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Summary

At MSI, every treatment option begins with a complimentary video-microscopic hair density test and digital documentation to calculate and monitor results. MSI offers physician formulated hair tonics. Hair tonics contain two drug molecules (i.e., 5% minoxidil solution and finasteride) to stop hair loss and help hair regrowth. During mesotherapy, the minoxidil, finasteride, vitamins, and trace elements are microinjected. Growth Factors for hair regrowth are added to our cocktail when mixed with Platelet-rich plasma (PRP). Several-time weekly application of a laser-emitting device (LED) to “stimulate” hair growth of existing miniaturized hairs is one of the new light therapies for hair loss. The most recent available hair preservation and restoration treatment is the newly introduced combination of mesotherapy, infrared technology, oxygen therapy, platelet-rich plasma (PRP), and nano fat or micro fat (stem cell therapy). Penetration of PRP and nano fat or micro fat is eased with microneedling, dermal roller, or the use of fractional radiofrequency. Hair restoration has become increasingly popular in recent years with both men and women. New technologies such as follicular unit extraction and grafting have allowed patients to get a natural-looking result with minimal downtime. In addition to hair loss treatment, I can successfully treat a variety of conditions with hair transplantation. I can repair scalp scarring, facial scars due to trauma or surgery, and hair loss due to traction with hair transplantation. Finally, hair transplantation can be successfully used to restore hair to the eyebrows, eyelashes, beard, mustache, or goatee area, and even in areas of the body, such as the pubis or chest.

Everyone loses hair. It is normal to lose about 50-100 hairs every day. If you see bald patches or lots of thinning, you may be experiencing hair loss. There are many causes of hair loss. People under a lot of stress can see noticeable hair loss. Some diseases and medical treatments can cause hair loss. The most common cause of hair loss is a medical condition called hereditary hair loss. About 80 million men and women in the United States have this type of hair loss. Other names for this type of hair loss are:

  • Male-pattern baldness.
  • Female-pattern baldness.
  • Androgenetic alopecia.

Hair has been referred to as our “crowning glory.” Society has placed a great deal of social and cultural importance on hair and hairstyles.  Color, length, style, and amount have been associated with youth, sex appeal, health, and power. It is no wonder that balding, thinning hair, or a receding hairline are severe concerns for men and women. If hairlines start to recede or hair thins, both men and women may become very concerned about that loss.  Without understanding why their hair is falling out, they may resort to so-called “magic potions,” megavitamins, scalp massage, and electric treatments to encourage new hair to grow. Luckily, most causes of hair loss can be stopped or treated. Anyone troubled by hair loss should see a dermatologist. These doctors specialize in treating our skin, hair, and nails.

What are the Signs and Symptoms of Male Hair Loss?

Hair loss may cause gradual thinning, bald patches, or complete baldness.

Who Experiences Male Hair Loss?

Millions of people experience hair loss. Some people see their hair re-grow without doing anything. Others need treatment for their hair to re-grow. Sometimes, the hair will not re-grow.  To find out what is possible, you should see a dermatologist. These doctors specialize in treating diseases that affect the skin, hair, and nails.

What Causes Male Hair Loss?

The reasons for hair loss are many. When hair loss begins suddenly, the cause may be due to illness, diet, medicine, or childbirth. If hair loss gradually becomes more noticeable with each passing year, a person may have hereditary hair loss. Certain hair care practices also can cause noticeable hair loss. The following describes some of the many things that cause hair loss:

Hereditary thinning or baldness (androgenetic alopecia)

Androgenic alopecia is the most common cause of hair loss. It affects men and women. About 80 million people in the United States have hereditary thinning or baldness.  When men have hereditary hair loss, they often get a receding hairline. Many men see bald patches, especially on the top of the head. In rare cases, men see noticeably thinning hair. The reasons for this are unknown.

Alopecia Areata

Researchers believe that this is an autoimmune disease. Autoimmune means the body attacks itself. In this case, the body attacks its hair. Alopecia causes smooth, round patches of hair loss on the scalp and other areas of the body. People with alopecia areata are often in excellent health. Most people see their hair re-grow. Dermatologists treat people with this disorder to help the hair re-grow more quickly.

Cicatricial (scarring) Alopecia

This rare disease develops in otherwise healthy people. The disease destroys a person’s hair follicles. Scar tissue forms where the follicles once were, so the hair cannot re-grow. Treatment tries to stop the inflammation, which destroys the hair follicles.

