If this sounds like you, this article is for you:

• You are consistent with treatment, but your hair loss or baldness still progresses.
• Minoxidil and/or finasteride helped at first, then results slowed or stopped.
• You have “dandruff” or scalp irritation that keeps coming back.
• A hair transplant result was disappointing, unpredictable, or did not last.

If you are doing “all the right things” for your androgenetic alopecia or pattern baldness, but results are stalling, read this.

Androgenetic alopecia (AGA), also known as male pattern baldness (MPB) or female pattern hair loss (FPHL), is common, visible, and emotionally heavy. Many patients do everything they are told: minoxidil, finasteride (or dutasteride), devices, shampoos, supplements, and still find that progress slows, stops, or becomes unpredictable.

When that happens, it is not always “bad luck,” and it is not always “you waited too long.”

The study titled “Perifollicular Inflammation and Fibrosis in Androgenetic Alopecia: Implications for Diagnosis and Treatment – A Comparative Histopathologic and Clinical Study with Normal-Appearing Scalp” was published in the peer-reviewed Clinical Cosmetic and Investigational Dermatology journal. There, we describe a specific histologic pattern that can live quietly under the surface and help explain why some AGA and pattern baldness patients stop responding as expected, progress faster, or respond unpredictably to both medical therapy and hair restoration surgery.

It is called PIILIF, short for Perifollicular Infundibulo-Isthmic Lymphocytic Infiltrates and Fibrosis.

Quick takeaways

• PIILIF is a low-grade, immune-type inflammatory and early fibrotic pattern found around the upper portion of hair follicles (infundibulo-isthmic region) that can coexist with AGA and pattern baldness.
• It can be easy to miss clinically and can be mislabeled as “seb derm” or “just dandruff.”
• It may help explain why finasteride or minoxidil alone may not be enough for some people over time.
• It supports a dual-pathway strategy: address the hormonal pathway and the immune-fibrotic pathway, not one or the other.
• This is exactly why I created the Inflammatory AGA Screen Program (PIILIF Track).
• Important classification insight: the paper proposes that what has been described as fibrosing alopecia of patterned distribution (FAPD) aligns with a later stage of AGA-PIILIF, and recommends staging AGA-PIILIF by the degree of perifollicular fibrosis to support earlier recognition and intervention.

The missing link for AGA medication non-responders

This section is for the patient who is not planning surgery (or not yet), but is frustrated because the standard plan is not delivering what it should.

If the scalp environment is immunologically active and early fibrosis is already present, “more of the same AGA routine” is not always the answer.

The answer is:

• better biology control
• better targeting
• better timing

Here is the practical point

If PIILIF is present, “DHT control only” can leave a second driver running.

Standard AGA treatment often focuses on androgen signaling and follicle cycling support (for example, finasteride and minoxidil). That can be appropriate, but in a subset of patients, there is an additional layer: a perifollicular inflammatory and early fibrotic process that may continue even when DHT is addressed.

That is why some patients report:

• good early improvement, then slow decline again
• a stable period, then sudden acceleration
• “I’m consistent, but the response does not match the effort”

What this changes in real life

For the non-responder, the best move is not to guess harder.

It is to confirm what is actually happening in the scalp environment, and then treat the relevant pathways when indicated.

That does not mean every patient needs a biopsy.

It means:

• for non-responders, ambiguous cases, or high-stakes decisions, it is worth considering early diagnostic confirmation, not late.

What is PIILIF, in plain language?

PIILIF describes a subclinical perifollicular inflammatory pattern that concentrates around the upper follicle and is associated with early perifollicular fibrosis.

Key idea: it can be present even when the scalp looks “quiet,” and it can be present even in areas that are not yet visibly thinning or bald.

This matters because once fibrosis progresses, it can reduce the predictability of regrowth and restoration. That is why early recognition is the whole game.

Seeing PIILIF makes the concept clearer.
The short video below illustrates how PIILIF can exist beneath visible pattern baldness and why scalp biology matters when treatments or hair transplants stop responding.

Where FAPD fits: why this paper matters beyond “routine AGA”

If you have heard the term FAPD (fibrosing alopecia of patterned distribution), you already know it sits at the crossroads of two worlds:

• pattern hair loss that looks like AGA or male pattern baldness, and
• fibrosing/scarring biology that behaves more like early scarring alopecia

The key contribution of the paper is that it proposes a unifying framework:

• FAPD may represent a later, more fibrosing stage within the AGA-PIILIF spectrum, rather than a completely separate diagnosis.
• The paper recommends staging AGA-PIILIF by the degree of perifollicular fibrosis, which supports earlier recognition and more informed management decisions.

For patients, the takeaway is not to panic about “scarring.”
The takeaway is precision: if inflammatory and fibrotic drivers are present, it changes what “optimal care” looks like and why durability sometimes requires more than growth stimulation alone.

Why PIILIF gets mislabeled as seb derm or “just dandruff”

Many people with PIILIF report flaking, scale, or irritation. So it is easy to default to seborrheic dermatitis (“seb derm”) or “dandruff.” Whatsmore, the trichoscopic features of PIILIF may show similar findings associated with seborrheic dermatitis

But in our cohort, true seborrheic dermatitis on biopsy was rare compared with PIILIF.

Even when anti-dandruff shampoos temporarily improve scale or redness, that does not necessarily address the deeper perifollicular inflammatory process.

If you are treating “seb derm” aggressively and hair outcomes are still slipping, it is time to consider whether the label is wrong.

Why this matters for hair transplant planning

If the scalp environment is immunologically active and early fibrosis is already present, “more grafts” is not the answer.

The answer is:

• better biology control
• better planning
• better timing

In higher-risk candidates, pre-transplant control of PIILIF and biopsy-informed planning are advisable.

That does not mean every patient needs a biopsy. It means that for non-responders and high-stakes surgical candidates, diagnostic confirmation should be considered early rather than late.

Who should consider PIILIF screening?

You should at least consider PIILIF screening if you relate to one or more of these:

• You are not responding as expected to a well-run AGA regimen (meds, topical plan, lifestyle, compliance is solid).
• You have been told you have “seb derm” for years, but hair continues to miniaturize.
• You have advanced AGA or you are a complex case (including prior surgery, donor depletion, body hair follicular unit excision (FUE) or beard hair FUE reliance).
• You are planning a transplant and you want to reduce the risk of disappointing yield, ongoing thinning, or unpredictable healing.
• You are 44 years or older.
• You have perifollicular scale, redness, itch, tenderness, or shedding that does not match the clinical look of “routine AGA.”
• You developed overt features of scarring alopecia or severe inflammation after a hair transplant.

The Inflammatory AGA Screen Program (PIILIF Track)

I created this because too many complex patients with hair loss and baldness were being managed with a one-pathway playbook.

Program name: Inflammatory AGA Screen Program (PIILIF Track)
Format: Virtual first (with in-person follow up when needed)
Deposit: Required to protect quality, reduce no-shows, and allow proper time allocation

What the PIILIF Track helps us do

• Identify whether a patient’s AGA is likely “standard AGA” alone, or AGA plus PIILIF biology.
• Decide when a biopsy is appropriate and where it should be taken to improve diagnostic yield.
• Build a personalized plan aimed at:
  • controlling the inflammatory axis when indicated
  • reducing progression and improving durability
  • planning surgery only when the scalp biology is optimized

Long-Term Care Matters Long-term

Sustainable treatment matters because AGA‑PIILIF is a long game
When PIILIF is present, the goal is not a short burst of change. The goal is long-term stability of the scalp environment. PIILIF is best understood as a chronic, genetically influenced tendency toward follicle‑centered inflammation and early fibrosis that is not “cured” once and for all. It is managed. That reality changes how we choose treatments.

Control, not cure, means the plan must be livable for years
If control may need to be maintained for the long term, the foundation of care should be something a patient can realistically sustain. This argues against building the core plan around high‑burden or high‑risk approaches, especially because AGA‑PIILIF can be subtle compared with overt primary scarring alopecias. The biology may be meaningful even when the scalp looks “quiet,” but the management must remain practical and tolerable over time.

