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Dermatol Surg 2002 Sep;28(9):783-94
The art of repair in surgical hair restoration part I: basic repair strategies.
BACKGROUND: An increasingly important part of many hair restoration practices is the correction of hair transplants that were performed using older, outdated methods, or the correction of hair transplants that have left disfiguring results. The skill and judgment involved in these repair procedures often exceed those needed to operate on patients who have had no prior surgery. The use of small grafts alone does not protect the patient from poor work. Errors in surgical and aesthetic judgment, performing procedures on noncandidate patients, and the failure to communicate successfully with patients about realistic expectations remain major problems. OBJECTIVE: This two-part series presents new insights into repair strategies and expands upon several techniques previously described in the hair restoration literature. The focus is on creative aesthetic solutions to solve the supply/demand limitations inherent in most repairs. This article is written to serve as a guide for surgeons who perform repairs in their daily practices. METHODS: The repairs are performed by excision with reimplantation and/or by camouflage. Follicular unit transplantation is used for the restorative aspects of the procedure. RESULTS: Using punch or linear excision techniques allows the surgeon to relocate poorly planted grafts to areas that are more appropriate. In special situations, removal of grafts without reimplantation can be accomplished using lasers or electrolysis. The key elements of camouflage include creating a deep zone of follicular units, angling grafts in their natural direction, and using forward and side weighting of grafts to increase the appearance of fullness. The available donor supply is limited by hair density, scalp laxity, and scar placement. CONCLUSION: Presented with significant cosmetic problems and severely limited donor reserves, the surgeon performing restorative hair transplantation work faces distinct challenges. Meticulous surgical techniques and optimal utilization of a limited hair supply will enable the surgeon to achieve the best possible cosmetic results for patients requiring repairs.
J Dermatol 2002 Aug;29(8):489-98
Comparative efficacy of various treatment regimens for androgenetic alopecia in men.
Our understanding of the aetiology of androgenetic alopecia (AGA) has substantially increased in recent years. As a result, several treatment modalities have been tried with promising results especially in early stages of AGA. However, as far as has been ascertained, there is no comprehensive study comparing the efficacy of these agents alone and in combination with each other. One hundered male patients with AGA of Hamilton grades II to IV were enrolled in an open, randomized, parallel-group study, designed to evaluate and compare the efficacy of oral finasteride (1 mg per day), topical 2% minoxidil solution and topical 2% ketoconazole shampoo alone and in combination. They were randomized into four groups. Group I (30 patients) was administered oral finasteride, Group II (36 patients) was given a combination of finasteride and topical minoxidil, Group III (24 patients) applied minoxidil alone and Group IV (10 patients) was administered finasteride with topical ketoconazole. Treatment efficacy was assessed on the basis of patient and physician assessment scores and global photographic review during the study period of one year. At the end of one year, hair growth was observed in all the groups with best results recorded with a combination of finasteride and minoxidil (Group II) followed by groups IV, I and III. Subjects receiving finasteride alone or in combination with minoxidil or ketoconazole showed statistically significant improvement (p<0.05) over minoxidil only recipients. No signifcant side-effects related to the drugs were observed. In conclusion, it is inferred that the therapeutic efficacy is enhanced by combining the two drugs acting on different aetiological aspects of AGA.
J Am Acad Dermatol 2002 Sep;47(3):377-85
A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men.