Underlying Medical Conditions 

Hair loss can be the first sign of a disease. About 30 conditions, including thyroid disease and anemia, cause hair loss. By treating the disease, hair loss can often be stopped or reversed. Significant hair loss can occur after an illness. A major surgery, high fever, severe infection, or even the flu can cause hair loss. Your dermatologist may call this type of hair loss telogen (tee-lə-jen) effluvium (ih-flu-vee-uhm).

Cancer Treatments 

Radiation therapy and chemotherapy can cause hair loss. This hair loss is often temporary, but it can cause significant distress. ​

Ringworm of the Scalp 

This disease is contagious and common in children. Without effective treatment, ringworm can cause balding.

Trichotillomania (trick-uh-til-uh-my-knee-uh) 

This medical disorder causes people to pull out their hair repeatedly. They often feel a constant urge to pull out the hair on the scalp. Some sufferers say they feel compelled to pull out their eyelashes, nose hairs, eyebrows, and other hairs on their bodies.

Stress and Psychological Factors

Stress: Experiencing a traumatic event (e.g., the death of a loved one or divorce) can cause hair loss.

Dieting and Poor Nutrition

  • Weight loss: Some people see hair loss after losing more than 15 pounds. The hair loss often appears 3 to 6 months after losing the weight. This hair loss is expected — the hair re-grows without help.
  • Vitamin A: Too much vitamin A can cause hair loss. People can get too much of this vitamin through vitamin supplements or medicines. Once the body stops getting too much vitamin A, healthy hair growth resumes.
  • Protein: When the body does not get enough protein, it rations the protein it does get. One way the body can distribute protein is to shut down hair growth. About 2 to 3 months after a person does not eat enough protein, you can see the hair loss. Eating more protein will stop hair loss. Meats, eggs, and fish are good sources of protein. Vegetarians can get more protein by adding nuts, seeds, and beans to their diet.
  • Iron: Not getting enough iron can lead to hair loss. Good vegetarian sources of iron are iron-fortified cereals, soybeans, pumpkin seeds, white beans, lentils, and spinach. Clams, oysters, and organ meats top the list of good animal sources of iron.
  • Eating disorder: When a person has an eating disorder, hair loss is common. Anorexia (not eating enough) and bulimia (vomiting after eating) can cause hair loss.

 Side Effects of Systemic Medication

  • Blood thinners.
  • High-dose vitamin A.
  • Medicine treats arthritis, depression, gout, heart problems, and high blood pressure.
  • Anabolic steroids (steroids are taken to build muscle and improve athletic performance) may cause hair loss.

 Lousy Hair Care 

Your hairstyle and even some of the products you use on your hair can cause hair loss.

  • Products: Frequent bleaching or permanents can cause the hair to break. Regular or improper use of dyes, gels, relaxers, and hair sprays also can cause hair breakage. Dermatologists recommend limiting the use of these hair products. Less use often means less hair breakage.
  • Blow dryers, flat irons, and other devices: Frequent use of a blow dryer tends to damage hair. The high heat from a blow dryer can boil the water in the hair shaft leaving the hair brittle and prone to breakage. Dermatologists recommend that you allow your hair to air dry. Then style your hair when it is dry. Dermatologists also recommend limiting flat irons (these straighten hair by using high heat) and curling irons.
  • Hairpins, clips, and rubber bands: When used to hold hair tightly, clasps, clips, and rubber bands can break hair.

Bad Hairstyles

Years of wearing hair in a style that pulls on the hair, such as a ponytail, cornrows, or braids, can create a type of hair loss known as traction alopecia. The following practices often cause the hair to break:

  • Too much shampooing, combing, or brushing (100 strokes or more a day).
  • I am rubbing wet hair dry with a towel.
  • Brushing or combing wet hair (especially people who are Asian or Caucasian).

For many people, hair is more elastic when wet, breaking off more quickly than dry hair. When hair breakage occurs, the hair appears shaggy or too thin. For people who are of African descent, their hair is not more elastic when wet.

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Because so many things can cause hair loss, a dermatologist acts like a detective. A dermatologist may begin by asking questions. The dermatologist will want to know whether the hair loss happened suddenly or gradually. Knowing this helps to cut causes. A dermatologist will also ask what medicines you take, what allergies you have, and whether dieting. It is essential to give the dermatologist the correct information. Like a murder mystery, the slightest clue can solve the case. Women asked about their periods, pregnancies, and menopause. The dermatologist will also carefully look at your scalp and other hair areas on the body, pull on your hair, or remove a part of the scalp to examine it under the microscope. A blood test is necessary. Because so many things can cause hair loss, it can take time to find the cause.