What we evaluated in our cohort
Because the working model involves long-term control, the study emphasized steroid-sparing options that may be suitable for longer-term use, with short-course therapies used selectively. Selections were informed by peer-reviewed literature on steroid-sparing management in primary cicatricial alopecias. Treatments used in the cohort, often in combination and individualized to the patient, included:

• Dutasteride and finasteride
• Oral minoxidil
• Topical calcineurin inhibitors
• Minocycline or doxycycline (typically as a time‑limited course)
• A selected phytoactive approach: Gashee topical and Gashee oral

What showed the clearest statistical signal in our analysis (and what did not)
In this retrospective cohort analysis, only some interventions showed a clear statistical association with improvement. In order of p‑value significance, the strongest signals in our dataset were observed with:

1. Topical and oral phytoactives (Gashee)
2. Topical calcineurin inhibitors
3. Minocycline
4. Dutasteride

Other treatments used in the cohort (including finasteride, oral minoxidil, and doxycycline) did not show the same level of statistical signal in this dataset. This may reflect sample size, duration, selection bias, combination regimens, dosing, or when and how an agent was deployed, rather than proving a treatment has no role.

The practical takeaway
The point is not that every patient needs every component. The point is that when AGA‑PIILIF biology may require long-term management, the strategy should prioritize approaches that are realistic to sustain, steroid‑sparing when appropriate, and matched to the level of inflammatory and fibrotic activity.

How this relates to Phytoactives
Within a long-term, steroid‑sparing framework, a phytoactive topical or oral option may be considered as supportive care as part of a broader plan, particularly when long‑term tolerability is a priority. In our cohort analysis, the use of Gashee in both topical and oral forms showed the strongest statistical signal among the steroid‑sparing measures evaluated, but this study is observational, and larger studies are needed to confirm and refine these findings. Gashee is not a substitute for diagnosis and is not positioned as a cure. It may be one tool within a clinician‑guided program when it fits the patient’s overall plan and risk profile.

Where a phytoactive product like Gashee fits (and where it does not)

Important points of clarification.

What Gashee is not

• It is not positioned as a “cure” for AGA, hair loss, or baldness.
• It is not a replacement for diagnosis.
• It is not a substitute for physician-directed therapy when stronger interventions are warranted.

Where Gashee can fit logically in the PIILIF conversation

PIILIF changes the strategy from “only push growth” to “optimize the scalp environment and protect follicle viability.”

Because AGA is a long-course condition, and because PIILIF (when present) can behave like a persistent, low-grade inflammatory process, long-term tolerability matters. That pushes smart clinicians toward steroid-sparing approaches whenever feasible.

In our PIILIF work, the practical takeaway is that some patients benefit when care includes scarring alopecia or PCA (primary cicatricial alopecia)-style anti-inflammatory and anti-fibrotic measures alongside appropriate androgen management.

In that context, phytoactive support can be part of a long-term maintenance philosophy, particularly for patients who need a plan they can sustain.

Gashee exists in both topical and oral forms. In my practice, when it is used, it is used as part of a broader plan, not as a standalone promise.

Important note: Gashee is designed to support the scalp environment as part of a broader hair loss program. It is not intended to diagnose, treat, cure, or prevent disease. Individual results vary.

The bigger point: stop guessing. Start staging.

If the biology is wrong, the plan will be wrong.

PIILIF gives us a clearer framework for:

• earlier detection
• better durability
• better surgical planning
• fewer “mystery non-responders”

If you are a patient who feels stuck, or a clinician managing difficult AGA cases, the PIILIF Track is built for you.

Next steps

Patients: Request a PIILIF Track evaluation
Start the PIILIF Track Intake

Clinicians: Refer a complex AGA case for PIILIF screening
Clinician Referral: PIILIF Track

Medical and product disclaimer

1. Gashee is designed to support the scalp environment as part of a broader hair loss program. It is not intended to diagnose, treat, cure, or prevent disease.
2. This article is for educational purposes and does not provide medical advice. Diagnosis and treatment should be individualized and guided by a qualified clinician. Product statements have not been evaluated by the FDA. Products are not intended to diagnose, treat, cure, or prevent any disease.

FREQUENTLY ASKED QUESTIONS

PIILIF, FAPD, treatment resistance, and what to do next

1) What is PIILIF?

PIILIF stands for Perifollicular Infundibulo-Isthmic Lymphocytic Infiltrates and Fibrosis. In plain terms, it describes a low-grade immune-type inflammation and early fibrotic change occurring around the upper portion of the hair follicle. It can coexist with androgenetic alopecia (AGA), also known as male pattern baldness or female pattern hair loss, and may be present even when the scalp looks “normal” on casual inspection.

2) Is PIILIF the same as FAPD?

Not exactly. FAPD (fibrosing alopecia of patterned distribution) is a term typically used when patterned hair loss shows a more advanced fibrosing or scarring-leaning biology. The key insight from this publication is that FAPD may align with a later stage within an AGA-PIILIF spectrum, rather than representing a completely separate condition.

From a practical standpoint, this means that earlier recognition of inflammatory and fibrotic drivers matters. Identifying AGA-PIILIF before extensive fibrosis develops allows clinicians to plan care with durability in mind, when the biology may still be more modifiable.

Waiting until the histologic features associated with FAPD are fully established may correspond to a more treatment-resistant stage. For this reason, the authors emphasize the value of recognizing and addressing AGA-PIILIF earlier, rather than deferring evaluation until later stages when fibrotic changes are more entrenched.

3) Do I need a biopsy to know if I have PIILIF?

Not everyone needs a biopsy. A biopsy becomes more relevant when your provider finds signs of inflammation on magnified (trichoscopic) examination of your scalp. The threshold is reduced if you are already a non-responder, your presentation is ambiguous, you have symptoms that do not fit “routine AGA” (itch, tenderness, burning, persistent scale), or you are making high-stakes decisions like hair transplant planning. The goal is not to biopsy everyone, it is to confirm scalp biology early when the stakes or uncertainty are high.

4) Why did my finasteride or minoxidil stop working?

There are several reasons treatments may stop working, and not all are about the medication itself. The main concept here is that AGA or pattern baldness is often treated as purely androgen-driven, but in a meaningful subset of patients an inflammatory and early fibrotic process may be operating in parallel. If that second driver is active, “more DHT control” alone may not fully stabilize the situation, which is why biology-aware evaluation and a dual-pathway strategy may be needed in selected cases.

5) Can PIILIF affect hair transplant outcomes?

It can. Hair transplantation is not just about graft numbers or technique, it is also about the health of the recipient scalp environment and long-term stability of surrounding native hair. If inflammatory-pattern biology and early fibrosis are active, predictability and durability can be affected, which is why scalp optimization and biopsy-informed planning can be important in higher-risk candidates.

6) What are phytoactives, and where do they fit in a long-term plan?

Phytoactives are plant-derived compounds that may support the scalp environment as part of a broader hair loss program. In a long-term maintenance context, many patients and clinicians prefer steroid-sparing approaches when appropriate, especially when scalp inflammation behaves as a chronic, low-grade process. In that framework, a phytoactive topical or oral product can be considered as supportive care, but it is not a replacement for diagnosis, and it should be used as part of a clinician-guided plan when stronger interventions are indicated.

7) Does PIILIF require lifelong treatment?
PIILIF, when present, may behave like a chronic, genetically influenced inflammatory tendency around hair follicles. The practical goal is long-term control and stability, not a one-time cure. Some patients may need ongoing maintenance for years, with the plan adjusted over time based on symptoms, exam findings, and overall risk profile under clinician guidance.

8) Do I need strong steroids or immunosuppressants to control PIILIF?
Not necessarily. AGA-PIILIF can be subtle compared with overt primary scarring alopecias, so aggressive therapy is not automatically the default. In our cohort, the emphasis was on steroid-sparing strategies that can be considered for longer-term use when clinically appropriate. Treatment choice and intensity should be individualized and supervised by a qualified clinician.

9) What kinds of long-term, steroid-sparing treatments were used in the study?
In this cohort, patients were managed with a steroid-sparing approach tailored to clinical context and often used in combination. Treatments used included dutasteride or finasteride, oral minoxidil, topical calcineurin inhibitors, and time-limited tetracyclines (such as minocycline or doxycycline). A selected phytoactive topical and oral option (Gashee) was also used as part of the broader scalp-care plan when appropriate.

In this retrospective dataset, the clearest statistical associations with improvement were observed in regimens that included: Gashee topical, Gashee oral, topical calcineurin inhibitors, minocycline, and dutasteride. Because many patients received combination regimens, these findings do not establish that any single component alone caused the observed outcomes. Observational findings do not prove cause and effect, larger studies are needed, and individual results vary. Gashee is not intended to diagnose, treat, cure, or prevent disease.

