By Carita Rizzo
Suddenly, it seems like everyone is talking about hair loss in women. This is, in part, due to a shift in the conversation around perimenopause and the side effects of plummeting estrogen – but it’s also because of a host of new treatments that go beyond tried-and-true solutions like Minoxidil (aka Rogaine).
In recent years, three types of treatments have emerged in mainstream hair-loss restoration: PRP/PRF injections, red-light therapy, and hair-growth supplements. As the hair-restoration market surges, more remedies are on the way. But are these existing methods viable, or are they just a way to drain your wallet?
When a patient comes to Dr. Somi Javaid, board certified OB/GYN and cofounder of HerMD, with hair loss, she walks them through all available treatments, even those she doesn’t believe are going to be helpful. “I want to explain it to them and empower them: Laser therapy theoretically stimulates follicles, but there have been modest results in data and it can be expensive. PRP is used in a lot of different avenues and medicines, but it’s costly and it can be painful.”
Dr. Javaid does not recommend the above as first-line solutions, and instead suggests starting with supplements. “Nutrafol is one of the only companies that has done a clinical study for hormonal hair loss, and I do recommend them if someone wants to start with a non-prescription supplement because of that study,” she says. “But there were case reports of liver toxicity, so people have to be careful. If anyone has liver disease or is nervous, they should always ask their doctor about supplements.”
She’d also recommend Minoxidil to extend the growth cycle of your hair. “Minoxidil is FDA approved, cost effective, safe for long-term use, and effective for many,” she says. “But Minoxidil is not without side effects, whether topical or oral. It can cause irritation, redness, itching, dryness, scaling, flaking of the scalp, sometimes excessive hair growth, initial hair shedding when you first start, headache, dizziness, GI changes like nausea and vomiting – less so when it’s applied topically than if you take it orally, because you bypass going through the liver.”
Whatever treatment is being considered, Dr. Javaid recommends starting with blood tests, a hormone level check, and a physical exam to rule out any deficiencies. “It sounds like a lot, but it can be done pretty quickly,” she says. “Sometimes it’s a B12 or folic acid deficiency. Sometimes anemia and acute illness can cause women to lose hair. Those are all different triggers and may present differently.”
“Managing expectations is important,” says board-certified plastic surgeon Dr. John Paul Tutela, who offers PRP injections, low-level laser therapy, and surgical hair restoration at his New Jersey practice, T Spa by Tutela Plastic Surgery.
When patients come in with hair loss, Dr. Tutela likes to start them on PRP injections. “It’s great for the early stages of hair loss and thinning, when you still have follicles that are active and you are boosting them to thicken,” he says.
PRP stands for platelet-rich plasma, which is extracted from a patient’s own blood and spun in a centrifuge until red blood cells are separated from platelets. What used to be known as the vampire facial is now a far less controversial treatment option for all kinds of ailments. “PRP is filled with growth factors and cytokines that stimulate healing and regeneration,” says Dr. Tutela.
PRP injections stimulate active hair follicles. “It improves blood supply,” says Dr. Tutela. “That healthier environment supports stronger, thicker hair growth. It also extends the growth phase of the hair, and that’s very important.” PRP is also known to reduce inflammation, which can be the cause of some hair loss. “It tackles so many different things and helps improve the local environment to encourage hair viability and vitality,” says Dr. Tutela. “I think it does a really great job.”
Red-light therapy, a form of low-level laser therapy, is another frequently promoted treatment – especially on social media, where $1,000 helmets are pitched as at-home solutions. “Red-light therapy improves mitochondrial activity,” says Dr. Tutela. “A sub-unit within cells is mitochondria, and by increasing that activity, it promotes growth and slows loss. It is one of those things where, if you’re going to get any effect (and it’s very mild at best), you absolutely need to be consistent. It’s worth trying.”
LA-based nurse practitioner Ginille Brown, founder of Ginille Beauty Aesthetics, agrees that red-light therapy can help when done consistently. “Realistically, you want to be doing it multiple times a week,” she says. “There’s a lot of research behind red-light therapy, in general, not just for aesthetics, but in wound healing, facial aging, and hair growth. It definitely works, but people have to understand that you have to be committed to doing it multiple times a week.”
Brown offers clients who are either suffering from hair loss or want to get ahead of the problem six-month programs that include a combination of monthly scalp facials with a serum by Keravive; PRF injections, where platelet-rich fibrin releases growth factors over a longer period than PRP; red-light therapy; and supplements, all to support the healthiest environment for hair growth. “I tell patients, ‘This is going to really be reflective of you and your health,’” says Brown, who sees clients with hair loss from stress and hormone issues to traction alopecia and overall scalp health. “It’s a lot of education, counseling, meeting people where they’re at, and trying to see if we can make some lifestyle changes to support the treatments that we’re doing in the office.”
Brown feels satisfied with the results she now sees in her patients. “Anything I’ve put out there, I really believe in,’” she says. “But these things are not overnight [solutions]; it’s going to take some maintenance.”
New hair-loss tech continues to emerge, including robotic hair transplanting to tools like the Italian electro current device Tricopat. Diabetes drug Metformin is being trialed off-label as a solution to central centrifugal cicatricial alopecia (CCCA), which predominantly affects Black women. But as of now, the only permanent solution currently available is a hair transplant, which ranges in cost from $5,000 to $20,000. “We take hairs from the back of the head, which are not subject to age and hormone changes. The hairs that get transplanted are permanent hairs,” says Dr. Tutela. “That being said, the hairs surrounding it may continue to fall out, so I also encourage people to maintain the hair they still have.”
Like Dr. Tutela and N.P. Brown, Dr. Javaid says hair loss is often a reflection of one’s overall health, and any treatment is going to require consistency. “I don’t think there is a singular solution. If we say it’s perimenopause, let’s get you on hormones, but let’s also manage your stress, let’s make sure you’re using good hair products, and let’s make sure that you’re eating well so that you’re not going to develop any nutritional deficiencies. I don’t want you to take two steps forward and three back.”