Tag Archives: finasteride

The Costs, Pros & Cons To Hair Loss Treatments


Hair-Loss-in-menAndrogenetic alopecia (AGA), or male pattern baldness, is the most common form of hair loss. It’s inherited from either one or both parents and is caused by the hormone Dihydrotestosterone (DHT), which shuts down hair follicle growth. Men with this pattern baldness tend to have the classic “horseshoe” appearance of the scalp; women usually have thinning hair concentrated on the center part or diffuse loss on their entire scalp.

There are many causes for hair loss such as medical illness (diabetes, lupus, hyperthyroidism, and hypothyroidism), medications (antidepressant, beta-blocker, and cholesterol reducer), physical/emotional stress, chemical dyes, and even wearing tight braids/ponytails (Traction Alopecia),and over-styling of the hair.

Here are a few pros and cons of FDA approved hair loss treatments:

Finasteride-DHT Inhibitor

According to clinical studies, this medication, sold as Propecia, was most successful with patients. It’s primarily prescribed for men because it can cause serious birth defects in women.  Women of child bearing years may be prescribed Propecia, but special precautions must be implemented to prevent pregnancy because of teratogenic side effects in male infants. The cost is around $60 to 80 per month depending on the pharmacy.

imagesPros: In clinical trials in which men with pattern baldness took 1 milligram per day for two years, new hair grew in 66 percent of patients. In 83 percent, hair loss was stopped.

images copyCons: Side effects are infrequent but may include decreased libido, impotence and depression. These symptoms typically disappear if the medicine is stopped. Patients should commit to it for at least six (6) months of therapy before evaluating treatment effectiveness. If the patient stops taking the medication   any hair gained or maintained through the therapy will be lost.

Minoxidil

This topical product is manufactured in strengths of 2% (the only version approved for women) and 5%, which also comes in a foam. Sold under the brand name Rogaine or generically, versions sell for as little as $10 per month. Minoxidil works best on patients whose hair loss is recent.

imagesPros: In a study cited in the journal ACP Medicine, even the 2 percent solution was shown to produce visible hair growth in about one-third of patients and fine-hair growth in another third.

images copyCons: In the same study, minoxidil was ineffective in one-third of patients. Results might not be visible for 4 to 12 months, and like Finasteride (Propecia) any benefits are lost when you stop applying the product. Side effects include dry, itchy, or irritated scalp and increased facial hair.

Hair Transplant Surgery & Costs

If you want to regain a natural youthful hairline and medical therapy does not work,  or your hair loss is too advance, you will most likely require hair restoration surgery.  Modern hair surgery uses your own natural hair grafts which are moved from the back of the scalp, to the top or front part of your head. There are two surgery techniques used in hair surgery- FUE and Strip. The average cost per graft for the  STRIP technique is $4-8,  and $ 8- 12 for FUE.  The average hair transplant requires 1500 to 2,000 grafts for mild hair loss. Depending on the severity of the hair loss, multiple procedures may be required with over 6000 to 8000 grafts harvested necessary to achieve the proper cosmetic outcome.

imagesPros: If you find a skilled and experienced hair transplant surgeon, and the transplant is successful, you will end up with a youthful appearance of your hair.

images copyCons: Rarely does a surgical hair transplant fail in the hands of an experienced hair surgeon. Make sure the surgeon is an active member of the ISHRS and that they actually perform the hair surgery. Some doctors lack the training and skills to perform FUE surgery. So what these doctors do is to hire hair technicians do perform the surgery, and shake your hand and leave the operating room. Not ethical or legal behavior.

pic-patient-testimonial-6mo-postHair transplant surgeon at OC Hair Restoration of Irvine, California , Dr. Ken Williams, specializes in FUE hair restoration technique. He also not only helps patients struggling with hair loss, but he also speaks to his patients from personal experience. Dr Williams is an advocate for a daily treatment program to treat hair loss.

