I’ve had a thinning spot on the top of my head for almost 10 years.

I’ve been using Minoxidil and Finasteride since 2004, and the combination seems to be working. I may have a little regrowth, but the important thing is that the spot seems not to be growing.

My question is this: Is there anything else I should be doing? The whole “Laser combs” thing sounds like a fly-by-night industry to me - do they really work?

Thanks in advance.

– Keith in NYC

Answer:

Hi Keith. You have a good question which has a highly debatable answer. The main idea behind the “laser comb” is basically that it increases the circulation in the area where the low level laser light therapy is used. This increase in blood flow to the follicles, according to the laser comb promoters, has a positive effect on the follicles which causes an overall decrease in hair loss.

I have a problem with the supposed mechanism by which the laser comb works to prevent hair loss. While I don’t dispute the comb’s ability to cause a transient increase in blood flow, I do feel that this does not treat the underlying cause of the hair loss. In my opinion, hair loss is not the result of a lack of blood supply to the scalp but rather, it is a result of the negative effects of DHT binding to the follicle receptors. This concept is widely accepted as the root of male pattern baldness and is the reason why finasteride helps prevent hair loss (by lowering the DHT level). Since the laser comb therapy does nothing to change the level of DHT at the receptor site, I do not feel that it has much more than a placebo-type effect on hair loss.

In practice, I have not heard many good things about laser comb therapy. I have had a few patients state their belief that the comb has helped stop their hair loss, but these are usually patients who are also taking finasteride. The problem in this lies in the fact that if a patient is taking two treatments at the same time, it is difficult to gauge the overall effects of each individual treatment. Basically, it is hard to show that the comb had any beneficial effects, as the hair loss prevention may have been attributable only to the finasteride.

I am going to point out one more issue regarding the comb. The laser comb does have FDA approval, though this may be misleading. The technology behind the laser comb has been around for decades. The FDA approval for this device is not based on any amazing new studies. Rather, it has been approved because the technology pre-dates when the FDA began its supervisory role. Therefore, this device did not have to pass through today’s stringent FDA approval process.

Brandon Ross, MD
http://www.rmhri.com
IAHRS Recommended Hair Transplant Surgeon

Hello,

I hope you answer my question. My 12 yrs. old daughter has been diagnosed with Androgenetic Alopecia. Her hair has been thinning in the front and at the temples. We have been using the 2% Rogaine for 3 weeks, as recommended by her dermatologist. The hair in the back of her head seems normal. This is starting to affect her emotionally.

Is it too soon to think about hair transplant? Should we wait until she is 18? Please let me know.

We live in the Bay Area, Any recommended hair transplant MD’s??

Thank you for your time,
Mariam

Answer:

Androgenic alopecia is quite uncommon in a 12 year old male or female. I am curious how the diagnosis was made. There are multiple reasons for hair loss in the front and temple areas besides androgenic alopecia. If it is androgenic alopecia, one would consider a full medical workup to determine why it is occurring at such a young age. Androgenic alopecia has some characteristic findings. These include miniaturization of the hair and lightening of the hair color in the affected areas. In addition, there are also some characteristic histological findings under a microscope. I would have her seen as quickly as possible. In the bay area, I recommend Sheldon Kabaker, who practices in Oakland or Peter Panagotacos, who practices in San Francisco. They can assist you with a diagnostic work up, as well as a treatment plan.

I really don’t think you should consider any surgical intervention until you are certain about the cause and any underlying medical conditions that might be treatable without the need for surgery. Certainly, it always best to delay any form of surgery as long as possible with androgenic alopecia. The reason for this is quite simple. Androgenic alopecia is a life long, unrelenting process. While there may be enough follicles to manage minor loss at a young age, the supply gradually declines as you beg from Peter to pay Paul. While someone may need enough bricks to build a 2000 square foot home, eventually they may need a 10,000 square foot home yet not possess enough bricks to build such a structure. Hair loss is much the same. It begins at minor levels, but gradually affects greater portions of the scalp. The donor area in the back and sides is finite and may even decline in quantity naturally itself due to senescence or old age of the follicles. Females are especially prone to loss of the donor hair especially on the sides.

It is certainly understandable that hair loss in a female at any age is psychologically troubling. You should have this evaluated as quickly as possible.

John P. Cole, MD
http://www.forhair.com
IAHRS Recommended Hair Transplant Surgeon

Why do I need to use Propecia and Rogaine? Why can’t I just have a hair transplant?

Answer:

The simplest way to answer these questions is to give you an analogy. A dentist does not prevent tooth decay, toothpaste prevents tooth decay. Just like tooth decay, hair loss is a progressive disease for men and women. You will continue to lose hair (usually about 4% density per year) if you do not use the “toothpaste” that prevents the hair loss – which is Propecia and Rogaine.

You can have a hair transplant, if you are a candidate. I can increase density by approximate 20% with one procedure. But that means after 5 years, you have essentially lost what you had gained. Then you need another transplant, and the cycle continues.

The greatest limitation to hair transplants is the fixed and limited amount of donor hair you have. The majority of patients don’t have enough to keep up with the progression of their hair loss. If I can help you prevent that hair loss with the medical therapies, then I can minimize the amount of restoration you will need and you will be a much happier and more satisfied patient.

Paul J. McAndrews, MD
http://www.hairgrowthdoctor.com
IAHRS Recommended Hair Transplant Surgeon

I just bought some minoxidil in the form of Rogaine foam and it says not to apply it to any areas of my scalp but the back. My problem area is the front and middle. Should I not use minoxidil, not use this form of minoxidil, or should I just use Rogaine any where that is thinning?

Answer:

The original studies with minoxidil, like 20 years ago, were only done on the crown so they are only allowed, by the FDA, to say it works in the crown. In reality it can work anywhere there are miniaturized hairs. So yes use it on the front and middle, anywhere you are thinning. I have been using it for over 10 years from front to back. Disregard the statement about it just working on the crown, it’s false.

Your surgery was about 7 months ago so you should be seeing some growth. Minoxidil will help the grafts grow in faster but once they have totally grown in, a year, you don’t need to use it on the grafts for them to keep growing. But I would suggest using it in the area of the grafts and behind just to keep the original hairs as much as possible.

Bradley Wolf, MD
http://www.wolfhair.com
IAHRS Recommended Hair Transplant Surgeon

I had hair restoration surgery performed by Dr. Wolf in June 2006 (about 1 year ago). I am satisifed with the results, but I am wondering if there is any continuing maintenance I should know about.

I have been using regular shampoo, going in the sun, etc. Are there ways to maximize the results going forward, or things that I might do at this point which could damage the hair?

Also, my procedure concentrated on the frontal hairline. Some of the new hairs are wavy/frizzy. Is there a good way to deal with this?

Answer:

The best was to prevent hair loss of un-transplanted hair is to use minoxidil and Propecia. Minoxidil (Rogaine) now comes in a foam preparation which is much easier to use than the liquid. Propecia is available from us if you aren’t already on it. Sun, dyeing, straightening, all damage the hair after it exits the skin. The best way to treat this type of damage is to avoid the conditions. You can go out in the sun, just use a conditioner to treat sun damage. A conditioner will help with the post transplant kinkiness also. This should be getting better and will continue to improve to a point. Sometimes when it is really humid my transplants are kinky.

-Bradley Wolf, MD
http://www.wolfhair.com
IAHRS Recommended Hair Transplant Surgeon