Important note: Products and supplements are not intended to diagnose, treat, cure, or prevent disease. Individual results vary, and medical decisions should be individualized with a qualified clinician.

The post VIDEO: Read This If Your Hair Loss Treatment or Hair Transplant Has Stopped Working. What Science Shows appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

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Defining Retrograde Alopecia: A Closer Look at Symptoms

Retrograde alopecia (RA) is characterized by a unique pattern of hair loss, particularly around the hairline at the neck and temples. Key symptoms include gradual thinning, halted hair growth in the affected area, and localized loss at the back or side of the head, potentially extending to the occipital region.

RA is closely connected to Androgenetic alopecia (AGA), resembling the typical male pattern hair loss. However, it differs from AGA as it involves factors beyond DHT and is not an inflammatory hair loss condition.

Distinguishing Features and Misconceptions: Retrograde Alopecia vs. Other Hair Loss Conditions

Spotting retrograde alopecia is challenging because it looks like other types of hair loss. Its unique location at the back or side of the head distinguishes it from conditions such as alopecia areata or some types of scarring alopecia.

Unlike the commonly used Norwood (NW) Scale for measuring male pattern baldness, retrograde alopecia doesn’t fit in. It needs specific recognition and labeling, especially when combined with severe NW 7 or Norwood 8.

One Man’s Battle with Retrograde Alopecia

Dealing with severe NW 7 baldness and retrograde alopecia, the patient faced years of struggle to find a solution. Despite setbacks, he had limited options.

“I waited a considerable amount of time to see if the technology would get to a level that would work for me. My condition was so extreme that nothing out there existed, so my search was at least ten years before I decided to do something. Because why do something unless it’s got a high probability of success?” 

However, he found hope with the UGraft Zeus FUE device, known for its precision and versatility. I had the privilege of using this technology to restore his hair, making him the first documented case of retrograde alopecia recovery. The patient was extremely impressed with the coverage he achieved.

“… this had the highest probability [of success], and the probability manifested in the results. I’m happy. This is quite an impressive result, I’d say.  I would do it again”, he reported in his testimonial. 

An important aspect of RA is the loss of hair in the temples, which this patient experienced. Remarkably, we successfully restored his temple points through FUE surgery, a usually challenging task in severe baldness cases. This framing of his face resulted in a natural, more youthful appearance.

Scalp Preparation: A Fundamental Step for Successful Hair Transplants in Retrograde Alopecia Treatment

Preparing the scalp before a hair transplant is crucial for the best results in treating RA. Before the procedure, we concentrate on nourishing and stimulating the scalp, boosting blood circulation, and improving overall skin health. These actions create an environment that supports the successful integration of transplanted hair follicles.

https://www.youtube.com/watch?v=xmUk7Kp0ACI 

Bridging the Knowledge Gap and Advocating Recognition

Retrograde alopecia, with its distinct symptoms, is noticeable in hair loss. Recognizing its nuances is vital for accurate diagnosis and personalized treatments. It’s crucial to advocate for its inclusion on the Norwood Scale to ensure individuals dealing with it get the attention and customized solutions they need in their journey to regain confidence and hair.

Notable Mention: Homer Simpson – an Example of Fully Progressed Retrograde Alopecia

Homer Simpson is a well-known case of RA, showing hair loss at the temples and the back of the head. This iconic character illustrates how RA is portrayed in popular culture, highlighting its significance and influence.

In a world where characters like Homer Simpson visually represent RA, real-life cases provide a deeper understanding of its challenges. Our patient was approaching the level of baldness seen in the famous cartoon character. Fortunately, he found a solution to halt that progression and treat his existing hair loss.

Frequently Asked Questions

Is retrograde alopecia a common condition?
Retrograde alopecia, though not widely recognized, is prevalent in the general population. This is mainly because it isn’t categorized and labeled in major systems like the Norwood Scale.

Are there specific risk factors or predispositions associated with the development of retrograde alopecia?

Although the exact causes of retrograde alopecia are not apparent yet, we know it’s not an inflammatory condition and that there is more going on in the scalp than sensitivity to DHT. 

The post The Enigma of Retrograde Alopecia: Understanding Symptoms and Unveiling Its Mysteries appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

The Journey Begins: Initial Consultation

Paul, a 62-year-old gentleman, arrived at my clinic seeking solutions for his hair loss predicament. Over the years, receding hairlines and thinning patches had taken a toll on his confidence. Drawn by my reputation for pioneering advancements in hair health, Paul considered hair transplant surgery his way forward.

A Different Approach

A deeper understanding emerged after a meticulous examination of Paul’s hair and scalp. It became evident that his hair loss might stem from androgenetic alopecia, a common condition. However, rather than hastening toward surgery, I proposed an alternative path that embraced non-invasive treatments. Specifically, I recommended incorporating Gashee Natural Hair Products in combination with pharmaceutical treatments such as Minoxidil and Finasteride. Gashee’s products, characterized by a unique, heat-free processing technique, preserve the potent properties of active plant compounds pivotal for hair health.

The journey embarked upon a more organic route, acknowledging the potential of botanical solutions before resorting to surgical interventions.

Progress Unveiled: Paul’s Regrowth Journey

Paul, motivated by the possibility of a surgery-free solution, embarked on the Gashee Hair Regrowth Journey. Adhering to my recommendations, he integrated Gashee Natural Topical Hair Lotion and Gashee Natural Oral Hair Supplements into his routine. The natural constituents and absence of adverse effects provided reassurance that he was moving in the right direction.

The Transformation Takes Shape

Weeks transitioned into months as Paul remained steadfast in his Gashee regimen. By the tenth month, the results were undeniable. Thinning patches were yielding new growth, and his receding hairline showcased tangible improvements. The positive changes were apparent to Paul and those in his circle. Fuelled by his progress, Paul shared his experience with friends and family, extending the recommendation of Gashee to others grappling with hair concerns.

A Renewed Confidence: The Visible Outcome

With the newfound hair growth, Paul regained his lost confidence. The transformation was evident to those around him, and even his hairdresser noticed the positive change in his hair. 

“She happened to be away for a few months to have a baby. She was like, ‘Oh my God, your hair’s come back; what’s going on?!’” recounts Paul. He expressed immense gratitude to Dr. Umar and the Gashee products for restoring his hair and helping him feel youthful.

As Paul’s natural hair growth mirrors the transformative potential of non-invasive approaches, his gratitude toward Gashee products and myself resonates deeply. The significance lies in restoring hair and rejuvenating his sense of self, capturing the essence of innovation in the realm of hair health.

Frequently Asked Questions

Do Gashee hair care products provide UV protection for the hair?

Our hair care products have aloe vera and shea butter, which protect from sun damage. 

Are Gashee products safe for all hair types?

Absolutely. Our cold-formulation botanicals are made to benefit individuals with all hair types. 

References

Umar S, Carter MJ. A Multimodal Hair-Loss Treatment Strategy Using a New Topical Phytoactive Formulation: A Report of Five Cases. Case Rep Dermatol Med. 2021;2021:6659943. Published 2021 Feb 4. doi:10.1155/2021/6659943

The post Regaining Confidence: A Success Story with Gashee Natural Hair Product appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

Introducing the Male Contraceptive Pill

According to the study, 75% of men in the trial who took the pill said they would be comfortable using it. This is a significant improvement from the feedback to previous versions of the male contraceptive pill, where most participants would feel like the side effects are too adverse for them to use it regularly. 

In another study, the pills were also shown to be 99% effective in preventing pregnancy in mice. This is solid evidence that they work well in lowering testosterone levels. It’s important to mention that the pill may not behave the same in human clinical trials because, as Hodge et al. demonstrated in a recent study, the same genes in humans and mice behave differently. This means more research is needed, but whatever results we have now seem promising.

More Than Birth Control: Potential Antidote to Hair Loss

Although the primary purpose of the pill is to prevent pregnancy, given that it works by bringing down testosterone levels, it could potentially be used to venture into other uses, such as Male Pattern Baldness (MPB) prevention. Suppose the studies that led to the development of the male contraceptive pill were to be used as a pilot study for androgenic alopecia treatment research. In that case, it could prove promising, given the mechanisms of MPB.

From Testosterone to DHT

DHT is an androgen hormone responsible for developing male sex characteristics such as facial hair and deepening of the voice. It is also implicated in some forms of male pattern baldness, as DHT receptors are also found in the scalp. 