Williams states, “Daily treatment is key.  The use of a DHT blocker, like Propecia, and topical application of minoxidil will stop further loss and maintain current hair density.” He adds, “I use Rogaine 5% foam in the morning when I am in a hurry to get to work because it acts like a muse and holds the hair in place in the morning. For the evening dose,  I use the liquid Minoxidil from Costco because it is four ($4) dollars a bottle. I take a DHT inhibitor once a day, and I use the Laser Cap (low-level laser therapy) every other day. I have an aggressive approach to a daily treatment program because I had FUE hair restoration surgery, and I don’t want to be bald ever again.”

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New Finasteride and Dutasteride Medical Study


coverNewly released study on effects of DHT blockers

For over three decades, hair restoration surgeons have known that the Dihydortestosterone (DHT) molecule  has caused miniaturization of the hair follicle in both men and women. For over two decades we have known about specific blockers of these hormones, but only recently has the medical community come to understand the potential side effects of these powerful blockers.

A recent study  from Mayo Clinic and Tulane University School of Medicine physicians, was just released in the June 2013 issue of  Sexual Medicine Reviews. The article’s intended to review and summarize findings from all published medical and scientific literature detailing adverse events associated with Dihydrotestosterone blockers.

The results of the study validated current knowledge that DHT blockers are associated with a slightly increased rate of decreased libido, erectile dysfunction, ejaculatory dysfunction, gynecomastia, depression, and/or anxiety. This manuscript confirms previously known information and its findings do not change existing scientific and medical knowledge.

imagesThe controversy of DHT blocker use causing chronic sexual dysfunction began in 2012.  It was medical researcher, Dr. Michael S. Irwig, from George Washington University, who published a paper in the esteemed medical research periodical, Journal of Sexual Medicine, announcing certain chronic and long-term adverse sexual symptoms from DHT blockers.

The controversy surfaced because the study was not designed as a double blinded and traditional objective scientific study. Irwig’s study introduced researcher bias by recruiting patients from an internet forum site and a previous study he performed on the same subject material. Many medical doctors denounced this study citing inaccurate results because it could not be used to draw definite conclusions, and it lacked the high standards traditionally established in scientific publications.

Although, the majority of Irwig’s patients met the definition of sexual dysfunction by the Arizona Sexual Experience Scale, Irwig’s methodology in establishing a cause for his subjects sexual dysfunction has been scrutinized for simple issues such as a lack of baseline serum hormone levels of testosterone and DHT.

Irwig’s study today remains one of the very few studies defining possible long-term effects from DHT blockers. Dr. Ken Williams, an Irvine, California  hair restoration surgeon concludes, “This most newest research study reflects the need for ongoing and  further research, specifically aimed at finding prevalence rates and persistence of sexual side effects to establish a cause and effect relationships from DHT inhibitors.”

PATIENT SURGICAL RESULTS


29 year-old male came into The Irvine Institute of Medicine & Cosmetic Surgery concerned about hair loss in his frontal hairline.  The patient began losing his widows peak at 22 years-old, he began taking Propecia several years later.  Patient desired to recreate his widows peak to restore his youthful looks. 1817 grafts were harvested from the donor site and transplanted to the frontal hairline using Follicular Unit Transplantation (FUT) Linear STRIP technique.  After the transplant procedure patient began using Rogaine 5% foam twice a day in addition to taking Propecia, as recommended by Dr. Ken Williams. The pictures above show the dramatic difference at only 9 months post op, with final surgical results at 12 to 18 months.

Tom Hanks Hair Loss-Genetic Testing for Children


There are many inheritable characteristics children stand to obtain from their parents, and an unfortunately hair loss is one of them. If Tom Hanks‘ sons, Colin and Chet, want to know if they will one day in the future develop their father’s receding hairline, there is new science that will help them gather that information. DermaGenoma has revolutionized the field of genetic testing with Hair Dx.  Hair Dx is the newest and exciting science based and FDA approved genetic testing for hair loss.

In the field of hair restoration, the greatest challenge is when to begin treatment for hair loss for those genetically at-risk children whose parents suffer from hair loss. It is a well-known fact that many at-risk teenagers and young adults will not notice their hair loss until approximately 50% of their hair follicles are permanently gone. Although the medical research is lacking, the question is always asked by those patients at risk because of a strong family history,  is it reasonable to begin a medical treatment program before the hair loss is observed.  The hair Dx test provides the needed accuracy for the patient to decide on an early prevention program.

