Hair Restoration

Platelet Rich Plasma (PRP) Therapy

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Platelet rich plasma therapy is an exciting non-surgical modality for management of hair loss and works as adjuvant to the hair transplantation.It is a part of hair treatment. It not only prevents further hair loss but also stimulates actual hair growth. The growth factors in platelet rich plasma removes the inhibitory factors present in the scalp and stimulate the dormant hair follicles to grow again and new hairs grow over the bald areas.

Results

prp-1It is equally effective in both male and female cases of alopecia. Platelet rich plasma therapy has given excellent results in more than 80% of the cases, good results in 15% of the cases whereas 5% cases had average to poor results. To get the maximum benefit PRP therapy can be combined with other modalities of non-surgical hair restoration.

What is Platelet Rich Plasma?

Human blood can be divided into two major components: plasma and cellular components. Plasma acts as carrier of the cellular components of the blood. Platelets are essential component of wound healing and repair.

  • Platelets contain various growth factors:
  • platelet-derived growth factor,
  • transforming growth factor beta,
  • fibroblast growth factor,
  • insulin-like growth factor 1,
  • insulin-like growth factor 2,
  • vascular endothelial growth factor,
  • epidermal growth factor,
  • Interleukin 8,
  • keratinocyte growth factor and
  • connective tissue growth factor.

These growth factors lead to regeneration and growth of various cells which come in their contact including the stem cells and hair follicles.

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How Does PRP Work?

When PRP (Platelet Rich Plasma) is injected into the tissues e.g. scalp then the platelets degranulate and release all their growth factors. What these growth factors do is:

  • Increase the vascularity of scalp,
  • Accelerate the growth of hair follicles which are already present in the scalp,
  • Causes reversal of miniaturisation of hair leading to increase the volume of hair in the scalp,
  • Stimulate the dormant hair follicles in the scalp and lead to growth of new hair follicles and appearance of new hair over the bald scalp.
  • Stimulate the mesenchymal stem cells and cause their differentiation into hair follicle cells and ultimately their conversion to hair follicles leading to new hair growth.

It is recommended to combine PRP therapy with the Stem cell therapy to get the best results.

Advantages of PRP

  • Non-surgical treatment of hairloss.
  • Inexpensive.
  • No side effects.
  • No downtime.

Indications

  • Prevention of hair loss
  • Regain lost hair
  • Increase hair density

PRP is not a substitute for Hair transplantation but can avoid undergoing hair transplantation if started on time.

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How Frequently and for How Long the Platelet Rich Plasma Injections Are To Be Given?

PRP injections are given at an interval of 4 weeks. Though results become apparent within 3 months, the PRP therapy is recommended to be taken for 6 months with once every year maintenance injections.

Where Else Is The PRP therapy Being Used?

Over the period of decades PRP therapy has established itself as an effective medical treatment modality in the specialty fields of: oral surgery, neurosurgery, plastic and cosmetic surgery, sports injury medicine and orthopedics. It has been used extensively in these specialties with positive outcomes and success. In the field of hair restoration, there are evidences which support the role of PRP therapy as a promising treatment option. While PRP is effective in hair restoration, it is not meant to replace the current FDA approved therapies such as DHT blockers and Minoxidil.

Steps of PRP Therapy:

prp-steps

LASER Treatment

Laser hair treatment is the newest and most advanced techniques of non-surgical hair growth. In this low level lasers are used to stimulate the hair follicles. It increases the blood flow to the scalp hence increase nutrient supply to the hair follicles. Laser treatment is effective for both men and women.

Some hair transplant surgeons have observed that laser hair treatment can improve the results of hair transplant by speedy postoperative wound healing, rapid growth of hair and a quicker resolution of postoperative telogen effluvium (“shock loss” of hair follicles). Laser treatment has also shown to increase the hair density over the vertex area and prevent further hair fall over the frontal areas of scalp. Low level laser treatment when combined with 5% minoxidil provided more noticeable cosmetic benefits for women especially where they are not prescribed finasteride.

