Trichology was, for years, given little consideration as far as aesthetic medicine is concerned, due to the fact that the general idea was that it had reached a certain degree of stagnation in terms of therapeutic options, which in itself was already limited and provided a poor response.
In the last eight to ten years this idea has been clearly reversed, especially certain types of alopecia. We have access to more and more publications regarding emerging new therapeutic options, both from a medical and a surgical point of view.
Overall, we can classify alopecia into two groups: scarring alopecia and non-scarring alopecia. In scarring alopecia in a smooth scalp, there is fibrosis, inflammation and loss of hair follicles, with a reduced number of follicular orifices.
With non-healing alopecia, there is loss of the hair root, but the hair follicles remain, which explains the reversibility of this type of alopecia.
Within non-healing alopecia, there are multiple types; one of the most frequent is androgenic alopecia, which is known as "common baldness" and affects up to 80% of men and 40% of women at some point in life. Its frequency increases with age and its etiology is multi-factorial. The main causes are genetic and hormonal; therefore, its incidence and intensity tend to increase with age, and in women, especially after menopause.
There are also other diseases, such as polycystic ovary syndrome or congenital adrenal hyperplasia, where, androgenic alopecia can be one of the symptoms due to excess of male hormones.
With this type of alopecia, loss of capillary density is observed on specific areas of the scalp, where hair follicles have additional androgen receptor (male hormone): mainly the temples and crown of the head. In women, loss of hair density is generally more diffuse. This loss of capillary density is due to the progressive reduction in hair thickness, until, in the final stages, the follicles become so small that the hair disappears.
Often, this type of alopecia is also associated with seborrhea, that is, excessively oily scalp, which also makes the hair look "oily" or dirty more rapidly than usual.
In order to diagnose this type of alopecia, it is usually sufficient to have an adequate medical history and a physical examination, where special devices such a trichoscope is used to observe the hair once magnified.
Only on certain occasions is it necessary to carry out other complementary tests, such as blood tests or skin biopsies.
Androgenic alopecia is reversible in the initial and intermediate stages, so that with appropriate medical treatment, progressive loss of capillary density can be delayed and even recovered; while in the final stages, when the follicle has disappeared, the only solution is a hair transplant.
Among the medical treatment used to improve hair density in women is
Minoxidil, which has been classically used topically (in the form of a liquid or foam, applied daily to the scalp). However, patients who are not using topical treatment, due to lack of time or because the product soils their hair, can take oral medication for short periods of time.
Other drugs used to treat female alopecia are administered orally such as Cyborone Acetate, Spironolactone or 5-alpha Reductase Inhibitors (Finasteride and Dutasteride). These contain male hormone suppressants, which includes some types of contraceptives and anti-androgenic drugs.
A new treatment to improve capillary density in androgenic alopecia, is capillary mesotherapy with dutasteride microinjection; this treatment consists of multiple injections of an anti-androgenic drug, administered under local anesthesia, directly into the hair follicles. This is a painless procedure.
More recently, scientific publications have emerged that confirm positive results in the treatment of androgenic alopecia using low-power LASER.
In the advanced stages of androgenic alopecia, the recommended treatment is hair transplant using the FUE technique, from the English – Follicular Unit Extraction.
This technique consists in transplanting individual hair follicles from the occipital region to the alopecia area. The transplanted follicles will retain their greater resistance to androgens in the recipient zone. The fact that the individual hair follicles are transplanted one by one, will mean a totally natural follicle growth, thus obtaining an excellent cosmetic result. Another determining factor in obtaining a natural result is defining a natural hairline, which must be compatible with the patient's sex, race and age, and also in harmony with the patient’s temples.
On a practical level, hair transplant surgery is a technique that is performed in the operating theater under local anesthesia (sometimes including superficial sedation), and the whole process takes place in 1 to 2 days, each intervention lasting between 5 and 10 hours. This surgery does not require hospital admission and has a rapid recovery period. The cosmetic improvement is not immediate. It is usually recommend for patients to abstain from social and work activities for a period of 7 to 10 days to avoid others recognizing that they have undergone surgery.
Initially the transplanted micro-grafts all have an identical appearance, short hair with a crust. One week after surgery, the capillary roots become detached and fall off leaving the scalp as before the surgery. Only after 5 to 6 months will new follicles begin to grow. The patient´s capillary density will start improving during the first year and the final results are usually obtained after one year.
The postoperative period is painless and the patient can resume his usual routine very quickly. Trauma of the transplanted area must be strictly avoided during the first week. Two weeks after surgery the patient can lead a normal life.
In the Hair Health and Surgery Consultation, the key point is consistency with the treatments proposes (medical or surgical), as well as patience, as it will take an average of 6 months for any results to be observed, which is the reason this treatment is long term. Each case is analyzed individually. The needs of each patient must be studied, his individual pathologies, possible interactions with other medications, each person’s lifestyle, as well as their concerns and expectations.
With the treatments mentioned, it is possible not only to improve the patient’s hair density, but also to improve the quality of life, due to the resulting improvement in the individual’s self-esteem.
On occasions, in the course of studying alopecia, we may come across other previously unknown pathologies.
Capillary photobiostimulation: low-power LASER
F.U.E. – Hair Transplant