The most reliable and effective form of hair restoration known to mankind. No other form of treatment even comes close. Hair roots that exist in over abundance in the back and sides of the scalp are removed and placed into the thin and balding areas of the front and top. After about 4 months these transplanted hairs begin to grow in the new location. Because it is your own body there is no chance of “rejection”. The hair will usually continue to grow for a lifetime just as it would have it were not moved from the back. This hair may be styled, washed, and cut just like regular hair because it IS regular hair. Most hair transplant procedures are performed in one or two sittings. It is considered a minor in-office procedure performed under local anesthetic. There are two different hair transplant procedures available: The first is Follicular Unit Transplant (FUT) also called the “Strip Method. This is the gold standard of hair transplant procedures. The second is Follicular Unit Extraction (FUE) now called Follicular Unit Excision. This is a secondary type procedure that should only be considered IF the FUT procedure is not an option. Some of the worst results coming out on the internet are due to improper use of the FUE procedure. At Feller and Bloxham we are recognized leaders in the field for both procedures.
The “hair pill”.
First of its kind
The first truly effective pill to treat hair loss is called Finasteride, and it has an interesting history. Like so many drugs it was not created to address hair loss, but rather to reduce the size of enlarged prostate glands in men. It’s hair enhancing property was only discovered incidentally, but it didn’t take long for the company to repackage and rebrand the product to serve a huge market. There is no doubt that this drug has efficacy in reducing or slowing the hair loss process in some young patients who still possess most of their hair. We have noticed this ourselves in patients who have visited our clinic over the past 24 years. However, we have found Finasteride to be of very limited value in patients who have already lost a significant amount of hair- from a Norwood stage 4 and higher.
We do not give this drug to just anyone who visits the office. Like all drugs there a risk to benefit analysis must be made to determine if it is right for each individual. If it were fine for just anyone to take at anytime it would have been marketed as an over the counter drug rather than by prescription. Finasteride works because it is a hormonally active drug. It blocks the formation of DHT which is responsible for hereditary hair loss. The problem is: DHT is also needed for normal healthy function of the body. So when it is decreased there are going to be some unpleasant side effects. In the case of this drug is the loss of sexual drive and the possibility of impotence. Unfortunately, we have had several patients visit for consultation who tried this drug and experience sexual dysfunction. If it were only a few men making such claims over the years I would have written it off to other likely causes, but so many different men have made the claim that I believe firmly it is a side effect of this particular drug- independent of other possible causes. At least two of these patients had hired attorneys to bring lawsuits against the manufacturer for their sexual dysfunction and asked us to provide medical information for their lawyers.
How we use this Finasteride
- If a patient visiting us for surgery has already been on the drug for over a year with no complications then we recommend they stay on the drug for as long as they or the prescribing doctor feel comfortable continuing it.
- If a patient visits us for surgery and wants to start the drug afterward we give them a prescription with enough refills for six months. Thereafter we recommend patients go to their primary care physician and inform them they are on the drug. A blood test to check liver function should be performed at least once prior to taking the drug to make sure the liver isn’t impaired. Thereafter, further prescriptions can be given by the patient’s own physician who can properly supervises its use.
How we don’t use Finasteride
Many doctors put all their post hair transplant surgery patients on Finasteride. This makes no sense considering, by definition, transplanted hair follicles do not have DHT receptors and therefore are not affected by DHT. So why put them on a drug that will reduce systemic levels of a needed hormone ? One may make this argument if there is a lot of weak native hair around the transplants, and perhaps that is a valid reason, but in reality any hair that is that thin (miniaturized) and weak is likely too far gone to respond to Finasteride. The possibility of side effects, known and unknown, do not make it a good gamble in our opinion.
And yet other doctors put almost all patients who just visit for consultation on the drug. Unfortunately, we believe this is done for marketing reasons.
This drug was going to be marketed as an improved competitor to Finasteride. It was hoped that since it blocked two pathways of DHT creation rather than just one that it would act as a better hair pill. The drug was offered off label by some doctors and it was found to indeed work better than Finasteride did. However, while approved to treat enlarged prostate, it has not yet received FDA approval. At Feller and Bloxham we do not recommend the use of this drug.
This hair medication was also discovered inadvertently. Originally it was used as an anti-hypertensive medication, but some patients started noticing an increase in body hair and scalp hair over time. It didn’t take long for the company to re-brand and repackage the drug for sale in the hair loss market. At Feller and Bloxham we have noticed over the years that this drug, applied topically, is not very effective. In fact, it seems to cause more hair loss through chronic irritation of the scalp. We do not recommend the use of this drug.
Hair Loss Treatments And Quackary
Pseudo treatments for hair loss go as far back as recorded history. Everything from incantations to bird droppings have been sold and used in an attempt to reclaim lost hair. Of course none of these “remedies” had any chance of working and in time they stopped making money. However, new “treatments” with at least some tenuous connection to science began to emerge- several of which are with us to this day. Below are some of the modern day “treatments” that I have found to be completely useless and even damaging.