How do Dermatologists Treat Male Hair Loss?

Male Pattern Alopecia

Once your dermatologist knows what is causing the hair loss, you can tell you what to expect. Sometimes hair loss does not need treatment. The hair will start to re-grow on its own. In some cases, changing what you do will stop the hair loss, allowing your hair to start re-growing. Sometimes treatment can restore hair. Treatment depends on patient preference. Topical minoxidil (2% or 5% solution) is approved to treat androgenetic alopecia in men. Hair regrowth is more robust at the vertex than in the frontal area and will take six to 12 months to improve. Treatment should continue indefinitely because hair loss reoccurs when therapy is stopped.

Minoxidil and oral finasteride for androgenetic alopecia are the only treatments approved by the U.S. Food and Drug Administration. Both drugs stimulate hair regrowth in some men but are more effective in preventing the progression of hair loss. Some physicians recommend the use of minoxidil after transplantation. Application to the grafted areas once per day can shorten the interval between the procedure and the growth of transplanted hair from 4 months to fewer than three months.

Finasteride (Propecia) is more effective than minoxidil in treating male-pattern hair loss. This 5-alpha-reductase inhibitor blocks the conversion of testosterone to DHT. The hormone thought most responsible for the miniaturization and eventual involution of scalp hairs in male pattern baldness. Finasteride 1 mg taken orally once per day is effective in two-thirds of men. The significant benefits of finasteride are the slowing and occasional cessation of hair loss and even the potential regrowth of hairs, primarily in the back half of the head. Several benefits gain from the addition of finasteride in individuals undergoing hair transplantation procedures. First, finasteride potentially reduces the need for further proceedings, increasing hair allocation to the anterior and middle scalp, areas that do not respond to medication. Second, by potentially minimizing and even reversing the miniaturization process of hairs in the back half of the scalp (including hairs in the donor strip along the back of the head), finasteride can increase the density of those transplanted hairs, thus improving surgical results. Although uncommon, adverse effects can include less than 2% published incidence of reduced libido and decreased sexual function.

Alopecia Areata

Treatment for adults with less than 50% of scalp involvement is intralesional triamcinolone acetonide injected intradermally using a 0.5-inch, 30-gauge needle. Maximal volume is 3 mL per session. I may repeat treatment every four to six weeks until resolution or for a maximum of six months. Local adverse effects include transient atrophy and telangiectasia. Other therapies for treating alopecia areata include topical mid- to high-potency corticosteroids, minoxidil, anthralin, immunotherapy (diphenylcyclopropenone, squaric acid dibutylester), and systemic corticosteroids. Currently, available therapies often yield unsatisfactory results, and some clinicians rely on the high rate of spontaneous remission or recommend a hairpiece or wig if reduction does not occur.

Tinea Capitis

Suppose the diagnosis is not clear from the history and physical examination. In that case, a skin scraping taken from the active border of the inflamed patch in a potassium hydroxide preparation can be examined microscopically for the presence of hyphae. Skin scrapings can be sent for fungal culture, but this is less helpful because the fungi can grow up to six weeks. Tinea capitis requires systemic treatment; topical antifungal agents do not penetrate hair follicles. All close contacts of patients with tinea capitis should be examined for signs of infection and treated, if necessary.

Telogen Effluvium

Examination of the scalp in patients with telogen effluvium typically shows smooth hair thinning. The presence of erythema, scaling, inflammation, altered or uneven hair distribution, or changes in shaft caliber, length, shape, or fragility may suggest other diagnoses. Laboratory investigations are shown if the history and physical examination findings suggest underlying systemic disorders (e.g., iron deficiency anemia, zinc deficiency, renal or liver disease, thyroid disease).  Telogen effluvium is usually self-limited and resolves within two to six months. Treatment involves ending the underlying cause and providing reassurance. Potentially causative medications should be stopped, if possible. Telogen effluvium may last for years if the underlying stress continues.

Trichotillomania

The optimal treatment for this condition is not known, and psychiatric referral may be indicated. Preliminary evidence suggests positive treatment effects with acetylcysteine, olanzapine (Zyprexa), and clomipramine (Anafranil). Although solid evidence of a treatment effect has not been proved, treatment options include cognitive behavior therapy and selective serotonin reuptake inhibitors. A combination of cognitive behavior therapy and medications may be more effective than either approach alone.