Hair loss surgeon Dr. Ken Williams of OC Hair Restoration Center in Irvine, California uses Hair DX genetic testing in his hair loss practice. “This test is based on solid science and academic understanding of DNA. It completely transformed what we know and how we treat hair loss in men and women” says Dr. Williams. “Those young adults can benefit from knowing their genetic test results so they can make a more complete decision on whether to start a medical prevention program.”

The Hair DX genetic test is not just for men, but it assist hair loss specialists in determining if specific medication, i.e., Finasteride,  will benefit women. In young men like Mr. Hanks children who have a strong genetic history of hair loss, it helps predict hair loss or thinning. If a patient is diagnosed early, timely medication stabilization and treatment programs will help delay miniaturization of the hair follicle.

FUE Is No Turnkey Procedure- Part Three: “Show Me The Money”


In parts one and two of the series,  “Plastic Surgeons Beware, FUE is No Turnkey Procedure,” the controversy was introduced and background information of FUE hair surgery addressed. In part three of this series, the details of the problem are further outlined. 

PROFIT AS A MOTIVE

To members and leaders of the authoritative hair surgery organization, The International Society of Hair Restoration Surgery (ISHRS), FUE is considered one of the most difficult and demanding surgical procedure to acquire the surgical skill sets and to perform.  It has a long learning curve and typically requires the surgeon to be present in the operating room up to 10 to 12 hours to complete a 2000 graft case. But the most troubling aspect of automated FUE is the “turnkey” promotion of certain FUE devices by sales people and business marketers.

Take for example one company located in the western United States that promotes the automated FUE device, NeoGraft.  This company  targets this technologically advance device to plastic surgeons, dermatologists, and med spas physicians who have either no or limited training in hair surgery.

Numerous physicians who are being  sold this “turnkey” model” FUE device by sales representatives representing NeoGraft without any patient oriented motivation or interests. These physicians lack the basic understanding of FUE hair surgery. Then there are some physicians have a sincere interest in entering the field of hair surgery, while some doctors just want to add FUE procedures to their  already successful Strip practice.

Sadly from my conversations, though, many physicians are entering hair surgery for personal financial gain based on “turnkey” assurances by sales people. In personal conversations, many physicians iterated they are minimally interested in mastering hair restoration surgery, or are primarily interested on additional income for their surgical practices in a weak economy.

One of the “turnkey” premises in marketing this device is a huge profit margin.  Marketers selling the NeoGraft FUE device claim quick profits. Amazingly, they simultaneously claim the surgeon does not have to learn, master,  or even perform hair surgery because the doctor can hire hair technicians.

Like the Tom Cruise “Show Me the Money” scene out of Jerry Maquire, one NeoGraft advertising claimed you can begin hair surgery and the “average revenue generated from a 2000 graft FUE Hair Transplant procedure: Between $14,000 & $18,000. We look forward to showing you how NeoGraft will be a positive addition to your practice.”

Another NeoGraft advertisement boasts,  “In the past, most physicians gravitated away from offering hair transplantation simply because it did not offer a good enough return for how much time and effort was required.  With the introduction of the latest, most advanced 4th generation NeoGraft, combined with an incredible turnkey business model for effortless implementation into your practice, those concerns are now a thing of the past.”

In this “turnkey” model, neophyte hair restoration surgeons are not required to learn hair basic knowledge or acquire advance hair surgery skills to start performing hair surgery. This is because affiliated staffing companies provide hair technicians with little or minimal skills or  training to perform the entire surgery from start to finish.

The business “turnkey” plan and financial model is based on hiring “highly skilled” and “certified per diem technicians” to perform the entire hair surgical procedure. Sales people mention nothing that removing human tissue from the human body requires a physician and surgeons license, and the physician and/or hair technicians may be in violation of state laws and subject to sanctions, license revocation, imprisonment and fines.

