Ultimate Hair Loss Guide | Dermatologist Tips

What'S up everyone we're back dr maxfield, dr shaw, and today we have a long awaited video, so a lot of people. I don't know if you always talk about this, but dermatologists specialize in the skin, the hair and the nails, and so today long-awaited video about hair loss. It'S finally, here we've been dying to talk about this on rn2 and now is just the time. This is certainly one of my passions, one of your passions as well from a personal standpoint. Hair loss can be devastating for people. It can really affect your psychological state of mind. It really is important to a lot of people, and so we get a lot of questions and we're going to try to answer most of the questions that we get today bear in mind. We will do a lot more videos on this. This would be more of a series. Today is going to be our intro to hair loss. So when we think of hair loss, we kind of go into scarring and then non-scarring and there's like this huge tree of different types with the non-scarring there's the really common type and that's androgenic or pattern hair loss. So that's the one we're gon na focus on today. It'S the most common, so we're just gon na start there now one of the most important things about hair loss, i'm gon na intro it right here, because i think it's so important because some people might not get through the whole video. The most important thing with hair loss is that time is the most crucial factor about acting on it. The sooner you intervene on hair loss, the better results that you're going to have with any hair growth treatment, and if you have a scarring form of hair loss, if you don't stop the scarring, those follicles are done absolutely. This is by far the most important thing. If you let those hair follicles die, they are dead, they are gone and you are only going to be able to help them with procedures. If that everything about androgenetic alopecia. Here we go here, we go so most of what we're talking about in this video is offered by bosley. Now you may have heard of bosley. I heard about bosley growing up always there were always commercials about bosley like what is this place right? This is a place that focuses solely on hair restoration. They have hair restoration specialists that work at these places and, as a matter of fact, at our office, we do not offer a hair transplant, and so, when i came here and i had some patients that were candidates for hair transplant, i asked where do i send These patients - and they said we send them to bosley, because bosley is the nearest hair transplant location to us. So for years, i'm sending patients to bosley, we decided to partner with bosley for this video and before we decided to actually officially partner, i actually drove out to the bosley center in raleigh north carolina to check out the facility to see actually what they have to Offer first, i'm like: why am i sending all these patients here? I want to see what they're getting into and also, if we're going to do this video. I want to make sure that taking really good care of patients - and they are what's up everyone - we're in raleigh north carolina at the bosley hair restoration center, we're going to be doing a tour, we're going to be doing a walk through so come with us join Us on this journey, let's go all right. What'S up everybody, i have the wonderful dr phipps here and first of all before i just met her amazing personality right off the bat you guys are going to love her uh, introduce yourself i'm dr angela phipps, and i am the medical and surgical hair restoration for The bosley office here in raleigh north carolina all right, so we drove out here to kind of learn more about what bosnia has to offer. You guys are pretty comprehensive yeah, so we offer any medical therapy for people who have just started or early in their hair loss and they're, not necessarily in need of any restoration procedures, or anything like that. So we highly advocate the use of the oral medication called finasteride as well as topical medications like rogaine or minoxidil, liquid or foam, as well as low level light therapy devices that you wear externally on the top of your head for photobiochemical stimulation. And then, if your hair loss has progressed to the point where you actually have a bald spot or a significant area of thinning that you would like to have enhanced, we offer two different hair transplantation techniques or restoration procedures. One is called the fut and that's where we actually remove a strip of scalp out of the back of the head and sew it back together and dissect the individual hair follicles out of that piece of tissue and then implant, those in the hair loss areas. Or we offer the minimally invasive fue follicular unit, excision technique, where i remove every hair follicle individually from the back of the head, which does not leave a linear scar like the fut procedure does, and then the implantation process is the same for both of those procedures. Like with all things, we talk about what causes it first, because if you know what causes it, then you can kind of know how to treat it. The problem with androgenetic alopecia is that both androgens and genetics play a role and it's a very complicated role. How these things come together now you can't change your genetics, but what you can do is try to alter some of the androgen dependent issues that are happening. So what are androgens androgens are the hormones such as testosterone and dhea or dheas, and these can act throughout the body and then for our purpose is specifically the scalp and the follicle. So we have these circulating androgens throughout our body, they're like floating little communication