Biological Effects of LASER

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When laser light treatment is used over the scalp it increases the blood flow to the hair follicles. The wavelength of light used in Low-Level Laser Light Treatment (650-670 nm) also stimulates the mitochondria of the cells of hair follicles. This in turn increases their metabolism which had earlier slowed down due to various reasons. Increased metabolism coupled with increased blood supply means increased synthesis of component of hair like keratin and increased turnover of the cells of hair follicle. Lasers have been said to improve overall quality of hair, promote hair growth and increase hair shaft diameter.

  1. It acts on cytochrome C oxidase leading to production of adenosine triphosphate (ATP) which is converted to cyclic AMP in the hair follicle cells, releasing energy and stimulating metabolic processes necessary for hair growth.
  2. Release of nitric oxide from cells leads to increased vascularity of scalp
  3. Excessive build-up of DHT is prevented.

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Device

Laser treatment devices have a similar appearance to a helmet which is placed over the top of head. The low level laser rotates allowing laser rays which are red in colour, to enter into the scalp. These new era devices are light weight and easy to use. They also have provision for listening to your favourite music while you are undergoing the treatment. Some of these products are FDA Approved and are proven to be safe and effective.

Hair loss is classified in men according to the Norwood-Hamilton Classification and in women according to the Ludwig-Savin Scale. Low level laser treatment is more effective in males who have Norwood Hamilton Classifications of IIa to V and in females who have Ludwig-Savin scale I-4, II-1, II-2, or frontal patterns of hair loss and have Fitzpatrick skin types I to IV.

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Warning and Caution

Laser treatment should not be used in patients who are on medications or products that are photosensitising.

Stem Cell Therapy

Stem cells are the cells in our body which are capable of differentiating into different cell lines and produce specialised cell types. They have enormous potential to cure various disease and medical problems including baldness.

Stem Cell Are of Three Basic Types:

Totipotent (total): Total potential to differentiate into any adult cell type and form specialized tissue needed.

Pluripotent (plural): Potential to form most or all 220 differentiated adult cell types.

Multipotent (multiple): Limited potential and forms only multiple adult cell types.

The various sources for harvesting Stem Cells in adults are: bone marrow, muscle, brain and adipose tissue. Among these adipose tissue is the richest and most readily available source of stem cells in adults. Next in the list comes the bone marrow derived stem cells. These are difficult to harvest and in adults are fewer in number as these cells undergo programmed cell death (apoptosis). Blood is also an important source of stem cells.

stem-cell-therapy

Hair follicles also have stem cells in them but when these follicles get old or damaged then they can no longer take part in regeneration of new follicles. This can be due to various factors like hereditary, stress and ageing.

The stem cells which are used to treat hair loss are harvested from fat or peripheral blood and these are called autologous stem cells. The stem cells segregated with PRP after centrifugation of blood are then injected into the bald area of the scalp using a microscopic needle.

This stem cell therapy is outpatient treatment procedure and the patient can be sent home immediately the procedure.

It is a revolutionary treatment for hair loss. The stem cells promote new hair growth within 3 to 4 weeks of treatment and the hair density increases by 30 to 40% after three sessions of treatment. On an average 5-6 sessions are required once in a week to 10 days.

Advantages:

  1. Non-operative procedure.
  2. Done on outpatient basis taking not more than 30mins.
  3. Painless procedure with no scars.
  4. No side-effects or complications.
  5. Affordable.

Mesotherapy

mesotherapy

Mesotherapy is one of the newer treatment options for excessive hair loss and baldness. It is suitable for both men and women. Mesotherapy can prevent further hair loss in male pattern baldness to a certain extent. Mesotherapy involves injection of nutrient serum into the scalp to stimulate the hair follicle growth. Mesotherapy increases the level of vitamins and nutrients in the scalp of the patient and prevents male pattern baldness by reducing hair loss and promoting hair growth.

Results of mesotherapy start becoming visible by 4-5 sessions and a total of 8 sessions of mesotherapy are recommended. The serum for injection is selected based on the cause for hair loss in that particular patient. There is no need of drawing of blood from the patient and it gives minimal pain and discomfort to the patient. The treatment is considered to be safe and has no side effects.

