Hair Restoration Research Articles

Epidemiology and Treatment of Male Androgenetic Alopecia

Hair loss affects self-image and is a significant contributor to anxiety and depression in some men, despite the fact that male androgenetic alopecia is frequently thought of as a relatively minor dermatological problem. Male androgenetic alopecia is also considered a risk factor for several other diseases including cardiovascular diseases. It affects 30-50% of men by the age of 50. Male androgenetic alopecia is a genetically transferred disease. Midfrontal scalp, vertex and temples are the commonly affected areas. Follicular shrinkage, inflammation, and altered hair development are the main pathophysiological characteristics the disease. The anagen phase gets shorter with each cycle whereas the telogen phase stays the same length or gets longer during the course of the disease. The purpose of this research is to review the available information about the epidemiology and treatment of male androgenetic alopecia. Male androgenetic alopecia shows variable prevalence among different ages and ethnicities. Caucasians have much high reported prevalence than Asians. The prevalence of male androgenetic increases with age. Minoxidil and finasteride are the drugs of choice and most commonly used in practice for the treatment. Even while the existing therapies for androgenetic alopecia are effective in slowing the disease's progression, they only allow for partial hair restoration. Early treatment leads to the most ideal outcome. Hair transplantation remains the option if medical treatment fails. Further research can aid in developing new treatment strategies.

Mesotherapy vs PRP: Hair loss

Hair loss is a very serious problem that men and women struggle with almost every day. Given that many people suffer from this disease, scientists try to find optimal solutions every year. There are many products and methods that claim to restore hair growth or reduce hair loss. Some of these methods seem to be almost completely useless, while others make significant changes. Fortunately, there are many inventions within the field of hair restoration in recent years. Nowadays, many hair loss treatments are available, and therefore the hottest ones are Mesotherapy and PRP. Both these treatments have completely modified the planet of hair loss treatments. Both methods are approved by the World Health Organization. PRP and mesotherapy are among the tried and tested methods of hair restoration which will make an enormous difference. It is not uncommon to mistake these two hair restoration methods, many people make this mistake. However, knowing the difference between PRP and mesotherapy will assist you opt which option is best for you. Because, although both try to repair hair, their performance is slightly different. Therefore, one of these methods may help you to get better results according to your individual characteristics. Although these two treatments have proven effective, people are often confused about choosing one. Each therapy has its pros and cons, so we’ve administered a comparison of mesotherapy vs PRP for hair.

Expert opinion on current and emerging treatment options in androgenetic alopecia and telogen effluvium: an Indian perspective

<p class="abstract">The diagnosis and management of hair loss needs an organized and systematic approach for recognizing pattern of hair loss and identification of hair loss etiology. Early and specific diagnosis is essential to initiate appropriate treatment in the early phases of hair loss. Topical minoxidil and oral finasteride are the only approved drugs for androgenetic alopecia (AGA). Various other treatment options are widely used but have limited clinical evidence. Similarly, there are no specific treatments recommended for telogen effluvium (TE). However, the treatment may become challenging with increasing availability of new formulations and drugs with no substantial evidence to support them. Multiple focused group discussions were conducted among Indian dermatologists to gain expert opinion on appropriate management of AGA and TE in the current scenario. This article summarizes the consensus clinical viewpoints for topical and oral medications, role of nutritional supplements, and other adjunctive therapies in managing AGA and TE. The panel highlighted that the choice of treatment for AGA and TE depends on the individual hair loss pattern and response to medications. A brief discussion on the use of shampoos and procedures has also been highlighted. </p>

The Comparison of Trichoscopic Findings in Female Pattern Hair Loss (FPHL) and Chronic Telogen Effluvium (CTE) in Female Patients

