Hair, beautiful hair! We love it and we hate it. We fuss over it. We take it for granted, until the unthinkable happens – it begins to thin or worse, fall out. Hair is our crowning glory; it’s something we want to have. Hair restoration is a growing trend, attracting a larger customer base each year.
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Hair, beautiful hair! We love it and we hate it. We fuss over it. We take it for granted, until the unthinkable happens – it begins to thin or worse, fall out. Hair is our crowning glory; it’s something we want to have. Hair restoration is a growing trend, attracting a larger customer base each year.
Current Hair Loss Trends
According to the International Society of Hair Restoration Surgery (ISHRS), 84% of surgical hair transplants were performed on men and 16% on women. Nonsurgical hair restoration procedures also reflected a male dominance, with 60% of procedures performed on men verses 40% on women. The age of patients was surprisingly young, with over half falling between 30-49 years old. Male patients tended to be slightly younger than female patients, which isn’t surprising given male pattern baldness often begins in a man’s late 20s or early 30s. The trend also shows that the average age of patients seeking their first hair restoration procedure is getting younger.
These trends are fueled by the desire of the aging population to look and feel younger, as evidenced by the fact that last year, hair product sales grew 4.7% and skin care products grew 3.2% in the US. Hair restoration methods/treatments have improved over the last decade, are more versatile and within the financial reach of more patients. Recent research by the ISHRS indicates that 85% of hair restoration procedures performed on men and 82% performed on women were hair transplants to the scalp area, while 15% of men had facial hair transplants to the mustache, beard or eyebrows. The most common facial hair transplants for women, which represented 18% of transplants, was eyebrows.
What does this mean for Medical Aesthetics and MedSpa practices? It indicates MedSpas should consider adding hair restoration to their services because hair restoration is a lucrative profit center that will continue to grow in the foreseeable future. Let’s delve a little deeper into hair loss and hair restoration. After all, the hair care segment is expanding at a CAGR of 6.4% from 2022 to 2030.
In an interview with Mac Fadra of Maximum hair restoration he explains todays trends.
“Thanks to advancing medical technology, non-surgical aesthetic treatments have experienced double-digit growth over the past decade, emerging as a viable alternative and partial substitute for some cosmetic surgery procedures.
This trend is expected to continue and is now making headway into peripheral areas of cosmetic surgery including hair restoration, wherein non-invasive and minimally invasive procedures such as PRP, PDO threads, stem cell micrografting, laser hair therapy and topical compounds have emerged as viable non-surgical options. These innovative procedures and treatments are particularly appealing for those who aren’t good candidates for hair transplants including women, men under 25 and those with limited donor tissue. Trichology is also an emerging service in the hair restoration sector which combines hair science with pharmaceuticals, injectables, compounds, topicals, laser hair therapy, oral supplements, shampoos and non-surgical procedures."
Causes of Hair Loss
First, there are many factors that may cause hair loss. In women, hair loss can be the result of medical conditions such as diabetes, acne or breast cancer. Hair loss may be the result of using birth control pills, implants or skin patches because they produce an increased level of androgens that may result in hair loss. Hair loss may occur while using birth control or several weeks or months after ceasing its use.
In women with darker skin tones, there’s a condition known as central centrifugal cicatricial alopecia (CCCA). CCCA is the most common type of hair loss for black women, affecting 15%. It can cause permanent scarring of the scalp by damaging the hair follicles. Early detection is very important, as CCCA is frequently linked to breast cancer, high cholesterol, diabetes and hypertension. Treatment is possible with antibiotics, topical steroids and corticosteroid injections.
Another type of hair loss affecting millions of women of all skin tones is female pattern hair loss, which is genetic or hereditary. With female pattern hair loss, the hair on top of the scalp thins, most often beginning with significant widening of the part in the hair. It is influenced by an increase in hormones, and may present with acne. Treatment for female pattern hair loss is hair transplantation.
In men, androgenetic alopecia or male pattern baldness is the most common type of hair loss. It is genetic in nature and caused by the effects of the male hormone dihydrotestosterone (DHT) on genetically susceptible scalp hair follicles. DHT causes male hair loss by reducing the growth, or “anagen,” phase of the hair cycle. The follicles produce progressively shorter, finer hairs until eventually the susceptible follicles disappear, leaving a bald scalp.
