How Effects of Minoxidil Wanes Over Time, and Importance of Saving Native Hair with Hair Transplants

Author: Amiya Prasad, M.D.

Thank you for your question. You submitted a question without any photos and you describe in your question that you have been on minoxidil for about 2 years and you noticed that after awhile, it wasn’t working. And you decided to stop the minoxidil and you’re going to undergo a hair transplant in about 2 months.

And you’re asking if the stopping of the minoxidil will allow for enough of the hair that was preserved with the minoxidil to be gone so your transplant doctor can do a more accurate and effective hair transplant. Well, I can certainly share with you my thoughts on your situation even though I don’t have the details of your clinical history, your age, the onset of your hair loss, the degree of progression and the amount of anticipated grafts, etc. However, I can give you a global understanding of how I approach this type of situation in our practice. A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Hair transplant has been a significant part of my practice for many years.

In fact, I am the founder of TrichoStem™ Hair Regeneration Centers. This is a system we developed to help men and women with thinning hair, actually manage their hair loss non-surgically using a system we developed that evolved from hair transplant. So I’ll get into that later. Now essentially when you think about hair loss treatment, you are first of all dealing with a condition that is progressive. So regardless of whatever the intervention is, minoxidil, the oral drug finasteride so that falls in the pharmacologic realm as well as PRP, Hair Regeneration and transplant, what you are really doing is managing hair loss.

You’re managing from one strategy the effective lifespan of hair follicles and in the other strategy, the surgical strategy, you’re trying to place coverage in areas that are devoid of coverage. So when it comes to the effect of minoxidil, certainly, there is some benefit with minoxidil. But as is the case for any pharmaceutical, when you stop the drug, you stop the effect of that drug. And the slow progressive loss of perception of effectiveness is very common with minoxidil. Minoxidil can prolong the growth cycle of thinning hairs but those thinning hairs will still fall out. And in my observation, a more effective benefit from a pharmaceutical will be the use of a drug finasteride which for the right candidate, by blocking DHT or dihydrotestosterone, result in a prolongation of the hair growth cycle and allow for a more sustainable longer lasting effect when compared with minoxidil.

How Effects of Minoxidil Wanes Over Time, and Importance of Saving Native Hair with Hair Transplants

A lot of people are unfortunately afraid of taking finasteride although clinically speaking, in my experience, it’s still a viable choice in the management of hair loss. We developed a system for hair loss that actually evolved from hair transplant and this treatment is called Hair Regeneration. Hair Regeneration was developed as a result of first using a material called extracellular matrix which is a wound healing material that is based on stem cell technologies.

It’s not placement of stem cells but rather your body’s recruitment of its own adult stem cells to expedite wound healing. This was in combination with something called PRP or platelet-rich plasma. This was derived from your own blood and what we developed over time is a combination that helps people with hair thinning. Now what developed from hair transplant was that we wanted the hair grafts heal better and have better outcomes in terms of yield as well as improve the healing of the donor area where the hair is harvested. I think it’s very important to understand that anything that can prolong the lifespan of your existing hair and mitigate this progressive condition of hair loss is important regardless of what transplant you do. People feel very good about getting hair transplant and as surgeons, we like doing the hair transplant. But the success of the long-term coverage of the transplant is dependent on the integration of existing hair with transplanted hair. And so, what you want is to maximize the lifespan of existing hair.

With Hair Regeneration, what we have learned over time and we have been at this for over 7 years is that for the right candidate, which basically means someone with moderate rate of progression and moderate degree of hair loss, we’re able to, for both men and women, achieve with an injection treatment 5 years of improvement. And this improvement is defined by stopping the progression, reactivating hair follicles that aren’t growing and prolonging the growth cycle and thickening existing thinning hair. In effect, getting the desirable coverage that we want with a hair transplant. So again, to answer your question about the minoxidil, certainly it’s likely that hair that is effectively not responding as well to the minoxidil which prompted your pursuing of hair transplant is likely to not be present in any significant numbers by the time the hair transplant is ready to be done. A lot of times, when you are doing hair transplant, just to blend the transplanted hair with existing hair, these finer, thinner, wispier hairs are essentially not seen as significant and the grafts are placed either between them or through them and that is the reality of hair transplant. So I think that it is important for you to discuss with your doctor what strategy for stabilization will be of benefit.

We are actually helping a lot of patients coming from all over the world with Hair Regeneration as a primary treatment for male and female pattern hair loss but we’re also helping people who undergo hair transplant. And the way this works is if the patient comes within the first month to 3 months after a transplant, we do this injection treatment and we are able to expedite the healing of the transplant, expedite the regrowth of the transplant as well as thicken existing hair so that the transplant and the existing hair blend very well, the coverage is improved. So there’s a nice synergy there. So I think that certainly, we have addressed the question about minoxidil but I think it’s important for you to at least learn about ways to help stabilize as much as possible. Again, you can’t stop hair loss but we can certainly slow it down and get coverage that can last as long as possible depending on your genetic situation. So I hope that was helpful, I wish you the best of luck and thank you for your question.

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