Thick, lush, healthy, silky smooth and shiny hair – it’s every woman’s dream. For men, it’s simpler but the same idea- a thick full head of hair. Hair thinning and loss is one of the most emotionally difficult concerns patients present with and it’s anything but superficial. Hair is deeply tied to our self-esteem. I wrote an article on hair loss for LVBX Magazine that reviews the common causes and facts – this post is devoted to the best treatments available to grow hair.  There are many options from over-the-counter products to in-office treatments and home-use lasers:

1. Over the counter

These are options available at your drugstore or online. They often contain the FDA approved active minoxidil, alone or in combination with other ingredients. Your dermatologist may also custom-make a formulation adding in prescription-strength ingredients not otherwise available.

• Minoxidil: at 5% is FDA approved to grow hair in both men and women and is available in various concentrations from lots of companies from your local drug store, online, department store or dermatologist. The ones dermatologists carry typically also include other supporting ingredients. I have one in my hair growth program that also contains niacinamide and caffeine to minimize irritation, improve absorption and also optimize the anti-aging effects to the skin and follicles.
• Antioxidants: are helpful in creating healthier scalp skin and hair follicles, improved circulation and stronger hair. They work well with other components of a hair growth program to support and optimize results.
• Julien Farel Magnifique serum: contains an excellent cocktail of antioxidants including resveratrol in a formulation that leaves the scalp rejuvenated. I’ve even seen it help with patients who have itching, scaling and redness of the scalp with or without hair loss. It works well alone and even better with Julien Farel Restore shampoo.
• Esteem botanical hair loss solution: is one I created and has a mix of natural actives (biomimetic peptide combined with a red clover extract rich in Bochanin A) to help support hair growth as part of my hair growth kit consisting of a specially formulated shampoo and conditioner to complement the botanical solution.

2. Low Level Laser Therapy

This is an area where I’ve seen excellent advances in quality, efficacy and ease of use. There are over 2,000 investigations from over 80 countries on the effect of Low Level Laser Therapy (LLLT) on humans and animals published in the medical literature.

The early hair combs are now also offered in versions that look like baseball hats that cover a broader surface area of the scalp, leaving your hands free and making treatments easier and more efficient. They also have better diodes, providing excellent energy while covering a broad area of the scalp at one time. It’s still not fully understood how they work but the idea is that they:

• Influence hair growth in 3 stages
  1. Stops hair loss
  2. Current hair becomes thicker and fuller
  3. Regrowth of new hair (hair follicle grows terminal (thicker) hair in place of very thin “peach fuzz” (vellus) hair)

• Almost 100% of patients using a Hair Growth Laser go through stages 1 and 2
• 70% of patients using the Hair Growth Laser experience stage 3 (regrowth)

Low level laser therapy caps allow for flexibility within your schedule as it can be done in the comfort of your own home and can absolutely be used in conjunction with other hair growth procedures and prescriptions. Brands I’ve researched that stand out as superior include:

Theradome

Laser Cap

3. Cortisone Injections

This is done by your dermatologist and, in my view, works well for all types of hair loss including the genetic male and female types. I do low concentration injections at monthly intervals for 5 months and then switch to treatment every 3 months. Using topical cortisone is not effective since the follicles are deep and the medication will be carried away by the bloodstream before reaching the follicle if applied topically. At the concentrations and volumes I use I have never seen any systemic side effects or atrophy (thinning of the skin of the scalp).

4. Supplements

There are two supplements I believe have the greatest amount of data for hair growth:

• Viviscal Professional: this is a 100% drug-free way to nourish thinning hair and promote existing hair growth and has excellent clinical data. The formulation includes:  
  • 50% more of revolutionary AminoMar ingredient. Exclusive and Patented AminoMar Marine Complex provides the essential proteins needed to nourish thinning hair and encourage growth of existing hair
  • Horsetail Extract, an organic form of silica which increases the strength of the hair and revitalizes lifeless hair
  • Vitamin C derived from the Acerola Cherry (one of the richest sources of Vitamin C available)
  • Fish and shellfish, making it not appropriate for those allergic to these ingredients or for those with celiac disease