Stanley Okoro, M.D., provides more information, “DHT or Dihydrotestosterone plays a huge role in shrinking hair follicles and shortening the hair growth cycle, resulting in hair Loss. So, you can’t really treat hair loss without an effective DHT blocker. At my practice - our objective is to provide safe and superior outcomes to our patients. Compared to finasteride, I prefer a good natural DHT blocker, as many of my patients are apprehensive about the side effects. I find the HairSmart DHT blocker to be a decent option on the market, as it has good quality ingredients in balanced proportions such as pygeum bark, saw palmetto, stinging nettle root and green tea - which are rich in beta sterols, polyphenols, essential oils and caffeine. I’ve prescribed it for maintenance for my post-transplant patients as well as to women, and it’s working well for them.”
Several things can result in hair loss in either men or women. These include:
Drug-induced hair loss, which is a side effect of medication. For example, blood-thinning medications, oral contraceptives, drugs for depression, anti-inflammatories and beta and calcium channel blockers can all lead to thinning hair or baldness. Excess vitamin A and vitamin A–based retinoids can also cause hair loss, as well as some chemotherapy drugs used to treat cancer. In addition, taking dietary supplements such as selenium may also cause hair loss.
Alopecia Areata is an autoimmune condition in which your immune system attacks and destroys your hair follicles, inhibiting the growth of new hair. Fortunately, Baricitinib, a drug approved for rheumatoid arthritis, was approved by the FDA in 2022 for treatment of alopecia areata.
Telogen Effluvium is hair loss caused by trauma. With telogen effluvium, severe physical stress can disrupt the hair growth cycle, resulting in hair thinning and loss; it may even come out in clumps. Possible causes include severe stress, childbirth, rapid weight loss, thyroid problems, a severe accident, surgery, burns or serious illness, which can shock the hair follicles. Trauma may result in up to 50-75% of your hair falling out, sometimes months after the fact. The good news is that this type of catastrophic hair event may resolve within six to eight months.
Anagen Effluvium is the rapid loss of large amounts of hair during growth phase of hair cycle. It may affect not only scalp, but also eyebrows, eyelashes and other parts of the body. Anagen Effluvium may be caused by chemotherapy, radiation, fungal infections or an autoimmune disease. The treatments vary, but often include topical minoxidil.
Stress, not just your day to day stress, but an intense amount of physical or mental stress, such as an illness or undergoing surgery or other major stressors may trigger hair loss.
Nutrient Deficiencies may result in a variety of hair issues, especially a diet that is inadequate in protein, biotin, zinc and iron. Vitamin or mineral deficiencies may disrupt the hair growth cycle and lead to hair loss. Malnutrition, low protein levels and vitamin/mineral deficiencies all put hair at risk. Signs of a dietary deficiency may include brittle hair, dull appearing hair, skin and scalp dryness and sparse, light-colored hair in children.
Alan Bauman, M.D., explains how weight loss can affect hair loss. “My office has been inundated by men and women who want to shed weight, but NOT HAIR. Unfortunately, ANY weight loss program can deprive hair follicles of the nutrients and fuel they need, resulting in a telogen effluvium. GLP-1 agonists can be quite effective for diabetes and weight loss, just like restrictive diets or even bariatric surgery. Treatments include TED (Transepidemal Delivery of growth factors and peptides) for the shedding, PRP (>10billion platelets), laser therapy, oral minox, exosomes, etc. What many people don’t realize is that just like COVID hair loss, postpartum hair loss and other severe shedding instances, this situation can “reveal” another underlying comorbid alopecia, like hereditary hair loss. That’s why quick evaluation, baseline AI-powered measurements and treatment should be initiated.”
Heavy Metal Poisoning results in many health issues, hair loss being one of them. Ingestion of excessive amount of certain heavy metals such as arsenic, thallium, mercury or lithium are likely to result in thinning hair or baldness.
Finally, Extreme Hair Care can cause significant hair damage and even loss. Common culprits include over styling with heated tools such as blow-dryers; excessive shampooing; traction alopecia -- pulling hair into tight hairstyles such as a too-tight ponytail, braids, bun, cornrows or hair extensions; rubbing the scalp too vigorously and damaging hair follicles; and lastly, the chemicals that are applied as perms, relaxers and hair dyes may lead to damage-induced hair loss.
