restoration.

Posted by

Q: Will Propecia and Minoxidil reverse some of the miniaturization going on with someone with thinning hair? If I do need a hair transplant will I have to stay on these medications? — C.C., — Fairfield County, Connecticut

A: Yes, both minoxidil (Rogaine) and finasteride (Propecia, Proscar) affect the miniaturization of the hair follicles and help restore the shrunken follicles to cosmetically viable hair.

Minoxidil works by directly simulating miniaturized follicles to grow, whereas finasteride blocks DHT, the hormone that causes hair to miniaturize and eventually fall out.

Finasteride is much more effective than minoxidil in preventing or reversing the miniaturization process and it is so much more convenient to use that we generally suggest finasteride after a hair transplant procedure, but rarely recommend minoxidil.

Posted by

Q: I am 22 and losing my hair all across the top of my head. How can I thicken my hair to its level a few years previously? — I.L., Kentfield, CA

A: If medication, such as finasteride, is successful it can thicken hair by increasing the diameter of the existing hair shafts. Although the cosmetic benefits can be dramatic in a person with significant hair loss, a hair transplant can not restore hair to its original density, since it only moves the existing hair around and does create new hair.

When hair cloning technology is available, this will change as a person’s donor supply will be increased.

Posted by

Q: I heard that Propecia was being used originally for shrinking the prostate, is this true? — M.D., New Hyde Park, N.Y.

A: Propecia (finasteride 1mg) is not a prostate medication that was serendipitously noted to have a side effect of re-growing hair, it is a medication that was known all along that it might be able to slow hair loss and/or to grow hair.

Although finasteride was first approved for the treatment of prostate enlargement, the researchers at Merck knew, at the outset, that there were families whose members were deficient in the 5-alpha reductase Type II enzyme and that the men in these families neither developed prostate disease nor went bald. In addition they had no long-term problems from the lack of this enzyme.

Merck used this natural model to develop a medication that could block the 5-alpha reductase Type II enzyme – the result was finasteride. Because the only approved treatment for symptoms related to prostate enlargement at the time was surgery, Merck developed finasteride as a medical treatment for this condition prior to developing finasteride as a potential treatment for men with male pattern hair loss.

This also meant that Merck would understand the safety profile of finasteride, and have it approved for a medical disease (symptomatic prostate enlargement), before developing it for a cosmetic condition.

The drug was first submitted to the FDA for the treatment of prostate enlargement as Proscar (finasteride 5mg) in 1991 and it was approved for this use in 1992. The drug was submitted for the treatment of men with male pattern hair loss as Propecia (finasteride 1mg) in 1996 and was approved for this use in 1997.

Posted by

Q: What is the difference between Rogaine for men and Rogaine for women? — G.K., Hawthorne, N.Y.

A: Rogaine, the brand name of generic minoxidil, comes in formulations for both men and women. The men’s versions come in a 5% solution and a 5% foam while women’s products are the 5% foam and 2% solution. Of these, the strongest and most effective is the 5% men’s solution. This is due to the inclusion of propylene glycol, which is a vehicle that helps the active ingredient, minoxidil, to more readily penetrate the scalp. As the other products do not contain propylene glycol, they may be slightly less effective.

Instructions for use also differ on the label between the men’s and women’s products. All products (5% men’s solution, 5% men’s foam, 2% women’s solution) recommend twice daily use, except for the 5% women’s foam which recommends once daily application. In reality, a thorough once daily application seems to be nearly as effective as twice daily for all version of topical minoxidil.

While the 5% solution may be stronger, it is more irritating to the scalp and more difficult for some to tolerate. Some people have a sensitivity to the added propylene glycol and will experience redness, burning, itching, and irritation. If this occurs, patients should switch to the 5% foam or 2% solution. We also recommend that patients use enough of the medication when they apply to adequately cover the treatment area of the scalp. Often, this means using 2 or 3 capfuls of foam or 2-3 droppers full of the solution (2-3mL).

It is important to understand, that contrary to the more restrictive package indications, it works in all areas of the scalp where there is thinning. It is not only for use in the crown. Many patients find that evening application allows the full 4-6 hours of contact time necessary for absorption and that the product will dry overnight and no longer look greasy in the morning. Results can appear as early as 3-6 months, but we often advise using minoxidil for a full year before judging its efficacy. As the hair is always cycling and growing, the product will need to be continued daily for ongoing benefit.

Posted by

Q Do Rogaine and Propecia work synergistically? — N.W., Chappaqua, N.Y.