Platelet Rich Plasma for hair loss (Quackary)
PRP is not a drug manufactured by a pharmaceutical company. Rather, it is a method of processing blood that is designed to allow one component of that blood, platelets, to be isolated and concentrated. Once prepared, the PRP is transferred into a syringe to be injected into the thinning and balding areas of scalp. The theory is that “dying” follicles will somehow be rejuvenated or reanimated by the properties of concentrated platelets. There may be some truth to this, but there is no solid evidence to support that there is really any clinical advantage to using PRP. In fact, we argue the opposite. We believe it is inappropriate to use PRP in the scalp for two reasons:
The first is that it has not been shown to actually work
In order for PRP to “function” or be “activated” the skin needs to be injured. This means stabbing the thinning and balding areas with a needle several hundred times. The problem with this method, however, is that over time all that stabbing causes fibrosis which actually accelerates hair loss. At Feller and Bloxham we do not recommend PRP and give it a 3 duck rating for quackary:
Steroid injection for hair loss (Quackary)
It’s amazing how many patients have visited for consultation over the years who have been given steroid injections for hair loss by their dermatologist. They almost never work. While some hair loss may be attributed to medical factors that may respond to steroid treatment, normal male pattern baldness (MPB) isn’t one of them. So how is such treatment justified ? It really isn’t. But here is the so-called “reasoning”: Hair doesn’t just fall or rot out of people’s heads. Rather, hair loss is a sophisticated process of steps. One of these steps includes an “inflammation” stage. So the “theory” is that if the inflammation stage can be halted or retarded, so will the hair loss. This is also one of the justifications for using PRP as well. Since steroid reduce inflammation they should reduce hair loss. At Feller and Bloxham we believe this reasoning is not only false, but irresponsible. A dermatologist who can plainly see that the progressive hair loss of their patient follows the Norwood classification should know better than to inject steroid needlessly. At Feller and Bloxham we do not recommend steroid injection for hair loss and give it a 2 duck rating for quackary:
Low Light Laser Therapy for hair loss (Quackary)
Also known as LLLT. It was all the rage when first seriously introduced in the late 1990s. No matter what hype you read online this “treatment” is pure quackary. Dr. Feller of Feller and Bloxham debated the owner of the largest laser hair comb manufacturer in the world and exposed this man as having no medical or scientific background and disproved right on the air that a major claim he was making about his product was pure nonsense. A few days after the debate the shows host reported that the man said he would never debate Dr. Feller again. Feller and Bloxham do not recommend the use of LLLT in any form.
Expensive Shampoos for hair loss (Quackary)
Many shampoo manufactures advertise that their shampoo will bring “life” back to the dying hair of customers who purchase and use their product. There’s just one small problem: hair isn’t alive. It never was. Only the hair follicles are alive. It doesn’t matter if there are herbs and vitamins in the shampoos. Unless there is “fountain of youth” water in that shampoo it isn’t going to work. All that will happen is that it will wind up in the drain of the shower. No shampoo is going to help hair roots which are deep in the skin. The only possible exception are shampoo companies who include Minoxidil in the shampoo. The problem with this scheme, however, is that for minoxidil to work it needs to be left on the scalp. Obviously shampoo is washed out of the hair during the shower and the minoxidil competent goes right out along with it into the floor drain. These shampoos usually cost more than what minoxidil could be picked up for on its own in any pharmacy or big box store. Because of this, some of these manufacturers have gotten clever and don’t identify that they’ve put minioxidil in the bottle. Rather, they state on the bottle that their product “contains an FDA approved ingredient to treat hair loss”. And rather than writing minioxidil in the ingredients section they use the chemical formula name of minoxidil instead. Would you recognize ” 6-piperidin-1-ylpyrimidine-2,4-diamine 3-oxide” ? Of course not, but that’s the actual chemical formula for minoxidil. At Feller and Bloxham we do not recommend the use of such shampoos. The best shampoo for hair loss sufferers to use in our opinion are thickening shampoos that coat each hair shaft with product that makes the hair appear thicker. The cost of these shampoos are nominal.
Vitamins for hair loss (Quackary)
The benefits and effects of vitamins have been exaggerated to the point of near criminality for decades. Their use in the “treatment” of hair loss has been no exception. Most people living in the western world are not malnourished nor vitamin deficient. Eat a burger, a piece of pizza, or enjoy an ice cream cone and you are most likely getting vitamins. Therefore, taking vitamins for hair loss is going to be pointless. When the body is not deficient in vitamins any excess vitamins introduced into the body are simply excreted as waste. The bottom line is that vitamins and supplements sold for hair loss does not produce better hair, only expensive urine. At Feller and Bloxham we do not recommend any more than the normal daily dose of vitamins.