We have to understand hair transplantation as a surgical treatment that is neither preventive nor regenerative: it is an excellent ally in repopulating specific areas where there is little follicular activity. We are talking about the «transfer» of a few thousand follicles from the almost one hundred thousand follicles on the scalp. However, it is extremely important to treat the follicles as a whole, without forgetting the follicles that are not transplanted. Moreover, not all patients are candidates for surgery: diffuse alopecia, young patients with progressing alopecia and poor follicular activity in the donor area are some of the cases in which medical treatment will be a priority.
Therefore, hair transplantation is not always the first option and it is extremely important to individualise each case in order to provide treatment in accordance with the results of a correct trichological study. With the trichoscope, we can determine if the type of hair loss is due to an inflammatory, autoimmune or acute pathology or if it is what we see in most cases in the consultation room: androgenic or androgenetic alopecia (AGA).
Androgenic alopecia (AGA) is a genetic condition and the most common form of hair loss. Hair follicles undergo miniaturisation or thinning, a shortening of hair growth cycles, resulting in shorter hairs and eventually baldness.
There can be a male or female pattern, and we know from numerous studies that it can affect up to 80% – 90% of the male population and 50% – 60% of the female population. The incidence increases with age and may be related to several factors: lifestyle, coronary heart disease, metabolic syndrome, stress, high body mass index, hormonal changes, COVID-19.
Scientific evidence has demonstrated the efficacy of various medical therapies in AGA, with combination treatments being the current trend for best results. Although the results of the treatments are very favourable, patients need to be aware that there must be continuity of treatment throughout life. Follicles are «programmed» to deteriorate, in most cases.
- Topical treatments: Topical application has shown good results. Increases blood flow to the area where it is applied within 15 minutes. However, it can have adverse effects such as irritation, dermatitis, flaking and sometimes has to be applied more than once a day. In addition, it does not penetrate as well as other applications.
- Microinjections of medication: Microinjections allow the follicular area to be flooded with medication. All of them, when infiltrated with microinjections directly into the scalp, reach high maximum concentrations that allow the thickening of the follicle in the long term and after repeated applications.
- Oral treatment: The use of oral medication has become popular in the treatment of alopecia. The fact that many of these oral treatments also act systemically, i.e. on other parts of the body, makes it important that all necessary information about side effects and drug interactions is clearly provided to the patient.
- Laser treatment: Low level laser therapy was discovered by chance in the 1960s after mice were irradiated with a low-fluence red laser and noticed that after several sessions, hair grew back. Side effects are minimal and infrequent, for example, discomfort from the light or mild headaches.
- Platelet Rich Plasma (PRP): This is a treatment generally indicated for patients with early stage AGA, as there are intact hair follicles and a more significant hair restoration effect can be achieved. During the procedure, approximately 10-20 ml of blood is drawn from the patient’s vein and centrifuged for 10 minutes to separate the plasma from the red blood cells. The platelet-rich plasma, which contains numerous growth factors, is then injected into the deep dermis or subcutaneous tissue in a volume of 4 to 8 ml per session.
- Exosomes: These are nanometre-sized membrane-bound vesicles and represent the new frontier in regenerative medicine. Exosomes contain potent cytokines (proteins) and growth factors.
An often overlooked aspect is hair miniaturisation in the donor area, which can affect the viability of the transplanted follicles. It is essential to assess the quality and density of the donor hair before proceeding with a hair transplant to ensure optimal long-term results.
In conclusion, hair transplantation is not always the only effective option for treating hair loss. Many medications, regenerative therapies and laser therapy are available. By combining these approaches with careful trichoscopic evaluation, it is possible to achieve more successful and long-lasting results in the fight against alopecia.
