HAIR LOSS: Expectations and Solutions


Even the most successful hair loss treatments aren’t without their limitations. Realistic expectations are key in order to avoid disappointment. Hair transplants and medications to help promote hair growth have been around for a while, but none of these are 100% effective and each comes with its own limitations that you need to be aware of prior to consideration.

Many folks over the years have ended up with disappointing results from hair loss solutions, so it’s vital not only to find the right solution but also to understand its limitations in reviving your hair to a more youthful density.

Wigs are uncomfortable and scratchy, which make them a less than ideal solution for baldness even before one encounters the stigma of wearing one. It’s also not uncommon for balding to have adverse effects on self-esteem, to the point of some sufferers having difficulties even leaving the house for extended periods of time. Since balding is often looked at disparagingly, it’s understandable why those of us suffering from hair loss would want a solution to improve body image. Everyone should ideally be able to accept their bodies, but that’s difficult for many in light of how much emphasis society places on our physical appearances.

Reasons for Hair Loss

reasons for hair loss

Hair loss is more common in men than women but affects people of all genders and sexes. There are primarily two forms of balding:

Male pattern baldness, in which there is significant hair loss around the crown and forehead

Female pattern balding which is a general thinning of hair on the head. Just as the terminology would imply, these most commonly affect men and women respectively.

The leading cause of balding is the hormone dihydrotestosterone, which is synthesized from testosterone by 5-alpha-reductase. That enzyme is found in the dermal papilla, and it leads to miniaturization of hair follicles in hormonally sensitive areas. As the follicles shrink, they stop producing normal hair.

Hair Loss Medications

Hair Loss Medications

There are a couple of medications which have been on the market for hair loss for many years now, and these also come with their own limitations on just how effective they’ll actually be for preventing further hair loss. Furthermore, your choices are somewhat limited by the fact that there are only two approved drugs on the market for treating hair loss. These are minoxidil and finasteride, and while each might give some people some signs of improvement, neither will actually reverse hair loss. Therefore, it’s best not to put high expectations into these drugs, though one or the other might offer you some benefit.

One of the best-known medications for male-pattern hair loss is finasteride, which has been around in the US since at least 1997, under the brand name Propecia. Finasteride hair-growing properties were first noticed with 5mg doses of Proscar (originally intended for the treatment of enlarged prostate glands), and it was subsequently discovered that a 1mg dose per day is enough to encourage hair growth. Finasteride seems to work by inhibiting the alpha-5-reductase enzyme in the dermal papilla, but it does carry the risk of a few side effects which aren’t particularly great for those who’re already insecure about their masculinity: these include erectile dysfunction, as well as libido and ejaculation disorders. That being said, there are millions of men on finasteride who do not experience any side effects from it.

HAIR LOSS: Expectations and Solutions

Minoxidil hair-growing properties were first noticed back in the 1960s when men taking the drug for a clinical trial for high blood pressure were observed as having improved hair growth. The exact way that this works is still unknown, but the FDA approved minoxidil as a hair loss solution in 1988 with the caveat that it may not work for everyone. Further tests have shown varying results, with some tests claiming that 80% of users can experience positive results and others claiming that only a small handful would see any improvement. While finasteride is available by prescription, minoxidil is available over the counter as a topical medication, under an array of names. The most common trade name for minoxidil in the US is Rogaine, which you’ve likely heard of.

Hair Transplants

Hair transplants are basically the only way to regrow hair in areas of your scalp that are already bald. What this means is that even if you wouldn’t get much benefit from medications which are supposed to encourage hair growth, a transplant could still be the appropriate solution to your problems. Regardless of which type of transplant you’re considering, the principles are the same: hair follicles are harvested from regions of the scalp which aren’t prone to follicle miniaturization from DHT and transplanted to new places where they continue to grow as if nothing happened.

In a transplant, follicles are harvested from the donor area and transplanted to balding regions to replace hair that’s already fallen out. This means that your success will be limited to the availability of hair follicles in the donor region since you don’t want to transplant hairs from dying follicles. Furthermore, transplant procedures can end up leaving scars as well as taking up a large amount of time to complete.

The Density of Transplanted Hair

One important thing to keep in mind is that the density of hair in areas where it is transplanted will be less. This is primarily due to the fact that hair will continue to thin in the area where the transplant is. In addition, transplants won’t have the same density as the original growth. A skilled surgeon can make transplanted hair look natural, but this isn’t without its limitations.

FUT vs. FUE: Know the Difference


Follicular Unit Transplants require a strip of skin to be taken from the back of the scalp, after which the follicular units are divided up and replanted in the designated area. The major disadvantage of FUT is that the technique will leave unsightly linear scars at the back of the head, which a good surgeon can minimize but never eliminate entirely. The main advantage of FUT is that it’s less time consuming than FUE and provides higher quality hair follicles than other transplant methods. FUT has a bad reputation owing to the scars it leaves and badly done procedures, but the negative perceptions about it could be somewhat undeserved.

The technique of Follicular Unit Extractions is a more recent technology, and unlike FUT the procedure won’t leave linear scars on the back of the patient’s head. FUE is a time-consuming process, with thousands of hairs being selected individually from the donor area and extracted using tools specifically designed for this purpose. The follicles are kept chilled and later transplanted, which is a long process since this has to be done individually. A good surgeon can replicate the general hair density and growth pattern. Of course, this takes a bit of artistic skill, meaning that it’s essential for follicles to go in the right places in order to look completely natural.

Jeffrey Epstein

Dr. Jeffrey Epstein is the founder and director of the Foundation for Hair Restoration and Plastic Surgery, with offices in both New York and Miami. Dr. Epstein is renowned for the naturalness of his hair restoration work using FUE, as well as beard and eyebrow restoration procedures. He has over 25 years of experience as a plastic surgeon, as well as 25 years in the field of hair restoration procedures. Dr. Epstein performs all of his procedures himself, with a team of 10 assistants. This doesn’t mean that he doesn’t also get time for research on cutting edge procedures so that he can educate the next generation of surgeons.

In addition to all of this, Dr. Epstein is an assistant clinical professor at the University of Miami, a Fellow of the American College of Surgeons, as well as the former president of the Florida Society of Facial Plastic and Reconstructive Surgery. He still manages to publish articles and give lectures on facial surgery and hair restoration, and even provides pro-bono procedures to those in need as a way of giving back to society.

If you’re in need of a hair transplant specialist in Miami, please contact Dr. Epstein.