signals and there's one receptor, maybe two, but one primary receptor on the scalp that this is mediated through and that's five alpha reductase. So this sits within the hair follicle. These little androgens act on it and this actually shifts the growth cycles in the hair shifts other things within the hair causes them to miniaturize and eventually stop growing, so it stops growing and then it falls out now. First, we have to kind of look at the cycle of hair, so hair goes from anagen to catagen and then to telogen. So antigen is the growth phase and then catagen is sort of this in between phase and then telogen. Is that resting phase? And then, after that, your hair falls out, so it kind of goes from it shortens that antigen phase and then shifts it to that telogen phase. Now this can manifest in male or female pattern, hair loss so for males you usually lose hair on the temple areas. First and then the vertex crown area and then for females, it's more of a diffuse thinning and they call this a christmas tree pattern of hair loss and basically it's just thinning in the center area. Here now it's worth noting that you really don't start to notice and other people don't just start to notice your hair loss until you've lost about 50 of the hair on your head, which means at this point, if you're starting to notice hair loss, you're really racing Against time yeah so interesting numbers here with this, you know we each actually have about 100 000 hairs on our head, so you would lose about 50 000 hairs before you even really notice that difference also, we all lose naturally about 100 hairs on our head. Every single day, so some conditions increase that tremendously by shifting the hairs from the growth phase to that shedding phase yeah, and we call that condition. Telogen effluvium and you often see that after really stressful events happen so pregnancy, a big move, a death of a family member. We saw this a lot when kobe was at its peak that people were starting to lose hair pretty rapidly. Now you start to lose hair. More rapidly and it's because of a stressful event and they sort of lose hair, so you get a little bit more stressed out, which makes it even worse right. So what ends up happening is that your hairs in telogen effluvium shift from that growth phase rapidly to that telogen phase, and it takes about three months for those hairs to actually fall out. And so you won't even sometimes remember what the stressful event is and then, when we're asking patients, we say: hey did something happen three months ago, four months ago and they're like yeah. Actually this really bad thing happened and then we kind of get to the bottom. That this is telogen effluvium, but if you start to lose hair more rapidly than you were before it may unmask androgenetic alopecia that you were already suffering from right. So let's say you have like 70 000 hairs left on your head and it looks pretty normal-ish. Then still genetic fluvium comes along shifts: 30 000 hairs into the shedding phase, all of a sudden you're left with what 30 000 hairs left. I forgot how many hairs you had on your head initially, but regardless you fall below that threshold and your hair just looks thinner overall and in the areas where you're already thinning like in in the temporal area there. It becomes very apparent. It'S like one of those math problems where they're like luke has a hundred thousand hairs. He loses thirty thousand years that he undergoes telogen effluvium. So basically, this is what happens and it's extremely stressful. It'S happened to me before i do have androgenetic alopecia. I do go through stressful moments, where i have telogen effluvium and those things combine exacerbate my stress, and so i completely empathize with anyone who is going through this yeah and we've said this in so many videos. I think we're both very passionate about this. I'M gon na out my dad here he is very bald and i've always been very concerned that i was going to follow in his footsteps. I might one day, but i'm doing everything i can to prevent that from happening. I also have a really bad family history of hair loss, so everybody in my family was pretty much bald at 25, and so i'm really trying to race against time, and so i've done everything that i can in my power, i've tried a lot of things that We'Re going to talk about today to try to fight hair loss. Now, not everybody cares about losing their hair. There are some people that have it like, dr maxfield. He looks like dwayne johnson, you know, so he can. He can go bald. I can't i have a very strangely shaped head. I cannot pull it off, so you know i'm doing whatever i can to stop it. So we'll talk about some of those treatments now, first, let's talk about some of the over-the-counter options that are available to you. So the big ones that come to mind are some of the natural supplements that a lot of people always ask us about, and i'm actually not against some of these, because some of them do have data other ones. Not so much we're just going to talk about them briefly and then we're going to do a whole video about natural supplements for hair loss and where the data is on some of those. So some of them here that do have some data are things like salt palmetto things like actually oral pumpkin seed oil has some data on it as well, then topical things like caffeine, topical things like green tea, topical things like rosemary peppermint, spearmint things like this do Have some data supporting their use um, but it is not fda or super high level evidence, but if you're somebody who wants to avoid some of these prescription medications, then i think would be reasonable to consider some of these yeah. I