The automated devices sold by sales peoples and businessmen are based on a quick profit and commission. There is no observed concern by sales people for the proper training of physicians, or the legitimacy of establishing the skills and knowledge of hair surgery of the purchasers of NeoGraft.

No one is making the argument a plastic surgeon, dermatologist, or physician practicing in a med spa are not capable of learning how to perform FUE, or acquiring the cognitive skills of hair science.  But what is troubling is well-meaning specialty surgeons enter hair surgery practice having little or no training in hair surgery since their residency or fellowship. These surgeons have not kept current on the art and science of hair restoration in the last 10 years, lack continuing education and training, and are not members of a professional surgical hair organization such as the ISHRS.

I don’t want NeoGraft to gain a bad reputation because of terrible surgical outcomes and failures because of unethical surgeons and “turnkey” marketing by slick business people. My  exhortations to colleagues is to acquire the skills and learn the most up-to-date hair surgery information before you buy a $90K device.  Constantly apply this new knowledge and skill, and do not enter into a new cosmetic specialty field until being fully committed to ethical patient care and surgical hair restoration practices.

As a disclaimer,  It takes a long time and many years to acquire the skills and knowledge to successfully perform FUE and FUT hair surgery.  Attendance of the ISHRS annual scientific meetings as well as other learning opportunities offered by this fine organization, are required to improve the skills and knowledge of hair restoration surgery.For these skills and knowledge  the collegiality of  ISHRS colleagues who unselfishly shared their techniques and skills to perform hair surgery is deeply appreciated.

Hair surgery is my passion and joy.  I am a hair loss sufferer and patient who has had 4500 FUE grafts implanted in my scalp. I understand those patients who have loss their hair and desire to restore their youthful appearance.  I still have more surgeries to go and I can’t wait to finally finish the crown region of my scalp.

CONCLUSION

In the end, I am worried about the future credibility of legitimate hair surgeons who perform automated FUE with this great device.  Great technology in the wrong hands will cause bad patient outcomes and the reputation of NeoGraft will be tarnished. I don’t want either of these events to happen.

Patients don’t want “turnkey” hair surgeons or those surgeons who are in hair surgery for financial gain. I believe patient’s want their hair surgeon to be intimately involved in the preoperative, intra-operative, and post-operative phases of surgical hair care; and not just hire a technician to perform the procedure. Hair loss suffers want their hair surgeon to be current state-of-the-art hair surgical knowledge, regularly obtain up-to-date continuing education, and perform hair surgery because it is in the best interest of the patient rather than the financial interest of the doctor.

About the author

Dr. Ken Williams is a member of the International Society of Hair Restoration Surgery, and the American Academy of Cosmetic Surgery. He is board certified primary care physician practicing hair restoration surgery in Irvine, California. He performs FUT surgery but is primarily dedicated to FUE, and was one of the first physicians in the United States who experienced the long FUE learning curve using NeoGraft.

FUE is No Turnkey Procedure-Part Two: “Good Technology In The Wrong Hands”


In the spirit of this blog being both entertaining and journalistically objective, the”turnkey” uproar is further defined and details are added to the list of concerns generated by hair surgeons.  In part one of this series,“FUE is No Turnkey Procedure: I’ll Show You How Deep the Rabbit Hole Goes,” the controversial  issues were introduced and background information of FUE hair surgery addressed. In part two of this series, the details of the quandary are further outlined.

We live in a technology driven society.  Computers, Smart Phones and IPads  are updated every 6 months with newer and faster versions. Some people don’t adapt to the changes while others do. These quick adapters pre-order the newest high tech toys and then stand in line for 8 hours just to have this new and improved technology.

Advances in technologies is a good thing for society, but new technology in the wrong hands can be dangerous. As hinted in the first article in this series, unethical business people see easy profits with FUE and many of us who perform this procedure are legitimately worried about the unintended and self-centered consequences of their business agenda.

