Non-surgical hair restoration is less painful, less invasive, and generally safer. For the faint-hearted, it’s the ultimate option.
In this article, we’ll explain what is non-surgical hair restoration and why should (or why shouldn’t) you consider them for your hair loss treatment.
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Why do you need to restore your hair?
Even though the hair is a mere strand of dead cells, it plays an integral part in the self-image and social confidence of an individual. The health and growth of a hair depend on multiple internal and external factors.
Chronic systemic disorders, nutrient deficiencies, hormonal imbalances, genetic predilection, and psychological stress can impede hair regrowth and deteriorate the quality of hair. That, when combined with external factors such as exposure to solar ultraviolet radiation, harmful chemicals, and medications, lead to diffuse thinning.
What is surgical hair restoration?
Aims at restoring the hair system and giving the surgery treatment recipients a more youthful appearance, but this treatment option does not treat the underlying cause of hair loss disorders. Rather, surgeons conceal bald areas of the scalp by transplanting hair follicles from donor sites to the affected regions of the scalp.
Surgeons may use either of the two techniques for performing hair transplant surgery:
This first technique of hair transplant surgery is known as follicular unit transplantation (FUT). FUT involves an excision strip of skin-bearing hair follicles from the back of the scalp. Natural hair follicles are extracted and then transplanted into the affected areas of the scalp.
The second is follicular unit extraction, also referred to as follicular unit excision (FUE) involves the direct extraction of hair follicles from the donor site followed by transplantation.
This hair replacement method is often done in plastic surgery or specialized clinics.
Why should you choose non-surgical hair restoration?
Potential complications of surgical hair replacement include the following.
- Post-surgical infections
- Epidermal cysts
- Ingrown hair
- The diffuse inflammatory response may damage the hair graft
- Telogen effluvium is self-limiting and arises due to post-surgery shock
- Edema or swelling of the transplantation site
- Bleeding at the transplantation site
- Numbness of the scalp
- Folliculitis or inflammation of the hair follicles
It is for these reasons that people have been considering non-surgical options of hair replacement to treat female and male pattern hair loss.
What is non-surgical hair restoration?
While the surgical restoration of hair is an effective technique for the treatment of hair loss disorders, it comes with a list of adverse effects as mentioned above. The cost of hair replacement by surgery is also relatively higher than most non-invasive and non-surgical treatment methods.
Owing to associated complications, restricted candidate selection, and cost, non-surgical hair restoration techniques are increasingly preferred by the majority of individuals.
A significant amount of the population also prefers non-surgical procedures over surgery due to the instilled fear of coming under the knife.
Non-surgical hair restoration modalities are medications including minoxidil, finasteride, dutasteride, and spironolactone, low-level laser therapy, micro-needling, PRP treatment, collagen-induced therapy, and stem cell therapy.
Other methods for restoring natural hair growth rate include the consumption of a healthy diet, a proper hair care routine, and the use of nutritional supplements and extracts for correct underlying pathologies.
Both minoxidil and finasteride are approved by the US Food and Drug Administration for the treatment of pattern hair loss disorders, particularly androgenic alopecia. However, both medications differ in their route of administration and mechanism of action.
Topical minoxidil is commonly prescribed for hair loss disorders. However, this drug was initially developed for oral therapy in hypertensive patients owing to its vasodilation effects. Topical minoxidil application may be administered in the form of foam or liquid.
The efficacy of topical minoxidil therapy varies from individual to individual. This is due to the varying catalytic activity of sulfotransferase in these individuals. Sulfotransferase converts minoxidil into its active metabolite known as minoxidil sulfate. This compound is responsible for the therapeutic effects of minoxidil. However, on average, minoxidil takes 3 to 6 months to work.
Minoxidil sulfate improves hair growth by stimulating the activity of potassium channels in hair follicles and smooth muscles. Potassium plays a crucial role in the normal progression of mitotic cell cycle stages as well as the progression of hair follicles through multiple stages of the hair growth cycle.
Potassium-mediated arteriolar vasodilation promotes blood flow towards the scalp and provides sufficient nutrition to the growing hair follicles.