think that's fair and i think these all have that role. It'S a very supporting role in my opinion, because when you're going after hair loss, you need something that's kind of consistently effective, something that would also be pretty moderately effective if you really want to stabilize and prevent that hair loss, and then these all could come in As adjuncts now, the one thing that people always ask me about is castor oil. Now i don't know i mean there's a lot. I get a lot of questions about it, so i feel like that's something worth looking into from a scientific perspective. There'S no data on it, though. Unfortunately there's no data that castor oil can help with hair growth uh, but do a lot of people do mention that has helped them so yeah they do uh. Oh, it's just so tough to validate that, because even when you look at how castor oil has been used historically or used for other things, it doesn't have like a really strong, compelling reason as to why it would be effective for hair loss and then the fact That there's no studies backing up that it has ever worked consistently for more than like one person at a time. I'M really not on that train. Yet so it'll take a lot more to convince me about castor oil right and the other ones that we mentioned earlier. Do have some evidence that they have anti-androgen, or you know, testosterone or dht, inhibiting properties, and that's why they potentially do actually work next up low-level laser therapy, which we've talked about the benefits of light on the skin in our led video in the past. But now we're going to talk about the benefits of light or laser on the hair. So is there evidence that this works right, and so we kind of hinted this with our led video saying that there was - and there is the whole umbrella term, for this is going to be photobiomodulation and that's do these different forms of light therapy have a role In this case for hair growth and studies show that they do right, so you know you may see these devices. You may think that it is kind of wacky to use these helmets on your head. There is evidence that they work. I think that personally, i think that they work best when used in combination with other therapies that we're going to talk about here, so you know used in combination with minoxidil used in combination with some of these natural supplements that we spoke of oral medications. All these things combined, they work on different mechanisms to stimulate hair growth, and so, when you use them all together, they can have additive benefits yeah. I would not personally use just a light device therapy for hair loss alone. I just don't suspect i would get enough out of it, so i wouldn't use it by itself. Great additive, adjunctive thing and also people have done some studies. Looking at you know, is the comb more effective is the little ball cap more effective is like a slipper or something more effective. It doesn't really matter. You can just find whatever kind of clothing option you would want to use, and that would work fine next up. Topical minoxidil, so this is the big one. This is the one that's approved for both male and female pattern: hair loss. So let's talk about it. That in and of itself, is like enough to talk about alone. Minoxidil or rogaine has been around for so long and there's some really good studies about this as well. In fact, this is probably going to be the best studied most consistently effective over-the-counter treatment for hair loss, at least topically. Now i'm going to put a number to that. Some studies have shown that only about 40 of people will get like a meaningful result with treatment for minoxidil, and that requires six months at least six months of use. So it's not going to work for everybody, but out of everything we've already talked about this one actually works best right and the interesting thing about this is this was like a lot of discoveries in medicine was sort of discovered by accident um, so minoxidil started out As an oral medication that was used to treat hypertension now what they started to notice, they were people that were taking. This medication started to grow hair all over the place right, so they basically came to the conclusion that minoxidil may stimulate hair growth and they started to look further into this, and then they started to use it in topical formulations. Now people still use it in oral formulations as well, and so people do treat hair loss with it orally, but we're going to talk about the topical one right, so that leads us into. How does this actually work? So they use this originally to treat hypertension or high blood pressure. This medication can help vasodilate blood vessels, increase something called vegf or like a vascular growth factor, but for the hair it kind of works in three ways. One is that it actually increases that growth phase of the hair cycle, so that's the antigen phase and then it actually shortens the telogen phase that shedding phase of the hair cycle. Third, it can actually enlarge some of those miniaturized reverse hairs that happen during this pattern. Hair loss yeah - and let's talk about number two briefly here, because if you notice he said that it will shorten the telogen phase. So this is really important when you're starting topical minoxidil, that, if something shortening the telogen phase, what ends up happening is that you have a bunch of hairs that are already in telogen phase. Like i mentioned it stays there for about three months before it falls out. Now, if you, if you shorten that phase, a bunch of your hairs are going to start to fall out as soon as you start minoxidil, but those are hairs that were already planned to fall out right. So