Hair restoration approaches:

There are several options to restore hair loss. In HRKlinik, depending on the age, general condition, the density of the donor area, and finally the grade of hair loss, we tailor those approaches and set up a plan to come up with the optimum results for a fully covered scalp.

Surgically approaches

Follicular Unit Extraction ( FUE ): The most commonly used technique for hair restoration. 

This procedure is performed with local anesthesia being injected at certain points in the scalp to cause Nerve block, then Tumescence is injected across the donor area. The Tumescence is a mixture of Normal Saline, Lidocaine 2% and Epinephrine at the subcutaneous level. That is to numb the donor area and keep it bloodless for the rest of the procedure’s duration.

This procedure is performed with local anesthesia being injected at certain points in the scalp to cause Nerve block, then Tumescence is injected across the donor area. The Tumescence is a mixture of Normal Saline, Lidocaine 2% and Epinephrine at the subcutaneous level. That is to numb the donor area and keep it bloodless for the rest of the procedure’s duration.

Next, by using a specialized micro-motor device, with a very narrow diameter punch, we harvest the hair follicle at the subcutaneous level of the donor area.

Since the punch is cylindrical in shape, a single follicle, 2 and up to 4 follicles could be harvested with little amount of surrounding skin tissue. This is called a Follicular graft.
The sites from which the grafts are harvested tend to heal in 10 days leaving fine white dots marks. The narrower the punch the narrower the scars.

In HRKlinik, we use a very advanced micro-motor device with the narrowest punch possible to yield the most meticulous results with the least transection rates.

Hair transection means accidentally cutting and harming the hair follicle while harvesting it. Transected follicles show poor to no growth of hair upon implantation.

The follicular grafts are then counted, the excess skin is trimmed and prepared for transplantation.

After nerve blocking the recipient site, and tumescence is injected, small incisions are made using a Sapphire-tipped Microblade to create channels into the skin for implanting the harvested hair grafts.

Sapphire-tipped Microblades which are crafted from Sapphire gemstone, are sharper, smoother and more durable than the regular steel blades. This innovative technique allows the creation of multiple incision sites for hair implantation per cm2 in the recipient area without jeopardizing the blood circulation, eventually resulting in a denser look. 

Strip surgery or FUT technique

This procedure is also performed with Local Anesthesia injected at certain points in the scalp to cause Nerve block, then Tumescence is injected across the donor area. The Tumescence is a mixture of Normal Saline, Lidocaine 2% and Epinephrine at the subcutaneous level. That is to numb the donor area and keep it bloodless for the rest of the procedure’s duration.

The idea of this technique is to harvest a single strip of skin from the donor area. The wound is sutured in place, while the skin strip is prepared and cutted into small pieces and the hair follicles are harvested from that strip. 

After nerve blocking the recipient site, and tumescence is injected, small incisions are made using a Sapphire-tipped Microblade to create channels into the skin for implanting the harvested hair grafts.

The sutures are to be removed later after two weeks, leaving a fine linear scar.

This procedure is very helpful for those who have small scalp donor areas, for females, and for those who underwent previous hair restoration procedures and seeking more density.

Scalp reduction procedures

These procedures are nearly obsolete, yet we resort to them in certain cases. 

The idea of scalp reduction procedures is to excise a part or the whole area of hair loss under General Anesthesia depending on the glidability and the elasticity of the scalp. The wound edges are then sutured and the sutures to be removed after two weeks, leaving a linear scar. 

The advantage of these procedures is that they have fast results, yet they are very invasive.

However, in certain post-traumatic cases, like motor accidents, or Burns, when we have a very small hair bearing area and massive hair loss area to be covered, we resort to the Tissue Expander option. 

A tissue expander is like a balloon that is being inserted under the hair bearing area of the scalp under General Anesthesia. After a period of time, we keep inflating the tissue expander by injecting saline inside it every two week until the hair bearing scalp becomes expanded, enough to cover the adjacent area of hair loss.