DHT (dihydrotestosterone) is converted from testosterone when the enzyme 5-alpha reductase (5AR) converts free testosterone into dihydrotestosterone (DHT). The process of producing the hormone is known as 5 alpha reduction. 

Why The Pill Could Work

Given that DHT plays a crucial role in male pattern baldness, one way to prevent hair loss is to target how much DHT is created in the body. Lowering testosterone levels decreases the amount of DHT circulating in the body, reducing its effect and the risk of MPB. 

As already discussed, the male contraceptive pill does bring down testosterone levels in the body, as shown by the effective pregnancy risk reduction. Since DHT is converted from testosterone, less testosterone in the bloodstream means less DHT floating around near the receptors in the scalp. 

Things to Consider

Although the results of this trial portray a very optimistic picture, it’s worth noting that at  96 participants, the trial size was too small to make any solid conclusions. Some of the 96 were in the control group and were given the placebo. This further reduces the number of participants who took the birth control pill. Naturally, a clinical trial with a bigger sample size would be needed for the results to be more conclusive.  

Another consideration is that one of the tests conducted was done in mice. This is the one that yielded the impressive results of 99% effective prevention of pregnancy. As we briefly touched on this above, although many genes are the same in humans and mice, those genes behave differently in the two species. It’s easy to get blinded by the 99% effectiveness statistics, but it’s crucial to understand where and how those statistics come from. Based on the study by Hodge et al., the high gene expression divergence score confirms that it’s better to study new drugs affecting species-specific mechanisms directly in humans. 

Something that can’t be overlooked is the importance of healthy testosterone levels in men. Low testosterone levels can lead to various negative consequences, including decreased sex drive, erectile dysfunction, low muscle mass, increased body fat, decreased bone density, and decreased energy levels. It can also cause depression, irritability, and difficulty concentrating. Additionally, low testosterone levels put men at an increased risk of heart disease, diabetes, and other health issues. Addressing low testosterone levels is vital to maintaining physical and mental health.

In the Meantime…

While the studies on the male control pill show promising effectiveness in reducing testosterone levels, it will be a while until the pill is on the market. Even further research and trials will be required to extend the scope of the pill usage to hair loss. So what are some other alternatives in the meantime?

FDA-Approved Drugs

Finasteride, an FDA-approved drug targets MPB by blocking the enzyme 5AR, thus, inhibiting the conversion of testosterone to dihydrotestosterone (DHT). However, the drug has severe side effects in men, such as erectile dysfunction, depression, loss of libido, anxiety, brain fog, and more. For women, it’s not even approved and is forbidden to be prescribed to pregnant women. 

Another FDA-approved drug for hair loss is Minoxidil. This drug works by inhibiting the effects of androgen hormones on the hair follicles to stop hair loss and by stimulating the follicles to prompt new hair growth. But Minoxdidl doesn’t come free of adverse effects either. Some unwanted effects of the drug include skin irritation, pruritus, and telogen effluvium (TE). 

Botanical Alternatives

Another way to improve scalp and hair health is using well-researched botanical products. Botanical hair and scalp treatments can be very beneficial for several reasons. They often contain natural ingredients packed with nutrients, vitamins, and minerals that can help nourish and revitalize the hair and scalp. Botanical treatments can help promote hair growth, reduce hair loss, and improve the overall health and condition of the hair. In addition, many botanical ingredients have anti-inflammatory and anti-bacterial properties that can help calm and soothe an irritated scalp, which can help reduce dandruff and other scalp-related issues. Botanical hair and scalp treatments can help you achieve healthier, more vibrant hair and improve overall health.

Some commercial products, such as Aveda and Gashee, use those botanical ingredients to maximize hair health without the side effect profile that comes with drugs. Gashee products, for instance, comprise plant-based ingredients such as green tea, aloe vera, horsetail, and rosemary oil. These ingredients have been known to improve hair strength, reduce breakage, and promote healthy hair growth. Green tea, for instance, contains catechin, antioxidants that reduce inflammation in the scalp – one of the main reasons for hair loss. The best part is, by using a product like Gashee, you get all the benefits of the natural ingredients without any adverse side effects of drugs such as Finasteride or Minoxidil. 

Frequently Asked Questions

Will the use of the male birth control pill cause erectile issues?

The pill is not on the market yet, so it’s hard to tell. The trial participants did say they did not experience any adverse side effects that would make them uncomfortable using the pill regularly. It’s good to keep in mind that low testosterone levels are unlikely to come without consequences. 

Can I improve my hair health and reduce hair loss without lowering my testosterone levels?

Ensuring your scalp is healthy, your hair follicles are nourished and protected, and your hair strands are strong and moisturized are all good places to start improving hair health. You can use well-researched and tested botanicals to achieve those goals. 

References

1. Endocrine Society. Dimethandrolone undecanoate shows promise as a male birth control pill. Endocrine Society. https://www.endocrine.org/news-and-advocacy/news-room/2018/dimethandrolone-undecanoate-shows-promise-as-a-male-birth-control-pill. Published November 15, 2019. Accessed March 18, 2023.
2. Endocrine Society. Male contraceptive pills show promise in new study. Endocrine Society. https://www.endocrine.org/news-and-advocacy/news-room/2022/male-contraceptive-pills-show-promise-in-new-study. Published June 22, 2022. Accessed March 18, 2023.
3. Hodge RD, Bakken TE, Miller JA, et al. Conserved cell types with divergent features in human versus Mouse Cortex. Nature. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919571/. Published September 2019. Accessed March 18, 2023.
4. Puckering E. New study shows huge breakthrough in male contraceptive pill. LADbible. https://www.ladbible.com/news/new-study-male-contraceptive-pill-20220903. Published September 3, 2022. Accessed March 18, 2023. 

Further Reading

https://dru.com/9-reddit-users-on-what-happens-when-youre-balding-at-20/

The post New Male Contraceptive Pills: Good for Hair Loss? appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

What is Lichen Planopilaris (LPP)

What Causes LPP?

Currently, the exact cause of LPP is unknown. However, according to the National Institute of Health (NIH) [1], LPP is believed to be an autoimmune disorder where white blood cells attack skin and hair cells, causing inflammation and destruction of hair follicles. While a direct cause has not been identified, practicing healthy hair and scalp behaviors can lessen the severity of the condition.

How to Avoid LPP or Reduce Symptoms of LPP

Several hair practices can be done to help avoid the onset of LPP or to reduce the symptoms of LPP:

1. Avoid tight hairstyles that put pull or traction on the hair and scalp
2. Avoid harsh chemicals
3. Avoid harsh hair products
4. Avoid using extreme heat on hair

Generally, practices that keep the scalp healthy are good in terms of helping avoid LPP. It is also essential to gently wash the hair and scalp and moisturize the hair as necessary.

Who Does LPP Affect?

Lichen Planopilaris typically affects adults ages 30-60, favoring women over men. This may be due to the likelihood of women using more products and demanding hairstyles over men, although the autoimmune disease is believed to be triggered by genetic factors [2]. Hair loss in men and women can begin as early as the teen years or 20s, but LPP can develop later in life, even after balding begins. 

LPP Symptoms to Look Out For:

Although LPP symptoms may be similar to what may be interpreted as common genetic balding or pattern baldness, there are specific LPP symptoms that should be noted:

1. Itching on the scalp
2. Bumps on the scalp
3. Pain around the scalp
4. Redness of the scalp
5. Increased hair loss
6. Patchy hair loss

It is essential to look out for itching, bumps, pain, or redness on the scalp, mainly if hair loss appears patchy and less patterned, as this is a signifier of LPP (Lichen Planopilaris).

How is LPP (Lichen Planopilaris) Diagnosed?

Dermatologists usually diagnose LPP after performing a biopsy, meaning they’ll take a small scalp sample and have it tested and analyzed in a lab. Furthermore, a trichoscopy can also be done to confirm the diagnosis of LPP for the patient.

LPP may be more challenging to diagnose, so inform your doctor of your symptoms in detail. Visiting a licensed and experienced dermatologist and hair expert is always recommended to diagnose the condition properly.

What Treatments Are Available for Lichen Planopilaris (LPP)?

Once diagnosed, several treatment options for LPP are available:

1. Steroid injections to the scalp
2. Pharmaceutical drugs, blockers
3. Botanicals

Generally, LPP (Lichen Planopilaris) treatments consist of steroids such as corticosteroids, antibiotics, and retinoids. All are meant to lessen the symptoms of inflammation and prevent the further spread of the condition.

