#43 - Alan Bauman, M.D.: The science of male and female hair restoration - how to protect, enhance, and restore the appearance and health of the hair and scalp

1. Act Early on Hair Loss

Take action soon to protect the functioning of hair follicles before they reach a ‘point of no return’ and miniaturize beyond repair, as once a follicle produces vellus hair, it cannot be revived.

2. Consult a Hair Loss Specialist

Seek out a physician who specializes full-time in hair loss, as they possess the expertise and tools (like trichometers for hair bundle measurements and genetic testing) to accurately diagnose and monitor your specific condition, unlike many general dermatologists.

3. Prioritize Scalp Health

Address any microinflammation or overactivity of yeast populations (like those causing dandruff) on the scalp, as poor scalp health can detrimentally affect hair growth by impairing follicle function.

4. Manage Transplant Expectations

Have a clear and honest discussion with your surgeon about what is realistically achievable with a hair transplant, as the main risk is not physical complications but dissatisfaction if expectations for density or coverage are not met.

5. Consider FUE for Transplants

Opt for Follicular Unit Extraction (FUE) over linear harvesting, as FUE uses tiny punches to harvest individual follicular units without a scalpel or stitches, resulting in minimal scarring and greater flexibility in hairstyling.

6. Use Compounded Topical Minoxidil

Seek compounded minoxidil formulations (e.g., 82M) from a pharmacy, as these are designed to penetrate better, be easier to use, less irritating to the scalp, and can include beneficial ingredients like tretinoin and anti-inflammatories, unlike many over-the-counter options.

7. Apply Minoxidil Correctly & Consistently

Apply topical minoxidil twice daily for 90 seconds, ensuring the applicator tip directly reaches the scalp by parting the hair, as once-daily application is rarely effective and proper technique is crucial for the medication to work.

8. Utilize Low-Level Laser Therapy

Consider low-level laser therapy (LLLT) using a laser cap device, as it’s a non-chemical, side-effect-free treatment that imparts energy to hair follicles, stimulating stronger, healthier hair growth and is a cost-effective long-term investment.

9. Choose Quantified PRP Treatments

Select a PRP (Platelet-Rich Plasma) provider who quantifies the platelet concentration of the injected product, as there’s a strong correlation between the amount of platelets and the clinical outcome, with an optimal range around 1.4-1.5 million platelets per microliter.

10. Inquire About Monocyte-Rich PRP

Ask your PRP provider about their process for creating monocyte-rich PRP, as monocytes are an underappreciated component that can significantly enhance the regenerative effects of the treatment.

11. Understand PRP Treatment Frequency

Expect optimized PRP treatments to be administered approximately once a year, as a well-prepared, high-concentration PRP can provide positive responses lasting 10 to 14 months, rather than requiring monthly sessions.

12. Know PRP Limitations & Benefits

Understand that PRP is not effective for completely bald areas with dead follicles, but it can significantly boost volume (20-50%) in thinning areas and help prevent further follicle function loss.

13. Adopt Combination Therapy

Layer different therapeutic interventions (e.g., systemic medication, topical treatments, laser, PRP) for hair loss, as this multi-modal approach is often more effective than relying on a single treatment.

14. Consider Finasteride for Men

Discuss finasteride (1mg/day) with your doctor for male pattern hair loss, as it has a 90% chance of maintaining or improving hair appearance over the long term by blocking DHT, the primary trigger for follicular homicide.

15. Finasteride for Post-Menopausal Women

If post-menopausal, discuss finasteride with your doctor, as it can be used off-label and has shown a 50% success rate in improving female pattern hair loss, but it is strictly contraindicated for women of childbearing age due to risks to a male fetus.

16. Monitor Medications for Hair Impact

Be aware that medications for blood pressure, cholesterol, and mood modulation can negatively impact hair quality; reflect on when you started these medications if you notice changes in your hair.

17. Use Biotin as an Adjunct

Take high-dose biotin (e.g., 10,000 micrograms) if recommended, as it can improve keratin production and strengthen existing hair, but it must be coupled with other effective treatments as it won’t cure hair loss on its own.

18. Always Condition After Shampooing

Follow every shampoo with a conditioner, as shampoo cleanses and can strip natural oils, while conditioner replaces moisture to keep hair healthy and prevent dryness and damage.

19. Tailor Conditioner to Hair Type

Choose conditioners based on your hair type: use durable conditioners for long, curly, or kinky hair, and very light conditioners for thin or limp hair to achieve desired weightlessness and style.

20. Treat Underlying Scalp Conditions

If you have severe scalp conditions like psoriasis or chronic dandruff, seek appropriate medical treatment to resolve these issues, as they can significantly impair hair growth.

21. Seek Artistic Transplant Design

Choose a hair transplant surgeon who employs an artistic approach to hairline design, considering the angle, orientation, position, and density variation of hairs to create a natural, undetectable result that complements your face and age.

22. Consider Two-Day FUE for Large Cases

For large hair transplant procedures (over 2000 grafts), discuss splitting the FUE into two consecutive days, as this approach enhances patient comfort, improves harvest rates, and ensures better graft quality.

23. Explore Alternative Donor Sites

If scalp donor hair is insufficient (e.g., due to previous harvesting or extensive baldness), discuss using beard or body hair as alternative donor sites, with beard hair being particularly effective for filler in the back of the scalp.

24. Utilize Women’s FUE Techniques

If you are a woman considering FUE, ask about partial shaving or ’no-shave’ techniques where only a few hairs are trimmed from the donor area, allowing you to maintain your current hairstyle during the process.

25. Debunk Hair Loss Genetic Myth

Do not solely rely on your maternal grandfather’s hair pattern to predict your own hair loss, as hair loss genetics are complex and involve factors from both sides of the family, not just X-linked inheritance.

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