Non-Surgical approaches

There are non-surgical supportive measures showing great results if the hair loss case is mild or could be combined with previously mentioned hair restoration procedures if the hair loss is advanced.

Plasma Injection

The injection of your blood’s plasma into the areas of miniaturized hair show great results after a few sessions. 
As plasma contains numerous nutrients and growth factors responsible for stimulating the hair follicle and help with the hair growth and its thickness.

Injecting plasma after hair restoration procedures helps significantly with wound healing, and accelerates the growth of the new hair.

Technique

Around 15-20 mL of Blood is withdrawn from the vein, placed in a Centrifuge device that rotates at a certain speed. It aims at separating the plasma from the rest of the other blood components. The plasma is then withdrawn and injected into the recipient site to help with wound healing and enhance the new hair follicle’s growth.

After approximately 6 sessions of plasma injections, decent results could be seen.

Hair Mesotherapy Injection

Injecting a mixture of minerals, vitamins and essential amino acids is very effective after multiple sessions. It works by activating the hair follicle and stimulating the growth of hair.

Growth Factors Injection

Growth factors are polypeptides that regulate the growth and differentiation of hair cells. Injecting a mixture of different growth factor families, for example the epidermal growth factor (EGF), fibroblast growth factors (FGF), insulin-like growth factor (IGF), Keratinocyte growth factor (KGF) and platelet-derived growth factor (PDGF) locally into the areas of hair loss or hair miniaturization will promote the hair growth cycle and induce hair growth.

Low level laser Therapy ( LLLT)

This is basically a device which sends low-intensity light to be absorbed by the skin with miniaturized hair. It promotes cellular activity and enhances the hair growth cycle adding thickness to the hair.

These LLLT devices like Laser caps, are easy to use and have no reported side effects. 30 minutes every other day  is enough to see decent results after 4 to 6 months.

Medical approaches

According to the grade of the androgenetic alopecia, some medications could alone do magnificent results, or could be combined with the surgical approaches in higher grades of hair loss.

Finasteride

For decades Finasteride has been used for scalp hair growth promotion, and preventing further loss for the hair in certain patterns of androgenetic alopecia.

Finasteride, is an FDA approved medication, a dosage of 1 mg daily will show great results after 6 months.

In male androgenetic alopecia the 5-alpha reductase enzyme converts Testosterone (the male androgen hormone) to Di-hydrotestosterone. (DHT). DHT attaches to the hair follicles in the recipient area, then due to hereditary factor, neural signals give an order to the hair follicles to induce hair loss.
Finasteride is a 5-alpha reductase Inhibitor Type 2 which acts on blocking the 5-alpha reductase enzyme, thus preventing the conversion of Testosterone to DHT. 

However, studies have proved that Finasteride has 1.9% side effects.

Minoxidil

Minoxidil was first used for high blood pressure treatment, but later they found it induces hair growth in bald patients , so a topical Minoxidil was developed, to be used topically over the scalp areas with hair loss.

Minoxidil has been used over the years combined with Finasteride 1 mg tabs, showing great results of hair growth.Its active ingredient, Minoxidil sulfate works by chemical reaction on the follicular cells inducing hair growth, and regulates the hair growth cycle.

Studies have shown that Minoxidil causes the follicular cells in the Telogen phase to shift rapidly to the Anagen phase. Thus abrupt termination of Minoxidil application causes disruption in the hair cycle leading back to hair loss within 12 and 24 weeks.

There are 2 forms of Topical Minoxidil which are FDA approved. Solution and Foam with dosage of 2% and 5%.
Minoxidil 5% Foam is recommended as it does not have the propyl glycol substance which could cause skin irritation.

Application of topical Minoxidil 6 times twice daily will show great results starting from 4 months of continuous treatment.

Other Medications Multivitamins and supplements could be added to the treatment regime to improve the hair growth, like Biotin, Zinc and Iron tabs.