Hair loss and baldness are incredibly common and are determined by a variety of underlying contributing factors, including endocrine problems; specific drugs; autoimmune diseases; systemic illness; infection; dermatological scalp conditions; and a lack of certain nutrients in the diet (Glancey, 2023).
There are many different types of hair loss, including:
- Alopecia areata (unpredictable, with patchy hair loss);
- Alopecia totalis (a complete hair loss of the scalp and a variation of alopecia areata);
- Alopecia universalis (a complete loss of hair in the scalp and body);
- Scarring alopecia (an inflammatory condition that results in destruction of hair follicles and hair loss);
- Traction alopecia (caused by constant pulling of the hair due to hair styling);
- Androgenic alopecia (AA) (characterised by hair loss from the top of the head and decided by hormonal and genetic factors) (Glancey, 2023).
This last type is the most common cause of hair loss in men and women, affecting approximately 80% of Caucasian males and 50% of females, respectively, by the age of 70 years (Yang et al, 2021), and will therefore be the presentation most frequently encountered by aesthetic practitioners. This would suggest that AA presents an urgent challenge for aesthetic practitioners, which is especially the case when considering the psychosocial impact of hair loss. More than 25% of males with AA report hair loss to be extremely upsetting, with 65% expressing modest to moderate emotional distress; according to a systematic review, males experiencing high levels of hair loss also indicated increased incidence of negative socioemotional events, including fear that others would notice and of looking older than their actual age; feeling less attractive and hopeless about their hair loss; and getting teased by their peers (Aukerman and Jafferany, 2023). The same systematic review found that 70% of women experiencing hair loss express feelings of extreme emotional distress due to their condition, with higher incidence levels of depression reported; ANOVAs comparing female AA patients to male AA patients found that, on average, women experienced a greater reduction in positive life events and more adverse psychosocial effects, including higher social anxiety, lower self esteem, and reduced life satisfaction (Aukerman and Jafferany, 2023). Women were also found to be more likely to demonstrate coping strategies or patterns, some of which could be maladaptive, including tendencies and characteristics associated with body dysmorphia and mood disorders (Aukerman and Jafferany, 2023). The prejudice faced by those experiencing hair loss is not merely a subjective perception: a study conducted in Korea in 2002 assessing the perception of baldness in society revealed that balding males were perceived as being older and less attractive than nonbalding males by over 90% of the total respondents (Aukerman and Jafferany, 2023).
Innovative therapies for hair restoration and rejuvenation
Thus far, only two drugs (minoxidil and finasteride) have been approved by the Food and Drug Administration for the treatment of hair loss, but their usage is limited, due to systematic administration causing sexual dysfunction (Yang et al, 2021; Mai et al, 2023); therefore, there remains a need for new and innovative therapies that offer sustained hair regrowth over extended durations with minimal side effects (Gupta et al, 2023). Significant advancements in hair restoration and rejuvenation in aesthetic medicine have been achieved, particularly in non-surgical options. Some of the options most commonly offered in aesthetics clinics are described below.
Photobiomodulation therapy
Photobiomodulation therapy (PBMT), discovered in the late 1960s, is commonly defined as ‘treatment using irradiation with light of low power intensity’ (Tran et al, 2021). Generally, PBMT can be divided into two modes, based on the duration of the wave light emitted by the device used: either pulsed or continuous (Tran et al, 2021). PBMT employs either non-coherent (light-emitting diodes (LEDs)) or coherent light sources (lasers), or a combination of both. While lasers are often used in medical applications, LED light is typically preferred in dermatology and aesthetic medicine, due to the relatively large areas of tissue that require irradiation (Tran et al, 2021). The exact mechanism behind PBMT's impact on hair regrowth remains unclear, but it is thought that PBMT drives hair follicle stem cell activation and relieves hair follicle atrophy (Mai et al, 2023). 650-nm red light was found to promote the proliferation of human hair follicles in an experimental cultured-tissue model and delay the transition of the hair follicles' cycle from the anagen (growth) to catagen (degeneration) stage in vitro (Yang et al, 2021). Likewise, in in vivo experiments, the shaved skin of mice was stimulated with flexible red vertical LEDs (5 mW/mm2) for 15 minutes every day; after 20 days of treatment, the mice in the experimental group presented with more hair regrowth in the area of irradiation than those in the control group (Lee et al, 2018). However, PBMT alone is not sufficient to treat hair loss (Mai et al, 2023), so this intervention is best used in combination with other therapies.
Regenerative medicine
In patients with hair loss, regenerative medicine utilises stem cells or tissue engineering to provide clinical hair regrowth strategies. In a randomised, double-blind, vehicle-controlled clinical trial, 38 patients (29 men) with AA were assigned to either a control or intervention group, in which participants self-applied adipose (a type of stem cell that secretes growth hormones)-derived stem cell constituent extract (ADSC-CE) topical solution over the scalp twice daily (Tak et al, 2020). At week 8, a greater increase in hair count was seen in the intervention group than in the control group, with intergroup differences in the change of hair count remaining significant until week 16, with overall changes of 28.1% vs 7.1%, respectively (Tak et al, 2020).
Conclusion
There is a variety of options for hair rejuvenation and restoration not covered here that may be more effective in meeting a patient's individual needs. Patient-centred care, with thorough consultation before and after any procedure, is advised.