• Nutrafol: This is a super-supplement that addresses the critical stages of hair health, helping to combat the effects of hair-damaging hormones, free radicals, inflammation, and stress – addressing the causes of unhealthy hair and empowering follicles to absorb nutrients and grow fuller, healthier hair. Key ingredients include:
  • Tocomax 20%™, a form of Vitamin E extracted from Tocomin® palm oil, that’s been shown in a clinical study to increase hair growth on average by 34%
  • Sensoril® Ashwagandha, clinically proven to decrease the levels of hair damaging stress hormone Cortisol by up to 30.5%, reduce inflammatory C-reactive protein (CRP) by 35.2% and improve resistance to stress
  • BCM-95® BioCurcumin, a potent anti-inflammatory and antioxidant clinically proven to lower inflammatory biomarkers, like CRP.  Extracted from turmeric, curcumin optimizes the immune system + fights many inflammatory molecules that slow hair growth
  • Cynantine® HNS, a solubilized, more bioavailable and bioactive keratin provides the building blocks of hair – amino acids like cysteine and proline; proven to improve hair strength and brightness
  • Hydrolyzed Marine Collagen & Hyaluronic Acid, rebuild the structural integrity of the hair follicle environment, improve moisture, and promote diffusion of nutrients. Hydrolyzed to a low molecular weight for better bioavailability
  • Bioperine®, a natural thermonutrient that synergistically increases the body’s absorption of other phytonutrients and key ingredients
  • It does not contain: Gluten, Wheat, Shellfish, Binders, Fillers

5. Prescription Medications

These include Propecia which is FDA approved for men and Avodart. I offer these to my male patients with male pattern hair loss alone or along with my hair growth program. If I use both medications, I have them take Propecia for 5 days and Avodart for 2 days of the week since Avodart stays in the blood longer and has more side effects (your dermatologist can review side effects and treatment options with you).  I recommend that patients alternate between the two medications, such as taking Avodart on tuesdays and fridays and Propecia the the remaining days.

Some doctors also prescribe these for women as well but it’s not something I’m comfortable with. For women with a hormonal pattern and who are not planning pregnancy, I sometimes offer Spironolactone, an off label use of Avodart, usually prescribed as a diuretic but also has effects of blocking androgen hormone receptors so it has some use in hair thinning. We need to use high doses and there can be side effects of irregular periods, dizziness, high blood potassium levels and breast swelling and tenderness. It can also take a full year or so before seeing results.

6. Platelet Rich Plasma (PRP) Injections

I spent years researching and reviewing data and devices for PRP for the scalp before deciding to add it to my hair growth program. The hair promoting effects of PRP are supported by studies showing a faster transition to the growing (anagen) phase of hair cycling back from the resting and transitional phases, and also an increase in the number of newly formed follicles and earlier hair formation.

The process is an in-office treatment which starts with gentle tapping into a vein in the arm to extract a small amount of blood, the equivalent of about 1.5 tablespoons, which is drawn into a specialized test tube. The test tube is actually the key to the process and is what separates one system from another. It contains filters that when placed in a centrifuge and spun at rapid speeds, separates out and concentrates the platelet-rich plasma. There is no FDA approved process or protocol so each office determines their own program.

Who is a good candidate? This is something I recommend for my patients with male or female pattern hair loss or for rejuvenation of the scalp and follicles to recover from the changes of loss of volume and density that comes with age even for those without male or female pattern hair loss. I do not recommend it for those with the autoimmune form of hair loss such as alopecia areata, alopecia totalis, universalis, or for scarring forms of hair loss.

Based on the data, I created a schedule for treatment as follows:

Active Phase:

• 4 treatment sessions at 1 month intervals
• Hair Growth supplements
• Esteem Hair Growth Kit
• Hair Growth Laser
• Esteem Active Drops

Year One Maintenance Phase:

• One Treatment every 3 months
• Hair Growth supplements
• Esteem Hair Growth Kit
• Hair Growth Laser
• Esteem Daily Drops

Year Two Maintenance Phase:

• One treatment every 4 months
• Hair Growth supplements
• Esteem Hair Growth Kit
• Hair Growth Laser
• Esteem Daily Drops

Follow up Maintenance:

• One treatment every 6 months
• Hair Growth supplements
• Esteem Hair Growth Kit
• Hair Growth Laser
• Esteem Daily Drops