Now that we’ve listed some of the more common causes of hair loss, let’s take a look at various
treatment options.
Hair Restoration Treatment Options
Medication:
In many cases, hair loss can be effectively treated using medication and/or non-surgical means. The most effective medications are oral or topical finasteride (Propecia), topical minoxidil (Rogaine) and low dose oral minoxidil. Let’s take a more in-depth look at each of these.
Finasteride (brand name Propecia) reduces the levels of DHT in the scalp. DHT is the androgen that shrinks the hair follicles causing shorter, thinner hairs. One of the downsides is that finasteride may not be effective in females, and it shouldn’t be taken by pregnant women or women looking to become pregnant. It is, however, often prescribed to both men and women between puberty and menopause who did not show improvement using minoxidil. Finasteride has some possible side effects, which include erectile dysfunction, decreased libido and gynecomastia (growth of breast tissue). Both oral and topical versions of finasteride are available.
Topical Minoxidil (brand name Rogaine), is the leading OTC hair loss treatment. It is an antihypertensive (treats high blood pressure) drug whose side effects include increased hair growth. Topical minoxidil does have some downsides. It can cause irritation or allergic reactions, as well as excessive hair growth on the face or other areas of the body. Additionally, the regrown hair texture may be of poor quality and it may take 6 to 12 months to grow. It is inconvenient to use topical minoxidil and minoxidil is not effective in all patients, as some lack the SULT1A1 enzyme that activates the medication. Lastly, it must be used continually. If patient stops using minoxidil, hair loss will recur.
Low Dose Oral Minoxidil is becoming a popular treatment option due to its convenience factor. While topical minoxidil has been approved by the FDA for hair loss treatment, oral minoxidil is gaining popularity as an off label treatment for hair loss. Studies in 2021 & 2022 show low dose oral minoxidil (.25 to .5 mg per day) to be a well-tolerated and effective therapy, but it doesn’t work for everyone. About 30-40% of women and 50% of men see improvement. The patient must have an adequate amount of the enzyme SULT1A1 in their hair follicles for either oral or topical minoxidil to be effective. A new test, the Minoxidil Response Test is able to confirm if minoxidil will be effective within 7-14 days. The test shows whether or not patient has adequate SULF1A1 enzyme present in their hair follicles to successfully regrow hair with minoxidil. Patience is also required, as it can take 6-9 months of LDOM treatment before results show.
Spironolactone is an oral treatment for women with pattern hair loss. Approved by the FDA as an antihypertension drug, one of its side effects is hair growth. It is a less potent inhibitor of androgen activity than finasteride.
Non-Surgical Restoration Options:
Low-Level Laser Therapy (LLLT), also called red light therapy or cold laser therapy is also used to promote hair growth. The laser irradiates the scalp, promoting increased blood circulation to promote hair growth. A 2020 trial in Korea showed that LLLT increased hair density and thickness in participants. LLLT treatments are safe for both men and women.
According to Michael Rabin, M.D., M.B.A., CEO, “Photobiomodulation, also known as Low-Level Laser Therapy (LLLT), targeting hair follicles in the scalp, is a form of photomedicine that is scientifically proven to restore the hair of both women and men suffering from hair loss. In simple terms, red laser light is absorbed by specialized cells deep within the follicle, providing energy to enhance cellular respiration and hair growth. As a result, follicles become awakened from their inactive state and produce thicker, healthier hair. LLLT has been proven to be a safe and effective treatment for female and male pattern hair loss in numerous large, high-quality clinical trials.”
One option for LLLT is the LaserCap. It is a lightweight baseball hat type devise. The LaserCap delivers light with pulse wave emission, which involves turning on and off the laser diodes many times per second during treatment. This allows for stronger LLLT treatments and enhanced biologic effect on the hair follicles. It provides full coverage illumination of the scalp areas affected by thinning and balding for the entire duration of its treatment session. This allows for more consistent and effective laser treatments and better hair growth results over time.
Corticosteroid Injections are used for alopecia areata, as is the newly approved drug, baricitinib. Prior to 2022, the American Academy of Dermatology (AAD) said that corticosteroid injections into bald or thinning areas of the scalp every 4 to 8 weeks is the most effective treatment for alopecia areata. Whether baricitinib is more effective than corticosteroids remains to be seen.
