Hair Loss Treatment Guide 2020 | Regenera vs Medical Topicals vs Surgical Hair Transplant
How do you choose a clinic for Hair loss when you noticed you have hair fall or thinning hair? Do you go to traditional spas for TLC or decide on a medical-grade procedure? Hair loss. Yes, it’s a pain.
What are the common causes of hair loss?
- Androgenic ( female and male pattern hair loss)
- Alopecia areata ( coin-shaped hair loss)
- Telogen effluvium ( stress-related)
- Traction ( tight hairstyles)
- Vitamin and mineral deficiencies ( Copper, zinc, iron magnesium)
First step is identifying if your hair loss is gradual hair thinning or a sudden fall of >100 strands, which would require medical attention. Next is looking at the pattern of the hair loss. Female pattern hair loss is the loss of hair along the top of the head and is the most common form of hair loss. Male pattern hair loss occurs at the back of the head and along the hairline in front. Treatment is dependent on the cause and can be divided into conservative and surgical.
Please note: hair thinning and hair falling is different! If you noticed your hair gradually thinning over time, androgenic hair loss is the most likely diagnosis. If however, there is a sudden spurt in the hair fall of >100 strands, this requires medical attention.
Can u name the diagnosis?
Essentially, the most common cause is Androgenic, meaning hormonal. Hence it is impt to recognise the different grades.
Grading Scales for Androgenic Alopecia Hamilton Norwood (Males)| Sinclair (Females)
Males tend to lose hair in the back of the head, and in the front along the hairline. Females tend to lose hair along the top of the head. Here are some illustrations.
To understand hair loss, you would first need to appreciate the hair cycle.
3 main phases exist. Anagen, Catagen and Telogen phase.
- Anagen is the growth phase.
- Catagen the intermediate phase.
- Telogen is the resting phase.
|Each hair follicle lives in a cycle. This consists of a growth phase termed Anagen, followed by a transition phase, Catagen and finally a short period of rest, Telogen Phase, where growth stops.After Telogen phase, the hair is lost and newer hair grows, starting another hair growth cycle.|
Key principle of hair loss treatment is to increase the growth phase and reduce the resting phase.
Hair Loss Treatment
3 Steps Formula to hair loss
Key principle is that once you stop your minoxidil, propecia etc, hair loss tends to return. Hence its for long term use.
- Lifestyle changes – healthy diet and reducing hair trauma
- Medical: topical minoxidil and oral Viviscal
- Specials: Light therapy and kiv Regenera Activa
- Topical Minoxidil 2-5% New users can start at 2% and gradually work up to 5%.
- Oral | Viviscal, finasteride, dutasteride, spironolactone | Treatment for 6 months or more for better results. Viviscal is derived from fish proteins, and has had quite consistent results and is arguably safer than Propecia, which can cause impotence, low libido, depression etc.
- Immunosuppressant | intralesional steroid, oral steroid, MTX| – Effective for alopecia areata
How to apply Minoxidil?
- Dry your hair and scalp
- Apply the prescribed amt twice daily to the affected area, starting from the centre.
- Allow natural drying – No hairdryer
- If you miss a dose, just continue with your next dose.
What are the side effects of minoxidil?
Minoxidil is generally well tolerated. However, there may be rare instances that you may experience the following side-effects: Localised skin reaction = itch, redness, rash, burning
How long do we need to use minoxidil?
Results take time. You may notice hair shedding as your old hair drops to allow regrowth of new hair. Peak results after a year of continued use. Minoxidil is safe and FDA approved. Need for continued usage.
Finasteride – Propecia and Proscar
Who is suitable to consume Propecia?
This medication is only suitable for males.
How does Propecia work?
It contains an enzyme, which inhibits the conversion of testosterone to dihydrotetosterone. DHT in excess causes shrinking of your hair follicles. It comes in a 1mg tablet. If you miss a dose, just continue from where you have left.
Results take time. You may notice hair shedding as your old hair falls to make way for regrowth of new hair. Peak results after a year of continued use.
What are the side-effects of Propecia?
In very rare instances, a decrease in libido may be experienced, reduced ability to get an erection and breast tenderness.
What are the evidence based treatments for hair loss?
Below are the top 3 FDA Approved products for hair loss. Viviscal, Propecia, Rogaine have been proven in controlled clinical studies to stop hair loss and regrow new hair. Scientists have discovered that men with male pattern hair loss have an increased level of dihydrotestosterone (DHT) in their scalps. Propecia blocks the formation of DHT. As a result, it interrupts a key factor in the development of inherited male pattern hair loss in men.