Patients are advised to follow a healthy diet, avoiding junk foods and toxins to get maximum benefit of the therapy. Following a fitness regime and regular exercise can also be beneficial.

Mesotherapy should not be offered to patients with diabetes, haemophilia, dermal inflations, other skin ailments and pregnant women.

Dermaroller Therapy

Introduction

dermaroller-2Androgenetic alopecia affects up to 30% of men below 30 years of age and approximately 50% of men above 50 years of age. The incidence of androgenetic alopecia seems to be increasing in women also. There is a significant psycho-social impact associated with hair loss and thinning of hair. There is a growing demand amongst the patients to seek treatment to prevent the existing hair loss and to regain new hair with good thickness, volume and density. About 40% of patients with androgenetic alopecia go bald inspite of conventional therapy with minoxidil and finasteride. Dermaroller is also known as Microneedling. It is a recent advancement to the treatment modality for androgenetic alopecia and hair loss due to other causes. The procedure is well tolerated and well accepted by the patients and is a cost-effective therapy for treatment of androgenetic alopecia and hair loss in both men and women.

Dermaroller-The Instrument

The standard dermaroller consists of a drum-shaped roller which is studded with 192 fine microneedles which are arranged in eight rows. The length of the needles varies from 0.20- 3.0 mm and has a diameter of 0.1 mm. The microneedles are usually synthesized by reactive ion etching techniques on silicon or medical-grade stainless steel. Dermaroller is presterilized by gamma irradiation.

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Mechanism of action

During treatment with dermaroller, the needles penetrate through the stratum corneum and create micro-channels (holes) without damaging the epidermis. Rolling with a dermaroller (192 needles, 200 µm length and 70 µm diameter) for 15 times over an area creates approximately 250 holes/ cm2. Dermaroller works by:

  1. Release of various platelet-derived growth factor and epidermal growth factors by activation of platelets and skin wound regeneration mechanism. This helps to stimulate the formation of new hair follicles and increase the nutrition to the existing hair follicles.
  2. Dermaroller causes activation of stem cells in the hair bulge area which stimulates new hair growth.
  3. Post dermaroller there is overexpression of hair growth-related genes, vascular endothelial growth factor, B catenin, Wnt3a, and Wnt10.
  4. It causes formation of new capillaries (neo-angiogenesis) which helps to stimulate growth of new hair follicles. Increase in blood supply to the hair follicles also increases the supply of nutrients to the follicle, which in turn helps to nourish them.
  5. Topical application of products after dermaroller can increase their absorption by atleast 40 fold as compared to their application on intact scalp. Hence it is used for enhancing the percutaneous penetration and absorption of various hair growth products such as minoxidil, hair serums, platelet rich plasma etc.

Indications of dermaroller for hair loss and thinning

  1. Treatment of androgenetic alopecia in both men and women.
  2. Treatment of alopecia areata in children and adults
  3. Treatment of other causes of hair loss such as telogen effluvium.
  4. Delivery of hair growth products to enhance their percutaneous absorption. Topical application of products after dermaroller can increase their absorption by atleast 40 fold as compared to their application on intact skin.
  5. Post Hair transplantation surgery in order to stimulate and maintain the growth of transplanted hair follicles.

Pre-Procedure Instructions for patients

On the day of treatment with dermaroller patients should:

  1. Wash their hair with shampoo
  2. Women should apply conditioner after shampoo to prevent the hair from tangling
  3. Do not use any oil or any other hair product after bath
  4. For men it is best to get a haircut prior to the procedure as short hair will interfere minimally with the treatment. There is no need to get bald, just little shorter hair should be good.
  5. There is no need to be fasting or to be empty stomach for this procedure. Please have a good meal before you come for the procedure.