Trichorrhexis Nodosa

Trichorrhexis nodosa occurs when hairs break secondary to trauma or because of fragile hair. It affects the proximal hair shaft, although I may also involve the distal shaft. Causative injuries include excessive brushing, heat application, tight hairstyles, trichotillomania, and conditions that cause excessive scalp scratching. Chemical injuries include harsh hair treatments (e.g., excessive bleach, dye, shampoo, perms, relaxers, and excessive saltwater exposure). Examples of congenital or genetic conditions that may cause trichorrhexis nodosa to include trichorrhexis invaginata (bamboo hair. Rarely, trichorrhexis nodosa can be a manifestation of hypothyroidism.

On examination, hairs appear to have white nodes; on closer inspection, these are shown to be fracture sites along the shaft and cortex that have split into several strands. On dermoscopy, hairs look like two brooms or paintbrushes thrust together. If the diagnosis is not precise, laboratory testing should include a complete blood count, iron studies, copper level, liver function testing, thyroid-stimulating hormone level, and serum and urine amino acid levels. Treatment includes avoiding or minimizing physical and chemical trauma.

Anagen Effluvium

Patients typically present diffuse hair loss that begins days to weeks after exposure to a chemotherapeutic agent and is most apparent after one or two months. Anagen effluvium is usually reversible, with regrowth one to three months after cessation of the offending agent. Permanent alopecia is rare.

What Does MSI Offer Male Hair Loss Patients?

Just as there are many causes, there are many treatments for hair loss. Prof Moawad recommends treating hair loss early. Early means before you lose a lot of hair. Hair loss is harder to treat when a person has a lot of hair loss. At MSI, every treatment option begins with a complimentary video-microscopic hair density test and digital documentation to calculate and monitor results. One or more of the following treatments may be part of your treatment plan.

dermatologists-skincare-product

Nowadays, two drug molecules (5% minoxidil solution and finasteride) stabilize hair loss and promote hair regrowth. These molecules stimulate, through various mechanisms, an increase in the diameter and length of preexisting fine hairs. Finasteride can also be given orally. We are proud at MSI to have formulated topical medications that effectively stop hair loss, and eventually, regrowth.

mesotherapy-injections

Techniques used in mesohair treatment for hair loss are derived from mesotherapy. It is an effective treatment for hair loss both in men and women. A tiny amount of active ingredients of minoxidil, finasteride together with all vitamins and trace elements are injected via computerized mesogun into the mesoderm of bald areas. Mesogun helps to make mesohair faster as well as potentially less painful when compared with manual injection. The most recent available hair preservation and restoration treatment is the newly introduced combination of mesotherapy, infrared technology, and oxygen therapy with or without platelet-rich plasma or (PRP) done only at the MSI hair care unit.   It gives an excellent result in both Androgenic and pseudo androgenic alopecia. Using a specialized cocktail, your scalp is given vitamins and essential growth factors that improve blood circulation, which will restore your hair loss.

prp-injections

Platelet Rich Plasma (PRP) is cutting-edge therapy in the field of cosmetic enhancements. Although the procedure is relatively new in aesthetics, PRP has been recognized as an effective treatment in sports injury, diabetic ulcer treatment, and orthopedics, to name a few. Read More on PRP. The hair follicle has a very complex biologic structure, and the growth of the hair process is regulated by specific growth cycles. Many growth factors play a fundamental role in the life-long cyclic transformation of the hair follicle functioning as biologic switches that are turned on and off during the different phases, controlling the active phase and promoting apoptosis to induce catagen and telogen. The main growth factors involved in the establishment of the hair follicle are vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), insulin 1-like growth factor, and fibroblast growth factor (FGF). Platelets release large amounts of platelet-derived growth factor (PDGFaa, PDGFbb, and PDGFab), transforming growth factor-beta (TGFβ1 and β2), EGF, and VEGF. The beneficial effects of platelet-rich plasma (PRP) in AGA can be attributed to various platelet-derived growth factors causing improvement in the function of the hair follicle and the promotion of hair growth. Read more on PRP.

