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Dr. Korman offers the following non-surgical treatment options for hair restoration:
Medical Treatments: Rogaine and Propecia
Rogaine (Minoxidil)
Minoxidil has been available for almost 20 years as a treatment for both male and female pattern hair loss. It is applied directly to the scalp skin to stop ongoing hair loss and stimulate new hair growth. The exact mechanism through which minoxidil works to prevents hair loss is poorly understood. It is available in 2% or 5% solutions and while the 2% strength is sold over-the-counter, it is best and most effectively used in a treatment program planned and supervised by Dr. Korman.
While not the “miracle drug” that was originally hoped for, when used as directed, 2% minoxidil has been shown to stimulate hair growth in about 30% of male patients. The 5% solution has been shown to be more effective than 2% in men. Women have been shown to have a better response than men to topical 2% minoxidil but 5% has not proven more beneficial to female patients.
Minoxidil is a lotion that is applied to the scalp twice per day. In the United States, it is also available as a mousse which is more convenient, however this formulation is not yet sold in Canada. In most patients, minoxidil takes several months to produce visible results and it is common to actually see some temporary shedding of existing hair one to two months following the initiation of treatment. Many patients are alarmed by this but there is no cause for concern as this shedding is the precursor to new hair growth. It is important to remember that the primary goal of treatment is to prevent additional hair loss. If there is no change in the appearance of your hair during the treatment period, this should be viewed as a success, not a failure.
Minoxidil is most effective in people with recent onset of hair loss affecting relatively small areas. It is often more effective in improving hair growth in the central, rather than the frontal area of the scalp.
Dr. Korman will sometimes recommend minoxidil as part of a treatment plan to prevent progression of small areas of male or female pattern hair loss or to slow hair loss in young patients, delaying hair transplantation for several years in order to conserve the supply of hair that will be needed later for transplantation. It is sometimes used to complement hair transplantation or in combination with Propecia (finasteride), enhancing the appearance of fullness in scalp hair.
If minoxidil proves effective, its use becomes a lifetime commitment. If application is stopped, all results of therapy will be rapidly lost over the next 3 months. Side effects of topical minoxidil are few and generally minor.
During your consultation, Dr. Korman will identify whether minoxidil might be helpful in your specific situation.
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Propecia (Finasteride)
Finasteride (Propecia®) is an orally-administered prescription medication that influences one of the key hormones responsible for male pattern baldness by blocking an enzyme known as 5-α reductase. Years of investigation and use by more than a million patients have demonstrated its long-term effectiveness and safety in treating male pattern hair loss in men of all ages and all ethnicities. Finasteride is sometimes used alone or in combination with minoxidil to complement hair transplantation. Normally, it is not prescribed for women.
Like minoxidil, finasteride is most effective in slowing hair loss and stimulating new hair growth among patients with early to moderate degrees of loss involving the crown of the scalp rather than the frontal area. Men with extensive hair loss are unlikely to experience much re-growth with finasteride and are generally better candidates for hair transplantation or other surgical approaches to hair restoration.
Finasteride will stabilize hair loss in approximately 90% of men who use it. It generally takes at least 4-6 months to realize an improvement and 1-2 years before the full benefit is achieved. It is important to remember that if left untreated, male pattern baldness will progress relentlessly. While some patients experience re-growth, the primary goal is to prevent additional hair loss. If there is no change in the appearance of your hair during the treatment period, this should be viewed as a success, not a failure.
Like minoxidil, if finasteride proves effective, it becomes a lifetime commitment. If treatment is stopped, all benefits are rapidly lost. Side effects such as reduced libido are rare and are reversible with cessation of treatment.
Finasteride is frequently used in combination with other treatments. For instance, hair transplantation may be recommended to recreate the frontal hairline with finasteride used to halt or slow further hair loss. Dr. Korman will identify whether the use of finasteride fits into your treatment plan.
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Low Level Laser Therapy (LLLT)
Low-level laser light has been found to have biomodulating effects on human hair and hair follicles and clinical studies have shown that low-level laser light is effective in preventing hair loss and stimulating re-growth in both men and women. There are a number of hand held devices that are now available and LLLT has been approved for the treatment of hair loss.
Dr. Martin Unger, with whom Dr. Korman trained, is a world authority on the subject of low-level laser therapy for the treatment of hair loss and has lectured extensively on the subject including at many of the Annual Meetings of the International Society of Hair Restoration Surgery (ISHRS). Dr. Unger is the past Medical Director of a firm that makes a hand-held low-level laser therapy device for home use in hair restoration (HairMAX LaserComb, Lexington International, LLC, Boca Raton, FL). Dr. Unger has noted that the cosmetic effects of low-level laser treatment include improvements in hair sheen and strength, characteristics that enhance the perception of "fullness" in overall hair appearance.
For more information about low-level laser therapy, visit www.ishrs.org
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Hair Systems
For individuals with advanced male or female pattern hair loss who would like the appearance of a very full head of hair, an external hair system such as a hairpiece may be appropriate. Hair systems may also play an adjunctive role to hair transplantation or other treatments or be appropriate for patients who are not candidates for or wish to avoid any form of surgery. They may also be appropriate for patients whose needs may be temporary, such as those undergoing chemotherapy or having other medical conditions.
When custom-made under the supervision of a specialist, hairpieces and replacements can meet the needs of selected patients. It is very important to note that hair systems require regular, long-term care. A hair system can be expected to last about 18 months before it begins to lose its natural appearance and needs to be replaced. Maintenance and replacement costs of hair systems are often many thousands of dollars, and should be taken into account when making a decision as the long-term investment can be substantial. Hair transplantation may involve a greater initial cost, but because the results are permanent, may ultimately be more economical when compared to costs of hair systems over time. Patients who already wear hair systems can still be candidates for hair transplantation and may continue to wear their systems until the transplanted hairs have grown in.
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