What is the difference between Rogaine and Propecia?
- Availability: Rogaine is available without a prescription. Propecia requires a prescription.
- Application: Rogaine is applied to the scalp. Propecia is taken as a pill.
- Mode of action: Rogaine works locally by reinvigorating the hair follicles. Propecia stimulates hair regrowth by altering male hormones.
- Suitability: While Rogaine Extra Strength is approved for men only, Rogaine as a 2% minoxidil solution is approved also for use by women. Propecia is not approved for use by women.
- Regenera Activa | A concealed micrograft treatment that takes under an hour
- Low level laser therapy is of ? benefit in pattern balding but one device has been approved by the FDA for marketing.
- PRP, platelet rich plasma is becoming more popular although not everyone is suitable for this procedure. ( Do note this is not approved in Singapore and you would have to go overseas for it)
How does Regenera Activa work?
Let me summarize in a simple 3 step process
1. First, identifying a well concealed area at the back of your scalp, a small sample of micro-grafts is harvested
2. Next, a special extraction of Regenerative cells using Regenera Activa
3. Finally, these cells are introduced into hair loss areas via an injector.
Who is suitable and unsuitable for Regenera Activa?
Both men and women with hair thinning, early hair loss and decrease in hair volume due to Androgenetic Alopecia/ Pattern Hair Loss are suitable. People with scarring alopecia and telogen effluvium are not suitable.
What can you expect with Regenera?
- Initially, you notice reduction of hair loss
- Next, there is improved thickness and density of existing hair
- Finally growth of new hair over the next 12 months || Do note: Numerous clinical studies have shown improvements in hair density, hair count and scalp coverage as early as 3 months, but results vary from person to person
What are the available Hair Loss treatment options in Singapore?
Low-Level Laser Therapy + Minoxidil + oral supplements cost $250 per month in Singapore
Hair Transplant cost in Singapore | It is a good permanent solution, time tested and proven. Average price at $5/graft for 2,000 grafts.
Regenera Activa cost in Singapore: From $4000 up | On discussion with global hair experts, the results primarily depend on patient selection. Not all patients will benefit from this. So this is a discussion to have with your physician. As the micrografts are well concealed, there is minimal social downtime.
Is Regenera Activa safe?
Regenera Activa is an evidence based hair loss treatment. It is approved by major health regulatory authorities globally FDA (US), CE (Europe) and HSA (Singapore).
A Cochrane systematic review published in 2012 concluded that minoxidil solution was effective for. Minoxidil is available as 2% and 5% solutions; the stronger preparation is more effective, but may irritate and may cause undesirable hair growth unintentionally on areas other than the scalp.
A combination of low dose oral minoxidil (0.25 mg daily) and spironolactone (25 mg daily) has been shown to be most effective.
PRP | Platelet rich plasma ( not HSA approved)
- PRP stands for platelet-rich plasma. PRP is blood plasma that has been enriched with platelets. PRP contains several different growth factors and other cytokines that stimulate healing of tissue, as well as hair growth.
- Human blood contains mesenchymal stem cells, and autologous blood products that contain essential and specific growth factors that assist in tissue regeneration and healing.
- PRP was developed in the 1970′s and first used in Italy in 1987 in an open heart surgery procedure.
What is the evidence for PRP in hair loss treatment?
- Medical literature worldwide confirms the safety and use of PRP therapy in medicine. In the past 20 years,
- PRP has been widely used in skin and wound healing, and is now being extensively used in cosmetic surgery, dentistry, sports medicine and pain management.
- In the field of hair loss treatment, evidence supports PRP therapy to promote hair growth. Studies have shown that growth factors released from platelets may act on stem cells in the bulge area of the hair follicles, stimulating the development of new follicles and promoting neo-vascularization. ( Journal of Aesthetic Cutaneous Surgery, 2014).
Can PRP replace medication for hair loss?
However, PRP is in the early stages of scientific research for hair loss therapy, hence PRP is not meant to replace current FDA approved therapies such as DHT blockers and Minoxidil.
How is PRP Hair Loss Therapy performed?
- Your blood is drawn and then spun in a sterile centrifuge system
- A topical anesthesia is applied to your scalp to reduce any discomfort during the PRP treatment.
- The highly concentrated platelet rich plasma is then injected into your scalp
- Your hair will then be washed and you may return to your daily routine. You are able to drive after the procedure.
Studies for hair loss indicate an average of 3 treatments scheduled 6 weeks apart. This may vary depending on the severity of hair loss and the desired result.
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Pigments and pigmentation in skin. Please click here PIGMENTS