don't panic if you start to lose hair immediately. This is a treatment that you want to wait at least six months to see results with, and you may notice your hair loss get worse, which is painful to feel and experience, but just bear in mind that it's a normal function of this medication right, we're cycling Through that hair cycle, so don't freak out, don't panic and you do have to stick with it. You know six months is where you start to see results 12 months of consistent use is where you actually have like the stabilized new hair growth everything's more towards where you would want it and back within that hair cycle going through it with minoxidil, though you have To stick with treatment right, so you actually have to start using it once or twice a day, and you have to use it consistently, otherwise that growth effect that it has is going to diminish and eventually those hairs that are in that prolonged antigen phase, will shift To that telogen phase again and eventually fall out, and so it is something that you have to commit to long term yeah and i get that question a ton it's just like do. I have to use this forever and because i do, i don't want to use it, and actually that makes no sense, look we're all programmed to age. This is a normal process of aging, so until we can like reprogram our bodies to turn back the clock and like go back to puberty, we're going to have to use this and pretty much any treatment until the end of time until we pass away - or until You stop caring right. So basically, you know minoxidil is a long-term treatment and is something you do have to commit to, and some people don't want to do that. But if you do want to stick with it, i do notice that most people, in my experience, do ducey benefits from it. Do you want to know my favorite side effect of minoxidil? What'S that hair growth in all of the studies, hypertrochosis or hair growth, excessive hair growth is actually listed as an adverse event, and that's exactly what you want out of a hair growth, serum or ingredient. Now a lot of people will also ask. Well, if i stop using it, will my hair loss be worse than when i started it. Um not because of minoxidil may be worse, because your hair loss is just progressing during that time period. You'Ll go back to how you were before you started the treatment based on the mechanism that it works. There'S no reason to believe that it would cause your hair loss to get worse than when it started. So last thing worth noting here is actually the addition of microneedling plus minoxidil yeah, and this kind of marries the world of over-the-counter plus like procedural office and prescription, and the reason is micro, needling plus minoxidil has been shown to be effective. Actually, one of my favorite studies in hair loss is this micro, needling, frost, minoxidil, study you're, one of them amazing photos, amazing, study design, i love it, but the micro needling they used was 1.5 millimeters, which is more than is probably safe to use at home and Is available at home, so don't really recommend using this at home and the reason why this may be beneficial twofold to me. One microneedling does cause collagen induction or stimulation of sort of growth factors that could potentially stimulate your hair follicle. I'M not exactly sure how that mechanism, it works in theory, but the other thing is that it also helps your minoxidil penetrate better into the skin, and this is true that the stratum cortium, which is the top layer of the skin, is actually the biggest inhibitor to Topical medications entering the skin, and so, if you're able to disrupt that stratum, corneum layer, it does allow your topical medications to penetrate better. So next up, let's talk about prescription medications and the big one we have to talk about here is finasteride or propecia. So let's talk about it, so this is a very interesting one to me. My research in undergrad was actually on prostate cancer. I was just like a lab technician in the lab now for hair loss. In particular, this medication inhibits one of the specific forms of 5-alpha reductase. Now this was initially developed, like many other medications, for the treatment of other things, and then they noticed hair growth as well, and so it did have a role on shrinking the prostate in people that do have bph or benign prostatic hyperplasia. So let's talk about five alpha reductase: this is a little enzyme. It lives in your hair, follicle area and what it does is it takes testosterone and it converts it into dht or dihydrotestosterone, which is much more potent than testosterone. Now, if you inhibit that enzyme, you will lower your levels locally of dht now this can be very effective because dht causes hair loss. Yeah. An interesting thing here too, is that dihydrotestosterone axon receptors that are most prominent here. So that's the reason you know. Males traditionally would go bald here, but not here is the receptor density is actually much higher in this area. So if you decrease that enzyme, if you decrease that hormone, you will prevent and hopefully reverse some of that early hair loss in that area. So with finasteride, it's actually only fda approved for men now it does have some benefit in women that have excess androgens. But the body of data for hair loss and the safety of it is way more studied in males, and so it really is only fda approved for males. So we will do a whole video on finasteride, but some of the side effects that you should look into are things like: decreased libido things like an increased risk of prostate cancer, which actually a recent study came out that showed that it actually decreases the risk of Prostate cancer, but this is a conversation