Procedure

Treatment with dermaroller is a simple office-based procedure. Scalp is cleansed using betadine and spirit. Topical Minoxidil solution is applied on the scalp. Dermaroller is rolled in the area in horizontal, vertical, and oblique directions until mild erythema and few pin point bleeding points are noted. The entire procedure lasts for 15 to 20 minutes. Immediately after this, topical minoxidil and hair growth serums are applied and massaged into the scalp inorder to enhance their penetration. Use of Platelet rich plasma can also be combined with dermaroller. The area is covered with an occlusive sheet for next 1 hour to enhance penetration of topical minoxidil and hair growth serums. The whole procedure from the time patient enters the hospital and leaves takes around 40 minutes. The patient can leave hospital and can remove the occlusive sheet by themselves after 1 hour.

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Post procedure

Treatment with dermaroller is usually well tolerated by the patients. As the microholes close immediately, postoperative infections do not occur.

  1. Cool ice packs may be applied to decrease post procedure discomfort which may be experienced by some patients.
  2. Patient can remove the occlusive sheet after 1 hour. The area may be cleansed with water and soap if the patient wishes, or can be left as it is.
  3. Though the treatment is usually well tolerated, patients can experience slight tenderness and pain in the scalp which can be treated with analgesics for 1-2 days.
  4. Scalp should be washed with shampoo on the next morning of the procedure.
  5. Slight erythema and oedema may be experienced by few patients which will subside in few hours to 1 day and can be decreased with the application of ice packs.
  6. Very rarely, few patients may experience enlargement of lymph nodes draining the scalp. In this case a course of antibiotics and analgesics may be required.

Schedule of treatment

It is advised to get 12-14 sessions of treatment with dermaroller at an interval of 2-4 weeks. For good results treatment plan for at least 6 months is advised.

Minoxidil

Minoxidil, applied topically used for the  hair loss treatment. It is effective in helping promote hair growth in people. Minoxidil in its liquid form is applied directly over the areas of the scalp undergoing hair loss. Originally minoxidil was indicated for the treatment of severe hypertension, and when patients reported slowing of the progression of hair loss and actual growth of new hair the research started for minoxidil use in hair loss. Minoxidil mechanism of action is dilatation of the local blood vessels of scalp and speculated direct activation of hair follicle growth.

Minoxidil is available in three concentrations 2%, 5% and 10%. Minoxidil is to be applied at night before going to sleep. Minoxidil can be applied twice daily also but not more than 2 ml should be applied in 24 hrs. Few patients can have burning sensation, eryhtema, palpitations and headache with the use of minoxidil. Once started, Minoxidil has to be used for indefinite period and minoxidil takes 4 months for the results to become apparent. In women, the minoxidil can be used in 2% concentration to prevent further hair loss and occasional hair regrowth can be achieved. Consult your doctor during pregnancy and lactation. Its cause in people with alopecia areata is unclear.

Some physicians recommend the use of minoxidil after hair transplantation. Application of minoxidil to the grafted areas once a day can shorten the time interval between the hair restoration procedure and the growth of transplanted hair by around one month.

Finasteride

finasterida

Finasteride is a medication used mainly to treat an enlarged prostate or scalp hair loss in men. Finasteride can also be used to treat excessive hair growth in women. Finasteride (Propecia) on the other hand has more direct action on the hair growth as finasteride is 5-alpha reductase inhibitor and blocks the conversion of testosterone to DHT, the hormone most responsible for hair loss in men.

Finasteride works by falling the creation of Dihydrotestosterone (DHT). Finasteride is mainly helpful on the vertex but can decrease hair loss in all areas of the scalp. Finasteride is taken in the dosage of 1 mg once a day orally to prevent further hairloss. Some physicians also prescribe Finasteride is the dosage of 2mg once a day on the alternate days.

Post hair transplantation finasteride use potentially increases hair growth over the anterior and middle scalp areas. Finasteride also causes minimizing and even reversing the miniaturization process of hairs in the back of the scalp. Finasteride can also increase the density of transplanted hairs leading to improvement of the surgical results. The most common side effects of finasteride are reduced libido and erection. Finasteride are not very common and are almost totally reversible on cessation of the medication. Finasteride have been tested for pattern hair loss in women, but the results were no better than placebo.