A commonly prescribed treatment is long-acting steroid injections (Typically triamcinolone) to the patient’s scalp, combined with pharmaceutical drugs (e.g., hydroxychloroquine, doxycycline, methotrexate, JAK Inhibitors like tofacitinib and naloxone) to inhibit specific pathways within the body to reduce the symptoms of LPP.

However, these treatments have potential side effects, so patients may desire a more natural approach to treatment. 

Although the above treatments are the traditional industry approach, they are often ineffective or unsustainable due to the patient’s discomfort with repeated scalp injections and potential side effects from pharmaceuticals and drug-based products. Due to these possible side effects, many patients may desire a more natural approach to treatment, such as studied and tested botanical products that may help reduce symptoms of LPP through natural means.

One example of natural botanical products studied for LPP is Dr.UGro Gashee Natural Hair Products, featured in this published medical journal, “Lichen Planopilaris Responsive to a Novel Phytoactive Botanical Treatment: A Case Series,” published in Dermatology and Therapy.

Treating LPP with Botanicals – Published Medical Study of Botanicals on LPP Patients

Dr.UGro Gashee, Natural Hair Products have recently been studied and reported in the journal Dermatology and Therapy.

The study, titled “Lichen Planopilaris Responsive to a Novel Phytoactive Botanical Treatment: A Case Series,” reported how all 4 out of 4 LPP patients had “consistently showed a significant improvement in [LPP symptoms]” such as “reduction in inflammation, complete resolution of symptoms, and signs of hair regrowth.”

As reported in the study, compared to pharmaceutical or drug-based treatments for LPP, such as corticosteroids, hydroxychloroquine, and scalp injections, Gashee’s natural ingredients and properties pose few side effects for patients. In addition, they were used repeatedly for the long term due to these natural ingredients that are holistically compatible with normal human physiology.

Some of Gashee’s quality botanical ingredients include green tea, turmeric, aloe vera, and more. The word “botanical” is derived from plants. Dr.UGro Gashee’s products were expertly forged from ingredients grown in nature. As many plants are known for their naturally-occurring medicinal and healing properties, Gashee utilizes botanicals to safely and holistically help strengthen scalp conditions.

Before and After – Dr. UGro Gashee Natural Hair Health Products & LPP Research

See below for more before and after results of patients from the Gashee – LPP study.

VIDEO: Gashee LPP Study Before & After Full Patient Results

For slides of more patients before and after the Gashee LPP study results, visit the YouTube video below.

Published Report, Lichen Planopilaris, LPP Responds to the Natural Hair Treatment Formula – Gashee

No Description

If you are interested in Gashee Natural Hair Products, use the button below to visit the Gashee website and online store at www.ugro.com. Suppose you suspect you have LPP (Lichen Planopilaris) and are interested in possibly using Dr. UGro Gashee Natural Hair Products to treat it. In that case, it is recommended to consult a dermatologist before using this product. To do so, you can use the free consultation button below to schedule a consultation with Dr. Sanusi Umar, MD, FAAD, the creator of Dr.UGro Gashee Natural Hair Products.

Frequently Asked Questions

Can Hair Grow Back After Lichen Planopilaris?

Hair regrows after Lichen Planopilaris – due to LPP scarring alopecia, typically left untreated, LPP can leave the user with permanent scarring, which leads to permanent hair loss – but if treated early enough, there may be the possibility of hair growth. However, this is based on the treatment and conditions of the patient’s hair and scalp.

Does Lichen Planopilaris Ever Go Away?

Typically Lichen Planopilaris (LPP) does not go away on its own – it will persist until the patient has no more hair for the body’s autoimmune system to attack.

Can You Dye Your Hair if You Have Lichen Planopilaris?

It is not recommended to dye your hair if you have Lichen Planopilaris (LPP) because it can aggravate hair follicles and scalp inflammation, worsening LPP symptoms and conditions.

What Causes Lichen Planopilaris of the Scalp?

Currently, there is no certainty on what causes LPP (Lichen Planopilaris). Only the mechanism of LPP is understood, in which the autoimmune system mistakes the body’s hair stem cells as a threat, therefore attacking and destroying it.

How Long Does Lichen Planopilaris Last?

There are no actual measurements of how long LPP lasts, but it often persists throughout a patient’s lifetime until there is no more hair for the patient’s immune system to attack.

How Common is Lichen Planopilaris?

LPP, also known as Lichen Planopilaris, is a rare disease and the most frequent cause of adult primary scarring alopecia [3].

One study states that LPP incidence varied from 1.15% – 7.59% [4].

Further Reading 

• For more in-depth scientific reading on Lichen Planopilaris, visit this NIH article. 
• For more information about the botanical ingredients used in Dr.UGro Gashee products, visit ugro.com.
• Visit this DermNet article for additional information regarding LPP basics.

Consult with an Experienced Dermatologist on LPP

If you are interested in Gashee or would like a free consultation with Dr. Umar, schedule a consultation with Dr. Umar using this link: 

References

1. 2022. [online] Available at: https://rarediseases.info.nih.gov/diseases/3247/lichen-planopilaris [Accessed 17 June 2022].
2. Dermnetnz.org. 2022. Lichen Planopilaris — DermNet. [online] Available at: https://dermnetnz.org/topics/lichen-planopilaris [Accessed 17 June 2022].
3. Cdn.mdedge.com. 2022. [online] Available at: https://cdn.mdedge.com/files/s3fs-public/issues/articles/vol28_i1_Lichen_Planopilaris.pdf [Accessed 18 June 2022].
4. Brankov N, Conic RZ, Atanaskova-Mesinkovska N, Piliang M, Bergfeld WF. Comorbid conditions in lichen planopilaris: A retrospective data analysis of 334 patients. International Journal of Women’s Dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116820/. Published June 7, 2018. Accessed June 17, 2022.

Further Reading:

What is central centrifugal cicatricial alopecia aka CCCA ?

The post What is Lichen Planopilaris AKA LPP? appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

Hair loss from CCCA can lead to permanent hair loss and cause scarring. The “cicatricial” part of its name comes from the scarring this form of alopecia causes due to the destruction of hair follicles, meaning that CCCA is a type of scarring alopecia. It can be uncomfortable with itching or burning on top of hair loss. The disease has also been called Hot Comb Alopecia and Follicular Degeneration Syndrome.

Central Centrifugal Cicatricial Alopecia (CCCA)

What causes CCCA?

CCCA is believed to be hereditary [2] but can be exacerbated by the following factors:

• Overuse of heated products on the hair, calling it “hot comb alopecia.”
• Tight braids, weaves, or extensions
• Chemical relaxers or other harsh products, such as hair dyes
• Tight or hot rollers
• Pulling from overuse of brushes or combs

Who does CCCA affect?

CCCA is known almost exclusively to affect Black women who are over the age of 30. This could be due to the more common use of tight hairstyles or harsh products used by women with Afro-textured hair. Recently, a genetic basis for the disease has been uncovered [3].  

Most dermatologists can diagnose patients with CCCA based on the visual appearance of their scalp or by using a special handheld magnifying lens instrument called a dermoscopy or trichoscopy.

However, confirming the diagnosis would require a biopsy. Using trichoscopy, the dermatologist would be directed to the best spot on the head from which the biopsy should be taken.

The biopsy entails taking a small piece of skin between 2-4mm in size after numbing the area with a local anesthetic similar to what you get at the dentist. Then, the specimen is studied under the microscope by the dermatologist or dermatopathologist, who looks for specific features that help confirm the diagnosis of CCCA.

If you suspect that you have CCCA, it is best to treat it early. Be sure to see a dermatologist such as Dr. Umar, who has extensive experience in successfully treating CCCA patients of all severity. It may be CCCA if you notice a circular, central hair loss pattern, particularly if it is combined with an itching or burning sensation on the scalp. Fortunately, Dr. U has various original treatment procedures that he has developed himself to treat and improve the condition, particularly the hair loss component of CCCA, successfully. 

What are the treatments for CCCA?

General treatment for CCCA includes oral, topical, or injectable steroids—these work by reducing inflammation and suppressing the immune system to prevent the destruction of healthy follicles. If the condition goes untreated until it is more advanced, anti-inflammatory medications are often used. Certain types of oral antibiotics (belonging to the tetracycline, for example, doxycycline and minocycline) can also potentially lessen inflammation and prevent further hair loss.