that you definitely want to have with your dermatologist, and the last thing is something called post finasteride syndrome which um you know. There'S been some new data. That'S come out about this and it has to do with mood swings. But again the studies that have been done on it are sort of low quality and we'll we'll talk more about that in a longer video yeah and the reason we want this to default, to a conversation between you and your physician is just we're so highly variable. In the way our bodies are, and the body of evidence for some of these prescription medications is either very weak, controversial or actually the body of evidence in the literature can go directly against what some of the recommendations from governing bodies are. So these are things that will always defer and would always prefer that you talk to your physician about it's just highly individualized and you need to have trust in them that they're guiding you in the right way. That being said, uh based on the evidence, that's out there. I do personally take oral finasteride, so you know it is what it is, and i do too, i think it's extremely effective. I think the literature is very much behind its use and the safety of it overall, so that takes us to dutastride, which is like a sister or brother of finasteride. There are different types of receptors, different types of 5-alpha, reductase, receptors and dutasteride inhibits two of them, and this is actually more potent than finasteride, which you know can be good and bad depending on what it does for you. So it's like at least three times more effective at hitting one type of enzyme up to 100 fold, more effective, inhibiting another type of this enzyme. So this medication shows a lot of promise. It'S not fda, approved and we'll kind of see how it does. I think, as we get more data about it right, but it has been shown to be more effective than finasteride, but then again you may experience some stronger side effects with it, depending on how you tolerate it. So, just something to keep in mind and something worth looking into. It is quite effective all right, so the last prescription medication we want to talk about is oral spironolactone, which is an excellent option for women with female pattern. Hair loss, so spironolactone was originally developed. Kind of like as a diuretic and then also used in antihypertension congestive heart failure has a myriad of rules outside of dermatology. For us, though, it inhibits some androgens androgen receptors and that's where it functions in the space of hair loss. So in dermatology we don't only use it for hair loss. It actually has a lot of different roles in women with skin conditions. It'S very effective for hormonal acne, it's very effective for hirsutism or increased hair growth. It'S very effective in women that have pcos. So it's an option that you definitely want to talk to your dermatologist if you're experiencing female pattern, hair loss now one of the side effects you may experience with it because it started out as a diuretic is increased urination high levels of potassium again, a conversation that You want to have with your dermatologist because it can also elevate your estrogen levels, so discuss with them, but it is very effective, especially at the low doses that we use in dermatology right and then you know hopefully they're coming out with some new topicals, specifically for Acne that kind of mimics bronolactone or ours bronolactone, even and you know maybe one day this will translate to the hair, but we're not there yet so. Finally, we're going to talk about some of the procedures that we do in dermatology to treat hair loss yep and this category could be broad, but most simply we're going to talk about some of the most common and then what i personally believe is the most effective Way to treat even kind of permanently your hair loss, so the first one we'll talk about is something called prp or platelet-rich plasma. So for this, basically, what ends up happening is that we draw blood from your vein and then we spin it down into centrifuge. What ends up happening is that platelet-rich growth factors or that plasma actually floats to the top of the centrifuge, and then we actually siphon off part of that, and we inject it directly into the scalp and that has tons of growth factors. It can basically stimulate your hair follicles back into that growth phase. Now, in my experience, it's like 50 50 of the benefits of this and there's more and more data coming out with this again. This is not an fda approved treatment, but it is something that we actually do at our office. Basically inject this prp directly into the scalp, and we've noticed that people do see. Hair growth with it right and people have tried this different ways, even microneedling in prp, but again the data kind of supports it. In some ways people respond people don't, and you know, i'm always looking forward to like large studies who can predict who will respond but again not there. Yet this may be a useful treatment option for some people and finally hair transplant hair transplant. This is something i actually love. I love this in theory, i love that it works, and so we've kind of gone down this road. I think differently. We'Ve talked about or thought about in our personal lives as well. Yeah we've talked about. When is the best time for us to do this right now, i'm happy with where my hair is, but if it does progress, this is definitely listen. I have no ego, i'm happy to get this procedure done myself, so this is something that i've always looked into for a long period of time. Now, basically, what this is is they take hair follicles from other areas on your scalp and