Researchers from the Harvard Medical School surveyed five clinical studies designed to measure the effects of low-level light laser therapy (LLLT) on androgenic alopecia in both men and women. In each case, they found that red and near-infrared LLLT was a safe and effective treatment option for both men and women with genetic balding.
Q: It seems that some doctors offer only FUT and others only FUE. What is your opinion on that? — D.E., Portland, M.E.
A: Both FUT and FUE are excellent techniques, but have different indications. To deliver the best care for our patients, hair restoration physicians should have expertise in both procedures, and they should offer both in their practices.
The main advantage of FUT is that it typically (but not always) gives the highest yield of hair. Therefore, when the patient’s primary goal is to achieve maximum fullness, FUT should be performed. There are many well described reasons for this, including the precision of stereo-microscopic dissection and the ability to efficiently harvest from a more select area of the donor zone, but these are beyond the scope of this brief commentary.
The main advantage of FUE is no linear scar. Therefore, when the patient’s primary goal is to be able to wear his hair very short, FUE should be performed. FUE is also indicated when there is an increased risk of a widened scar or when scalp laxity does not permit a strip excision. The patient may sometimes chose FUE simply to avoid the stigma of a linear donor scar.
There are situations in which both procedures are useful in the same patient. For example, FUT may first be used to maximize yield, but then, after several sessions, the scalp may become too tight to continue to perform FUT, or the donor scar may become wider than anticipated. In the former case, the physician can switch to FUE to obtain additional grafts; in the latter case FUE may be used to camouflage the scar of the FUT procedure.
It is tempting to see the world in black and white, and it is easiest to learn and train one’s staff in just one hair transplant technique — but medicine is never so simple. Developments over the past twenty years have given us two excellent hair restoration procedures. We should offer our patients both.
Q: Hi. I am 52 years old and wish to know if Propecia will work for 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. Occasionally we see patients in their 50s re-grow some hair with Propecia, but this is the exception rather than the rule.
According to an article published in the journal of Clinical Aesthetic, scalp micro-pigmentation (SMP) is an effective cosmetic solution for millions of men and women who currently have significant scalp deformities for which there are few, if any, good medical treatment options.
Synopsis: A limitation of FUE procedures is the short-term cosmetic problem of clipping the entire donor area in the back and sides of the scalp. The long-hair robotic technique avoids this problem by harvesting through a broad band of clipped hair that is covered with longer hair combed down over the harvested area. This technique enables the physician to harvest relatively large amounts of donor hair without shaving the patient’s entire scalp.
Hair restoration physicians William R. Rassman, Jae P. Pak, and Jino Kim have outlined a practical, permanent cosmetic treatment for hair loss, called scalp micro-pigmentation (SMP) in a paper published in the journal Hair Transplant Forum International.
The paper discussed case studies of six hair loss patients of varying age and hair loss condition who used SMP to camouflage scalp scars or areas of hair loss:
According to an article published in the journal of Facial Plastic Surgery Clinics, scalp micro-pigmentation (SMP) has been found to be a useful cosmetic treatment for hair loss and scalp scars.
SMP is a scalp tattooing technique that uses fine dots – like a stippled painting – to mimic the appearance of extremely short hairs on an otherwise bald scalp.
SMP can create the appearance of a fuller head of hair on a scalp that is losing hair by softening the contrast between the hair that remains and the color of the scalp. It can also effectively camouflage a scalp scar, like the donor scar from a strip hair transplant procedure, the scar from a scalp reduction or scars from trauma to the scalp.
Finally, SMP can help augment the results from either a Follicular Unit Hair Transplant (FUT) or a Robotic FUE Transplant (R-FUE), especially for patients who do not have enough donor hair to give the appearance of full coverage.
Q: Does finasteride need to be taken every day?
A: Finasteride (Propecia) is a competitive inhibitor of Type II, 5 alpha-reductase (5AR is the enzyme that converts Testosterone to DHT which then causes hair to miniaturize and eventually be lost). Finasteride is 100x times more selective in inhibiting the Type II enzyme (present in hair follicles) than the Type I enzyme (present in other body tissues). The turnover (T1/2) of the finasteride/5AR Type II complex is 30 days and the finasteride/5AR Type I complex is 15 days. This explains why finasteride does not need to be taken every day and why, after stopping finasteride, the effects may take a month or longer to begin to dissappear.
Q: Why is using the robot to create recipient sites useful in a hair transplant? — S.K., Jersey City, NJ
A: The ARTAS® Robotic Hair Transplant system eliminates the inconsistencies inherent in creating large numbers of recipient sites by hand. The robot can create sites at a rate of up to 2,000 per hour. Although there is more set-up time compared to sites made manually, once the physician specifies the parameters such as punch depth, punch angle, and site direction, recipient site creation is precise and rapid.
One of the benefits of robotic site creation is that the distribution of grafts over a fixed area of the scalp can be exact. For example, if one wants to transplant 1,000 grafts evenly over 50cm2 of area, this can be done with great precision and with uniform site spacing. In addition, the physician can vary the densities in select regions of the scalp and the robot will adjust the densities in other areas so that the total number of sites remains the same.
Another benefit of the new technology is that the robot can be programmed to avoid existing hair and select which specific hair diameters to avoid. The robot is programmed to keep a specified distance from the existing hair to ensure that the resident follicles will not be damaged and that the distribution of new hair is even and natural. This computerized mechanism appears to be more accurate than what can be done by hand and, importantly, does not sacrifice speed in the process.
A 2014 study in the journal Dermatologic Surgery measured follicular unit transection (follicle damage) during the extraction step of a robotic follicular unit extraction (R-FUE) procedure. The study found that robotic transection rates, using the ARTAS Robotic System, compared favorably with non-robotic (manual) FUE transection rates.