BACKGROUND: Topical minoxidil solution 2% stimulates new hair growth and helps stop the loss of hair in individuals with androgenetic alopecia (AGA). Results can be variable, and historical experience suggests that higher concentrations of topical minoxidil may enhance efficacy. OBJECTIVE: The purpose of this 48-week, double-blind, placebo-controlled, randomized, multicenter trial was to compare 5% topical minoxidil with 2% topical minoxidil and placebo in the treatment of men with AGA. METHODS: A total of 393 men (18-49 years old) with AGA applied 5% topical minoxidil solution (n = 157), 2% topical minoxidil solution (n = 158), or placebo (vehicle for 5% solution; n = 78) twice daily. Efficacy was evaluated by scalp target area hair counts and patient and investigator assessments of change in scalp coverage and benefit of treatment. RESULTS: After 48 weeks of therapy, 5% topical minoxidil was significantly superior to 2% topical minoxidil and placebo in terms of change from baseline in nonvellus hair count, patient rating of scalp coverage and treatment benefit, and investigator rating of scalp coverage. Hair count data indicate that response to treatment occurred earlier with 5% compared with 2% topical minoxidil. Additionally, data from a patient questionnaire on quality of life, global benefit, hair growth, and hair styling demonstrated that 5% topical minoxidil helped improve patients' psychosocial perceptions of hair loss. An increased occurrence of pruritus and local irritation was observed with 5% topical minoxidil compared with 2% topical minoxidil. CONCLUSION: In men with AGA, 5% topical minoxidil was clearly superior to 2% topical minoxidil and placebo in increasing hair regrowth, and the magnitude of its effect was marked (45% more hair regrowth than 2% topical minoxidil at week 48). Men who used 5% topical minoxidil also had an earlier response to treatment than those who used 2% topical minoxidil. Psychosocial perceptions of hair loss in men with AGA were also improved. Topical minoxidil (5% and 2%) was well tolerated by the men in this trial without evidence of systemic effects.
Ther Umsch 2002 May;59(5):217-22
Diffuse hair loss in women
The complaint "Doctor, I am losing my hair" represents a particular challenge to the physician, and involves making a specific diagnosis, selecting an appropriate therapy, and expressing empathy for the patient's anxiety. Diffuse hair loss in women was formerly classified as an entity of its own. Since the identification of female pattern hair loss, most cases have been recognized to be due to androgenetic alopecia, often during phases of life characterized by fluctuations of sexual hormone levels or in connection with intake or cessation of hormonal therapy. The most difficult differential diagnosis includes androgenetic alopecia, chronic telogen effluvium, and psychogenic pseudo efflvuium. Androgenetic alopecia is due to androgen-induced, non-synchronized, progressive shortening of the hair growth cycle and gradually leads to thinning of the central scalp area. Idiopathic chronic telogen effluvium typically occurs in women, starting abruptly without a recognizable initiating factor, and involves the entire scalp area with increased shedding of telogen hair. It is believed to be due to synchronization phenomena of the cyclic hair growth. Psychogenic pseudo effluvium affects fashion-oriented, self-conscious women suffering of a discrepancy between the actual state of their hair and idealized expectations. Later the problem of age-related hair thinning oft becomes a surrogate for the more generalized problem of senescence. Rational therapy of androgenetic alopecia aims at blocking the androgen effect on hair follicles with estrogens and antiandrogens or at pharmacologically reversing vellus hair transformation with topical minoxidil. In contrast, women with idiopathic chronic telogen effluvium should be reassured that their problem is rather a state of exaggerated "hair shedding" than of actual "hair loss".
Made of well known Chinese traditional herbs, Hair Million is a herbal hair restoration formula that addresses hair loss problems.
Since the herbs have been in use for thousands of years, there have been numerous anecdotal cases so far that Hair Million herbs can really improves the age-related hair thinning and hair loss for a significant fraction of people who take it diligently.
It is unknown how Hair Million stops hair loss, and promotes hair growth, despite all the anecdotal observations.
Neither scientific research nor placebo controlled clinical trials has been conducted due to the cost.
Shortage or total lack of scientific/clinical research is not uncommon in herbal/nutritional arena.
It is not reasonable to stop taking daily food and herbal supplements altogether just because of scietific/clinical support: our life must go on while we stive to better understand food and herb.
There are two merits that Hair Million enjoys: Firstly, Hair Million is relatively inexpensive, and secondly, it is made only of edible herbs that are known to be safe when consumed in regular quantities. Propecia is a clinically tested prescription drug for hair loss treatment.
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