they transplant them to the areas where you're missing hair? Now, as we said earlier, those receptors that cause hair loss or those enzymes that cause hair loss in the scalp have higher concentrations in different areas and so they're more focused on these areas and they're, not as focused on these areas, and so you can transplant these Hairs here to this area here and not experience, hair loss in those areas after they're transplanted right, and so this technique has actually progressively improved over years and we're at a point now that it's actually extremely effective and the results, i think, are very very meaningful, which Is for me probably the most important outcome when you see somebody, does it look like their hair's thin? Does it look like it's natural? Does it look like it's thick and natural, and this can offer ladder right and the interesting thing is it used to? You might see somebody with an old hair transplant. It looks like little doll hairs, it doesn't look very natural. We have made tons of progress, they're, really two ways that we do hair transplant. Nowadays you have follicular unit transfer or fut. This is basically where they take a strip of hair from the back of their head, and then they take out little follicles individually and transplant them into the scalp in a very elegant and artistic way. The other way to do it is follicular unit extraction or fue, where actually, they punch out little holes in the back of the scalp to basically remove those hair, follicles and then transplant them to the areas where you need them now. This doesn't cause a strip of missing hair. Instead, it's a little bit more natural. It does take a lot more time to do the procedure because you have to individually extract each group of follicles, so another important thing with hair transplant. Is you actually have to do more around this? So we've already talked about doing. Multiple things for hair treatment is very important, and this is actually no exception. Transplant, in my opinion, is like kind of the actual core or foundation of the most effective treatment, and then everything else is going to be supportive. So basically transplants like planting the seeds right, but you still have the water. That'S where things like minoxidil and your finasteride come in as basically your fertilizer and your water for the plants once they're planted and so um in combination now transplant can work well on its own, but in combination does even better and then the phototherapy, i guess, is The sun, the sunshine to grow the hair, okay, and so with this, how much does it cost? This is kind of a tough question to answer, because it really depends on how many units or follicles that you need to transfer. So if you have a small area to transfer, it can be less expensive. If you have a lot to transfer, then it can be more expensive, so the price ultimately depends on what treatment is required, but bosley does offer financing options through care credit credit cards which does allow you to pay over time. So when it comes to hair loss, bosley is the real deal. They offer a lot of what we're talking about today, but the biggest thing that i can stress to you - and i'm going to stress it again - is that time is hair act quickly on your hair loss, the sooner you act, the better your outcome will be for Hair restoration, you need to make sure you see someone who has an expert opinion who can weigh in for what you can do now. We can do later. We can plan for 10 years down the road. So when you have this problem, you can address it. Impactfully right so sign up, we have a link below. Basically, you click on it. We'Ll take you to the bosley website, they'll, send you a completely free booklet on hair loss and all the different options you have out there. You can get a free consultation, but the biggest thing i can say to you is: if you are concerned about your hair loss and if you're watching this video, you probably are see someone as soon as possible. That is how you're gon na have the best results and not have regrets later. So to summarize, we went over a lot of different treatments for hair loss today and there are a lot of options that are out there and we will do individual videos on each of these things that we kind of talked about, because i think they're much bigger Topics, so this is kind of more like part, one of a series, but the biggest thing that we can stress to you is if it's important to you, get an evaluation figure out. What'S causing your hair loss? Is it scarring? Is it non-scarring and then act quickly to restore your hair yeah? That is the most important thing in my mind, is getting that initial diagnosis, because you treat these things completely differently. These things end completely differently. So seeing an expert is one of the first steps and is the most important step to getting this fixed right so see a dermatologist see a hair restoration. Specialist bosley is really truly, i truly believe a great option. After visiting there, i was actually extremely impressed and you know i have a high bar for being impressed with things. But when i went out there, i truly was impressed by the quality of care that they were providing, but also just their sort of ethics and the way that they looked at hair loss and how they really wanted people to have the best results. Plus it was a really nice facility and dr phipps was amazing, so it was overall a really good experience and i think it's worth looking into for someone who's having hair loss more on hair loss to come. Please like comment subscribe. Thank you all so much. We really appreciate you yeah greatly, appreciate you, love being on this journey with you all. You