Background: Chronic hair loss is a major complaint in middle-aged females. It is sometime difficult to differentiate between female pattern hair loss (FPHL) and chronic telogen effluvium (CTE) in female patients. Trichoscopy is a non-invasive technique that can help to distinguish between FPHL and CTE.
 Aims: To compare the trichoscopic findings in female pattern hair loss (FPHL) and chronic telogen effluvium (CTE) in female patients.
 Materials and Methods: It is a cross sectional prospective comparative study carried out in the department of dermatology, Acharya Vinoba Bhave Rural Hospital affiliated to Jawaharlal Nehru Medical College, Wardha, Maharashtra. Adult female patients with ages ranging from 30 to 60 years old complaining of diffuse hair loss were included in the study. Patients with scarring alopecia were excluded from the study. Patients were divided into two groups consisting of 20 patients in each group. Group A and B included patients with FPHL and CTE respectively. Trichoscan (SIF hair analysis system) was performed on frontal region of the scalp.
 Results: Hair diameter variability was significantly seen in FPHL. Hair diameter was reduced in FPHL (0.045) as compared to chronic telogen effluvium (0.063) with statistical difference between them. Hair density was significantly reduced in FPHL (32 ± 12.24) as compared to CTE (60.66 ± 18.12). Vellus hair density was significantly more in FPHL (22.4 ± 14.3) as compared to chronic telogen effluvium (7.73 ± 6.71). Single hair unit was more in FPHL (65 ± 17.08) as compared to chronic telogen effluvium. Density of yellow dots is more significantly observed in female pattern hair loss as compared to chronic telogen effluvium.
 Conclusion: Trichoscopic features based on hair shaft diameter, hair follicular density, vellus hairs, yellow dots and variability in hair shaft diameter can easily help to distinguish female pattern hair loss from chronic telogen effluvium. This differentiation can help dermatologists to plan better and specific management of hair loss in female patients.

Platelet-rich plasma in hair loss-Mechanism, preparation, and classification.

Platelet-rich plasma is the autologous plasma containing platelet concentration more than the baseline separated after centrifugation. It has become a very popular option for the treatment of hair loss in the past few decades. Used alone or in combination with other treatment options it has found a place as a hair restoration procedure throughout the world. However, evidence supporting its credibility is quite ambiguous with contradictory reports available in the literature. In this article, we try to analyze the available data regarding its mechanism of action, preparation protocols, and classification, with regard to hair loss.

Commentary on Elimination of Sweat Glands Using the Follicular Unit Excision Technique.

Hair Restoration of the South, Metairie, Louisiana The author has indicated no significant interest with commercial supporters.

The Rise of Induced Pluripotent Stem Cell Approach to Hair Restoration.

The advent of pluripotent stem cells following the discovery of Shinya Yamanaka (2012 Nobel prize in Medicine) brought about a regenerative medicine approach to virtually every human condition including hair loss. It is now possible to reprogram somatic cells (eg, blood or skin cells) from a person experiencing hair loss to generate autologous induced pluripotent stem cells (iPSCs), which could be amplified and cryopreserved. Subsequently, these iPSCs could be differentiated into various cell types such as dermal papilla cells, epithelial cells, melanocytes, and other cell types constituting functional hair follicle. Transplantation of human iPSC-derived folliculogenic cells into the nude mice has successfully generated xenografts with hair outgrowth. Because iPSCs provide a virtually unlimited source of folliculogenic cells for de novo formation of hair follicles, this approach has major advantages over current surgical hair restoration procedures, which merely redistribute existing hair follicles from one part of the sculp to another. Combined with robotics and automation of the transplantation process, this novel regenerative medicine approach is well poised to make hair restoration a routine procedure affordable for everybody who can benefit from it.

Advances in Hair Restoration

Advances in Hair Restoration

Exploring the Reasons and Financial Implications of Same-Day Cancellations of Hair Restoration Surgery: A Single-Center Retrospective Study.

Exploring the Reasons and Financial Implications of Same-Day Cancellations of Hair Restoration Surgery: A Single-Center Retrospective Study.

Perspectives on miRNAs Targeting DKK1 for Developing Hair Regeneration Therapy.