While minoxidil is approved by FDA for the treatment of androgenetic alopecia for female and male pattern baldness, it is also used for the treatment of other hair loss disorders. These include alopecia areata, chemotherapy-induced alopecia, telogen effluvium, and loose anagen syndrome.
Finasteride is an alternative to minoxidil.
Oral finasteride is the first-line treatment for people affected by androgenic alopecia, v hairline, and benign prostatic hyperplasia. Finasteride is a competitive inhibitor of the enzyme, 5-alpha reductase, that catalyzes the conversion of testosterone to dihydrotestosterone (DHT).
While androgens are important for hair growth, excessive concentrations of DHT suppress the growth of hair follicles and disrupt the normal hair growth cycle. That’s why many are also looking for DHT blockers to reduce DHT.
An oral dosage of 1 mg of finasteride is effective for the treatment of androgenetic alopecia. Finasteride suppresses the activity of types II and III 5-alpha reductases in the hair follicles. Hair count is improved within 12 months of finasteride therapy. Pathological markers shall be monitored during the hair restoration procedure as finasteride is associated with an increased risk of prostate cancer.
However, since finasteride blocks the function of testosterone, there are possible side effects of DHT blockers that you should know.
Dutasteride also serves as an inhibitor of 5-alpha reductase and subsequently reduces the concentration of DHT. Increased levels of DHT disrupt the hair growth cycle, inhibit follicular proliferation, and lead to miniaturization of the hair follicles.
Studies demonstrate that dutasteride is a more potent inhibitor of 5-alpha reductase as compared to finasteride, thus having greater efficacy and better treatment outcomes.
Dutasteride is known to have less frequent adverse effects and tends to be well tolerated by drug recipients. However, dutasteride has a similar association with the onset of prostate cancer as finasteride. Similar adverse effects of finasteride and dutasteride include erectile dysfunction, loss of libido, and disorders of ejaculation.
Spironolactone is an off-label anti-androgen medication that is primarily used for the treatment and management of female pattern hair loss (FPHL). Spironolactone is primarily used as an aldosterone antagonist.
Spironolactone is a potassium-sparing diuretic and achieves this effect via its active metabolite called canrenone. Spironolactone also acts as an antagonist of androgens, thus, serving as an effective medication for the treatment of FPHL.
The antiandrogenic effect of spironolactone reduces the production and action of androgens in the hair follicles. Spironolactone suppresses the activity of 17-alpha hydroxylase, an enzyme involved in the synthesis of testosterone. Reduces levels of testosterone in blood results and reduces the formation of DHT, thus, protecting hair follicles from detrimental effects of DHT.
Spironolactone is also a competitive inhibitor of androgen receptors and it blocks the action of androgen on the hair follicles. Spironolactone is usually consumed in a dosage range of 150-200 mg per day.
Spironolactone has dose-dependent adverse effects including hyperkalemia, tiredness, breast tenderness, and menstrual irregularities. Spironolactone is contraindicated in males owing to its feminizing effects.
Low-level laser therapy
Low-Level Laser (Light) Therapy (LLLT) is a safe and effective way of stimulating hair growth in both men and women. LLLT is known for promoting cellular activity and stimulating tissue repair and regeneration mechanisms. LLLT is widely used for different health ailments including stroke recovery, mucositis, joint pain relief, wound healing, and nerve regeneration. LLLT has the following effects on the growth cycle.
- Stimulation of hair follicles in the telogen phase to re-enter the anagen phase
- Increased duration of the anagen phase
- Increased active proliferation of hair follicle cells in the anagen phase
- Prevent premature progression of hair follicles to the catagen phase
Laser treatment promotes vasodilation by increased dissociation of nitric oxide (NO) and increases gene expression and protein synthesis in the hair follicle cells. LLLT also modulates inflammatory mediators and reactive oxygen species. LLLT also modulates the genetic expression of 5-alpha reductase and regulates the production of DHT. Hence, LLLT helps create a conducive environment for the growth of healthy hair.
LLLT has a relatively low incidence of side effects as compared to other treatment options. Patients may report the onset of telogen effluvium approximately 1-2 months after initiation of LLLT, however, this hair loss condition is self-limiting.
This is a minimally invasive procedure that involves the use of fine needles to create micropunctures in the skin. This induces collagen production, formation and growth of blood vessels, and production and release of growth factors.
