NOV-DEC 2015

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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Page 50 of 75 | NOVEMBER/DECEMBER 2015 49 says facial plastic surgeon Sean R. Weiss, MD, of Khoobehi and Associates in New Orleans. "Facelifts can leave areas behind and in front of the ear where hair doesn't grow prop- erly, and I have great success restoring sideburns and hair lines for these patients. Although this is currently just a tiny fraction of our business, it is something I think we'll be seeing more often in the future." While men have been the primary focus—and still make up the majority of patients—for practices that offer hair re- stora tion services, a growing number of women are seeking treatment for age-related hair loss and thinning. In 2014, women comprised only 15% of surgical hair restoration patients, but they made up 40% of nonsurgical patients, according to ISHRS data. "My husband is a hair transplant surgeon, and we found that his practice really didn't serve the unique needs of his female clients," says Mary Wendel, MD, medical director of Medi Tresse in Wellesley, Massachusetts, New England's only medical hair rejuvenation center catering exclusively to women. "It is often harder for women to seek help, and we soon realized that a transplant offi ce populated with men was not ideal." Nadia Satya Urato, MD, of Urato Dermatology in Fram- ingham, Massachusetts, is also seeing an increase in female patients at her practice. "For women, hair loss is perhaps more devastating than for men because luxuriant hair is so tied to femininity," she says. While physicians specializing in hair restoration still don't have the silver bullet many patients seek to stop hair loss, their ability to help men and women with thinning hair is improving with new noninvasive procedures and more effective surgical treatments. NONINVASIVE OPTIONS All of the physicians we interviewed recommend a compre- hensive approach to hair loss that includes not only a thorough scalp examination and testing to rule out systemic conditions that might cause thinning hair, but also a discussion of nutrition and lifestyle. All but one of our panelists recommend minoxidil, which works by increasing blood fl ow to the follicles, and fi nasteride, which inhibits DHT, for appropriate patients. Some patients even combine the two medications. Richard P. Giannotto, MD, of Giannotto Clinic in McClean, Virginia, is cautious. "I feel that minoxidil and fi nasteride have too many side effects to be used long term," he says. "I do recommend saw palmetto for many patients desiring a natural remedy to help slow down hair loss progression." Androgenic alopecia is the most common cause of hair loss among both men and women. "Men can begin to see the effects of male pattern baldness in their early 20s and often seek help at that time," says Jeffrey Epstein, MD, a facial plastic surgeon with offi ces in New York City and Miami, and spokesman for the International Alliance of Hair Restoration Surgeons. "With men we often use a combination of medical and surgical treatments. To help younger men hang on to the hair they have, we prescribe medications such as Propecia (fi nasteride) and low level laser therapy (LLLT). For women, who comprise about 30% of our practice, we combine Rogaine (minoxidil) and LLLT treatments. Shampoos such as Nizoral (ketocon- azole dandruff shampoo, McNeil) or Nioxin can help clean up the scalp and perhaps improve the effectiveness of other treatments." John Kahen, MD, founder and medical director of Beverly Hills Hair Restoration, says shampoos that inhibit DHT "show fairly positive effects on my patients suffering from hair loss." He also recommends minoxidil and vitamins targeted to hair and nail growth. Dr. Weiss encourages all of his patients to use minoxidil and fi nasteride if they can. "These medications not only help patients hold on to existing hair but can help improve the quality of hair growth, even for patients after transplant sur- gery," he says. He also recommends vitamins such as BioSil and Viviscal to support the overall quality of hair growth. "I like Propecia for older men with more advanced hair loss who may be thinking about hair transplantation but aren't ready yet," says Dr. Urato. "It helps them preserve the hair they have and can give them a small amount of regrowth, about 15%. I am less likely to suggest it to younger men because of its side effects." Low Level Laser Therapy (LLLT): "We are thrilled with LLLT," says Dr. Urato. "It is safe, safe, safe and it works, works, works. I've used several devices but my favorite is the iGrow (Apira Science). It's easy to use, but I am frank about expecta- tions. LLLT won't suddenly produce luxurious hair growth, but it can help patients keep what they do have and add on average 20% regrowth. Most women are thrilled with the responses they get. During the fi rst month they are relieved that their hair is no longer falling out as it was and then during the next few months they begin to see new growth. Fewer than 2% express dissatisfaction." A randomized, blinded study of the iGrow Hair Growth "H air restoration is about 40% of my practice, mostly men and a few women with androgenic alopecia, but we also see female patients for scar revision,"

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