Androgenetic alopecia (AGA) remains an unsolved problem for the well-being of humankind, although multiple important involvements in hair growth have been discovered. Up until now, there is no ideal therapy in clinical practice in terms of efficacy and safety. Ultimately, there is a strong need for developing a feasible remedy for preventing and treating AGA. The Wnt/β-catenin signaling pathway is critical in hair restoration. Thus, AGA treatment via modulating this pathway is rational, although challenging. Dickkopf-related protein 1 (DKK1) is distinctly identified as an inhibitor of canonical Wnt/β-catenin signaling. Thus, in order to stimulate the Wnt/β-catenin signaling pathway, inhibition of DKK1 is greatly demanding. Studying DKK1-targeting microRNAs (miRNAs) involved in the Wnt/β-catenin signaling pathway may lay the groundwork for the promotion of hair growth. Bearing in mind that DKK1 inhibition in the balding scalp of AGA certainly makes sense, this review sheds light on the perspectives of miRNA-mediated hair growth for treating AGA via regulating DKK1 and, eventually, modulating Wnt/β-catenin signaling. Consequently, certain miRNAs regulating the Wnt/β-catenin signaling pathway via DKK1 inhibition might represent attractive candidates for further studies focusing on promoting hair growth and AGA therapy.

COVID-19 Infection: Impact on Hair.

With a practice dedicated to hair restoration and hair loss management, the authors have seen a large number of patients presenting with increased hair fall in the last 18 months. Hair fall after a stressfull event such as infections with febrile episodes is known. However, the latent period between the infective episode and hair fall has been shorter after COVID-19 infection than before. This review attempts to look at various pathways responsible for hair fall and if this differs from the conventional hair fall seen after any infection. It also tries to understand if the infection with the SARS-CoV-2 virus has a direct impact on the hair follicle leading to hair fall.

WITHDRAWN: A three-dimensional bioprinting technique, based on a gelatin/alginate hydrogel, for the tissue engineering of hair follicle reconstruction

Hair loss remains a challenging clinical problem that influences the quality of life. Three-dimensional (3D) bioprinting has become a valuable tool for fabricating tissue constructs for transplantation and other biomedical applications. Although some simple organs, such as skin and cartilage, have been successfully simulated, it remains challenging to make hair follicles (HFs), which are highly complex organs. The tissue engineering of human HFs has been a long-standing challenge, and progress with this has lagged behind that with other lab-grown tissues. This is principally due to a lack of availability of a platform that can successfully recapitulate the microenvironmental cues required to maintain the requisite cellular interactions for hair neogenesis. In this study, we used a 3D bioprinting technique based on a gelatin/alginate hydrogel to construct a multilayer composite scaffold with cuticular and corium layers to simulate the microenvironment of dermal papilla cells (DPCs) in the human body. This new approach permits the controllable formation of self-aggregating spheroids of DPCs in a physiologically relevant extracellular matrix and the initiation of epidermal-mesenchymal interactions, which results in HF formation in vivo. In conclusion, our 3D-bioprinted multilayer composite scaffold prepared using a gelatin/alginate hydrogel provides a suitable 3D microenvironment for DPCs to induce HF formation. The ability to regenerate entire HFs should have a significant impact on the medical management of hair loss. This method may also have critical applications for skin tissue engineering, with its appendages, for other purposes.

Head and Neck Restoration in Scar Alopecia: Hair Transplantation in Scalp, Eyebrows, Beard and Mustache.