Other medications that have been tried include potent immunosuppressants and modulators such as hydroxychloroquine, Tacrolimus, cyclosporine, and mycophenolate. All these treatments can be combined with procedures that harness the potential of platelets or light. Unfortunately, many of these treatments show variable and inconsistent response rates.

Furthermore, since these treatments do not cure CCCA but keep it under control, they would require chronic use. Unfortunately, many of these medications cannot be used long-term and must be discontinued often because of side effects and complications. To this end, there is a need to find a treatment that can be used in the long term with fewer concerns for adverse effects of treatment toxicity.  

The Dr. U Skin & Hair Clinic Difference: How Does Dr. U Treat CCCA?

Over years of experience managing hair conditions and as a world-renowned hair expert, and having used all the conventional approaches for treating CCCA, Dr. U has devised his own original natural botanical products for treating CCCA.

Instead of using steroid scalp injections, topicals, and other drugs, Dr. U has been able to help save his patients from the pain and discomfort associated with those treatments by using his self-formulated natural hair product line, Dr.UGro Gashee.

Whereas other general treatments have shown little to no improvement in CCCA symptoms, Dr. U’s self-formulated Gashee has recently been reported as the first botanical to show a positive response toward CCCA.

Dr.UGro Gashee – Natural Alternative

Gashee is a popular hair care product brand that utilizes natural ingredients to nourish the hair and scalp while effectively maximizing hair health for growth and strength.

Dr.UGro Gashee products are formulated with natural ingredients, including necessary vitamins for hair health. Some of their quality natural ingredients include a proprietary blend of green tea, cinnamon, celery, grape seed, rosemary, aloe vera, pumpkin seed, and more.

In addition to these botanical ingredients, Gashee uses hyaluronic acid, zinc, iron, and other crucial vitamins to reduce inflammation, boost growing hair health, provide moisture, and repair damaged hair with healthy growth. The botanical lotion and pomade work topically to fight various forms of alopecia and improve hair and scalp health, while the oral botanical supplements assist hair health through internal means. 

In a recently published peer-reviewed medical journal, Dr.UGro Gashee’s hair products have been reported as the first botanical to impact CCCA symptoms, including hair loss, positively. In the study, several women with a history of CCCA, previously treated with pharmaceuticals and drug-based means such as topical and injectable steroids with little to no positive results, have shown positive responses when using Gashee natural hair products. This is a significant finding that warrants further study, as the role of natural products in the future of CCCA treatment can have massive potential, as natural products often come with more favorable side effect profiles better suited for long-term patient use.

View Full Gashee Publication on CCCA: First Natural Botanical to Show Positive Response Towards CCCA

What are botanicals?

The term “Botanical” refers to something derived from plants. Utilizing plants to curate natural ingredients allows for a healthier, more effective product. Botanicals are mainly known for their naturally-occurring healing and medicinal properties. Dr.UGro Gashee uses botanicals in all products, providing naturally-derived lotions, pomades, and supplements. These products, made from plants, promote holistic wellness and hair health, helping fight symptoms of CCCA safely, naturally, and effectively. 

Before and After – CCCA Gashee Published Patient Results

The pictures below show the before and after results of the previously mentioned Gashee publication in the Clinical Cosmetic and Investigational Dermatology peer-reviewed medical journal. The patient was able to recover a large portion of hair loss in the areas of balding after the use of Gashee topical and oral supplements.

If you are interested in Dr. UGro Gashee products, visit our Gashee product page using the shop Gashee button link below:

CCCA Frequently Asked Questions

What is Scarring Alopecia?

• Scarring Alopecia, or cicatricial, refers to any alopecia where hair follicles are destroyed, resulting in scarring. 

Is Scarring Alopecia the same thing as CCCA?

• CCCA is a form of scarring alopecia, of which there are many other types. Other types of scarring alopecia include lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA)
  

Is Alopecia a diagnosis?

• Yes. Alopecia can be diagnosed by your dermatologist, including the particular form of the disease you may have.

Can CCCA be cured?

• When caught and treated early enough, symptoms of CCCA can be lessened to the point where its effects may not be noticeable, but severe damage from CCCA can be irreversible. 

Can I treat CCCA with hair transplantation?

• With the right experienced hair surgeon, hair transplantation is possible. Be sure to find a reliable doctor, like Dr. U, who specializes in covering scars and restoring damaged scalps.

What about platelet-based treatments?

• Some studies, including one linked here, have shown that platelet-based treatments may help combat CCCA symptoms. Be sure to speak with your dermatologist in detail and consider all your options.

Can I use Gashee or other botanicals to treat my scarring alopecia or CCCA on my own?

• If you suspect you have scarring alopecia, you must first consult your dermatologist to get a proper diagnosis and then follow their recommendation on how best to treat the condition. Unfortunately, nothing has been specifically approved for the treatment of CCCA, so your dermatologist must use their judgment to determine the best treatment for you.
• You can complete a free consultation for your hair loss with board-certified dermatologist Dr. Sanusi Umar by using this link: https://dru.com/hair-free-consultation/ or using the free consultation button below.

If you suspect you have CCCA or any other hair or skin condition and would like to consult Dr. Umar, who has had a great deal of experience in treating CCCA patients successfully, please feel free to do so using the link below:

References 

1. Central Centrifugal Cicatricial Alopecia (CCCA) | Hair Loss in Black Women. (2015, March 13). Skin of Color Society. https://skinofcolorsociety.org/patient-dermatology-education/central-centrifugal-cicatricial-alopecia-ccca/
2. Central centrifugal cicatricial alopecia | DermNet NZ. (n.d.). Dermnetnz.org. https://dermnetnz.org/topics/central-centrifugal-cicatricial-alopecia
3. Malki, L., Sarig, O., Romano, M.-T., Méchin, M.-C., Peled, A., Pavlovsky, M., Warshauer, E., Samuelov, L., Uwakwe, L., Briskin, V., Mohamad, J., Gat, A., Isakov, O., Rabinowitz, T., Shomron, N., Adir, N., Simon, M., McMichael, A., Dlova, N. C., & Betz, R. C. (2019). Variant PADI3 in Central Centrifugal Cicatricial Alopecia. New England Journal of Medicine, 380(9), 833–841. https://doi.org/10.1056/nejmoa1816614

The post What is Central Centrifugal Cicatricial Alopecia (CCCA)? appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

Curious to see if ACELL could work to support patients undergoing an FUE, follicular unit extraction, or hair transplant, Dr. Sanusi Umar of Dr. U Hair and Skin Clinic sought to find the answer for himself – conducted an informal analysis of the benefits of ACell.

Article Update July 2022

There are now new treatments that can be done to help optimize and maximize your hair transplant results.

One of these regenerative medicine treatments is Regenera Activa, offered by Dr. U Skin & Hair Clinic.

Regenera Activa helps stimulate hair growth and reduces hair fall. It can be done as a regular treatment to help treat hair loss, but it can also be combined with a hair transplant procedure to help maximize the results. For more information about Acell for hair restoration and its effects on hair transplants, continue below.

The Dr. U Hair and Skin Clinic ACELL Test:

The test had 2 objectives:

1. To determine if the grafts survived better after soaking in a solution of ACELL before grafting
2. To determine if the healing of wounds created by the UGraft FUE techniques benefitted or not from the use of ACELL

Methods: In patients undergoing typical hair transplantation with a symmetric recipient site. Grafts implanted in one-half of the recipient site were dipped in a solution of ACELL before being implanted into premade slits, while grafts going to the other half of the recipient area were not dipped in an ACELL solution. All grafts are stored in a chilled lactated ringer’s solution before grafting or dipping into the Acell solution.

Similarly, in the same patients, one-half of the donor areas were coated with a thick solution of ACELL before being coated over with bacitracin ointment. At the same time, the other half was treated with bacitracin ointment and no ACELL precoating.

Results: After a waiting period of 1 year, there was no difference in either half of the grafted sites in regrowth count or onset or completion growth. No difference was noted in the recipient’s healing. Similarly, the donor areas did not show any difference in the healing rate or quality of the scar.

Conclusion: ACELL ECM did not enhance recipient performance or donor healing when used. More extensive studies would help confirm these findings.

But what is ACELL? 