A cleaver and humorous analogy  is found in Hollywood’s sci-fi and entertaining movie, “The Stepford Wives.”  In this sexist Hollywood satire of the relationships between husbands and wives, certain residents in the city of Stepford take advance science and computer technology to secretly create the perfect wife. But at the end of the movie we witness disastrous outcomes because of self-centered purposes. The common thread with Stepford and FUE is advanced technology coupled with bad applications is a problem waiting to happen.

FUE IS NOT A “SEE ONE, PERFORM ONE, OR TEACH ONE” PROCEDURE

During medical school and residency training, numerous invasive surgical procedures are taught in hospitals and clinics. These procedures are taught to medical students, interns and junior residents by senior residents or attending staff physicians. They are often referred to as a “see one, do one, and then teach one” type. They are considered simple, straightforward, require ordinary hand eye coordination and skills, typically performed without complications, and obligate little time commitment to complete the procedure.

For the record, FUE hair surgery is not one of the “see one, do one, and teach one” types. Amazingly, though, sales people market certain FUE devices with the central concept that FUE is a simple procedure to master. Truth be said, FUE is anything but simple to perform or straight forward; and this procedure requires more than minimal skills and knowledge. But these device sales companies are marketing this simplistic viewpoint and then selling these devices to unaware and naive doctors.

The truth is FUE requires:

  1. Excellent physical stamina and strength because the operation usually lasts  10 hours to complete a 2000 graft case.
  2. A long learning curve to acquire the skills and knowledge to consistently avoid transection of the hair follicle.
  3. The patience of the Biblical character Job in harvesting hair follicles with steep exit angles.
  4. Steady hands and excellent hand-eye coordination to use a hand held instrument that cuts 2-3 mm into the skin to remove the hair follicle.
  5. No concurrent musculoskeletal or repetitive motion disorders as the surgeon is required to maintain a fixed sitting position for extended periods while moving exclusively the upper extremities.

FUE hair surgery is unlike any cosmetic surgery because of the required physical stamina for completing typically long cases.  Again, a case usually requires 10 hours to perform and the surgeon needs to commit to be present and involved in the surgery for the entire time period. For comparison, breast augmentation or a face lift typically take  2 hours to perform.

I recall one of my early challenging 2000 graft cases that lasted fifteen 15 hours because the hair follicle exit angles were very steep, thus making it more difficult to extract the hair follicles. We started the case at 7 am and ended around 9 pm.  In this specific situation, the harvesting of the hair follicles required a much slower rate of extraction causing the length of procedure to be longer than usual.

NO EXPERIENCE NECESSARY-JUST HIRE TECHNICIANS TO PERFORM HAIR SURGERY

Another serious issue of the “turnkey” controversy is that surgeons are being told by sales people they don’t need any experience to perform hair surgery in order to begin charging patients for the FUE procedure. The only requirement is a state issued physician and surgeons license, and a signed service contract with an affiliated company to hire hair technicians that will perform the entire procedure from start-to-finish.

The sales pitch to the surgeon also includes the most reckless patient care concept, i.e., with minimal oversight of the hair surgery case, the doctor can simultaneously perform other surgical cases in their office while the hair technicians performs the entire hair transplantation case without physician expertise or oversight.

No person has a problem when a medical device is being marketed and sold with high standards and regards for the patient and cosmetic outcomes. But unscrupulous business people are specifically targeting the medical disciplines of Dermatology, Plastic Surgery and Medical Spas. They are promoting principles for the practice of medicine and surgery primarily motivated on financial gain.  The controversial issue comes down to physicians being motivated to perform hair surgery based on what is in their best interests (usually financial), rather than the best interests of the patient.

Yes, there are people who enter into the medical profession with bad intentions, but medical state disciplinary boards weed these doctors out of practice after problems are encountered. But money should never be the central driving force of performing surgical procedures, especially in highly difficult and demanding procedures like FUE.

The  bottom line is business people promoting an unethical premise with “turnkey” promises, personal financial gain by physicians, coupled with improper training and performance of this procedure, it is a recipe for disaster and bad patient outcomes.

 

In tomorrows final article on the controversy of FUE devices being sold as a “turnkey” model to physicians and surgeons, Dr. Williams explores the “Show me the Money” advertising claims and agenda of business people.