BACKGROUNDSurgical management of hair loss has become an increasingly challenging procedure, when dealing with scar alopecia. We investigated the efficacy of hair transplantation in patients with head and neck scar alopecia.METHODSFrom 2016 to 2018 in Shiraz, Iran, all patients with scar alopecia in head and neck were evaluated for efficacy of follicular unit extraction (FUE), follicular unit transplantation (FUT) or a combination of two methods from donor sites in scalp and beard various hair-grafts were compared. RESULTSFifty-six patients were enrolled. Most of them were between 31 and 40 yr old (48.3%) and male (71.4%). Trauma, burn, surgical excision of adjacent skin, radiotherapy and leishmaniasis were the registered causes. Scars were visible in scalp (39.3%), beard (28.6%), eyebrow (21.4%), and moustache (10.7%) regions. FUE (87.5%), FUT (10.7%) and a combination (1.8%) were the used methods. One-hair-grafts were used in eyebrows (100%), moustache (100%), beard (88%) and scalp (7.9%), while 2-hair-grafts in beard (6%) and scalp (47.4%) and 3-haired grafts in beard (6%) and scalp (44.7%) transplantations. CONCLUSIONIn head and neck scar alopecia, hair transplantation was selected based on type and depth of scar. FUE was targeted when huge grafts were not needed, including beard, moustache, and eyebrow, while FIT was used when extensive scars were present in scalp. One-hair-grafts were mostly applied for eyebrow, moustache and beard, 2-hair- and 3-hair- grafts for beard and scalp transplantation. These findings can be added to the literature when FUE, FIT, or their combination are targeted in hair restoration of scar alopecia in head and neck.

Co-Editors’ Messages

![Figure][1]</img> In this issue of the Forum , outgoing president Paul McAndrews reminds us to be vigilant against practitioners illegally performing medicine by unlicensed individuals. He further underlies the ISHRS policy on who should perform hair restoration surgery. ABHRS president Sam Lam

The P&P Hairline Laser: A Novel Hands-Free Laser-Assisted Hairline Device for Hair Restoration Surgery

<h3>Background:</h3> There are many methods to try to achieve symmetry in hairline design, for example, by using eyesight to adjust the drawing or by using measurements with a ruler, but it is difficult to do when there is no anatomical landmark to use. Here, we compare our hands-free, laser-assisted device—the P&amp;P Hairline Laser—with the widely used original handheld laser device. Our goal was to achieve better symmetry by providing a fix for the difficulty in stabilizing the handheld device to the forehead while drawing the hairline. <h3>Method:</h3> We invented a new hands-free, laser-assisted hairline device that can be used in several ways such as for placing a hairline (male or female), placing a posterior hairline, placing a symmetrical strip scar for FUT, and measuring scalp laxity. We have been testing this device on our patients (both men and women) at the DHT clinic since 2020. <h3>Results:</h3> After using and testing this hands-free device in almost 100 patients, we are satisfied with the results and have concluded that the hairline that is traced and drawn by our enhanced device is very smooth compared with the one created by the original handheld device. <h3>Discussion:</h3> The P&amp;P Hairline Laser is convenient and lightweight and allows the surgeon to achieve a symmetrical hairline in less than a minute. It also can be used to draw the posterior hairline, eyebrows, beard cheek lines, and mustache; and it can be used to outline a strip incision symmetrically as well as measure scalp laxity. We feel by being hands-free and able to affix to the forehead, our device provides a benefit over the currently used handheld device.

Hair Tonic Formulation of Black Tea Extract (Camellia sinensis) as Hair Growth

Black tea contains flavonoid and its derivate which is a mechanism of actions to stimulate and increase cell proliferation of hair dermal papilla cell to suppress the production of tumor necrosis factor alpha (TNF alpha) that trigger baldness. This study aimed to determine the stable hair tonic formula and to investigate the effectiveness of black tea extract hair tonic in rabbits (oryctolagus cuniculus) as animal testing. There were 3 different concentrations used in this study namely formula 1 (1.25 % of black tea extract), formula 2 (2.5 % of black tea extract) and formula 3 (5 % of black tea extract). The physical stability evaluation was conducted using some tests such as organoleptic, pH, density determination and viscosity test. The result of this evaluation showed that all the three formulas were stable, its effectiveness as hair restorer then was tested and the result of this test indicated that black tea extract has activity as a hair fertilizer and the optimum extract was shown by the formula 3 with black tea extract concentration of 5% with the hair growth in the 18th day i.e., 9.62 ± 0.365 mm.