A: They are synergistic, since the mechanisms of action are different.

Rogaine directly stimulates hair growth, while Propecia is permissive for hair growth by blocking DHT, the byproduct of testosterone that causes hair to miniaturize and eventually disappear.

The important thing to remember, however, is that for most people, Propecia is far more effective.

Posted by

Q: I have early thinning on the top of my scalp and I was told to use Propecia, but I heard that is was only for men. What do you think? — T.G., Staten Island, NY

A: Women can’t take Propecia during the child-bearing years because, if ingested, it can cause birth defects in male offspring.

In post-menopausal women, where we see the greatest frequency of hair loss, it doesn’t seem to be effective.

In pre-menopausal women who do not plan to become pregnant or who already have children, we are still cautious about using the medication, since there effectiveness has not been proven and its long-term safety in this population has not been tested.

Posted by

Q: How does a hair transplant prevent hair loss? — M.M., White Plains, N.Y.

A: It doesn’t. Surgical hair restoration does just what it says. It restores hair to an area where the hair has been lost (by borrowing it from an area of greater density that is less important cosmetically, such as the back of the scalp).

To prevent, or slow down, further balding one would need to receive treatment with hair loss medication such as finasteride (Propecia).

Posted by

Q: If Rogaine is used only once a day will it still be effective? — I.P., Hempstead, Long Island, NY

A: Once a day topical use of Rogaine (topical minoxidil 2% and 5%) is probably almost as effective as using it twice a day. The reason is, although minoxidil has a relatively short half-life of several hours when given orally, when topically applied, it has a half-life of 22 hours in the skin.

This suggests that once-a-day dosing is a reasonable option. It is important to realize that Pfizer, the company that now makes Rogaine, specifically states that it will be less effective if used only once a day.

Read about Rogaine (minoxidil)
Read Tips on Using Rogaine

Posted by

Q: I heard that Proscar, the 5mg version of finasteride, is now generic. Is that correct and is Propecia going generic as well? — F.J., Red Hook, Brooklyn, NYC

A: Yes, Finasteride 5mg (Proscar) is now available in a generic formulation. It is my understanding that Finasteride 1mg (Propecia) will not be available generically until the year 2012.

Posted by

Q: I am currently taking Propecia 1mg a day for hair loss and heard that Proscar 5mg now comes in a generic form. If I get that, how should I take it? — G.A., Fort Lauderdale, FL

A: If you are currently taking Propecia 1mg a day, and want to switch to Proscar (Finasteride 5mg), you can either take Proscar 5mg, 1/4 pill every day or 1/2 pill every other day.

If you break up the pills, be mindful of the potential risk to pregnant women from handling crushed tablets. You can purchase a pill cutter in any pharmacy.

You should be aware that this dosing is not recommended by Merck and that there are no studies showing that either breaking up the pills or taking alternate day dosing is as effective as taking Propecia (Finasteride 1mg) a day.

That said, finasteride lasts in tissues for several days, so these alternate day dosing schedules seem reasonable.

Posted by

Q: I am 35 years old and have been using Propecia for the last 3 years, waiting to save enough money for a hair transplant. I no longer feel comfortable using it due to side effects. Can hair transplantation still be effective even without continuing to take this drug afterwards? — Y.C., Matinecock, New York

A: Many people choose not to take Propecia or choose not to take it due to side effects and the surgical hair restoration is just as effective. The only difference is that medications can prevent further hair loss whereas surgery cannot.

Medications are not needed for the hair transplant to be successful or the transplanted hair to grow and be permanent.

Posted by

Q: I have read on numerous websites that Propecia and Minoxidil work synergistically, and that a hair loss sufferer will see better results using them together than either one alone. Do you believe this is the case, or do you think Propecia is enough treatment by itself for someone who just began to experience slight hair thinning and is too early for hair transplantation? — K.V., Hewlett Bay Park, New York

A: They may act synergistically since their mechanisms of action are different.

Rogaine (Minoxidil) stimulates the hair follicle directly, but Propecia (Finasteride 1 mg) permits hair growth by blocking the negative effects of DHT. Of the two, Propecia is far more effective. It is reasonable to use the two together as long as the medications are used regularly.

For patients contemplating surgical hair restoration, we generally have them continue Propecia only, since applying Minoxidil is too fussy and offers only incremental benefit.

