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Restoring Hair

When you think about hair loss, you may picture Uncle Fred’s bald spot or Dad’s receding hairline.  But surprisingly, women actually make up 40% of people dealing with hair loss -- and there are more ways than ever to treat it. 

You need to be careful. Although people with hair loss spend more than $ 3.5 billion a year in an attempt to treat it, most hair loss treatment products and techniques on the market are useless. What’s new and what really works?

Men have more effective options for medical hair loss treatment than women do. Finasteride, the generic name for brand-name drugs Proscar and Propecia, is the "gold standard" drug for male hair loss, according to Jeffrey Epstein, MD, a hair transplant surgeon with offices in Miami and New York, and past president of the Florida Society of Facial Plastic and Reconstructive Surgery. It lowers the body’s levels of an androgen called DHT, which shrinks hair follicles and eventually leads to baldness.

Another drug, dutasteride (Avodart), has the same effect. "It’s a stronger drug, so there was the hope that it would be even more effective than Propecia, but so far, studies don’t show that," says Epstein. "These drugs have also been tried in women who are postmenopausal -- you should never become pregnant while taking them -- but it’s not clear whether they’re as effective in women as in men."

For women, minoxidil (Rogaine) is the primary medical treatment available. It’s used topically and has some effectiveness.  About 20% of women report moderate hair regrowth after using it. Doctors may also prescribe spironolactone, a type of blood pressure medication that also slows down the production of hormones that can lead to hair loss, and hormones or oral contraceptives. Both of these treatments are used in women that have hair loss secondary to hormonal abnormalities such as those with polycystic ovarian syndrome.

But what’s really advanced in recent years is the surgical capability to do more complete and more natural-looking hair replacement. "The state of the art for the last decade has been follicular unit transplantation, or FUT," says Epstein. In FUT, hair from an area of your head that’s not yet balding is grafted to the thinning area, in naturally occurring groups of 1 to 4 hairs.

"Once, the most grafts anyone would do was about 1,500 to 2,000," says Epstein. "Now, we can routinely do 3,000 grafts, which offers much more impressive results. With a bald scalp, we can fill in the frontal half with reasonable to good density in just one procedure. For women, smaller grafts allow us to place more of them in a single procedure and treat not only female pattern hair loss, but also hairline advancement. So women can have a high hairline restored back down." The small size of the newer grafts also creates a more natural appearance.