Follicular Unit Extraction in Management of Secondary Cicatricial Alopecia

Background: Management of Cicatricial alopecia has been a challenge to plastic surgeons nowadays ,the variability of surgical methods makes it difficult to choose the right treatment for each patient, also proper diagnosis of the type of cicatricial alopecia, whether it is primary or secondary, reversible or irreversible, scaring or non-scaring and stable or unstable, needs certain experience and skills. Objective: To assess results of Follicular Unit Extraction in management of secondary cicatricial alopecia. Patients and methods: This prospective cohort study, on 20 patients with secondary cicatricial alopecia. These Patients were operated upon in the Plastic and burn Department, Al-Azhar University Hospitals and were referred to our outpatient clinic for follow up visits. Results: There was sixteen (80%) males and four (20%) females, the mean age of the studied cases was 18.85 (±2.94 SD) with range (15-25) years. General outcome there were two (10%) bad, six (30%) good and twelve (60%) very good, according to hair density there were one (5%) poor, thirteen (65%) good and six (30%) very good, according to postoperative scars there were eighteen (90%) low and two (10%) high and according to hair direction there were four (20%) bad, eleven (55%) good and five (25%) very good. Among the studied cases there were nine (45%) who needed another surgery. Conclusion: We concluded that hair transplantation is very useful in the field of cicatricial alopecia treatment, hair transplantation has less hazards during anesthesia, less post-operative scars and less recovery time than the usual method of hair restoration.

Robotically Assisted Recipient Site Preparation in Hair Restoration Surgery: Surgical Safety and Clinical Outcomes in 31 Consecutive Patients.

Recent advances in robotic surgery have extended to hair restoration surgery, using a robotic recipient site creation device. This study aimed to assess the surgical safety and postoperative clinical outcomes of using this robotic system. Thirty-one men diagnosed with androgenetic alopecia, who underwent hair transplantation with robotic recipient site creation, were retrospectively reviewed. Their mean age was 38.7 ± 9.5 (range, 22‒67) years. The total number of robotically created recipient sites was 36,273. The average site creation speed was 1,593 ± 544 sites per hour. Postoperative crusting (54.8%) was the most frequent complication in the recipient area, followed by pruritus (12.9%), asymmetry (6.5%), and folliculitis (6.5%). The mean score of cosmetic outcomes and patient satisfaction, scored on a 5-point scale, was 4.10 ± 0.54 and 4.13 ± 0.85, respectively. No significant differences in cosmetic outcomes and patient satisfaction were found between 3 operators. The current device can automatically make slit incisions in the recipient area with speed and consistency noninferior to manual site creation. It is both safe and reliable for clinical use, and it is also easily managed by different hair surgeons without a long learning curve.

Commentary on Robotically Assisted Recipient Site Preparation in Hair Restoration Surgery: Surgical Safety and Clinical Outcomes in 31 Consecutive Patients.

Commentary on Robotically Assisted Recipient Site Preparation in Hair Restoration Surgery: Surgical Safety and Clinical Outcomes in 31 Consecutive Patients.

Facial Masculinization from Procedures to Payment: A Review.

As the demand for gender-affirming procedures continues to increase, patients and providers have a greater imperative to understand the current state of facial masculinization. Facial reconstruction for transgender women has been shown to treat gender dysphoria effectively and reduce rates of discrimination and victimization. Although facial masculinization surgery for transgender men is less common, there are multiple surgical and nonsurgical options to supplement the effect of hormone therapy on facial appearance, including but not limited to: receding the hair line, flattening the forehead, expanding the supraorbital ridge, increasing the dorsal nasal projection, squaring the jaw, and augmenting the chin. This review aims to summarize these techniques for providers who wish to inform transgender male patients about their options and discuss them in the context of patient satisfaction and availability of insurance coverage.