A small amount (about 10cc) of blood is collected in a specially prepared test tube containing a separating gel that helps manage the precious platelets. The separation process, requiring a centrifuge, takes approximately 9 minutes. Once the PRP serum is ready, it’s placed in a syringe; and prepared for injection. The same techniques which are used to deliver mesohair cocktails in the scalp are used to provide PRP.  Derma roller can help the penetration of PRP with Dermal roller or recently using fractional CO2 Laser in male patients.  The newer platelet-rich plasma (PRP) modality has been active in androgenic alopecia (AGA) in both males and females. PRP is injected subcutaneously into the area of alopecia with many growth factors and stem cells. Hair transplantation is no exception, and MSI is at the forefront in developing these applications. You may need as many as six sessions of mesohair done weekly or every other week before you see significant results. The results require at least six months. After obtaining the desired results, you need to maintain the results by additional sessions done every 3-6 months as maintenance therapy. PRP is offered as a stand-alone procedure for male and female pattern hair loss, where it is occasionally helpful in slowing down shedding or progressive hair loss. You may need at least three sessions done per month before you see significant results. We advise our patients to incorporate PRP alternatively with mesohair for optimum results. Moawad Skin Institute (MSI) is excited and continues to strive on the cutting edge of the most advanced esthetic technology.

fat-injections

In males and females with a diagnosis of androgen alopecia, males with hair loss consistent with grades II, IIA, III, IIIA, III-Vertex, IV, IV-A, V-A, V-V based on Norwood- Hamilton scale and females with hair loss consistent with grades I to 7 based on the Savin scale might benefit from regenerative approaches when injected the first use of adipocyte-derived stem and regenerative cells, also known as SVF, for alopecia in combination with fat in 2010 for a woman who demonstrated a marked improvement in hair growth. Mechanically dissociated SVF, nano fat, and PRP alone or combined with fat grafts have been used to treat alopecia. Combination treatments (micro fat and nano fat delivered by mesotherapy are the standards at MSI, and most patients are put on topical medications. Patients with earlier stage hair loss are the best candidates for these strategies. The injection of nano fat or SVF enriched micro fat is performed subcutaneously above the galea and in proximity to the hair bulb, which is the region where stem cells exist. An 18 to 19 gauge cannula is used for grafting. The fat is injected retrograde in a radial and crisscrossing fashion.

light skin treatment

A new treatment modality to receive FDA approval is low-level laser light therapy. We are proud to have this latest treatment that involves the several-time weekly application of a laser-emitting device to “stimulate” hair growth of existing miniaturized hairs. It is not clear whether this technique has the equivalent benefits of medical treatments minoxidil or finasteride. Still, it does appear to be tremendously valuable, slowing down the shedding of hair. While low-level light therapy can increase hair caliber in both men and women, any aesthetic improvement is more evident in women than in men.

hair-transplant-surgery

Surgical hair restoration is the procedure of choice for restoring hair. The concept behind all forms of hair restoration is a redistribution of hair rather than the addition of new hair. Three hair-restoration procedures have traditionally been available: hair grafting, bald scalp reductions, and scalp-flap surgery. Today, hair grafting accounts for more than 99% of the procedures performed. Hair grafting has a high success rate with a low incidence of complications; it is presented in MSI surgical suite as an outpatient setting with little surgical preparation or specialized setup, and (most important) patient acceptance is high. Hair grafting, the most common hair-restoration procedure, can be performed by using different techniques. From the early 1990s until recently, transplanting with micrograft (1-2 hairs), often combined with mini-grafts (3-5 hairs), was considered state of the art. Today, most surgeons consider follicular-unit grafting the definitive procedure.

Transplanting only follicular units and dissecting away all nonhair-bearing tissue can offer several advantages. These follicular-unit grafts can be placed into tiny recipient sites, allowing for dense packing and reducing post-procedure crusting. The requirement for careful dissection reduces the accidental transaction rate. It, therefore, minimizes the depletion of good hair follicles, a benefit that potentially maximizes hair yield from a strip of donor’s hairs. Finally, the results are virtually undetectable because beards are transplanted under their natural growth in these small follicular units. The follicular units can be obtained by either the strip technique (follicular unit grafting of follicular unit strip surgery) or single extraction (follicular unit extraction). Follicular unit extraction is preferred for younger men and those who wish to shave their heads because it avoids making a linear donor site scar. Larger grafts behind the hairline are necessary to create increased density. Some authorities prefer the 0.5 X 2.5-mm slot graft, which contains 5-7 hairs, and routine 3.5X loupe magnification to avoid injury to existing hairs.

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