ACell is a wound management medical device/treatment developed to enhance wound healing using novel concepts in regenerative medicine. It is based on the extracellular matrix (ECM) derived from the Porcine urinary bladder matrix and works by forming the framework into which regenerative cells and structural tissue grows. The result is faster healing with less scarring. Scarring is less because the repair is more cellular than cicatricial. In plain language, non-scar-forming cells migrate into the extracellular matrix of Acell to cover the defect rather than in conventional scenarios where scar-forming fibroblasts and their ground substances move in to cover the wound defect with a scar (1). But according to Acell’s research, not all acellular products function or respond similarly and vary from person to person (2). The FDA indication for Acell is a device used in wound management.

WHAT IS THE ROLE OF ACELL IN HAIR RESTORATION?

Soon after its emergence over a decade ago, some hair restoration clinics began:

1. Using ACELL to treat baldness all by itself
2. It is adding ACELL to grafts at the time of implantation with the hope it will increase hair transplant yield/survival.
3. Applying ACELL topically to donor site wounds with the hope that it would optimize wound healing rate and esthetics
4. Using ACELL as an adjunct in other regenerative methods of hair loss treatment

DOES ACELL TREAT BALDNESS ALL BY ITSELF?

Whether ACELL is injected or applied topically, there is no evidence that it will grow new or improve pre-existing hair. Moreover, there is not enough theoretical science to support using it in this context.

DOES ACELL IMPROVE GRAFT SURVIVAL IN HAIR TRANSPLANTATION?

Based on Dr.U’s study, this does not occur. Dipping hair transplant grafts in ACELL solution before implantation did not increase hair transplant yield

DOES ACELL IMPROVE WOUND HEALING IN HAIR TRANSPLANTATION

Average wounds created by FUE are microscopic and would typically heal very well with minimal scar formation. Wounds created by UGraft punches called Intelligent punches are optimized further to heal better than typical FUE wounds.

IN HIS STUDY, Dr. U found no advantage of adding Acell to the FUE wounds created by the UPunch. According to Dr. U, this is likely to be the case with FUE wounds of less than 1.12mm. That said, Dr. U believes that Acell will most likely be helpful in Follicular unit strip surgery (FUSS) in much larger donor wounds. According to Dr. U, even in strip surgeries, one has to be careful in using ECM to minimize scar formation, as some degree of scar formation is required to create a strong scar that will hold and not stretch. By using ECM such as Acell to minimize the scar-forming process, FUSS practitioners should watch out for the possibility of increased incidence of scar stretching, which might manifest as long as 6 months after the surgery.

DOES ACELL ENHANCE THE EFFECT OF OTHER REGENERATIVE MEDICAL TREATMENTS OF HAIR LOSS?

According to doctor Umar, regenerative medicine plays a prominent role in hair restoration. It is becoming more so as we are beginning to expand our knowledge of the various mechanisms by which hair loss occurs at cellular and autocrine levels.

The explosion of research in various aspects of the regenerative science field, such as Platelet-derived methods, autologous stem cells derived from fat and blood, use of exosomes, and allogeneic stem cells derived from placental tissue, is already making inroads into the field of hair restoration.

Platelet-based technologies are rampant and common in hair restoration, and one of the methods used by many to enhance efficacy and longevity is a regimen that combines platelets with an extracellular matrix, of which Acell is a favorite. Another ECM hyaluronic acid has been used to enhance Platelet-based regenerative procedures’ effect in other areas of medicine, such as orthopedics.

ACELL & Hyaluronic Acid for Hair Loss

Dr. U has observed enhanced effects of adding hyaluronic acid to regenerative medical processes when used to treat hair loss. There is thus a good reason to study the role of ACell, hyaluronic acid, and other ECM in conjunction with platelet-based treatments, stem cell, or exosome-based treatments in hair loss.

Finally, practitioners should be aware that overall, the use of Acell or any ECM for hair restoration is an off-label use and not approved by the federal drug administration (FDA). The FDA came down hard on Acell manufacturers with fines and sanctions for alleged claims of approval or topical use. Acell is not approved as a medicine that can be applied topically; instead, it is approved as a medical device.

VIDEO: Is ACELL Useful For Hair Restoration?

ACELL: Is it useful in hair restoration?

Many individuals who are considering a hair transplant surgery wonder if they should choose an additional treatment called ACell to achieve the best possible…

Are you interested in chatting with Dr.U about ACELL? Submit your question by clicking the Ask Dr.U button below! He will send you a response within 72 hours.

Free Hair Consultation
 

References 

1. Brown BN, Londono R, Tottey S, Zhang L, Kukla KA, Wolf MT, Daly KAReing JE, Badylak SF. Macrophage phenotype as a predictor of constructive remodeling following the implantation of biologically derived surgical mesh materials. Acta Biomater. 2012 Mar; 8(3):978-87.
2. Mulder, Gerit & Wallin,Kelly. (2012) Regenerative Materials That Facilitate Wound Healing. Clinics in Plastic Surgery, Volume 39, Issue 3, July 2012, Pages: 249-267

Further Reading

Acell porcine origin and implications to Kosher and Halal observers

The post Is ACELL Useful For Hair Restoration? appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

What is the best age for Hair Transplant Surgery? FUE FAQ by Dr. Umar

Schedule a free consultation here: https://dru.com/free-consultation/Am I too young for a Hair Transplant?What to do when you are first noticing the signs of…

What to do when you are first noticing the signs of hair loss

At Dr. U Hair Clinic, we emphasize that the first step when noticing areas of thinning is to speak to a dermatologist or hair specialist to determine the cause(s) responsible for the hair loss. A doctor will also be able to provide an accurate diagnosis.

The majority of cases will be due to genetic pattern baldness (i.e. androgenic alopecia).  Instead of choosing hair transplant surgery right away, patients should see if medical treatment with Minoxidil or Finasteride can help manage their condition.

If improvement is not seen after 6-8 months of using the medication, then it may be appropriate to consider hair transplant surgery as the next step.

Patients should seek a  solid understanding of the larger picture involved as well as the full extent of treatment options available.

It will be important to carefully weigh the pros and cons of each one.

Should you get a hair transplant at age 27 or a hair transplant at age 23?

Many younger male patients of Dr. U Hair Clinic have often been told that hair transplants should not be done under the age of 25.

However, age doesn’t necessarily correlate with a person’s hair loss progression. The nature of this course is an essential consideration when considering a hair transplant at a younger age.

Realistically speaking, men in their 20’s should expect to continue losing hair.

With this in mind, it becomes easy to see that transplanting hair to fill in a receded hairline will not solve their problem if hair continues to shed beyond the treated zone.

This may occur whether you are under or over the age of 25.

What is the perfect age for a hair transplant?

According to our clinic’s philosophy, there is no perfect age for a hair transplant.  Hair restoration surgery can be the right course of action as long as there are enough donor resources for multiple future surgeries.

Some people will reach severe baldness (Norwood 6-7) in their lifetime. In these instances, a person’s supply of head hair won’t be sufficient to provide full coverage in the long term.

We do not believe that family history accurately predicts the course of an individual’s hair loss or offers certainty as to whether or not they will become severely bald.

It’s best that individuals prepare themselves for the worst-case scenarios by anticipating this possibility well in advance. This involves being able to attain additional donor grafts to cover emerging areas of hair loss.

The Dr. U Hair Clinic specializes in harvesting additional sources of grafts from areas like the beard and body. The quantities of follicles that can be harvested from these regions make it possible to reverse severe cases of baldness. However, specialized technology is necessary to safely harvest these grafts.

This type of instrumentation must accommodate the smaller growth angles of body hair. Also, it needs to impart higher wound healing standards on open and exposed donor areas like the face, neck, chest, etc.

If a younger patient has enough body-done hair available, they can feasibly undergo hair transplant surgery in their early twenties. However, going this route requires the full awareness that future procedures will be likely in the years to come.

Any age for hair transplant surgery can be appropriate if the right resources are in place to provide coverage for continued hair loss.

Is there a best age to get a hair transplant? 

The best point in time to undergo hair transplant surgery will vary for each person. So there is no universal, one-size-fits-all age for hair transplant surgery when planning on a procedure.

As mentioned in the video, there are several essential factors to consider for getting a hair transplant early in life. These include:

• The number of donor resources available for multiple future surgeries. When head hair is not enough, body areas may be considered for expanding the donor pool.
• The means to harvest non-head hair as an additional reserve of donor grafts
• Having the finances to afford more than one hair transplant surgery in later years

Younger patients must prepare for the inevitability of continued hair loss. Having a reliable strategy and resources to tackle this issue should be prioritized over choosing the exact age for hair transplant surgery. Doing so will prevent regretful outcomes of struggling with continued baldness that occurs past the transplanted recipient regions.