Platelet-Rich Plasma (PRP) therapy is frequently used in hair restoration. PRP injections into balding areas every month for 3 months are performed to start the hair growth. Retail home hair maintenance programs we have created for our clients increases revenue and delivers natural regrowth.
HydraFacial Keravive represents an important state-of-the-art treatment tool for any clinic, practice or spa seeking to provide cutting-edge care for their clients with scalp and/or hair issues. It cleanses, exfoliates, stimulates and delivers a proprietary blend of growth factors and skin proteins to hydrate, nourish and stimulate the scalp and hair follicles. A clinical evaluation by the HydraFacial company has shown that treatment with this tool produces decreased scalp itchiness, dryness and flakiness; improvement in overall hair appearance; significant improvements in hair fullness and health; increased patient happiness with hair thickness and texture; improved look and feel of hair; reduced hair thinning and hairline recession; reduced hair loss and improved evenness of hair and hair growth.
“The benefits of a healthy scalp are critically important, yet not widely understood. Any patient who has concerns about thinning or damaged hair can benefit by improving the health of their scalp. A healthy scalp is the foundation for healthier and fuller−looking hair,” says Yael Halaas, M.D., FACS.Exosomes are one of the newest nonsurgical hair loss treatments. According to Alex Rios, M.D., of True Bliss Medspa, “As an aesthetic physician, I apply Exo-Pro in all of my hair growth treatments on my patients. The results have been amazing. Even with just one treatment, there is significant improvement in hair growth and thickness. The growth factors and cytokines in exosomes can promote tissue regeneration and stimulate hair follicles, leading to improved hair growth and overall appearance. While more research is needed to fully understand the benefits and long term effects of exosomes, the initial results with my patients have been very promising.”
Surgical Hair Restoration
Surgical hair restoration can take different forms. The most popular are: FUT Follicular Unit or Strip transplant and FUE or R-FUE, Follicular Unit Extraction or Robotic FUE. All forms provide excellent results.
Hair Restoration Services Advantageous for MedSpas
As you can see, hair restoration can vary from a laser treatment, to the application of a cream or taking of a pill, to a surgical procedure. The demand for this broad spectrum of hair restoration treatments continues to grow with no end in sight, offering a growth and revenue generation opportunity to MedSpa practices. The advantages for practices are fourfold. First, hair restoration services provide a potentially lucrative income stream for MedSpas. Second, they generate increased awareness of your practice among target clients. Third, offering hair restoration provides clients with a wider range of options for achieving their desired results in terms of appearance enhancement. Lastly, adding hair restoration services allows you to expand your practice and generate increased revenue and profits.
Before You Begin
Before you update your services menu, there are a few challenges you must overcome. First, understand the legal requirements in your state and ensure you are able to conform to them. Second, obtain the necessary professional training so your staff is fully competent to perform these procedures. Third, review the potential new services with your insurance carrier and finally, educate your staff to properly communicate and establish clear expectations with your hair restoration patients while balancing their appearance enhancement goals.
Summary
The hair restoration market is growing as the population ages, and it offers an excellent way to increase your practice's bottom line.
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Cheryl Whitman is a celebrated author, speaker, and highly regarded national cosmetic marketing professional with more than 35 years in the Aesthetic Medical Spa Industry. A cosmetic anti-aging wellness “Influencer” she is one of the most sought after speakers in the industry. Mentoring all size practices and laser centers.
Ms. Whitman is the Founder and CEO of Beautiful Forever Consulting where she leads a top-notch team of executive-level consultants and business professionals to assist providers physicians expanding their existing practices and launching new profit centers.
Ms. Whitman is also the founder of Beautiful Forever University, which offers educational programs to Medi-spas and Aesthetic Practices. She is a Member of the MedEsthetics Advisory Board and is a Consultant for CareCredit Healthcare Financing.
Cheryl is the author of the “Aesthetic Medical Success System,” a revolutionary program providing a turnkey educational success system that assists clients in brilliantly jumpstarting successful aesthetic and medical spa businesses.
Contact Cheryl Whitman by email at: [email protected] or by telephone at: 561-299-3909.