Posted by

Q: I recently turned 22 and have been on Propecia for about 2.5 years. The amount of hair that de-miniaturized with daily 1 mg peaked about a year ago and I have seen steady thinning since. I feel that I am too young for a hair transplant. My question is whether or not an increase in dosage of Propecia is indicated here or if I should seek other options entirely? — N.W., Portland, Oregon

A: At 22 years old, I would increase the dose of Propecia before considering hair restoration surgery. However, it is important to realize that there is no scientific evidence that increasing the dose will have any additional effects. There are published data by Roberts et al in the JAAD in 1999 demonstrating that 5 mg is no better than 1 mg from controlled clinical trials.

I usually increase the dose when someone has been on the same dose of medication for about three years, although there is no good data on how exactly to increase the dose, or that it will actually make a difference.

For this purpose, I generally use finasteride in the form of Proscar 5mg every other day (or Proscar 1/2 pill every day).

If you break up the pills, be mindful of the potential risk to pregnant women from handling crushed tablets.

Posted by

Leavitt M, Perez-Meza D, Rao N, Barusco M, Kaufman K, Ziering C. Effects of Finasteride (1mg) on Hair Transplant. Dermatol Surg 2005; 31: 1268-1276.

SUMMARY

The progressive decrease in hair shaft diameter that causes thinning (also called miniaturization) characteristic of male pattern baldness, can be decreased by the use of the DHT blocker Propecia (chemical name finasteride). Most men undergoing hair restoration surgery have some existing hair in the area that is to be transplanted that will thin over time and, in fact, may thin a bit more quickly as a result of the surgery. For men undergoing surgical hair restoration, the thinning of the surrounding hair can diminish the overall impact of the hair transplant. Even though Propecia has no effect on the transplanted hair, it can help to maintain the patient’s surrounding hair and is, therefore, useful as an adjunct to hair transplant surgery, to enable the patient to obtain a better overall result.

The present study looks to see if Propecia given from one month before surgical hair restoration until eleven months after, can increase hair growth in the area surrounding the hair transplant. In the study, consisting of almost eighty men divided into two groups in a double-blind fashion were either given Propecia or a placebo. Growth was recorded by hair counts and by photos.

The study showed that Propecia was substantially better than the control group in increasing hair counts and in increasing visible fullness when patients started Propecia a month before their hair transplant and were on the medication for one year.

Comments by Dr. Bernstein: The present study confirms scientifically what has already been widely observed, that treatment with finasteride is an important adjunct to hair restoration surgery, for those with androgenetic hair loss. The authors appropriately state their conclusion based upon the parameters studied. As a result, the paper does not stress enough the importance of continuing Propecia for an extended period of time after the hair transplant. At the conclusion of the paper, the authors state that Propecia, taken for a year (i.e. one month before and eleven months after surgery) will increase the density of the surrounding hair. Some may interpret this as indicating that one only needs to take Propecia for a year in order for it to be a useful complement to hair transplant surgery. Of course, this is not the case, as one must continue to use Propecia for it to be beneficial.

Posted by

Dr. Bernstein summarizes an article in the Journal of the National Cancer Institute:

Curis, Inc., a drug development company, has published data showing the effectiveness of a proprietary Hedgehog pathway activator to stimulate hair growth in adult mice. The study shows that a topically applied small molecule agonist of the Hedgehog signaling pathway can stimulate hair follicles to pass from the resting stage to the growth stage of the hair cycle. The Hedgehog agonist produces no other noticeable short or long-term changes in the skin of the mice.

This study also demonstrated that the Hedgehog agonist is active in human scalp in vitro as measured by Hedgehog pathway gene expression. The results suggest that topical application of a Hedgehog agonist could be effective in treating hair loss conditions, including male and female pattern genetic hair loss.

Preliminary results were presented at the American Academy of Dermatology (AAD) in February 2005. This work was based on a study in 2001 by Sato et. Al. who showed that the Sonic hedgehog gene is involved in the initiation of hair growth in mice.

Reference: Sato N., Leopold PL, Crystal, RG. Effect of Adenovirus-Mediated Expression of Sonic Hedgehog Gene on Hair Regrowth in Mice With Chemotherapy-Induced Alopecia. Journal of the National Cancer Institute, 2001, Vol. 93, No. 24.

Posted by



Browse Hair Restoration Answers by topic:








212-826-2400
Scroll to Top
Learn more about hair restoration

Hair loss has a variety of causes. Diagnosis and treatment is best determined by a board-certified dermatologist. We offer both in-person and online photo consults.

Provide your email to learn more.