You Age Hair Restoration in Torrance, Los Angeles

If you would like to speak about your options for hair loss treatment, submit your information and photos through our complimentary online consultation system.

Further Reading

Learn more about this young patient who underwent a budget-friendly hair transplant surgery performed at Dr. U Hair Clinic.

Read about another young patient of Dr. U Hair Clinic who restored his coverage through a body hair transplant.

The post What is the Right Age for Hair Transplant Surgery? appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.

Article Update August 2022

Although it is typically acceptable to wear a hair piece after hair transplant surgery, certain materials are recommended, as well as other materials that are not recommended – more information on this is detailed below.

On the other hand, these are some of the things you should avoid after hair transplant surgery:

1. Swimming
2. Drinking Alcohol
3. Smoking
4. High-Impact Excersise

Can I Wear a Hair Piece After Hair Transplant Surgery?

In this Q&A video, Dr. U addresses the desire of patients to continue relying on wigs and hair systems after their operation. His advice is that it is best to abandon the use of hair prosthetics and explain why this is the best course of action.

How do the use of hairpieces and toupees affect my hair transplant surgery?

After a hair restoration procedure, growth will take some time to develop. In the meantime, is it a good idea for patients to use hairpieces and toupees to c…

Types of Wigs and Hairpieces Used by Hair Loss Sufferers

When people lose their hair, they feel very self-conscious about the regions of baldness or sparseness on the scalp.

An easy solution to resort to is to adopt the practice of wearing wigs [1] and hairpieces [2]. This offers immediate gratification for those who are not yet ready or willing to undergo hair transplant surgery.

Wigs and hairpieces are made of synthetic or natural human hair. Today’s hair system products are often classified by the base used. These include two general categories.

• Mesh
• Polymer

Some hairpiece products use a combination of both.

Wigs and Hairpieces With a Mesh Base

The mesh itself is usually made of polyester or nylon to create a thin layer that appears more natural, especially for the hairline region. 

The main benefit of having a mesh base is that it is lightweight and more relaxed. However, it does wear faster due to acids released from the skin.

In some hairpiece products, the mesh is only used for the underside of the hairline portion. In others, the entire base is constructed of mesh.

Hairpiece Systems With a Polymer Base

To avoid slipping, other types of wigs and hairpieces are constructed with a polymer base made of silicone or polyurethane. This type of material offers more durability, tends to last longer, and is less expensive.

On the downside, rubber-like bases can appear unnatural and trap more heat. 

These types of wigs and hairpieces should not be worn after a hair transplant. According to Dr.U, the added weight of the polymer base will shift the angles of the inserted grafts, which will undermine the appearance of the outcome.

Methods of Adhering to Wigs and Hairpieces

Wigs and hairpieces are also classified by how they adhere to the scalp. These include:

• Semi-permanent hairpieces (non-surgical hair replacement)
• Temporary adhesive-attached hairpieces
• Clip-on hairpieces

Many of Dr. U’s patients utilized one of these three methods before their hair transplant procedure, including those who needed to repair last hair restoration surgical mistakes. 

How Does Non-Surgical Hair Replacement Work?

Some wigs and hairpieces are affixed to the scalp using semi-permanent techniques that involve liquid adhesives such as polyfuse or natural bond. This method is also referred to as non-surgical hair replacement. The hair prosthesis is not meant to be removed by the wearer but by stylists or hair technicians. This is usually done every five to six weeks to remove accumulated dead skin cells, flakes, shed hair, and other forms of debris.

Any glue should not be used after a hair transplant surgery.

Hairpieces with Temporary Adhesive

These wigs and hairpieces use double-sided tape to stay on the scalp. Wearers can reattach the tape themselves. However, this can leave a residue on the skin.

Dr. U recommends stopping double-sided tape for wigs and hairpieces after a hair transplant.

Clip-On Hair Pieces

Wigs and hairpieces with a base made entirely of mesh can be safely worn using clips after a hair transplant procedure. This is only advised in cases where the patient must attend an important social event. The clips on the underside would attach to the surrounding margins of hair.

Following surgery, Dr. U advises that clip-on wigs and hairpieces be worn for about 12 hours daily. Patients should immediately remove their hairpieces when they arrive home.

What Happens If You Continue Wearing Wigs and Hairpieces After Surgery?

As mentioned earlier, many of Dr. U’s patients are used to wearing wigs and hairpieces. They often wonder if continuing this practice after their hair transplant surgery is possible.

According to Dr. U, the occlusive effect of the base can damage the grafts and growth yield. The weight and pressure of a rubber base can change the graft angulation. Glues and tape adhesive can stick to the shaved hair shafts and shift these angles. Furthermore, the wounds created during surgery provide vulnerable openings in the skin. And these types of chemicals can irritate. Sweating and moisture due to tapes, rubber surfaces, or glue will encourage bacterial growth, which is likely to cause inflammation and inflict irreversible damage to the newly inserted follicles.

How to Conceal Signs of Surgery After a Hair Transplant

After a hair transplant procedure, it usually takes about three to four months before seeing the first signs of growth. Around the sixth to the nine-month point, many people can start grooming their hair. But this will differ for individual patients on a case-by-case basis.

A significant concern for many patients is seeing obvious signs of surgery following their operation. Dr. U recommends using loose hats, baseball caps, or beanies after hair transplantation. These head coverings will not press tightly against the scalp’s surface and cause harm to the grafts.

Schedule a Free Consultation with Dr. U Now

For more information regarding hair transplantation, use the button below for a free consultation with Dr. Umar.

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Frequently Asked Questions on Wigs and Hairpieces

What is the difference between a hair transplant and hair restoration? Do wigs and hairpieces fall under the category of hair restoration? 

Hair transplant refers to the surgical process of extracting hair follicles and transplanting them to bald or thinning areas of the scalp. It is considered one approach to hair restoration concerned with the restoration of hair in general.

While surgery is one way to restore hair, other means include using drugs or medications that may include synthetic or natural chemical compounds. The use of wigs and hairpieces helps to mimic approximate the appearance of a restored head of hair. But this practice is technically not a natural hair restoration treatment.

Is non-surgical hair replacement worth it?

Non-surgical hair replacement uses liquid adhesive to affix a hairpiece unit to the scalp. In the long term, this hair care method is quite time-consuming. It involves having a technician apply the base portion to the scalp. It must also be removed by a specialist periodically to clean up flakes and debris accumulated. The overall system can be uncomfortable for the wearer in hot temperatures as they sweat. It may not be utterly foolproof as the position of the hairpiece may shift in wet conditions, like when it rains or if the person wants to go swimming. Although it creates the look of a full head of hair, the wearer can still feel a sense of inauthenticity about using non-surgical hair replacement systems.

Instead of wearing wigs and hairpieces, is it okay to use hair concealers after my hair transplant?

Hair concealer products contain tiny particles made of synthetic chemicals. After a hair transplant, when your wounds have not entirely closed, these particles can enter the skin and cause irritation and inflammation. It takes about 7 to 10 days for the wounds to close.

Most doctors recommend waiting for the skin to heal before resuming personal hair grooming products. Although there are standard timeframes for average cases, it is best to speak to your doctor about when it would be safe to start using powdered concealers. As long as the skin has healed sufficiently, they would be less risky to the grafts than wigs and hairpieces, which can alter the angles of the inserted hair follicles.

Do you still have questions about using wigs and hairpieces after a hair transplant? Submit them to Dr. U directly by using the button below:

Free Hair Consultation

Further Reading

Meet a patient who could finally toss his toupee after his Dr.UGraft body hair-to-head transplant.

Learn why Dr. UGraft’s surgery makes the use of hair systems completely unnecessary for male pattern baldness suffers and victims of poorly conducted hair transplant procedures.

Discover a patient who opted for a hair transplant and hairpiece combination through a Dr.UGraft operation.

References

1. “Wig.” Wikipedia, Wikimedia Foundation, 2 Nov. 2019, en.wikipedia.org/wiki/Wig.
2. “Toupée.” Wikipedia, Wikimedia Foundation, 26 June 2022, en.wikipedia.org/wiki/Toup%C3%A9e. Accessed 3 Aug. 2022.

The post Can I Wear Wigs and Hair Pieces After My Hair Transplant Surgery? appeared first on Dr. U Hair & Skin Clinic | FUE Hair Restoration, Dermatology and Laser Surgery | Los Angeles, Manhattan Beach | Dr Sanusi Umar MD.