Forbes India 15th Anniversary Special

The Hair Revolution

MBBS. MD. (Dermatology), Medical Director of COZMAA Clinic in Lower Parel, Mumbai. Specialist in Skin, Hair, and Nail Diseases, Laser Treatments and Advanced Cosmetology Procedure like Botox and Fillers.

Published: Oct 11, 2021 03:34:46 PM IST
Updated: Oct 11, 2021 03:37:07 PM IST

The Hair Revolution

From childhood a constant memory of evolutionary process has been established in our minds, one with our ancestors with a hunched back and a club in his hand, gradually becoming straighter in gait and finally a modern man sitting on a computer. Sinisterly however he is also gradually losing hair. The prehistoric man had body covered in hair and modern man with hair on head and beard. The reality is that as we are progressing in evolution, we are losing more and more hair with each passing generation. Just look in our own family, every generation losing hair earlier, easier and faster, corresponding to our technological advancements. Welcome to the MATRIX of hair loss. Let’s dip into the complex world of hair loss and find some answers, find a solution for hair loss.

Of all the types of hair loss, the most common type in androgenetic alopecia (Natural baldness). It affects 90% men and up to 50% women in their lifetime. It is caused by a genetically determined and transmitted sensitivity of the hair to testosterone by-product also called Dihydrotestosterone (DHT). This DHT causes sensitive hair root to shrink, a phenomenon called Miniaturization of hair or Bonsai effect. The hair progressively becomes thinner and gradually disappears permanently leading to permanent baldness.  A pattern thus evolves which in men is either frontal (loss of frontal hair) or vertex (loss of hair on top) or diffuse (loss all over), with grades ranging from grade 1 to grade 7 (most popular Hamilton- Norwood scale). The grade 1 is early loss and grade 7 is complete loss of hair. In women however it presents as a gradual widening of partitions, more in front than the back giving a typical Christmas tree pattern. Again classified as grade 1 to grade 3 (Ludwig grade). Before the solution let’s look at the causative factors and triggers.

Genetic and advancing age make up for 90% of the cause, the remaining 10% is made of small but significant factors called triggers. Stress is the most important of all the known triggers. Stress in form of either physical, mental, emotional, psychological factors can adversely affect hair. Other triggers include poor nutrition, hormonal issues or disturbances, smoking or tobacco use, dandruff, hard water etc.

So what is the Solution?

Since the causes are multifactorial the treatment is a combination of various modalities. Management of the triggers is a good starting point. Though hair loss is known to humans since ages the real changes in management started in the latter half of the 20th century. Some modalities have been discovered quiet by accident and it is interesting to know that mostly these treatments are very safe. Since a large portion of younger population is suffering from hair loss the treatment have to be minimally invasive, safe for long term use and highly effective. None of the treatments can currently fulfill the criteria and hence we need to use combinations of different approaches to achieve the ultimate goal. Treatments are chosen in combinations, considering the age and sex of the person, stage of hair loss, availability of the resources, causes and triggers to customize for sustainable and satisfying hair treatment outcome.


A successful treatment is an outcome of a careful and detailed counseling and is by far the most important step before beginning any treatment. This includes detailed assessment, communicating the same to the patient, and chalking down the treatment plan and discussion of each steps pros and cons of each and every treatment options. This will not only empower the patients to choose wisely but it makes them a part of the decision making team and make them comfortable to choose a pace of their treatment.
Treatment options are broadly classifies as medicines (oral tablets and local solutions), energy based devices, stem cell therapy or plasma therapy, cosmetic camouflage and surgical intervention.

Medical Management

It is best suited for early stage hair loss and for maintenance of treatment for long term. Its aim is to provide nutritional support, increase blood supply to weak scalp and reduce effect of DHT.

Treatment of comorbidities like diabetes and Thyroid diseases must be done prior to hair treatment.

Nutritional supplements like Biotin, protein, vitamins and minerals provide nutritional support to the weak and recovering hair.

Minoxidil solution increases local blood supply and sustains hair growth. It’s an USFDA approved medicine for hair loss and is probably the most important of all treatments with minimal side effects and is available without prescription in most parts of the world. It’s available as 2%and 5% with or without Finasteride in solution form.

DHT blockers like Finasteride is other USFDA approved medicine in our kitty and blocks the action of DHT on hair roots thereby reducing the pressure of thinning on the hair roots. Dutasteride another DHT blocker is 3 times more potent than Finasteride. Other natural DHT blockers like Saw Palmetto, beta sisterol etc are also used.
Ketaonazole in the form of a shampoo can help with its anti androgen effect.
Energy Based Devices

It is most suitable to be used in combination with other treatments options and as maintenance. Also known as LLLT (low light laser therapy), it’s based on the concept that low level of laser energy stimulates hair growth.
Stem Cell therapy / Plasma Therapy (PRP)

It is the most exciting among the newer treatment options. It helps boots hair treatment by helping with tissue repair and stimulating its growth. Various studies have shown enough evidence of its efficiency. Though minimally invasive, it’s very well tolerated with minimal discomfort and side effects it uses use of various growth factors to achieve this effect. Some treatments like PRP (Platelet Rich Plasma) and GFC

(Growth Factor Concentrate) uses own blood while others like mesotherapy, adipose exosomes and microfat injections uses Fat cells to extract these growth factors. It is suited for all stages of hair loss especially advanced stages of hair loss and can be used as a preparatory step before surgical intervention and can also be used post hair transplant surgery for optimal results.
Cosmetic Camouflage

It is best suited for advanced stages of hair loss or when medical line of management or other interventions have failed. It has given hope to a lot of people who have no realistic chance to achieve natural growth by other means.  It includes wigs, systems, toupees, hair weaving which are either directly glued to the skin or woven in existing hair. Recent advances in manufacturing of these products with human hair have led to more natural look with minimal maintenance.

Hair fibers are coloured collagen fibers or crushed hair which is used for instant camouflage of bald or thin area. It sticks to existing hair and fills up spaces in between hair to give fullness and hence covers baldness.

Scalp micropigmentation is suited for advanced stages of hair loss. It involves creating an illusion of hair by generating tiny tattoo dots on scalp which mimics short hair and can look extremely appealing for someone who wants to sport a trimmed hair look.
Surgical Intervention

It is the gold standard for hair restoration, its ideal for all stages of permanent hair loss. Aim in early hair loss is to achieve density by replacing lost hair. In advanced stages the main is to achieve a camouflage effect so that baldness is covered. Transplanted Hair look very natural and match with existing hair and hence is very cosmetically appealing. Hair transplant has come a long way and evolved over years to reach today’s level. It started with using large punches grafts for surgery to eventually evolving into FUT (Follicular Unit Transplant) surgery, Manual FUE (Follicular Unit Extraction) surgery, Motorized FUE surgery and now Robotic FUE surgery. With better understanding of a follicular unit and the concept of donor dominance, it is the most promising method to restore the lost hair.
Surgical methods are broadly divided into FUT and FUE methods, basic difference being the method of hair removal or extraction .In FUT a strip from donor scalp is used to harvest grafts. In FUE a fine punch of 0.8 or 0.9mm diameter is used to remove hair one by one .in the hands of experienced surgeon both methods give excellent results. Some surgeons also use artificial hair for transplant. Surgeries are consistently giving standardized, more natural and dependable results to a large section of people suffering from baldness. Also this option is becoming more cost effective to give permanent solution for baldness.

So both young and middle aged bald people either in their early stages or advanced stages can utilize the available options that better suits their needs, convenience, budget and expectation to get back their HAIR and CONFIDENCE.

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