A Comprehensive Approach

March, 2008

Medical hair restoration therapy and hair transplantation are two different approaches to the correction of hair loss due to androgenetic alopecia. Either medical hair restoration or surgical hair restoration may be the best approach to hair loss for an individual, depending on variable factors such as degree of hair loss, rapidity of hair loss, pattern of hair loss, and response to medical treatment. Some persons may benefit from a carefully controlled use of both medical hair restoration therapy and hair transplantation, under the supervision of a physician hair restoration specialist.

Combined Medical/Surgical Restoration Therapy

Two pharmacologic hair restoration treatments are approved by the U.S. Food and Drug Administration (FDA) for treatment of hair loss due to androgenetic alopecia:

• Finasteride (Propecia®) an orally administered agent, and

• Minoxidil (Rogaine®) a topically applied agent.

Both have been found effective in slowing hair loss due to androgenetic alopecia in some persons, and in some to stimulate new hair growth. Response varies from person to person by objective criteria such as new-hair count, and by subjective criteria of the individual person’s satisfaction with the result of medical treatment.

Consultation with a physician hair restoration specialist will yield a plan for hair restoration that may, in carefully selected patients, include both hair transplantation and medical hair restoration therapy that complements and supplements hair transplantation.

The combined use of medical hair restoration therapy and hair transplantation can contribute to a long-range approach to hair restoration. For example:

• Medical hair restoration therapy might be used to slow hair loss in a very young man, until the physician hair restoration specialist determines that hair transplantation will have a successful outcome. When hair loss due to androgenetic alopecia begins in the age range of late teens to mid-twenties, the progression and pattern of hair loss may not be fully evident. If hair loss appears likely to be progressive over the next several decades, hair restoration planning will encompass the probable need to reserve supplies of donor hair to use in future transplantation that keeps pace with hair loss. Transplantation done too early may not address the future needs.

• Medical hair restoration therapy may be combined with hair transplantation to complement the cosmetic benefit of hair transplantation. In persons who respond to medical hair restoration therapy, the medical therapy may stimulate some new hair growth that will enhance the appearance of “fullness” in a transplanted area. Even if the new hair growth is diffuse, the cumulative effect of medical therapy plus hair transplantation may improve the cosmetic outcome.

Combined Medical Hair Restoration Therapy and Hair Transplantation Requires Planning and Commitment

While the possible benefit of combined medical hair restoration therapy and hair transplantation may be attractive, it is a choice that must be based on carefully considered factors. For example:

• The patient must have an acceptable response to medical hair restoration therapy in slowing of hair loss and/or stimulation of new hair growth. Some patients respond well, some less well, some poorly.

• As with all medications, the best result is obtained when the patient complies with instructions for use. Poor compliance can significantly alter benefit. A patient may become discouraged if benefit does not appear to be rapidly or consistently apparent; the patient should discuss this with the physician hair restoration specialist rather than unilaterally altering dose or timing of the hair restoration agent.

Is Hair Transplantation Needed If Medical Hair restoration Therapy is Successful?

Clinical trials of minoxidil and finasteride have shown patterns of benefit, or lack of benefit, for both agents. Some persons who respond well to a pharamcologicl hair restoration agent—with slowing of hair loss and/or stimulation of new hair growth—may not seek hair transplantation if the outcome of medical hair restoration therapy is satisfactory. Some of these persons may eventually consider hair transplantation if the medical hair restoration benefit is not maintained over time.

In Summary

For the properly selected patient, combined surgical and medical approached to hair restoration is likely to yield excellent results over the lifetime of the patient. Results of minoxidil and finasteride clinical trials and treatment indicate that use of a medical agent in a responsive patient will have an satisfactory response with minimal side effects that complements surgical therapy.

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