Microneedling may also be used in conjugation with the administration of pharmacologic formulations. The creation of micro punctures in the skin during micro-needling leads to effective penetration of these medications including minoxidil.
PRP injection (Platelet-Rich Plasma) uses a concentration of the patient’s platelets to prevent further hair loss and promote new hair regrowth.
Stem cell therapy
Stem cell therapy preserves your follicle stem cells at the onset of pattern baldness. However, follicle progenitor cells are lost in this disorder. These stem cells can be used to reverse pattern baldness and stimulate increased growth.
Stem cell therapy involves three key mechanisms which are listed below.
- Stem cell transplantation
- Application of condition medium derived from follicle stem cells
- Application of exosomes derived from follicle stem cells
Stem cell transplantation involves the transplantation of stem cells obtained from bone marrow, adipose tissue, or umbilical cord blood. The stem cell suspension is injected or applied onto the affected areas of the scalp resulting in increased hair density and growth in the treated area.
Stem-cell-derived culture medium contains cytokines and growth factors secreted from the stem cells that are added into the nutrient-rich medium. Since CM is devoid of cellular entities, the donor-recipient match is not required. Individuals treated with stem-cell-derived CM present with increased thickness and density of hair.
Exosomes are referred to as vesicles secreted by follicle stem cells. These exosomes contain cytokines, RNA, and transcription factors. Stem cell-derived exosomes may serve as potential inducers of follicle growth and regeneration.
Unlike other therapeutic techniques, scalp micro pigmentation does not correct the underlying pathology, but rather conceals scalp baldness. This micro pigmentation serves as a permanent concealer that creates an illusion of fullness and characteristic texture of the scalp.
The operator may use pigments of different hues and viscosities to create this effect. Micro pigmentation of the area involves the insertion of pigment via a needle in the upper dermis layer of the scalp.
This micro pigmentation may be used for scarring alopecias, alopecia areata, hair loss disorders that do not respond to medical treatments, individuals who are not fit for hair transplantation, surgery, trauma scars, and chemotherapy-induced alopecia.
Consuming a healthy diet
The overall health and well-being of an individual largely depend on the food they consume. Eating a balanced and healthy diet conjugated with the intake of necessary supplements is essential for restoring nutrient deficiencies and combating thinning hair.
Since vitamin C, vitamin B, iron, vitamin D, selenium, and zinc deficiencies lead to alterations in the normal physiology of hair growth, it is important to consume supplements and natural foods to restore the normal levels of these micronutrients. One shall consult a physician to determine the nutritional deficiency and form a diet regimen to improve growth.
Natural, herbal non-surgical hair restoration
Herbal extracts have been used for growing hair and reducing hair loss since ancient times. Herbal extracts are derived from nature and have far lesser side effects than synthetic pharmacologic formulations used for hair restoration. Herbal extracts may be obtained from the following plants:
- Althaea officinalis
- Chamaemelum nobile
- Thymus vulgaris
- Rosmarinus officinalis
- Utrica dioica
Herbal extracts reduce the genetic expression of 5-alpha reductase, decreasing the formation of DHT, and protecting hair follicles against the growth-inhibiting action of DHT. Herbal extracts also stimulate cellular proliferation in the dermal papilla. Herbal extracts act at the molecular levels to improve hair growth and combat hair loss in alopecia patients.
Which non-surgical hair restoration is the best?
Picking the best is always based on your own preference or situation. It’s based on your needs, goals, budget, and time.
Hair loss is a global concern that rises with increasing age in men and women. Natural, medical, and surgical treatment options are available, each with variable efficacy and side effect profiles.
Surgical restoration of hair is often disfavoured owing to severe complications, increased cost, and failure of individuals to qualify as suitable candidates for hair transplantation.
Non-surgical hair restoration techniques are relatively safe and treat hair loss at its root cause.
This includes medications such as minoxidil, finasteride, spironolactone, and dutasteride. Non-pharmacologic hair restoration includes stem cell therapy, micro-needling, PRP therapy, LLT, herbal extracts, and a healthy diet.
While scalp micro pigmentation does not correct underlying pathology, it effectively conceals bald areas of the area.