The quintessential alopecia treatment. Its history is curious, because it is a treatment for hypertension. When high doses were given, it was observed that patients experienced significant hair growth, and it began to be studied for hair use only. Its usefulness was described more than two decades ago, and it continues to be used with good results. This molecule is capable of stimulating hair growth, improving its vascularization. This prolongs the hair's growth phase, making it appear thicker and denser.

There are multiple routes of administration, including topical, oral, or repeated microinjections (minoxidil mesotherapy).

Topical application is associated with good results if applied daily. As minoxidil contains an alcoholic excipient, it can sometimes cause mild irritation, which is controlled with appropriate shampoos or cosmetics. Its main problem is the inconvenience of its application, as it can leave residue and make hair look dirty.

For several years now, oral treatment at low doses of 0.5-2.5mg has been available (higher doses of 40-80mg daily are used to treat hypertension). This treatment has proven to be effective and have a good safety profile. It will not lower the patient's blood pressure if the dose is chosen correctly. The main adverse effect is hair growth in other body areas, which is reversible by lowering the dose. Many of my patients are so happy with the hair growth that they prefer to remove unwanted hair rather than lower the dose, but that is a personal decision.

Minoxidil mesotherapy involves injecting the molecule into the scalp at the level of the hair roots, which are approximately 4mm deep. This is a treatment performed in the clinic every 15 days. It is practically painless. Since the injections are performed, I usually combine it with vitamins or other components depending on the patient's characteristics.

Antiandrogens are drugs that reduce the negative effect that some hormones have on hair growth. To be able to administer higher doses without affecting the rest of the body, they began to be used locally, injecting them directly into the area where the hair roots are located (4mm deep in the scalp). This is an innovative way of treatment, having demonstrated its beneficial effects scientifically. Mesotherapy is used in hormone-influenced conditions and will achieve better growth, greater thickness and density, and a better overall appearance, all without administering a systemic drug.

It is a treatment performed in the clinic, under local anesthesia with minimal discomfort. Depending on the patient, it can be done monthly or quarterly. It does not require specific preparation, and after the treatment, the patient can immediately return to their normal daily activities. Discomfort only occurs during the treatment and is completely tolerable. When performing the treatment, it can be combined with the topical application of active substances to improve the treatment's results. It must be repeated to observe the effects, ideally every 15 or 30 days.

When a wound is created on the skin, the body sends all its artillery to repair it. This is the idea behind this treatment, which aims to create controlled micro-injuries to encourage the body to release growth factors. Since we perform them in the scalp area and at a depth equivalent to the hair root, an effect is achieved on the hair cells. The result is an improvement in hair growth capacity and increased hair density. It is often used in conjunction with specific treatments for different pathologies or as an aesthetic treatment to improve hair quality without disease.

The technique is performed in the clinic with local anesthesia. It does not require specific patient preparation, and after its completion, the patient can return to normal daily activities. Discomfort only occurs during treatment and is completely tolerable. When performing the treatment, it can be combined with the topical application of active substances to improve the treatment's results. It must be repeated to observe the effects, ideally every 15 or 30 days.

Androgen hormones are known as "male" hormones as they predominate in men, but are present in both sexes. In predisposed individuals, when they come into contact with the hair root, they alter its growth, making it slower and less effective, which eventually leads to finer hair and even hair loss. The various drugs with antiandrogen effects will curb and reverse this effect to allow hair to grow with better quality. It is a highly effective treatment that seeks to control the hormonal effect on hair follicles that causes hair to become progressively finer. They can slow the progression of alopecia, and in many cases even improve it. These are very safe drugs whose efficacy has been scientifically demonstrated for many years. They are contraindicated during pregnancy. There are different types, each indicated for different types of patients.

Antiandrogenic Contraceptives

Certain contraceptive pills have an antiandrogenic effect that can be useful in cases of incipient androgenetic alopecia in young women. They will be chosen based on the patient's specific characteristics and can be used alone or in combination with other antiandrogens. Not all contraceptives are suitable, as some may even increase the effects of androgens.

Other antiandrogens:

Cyproterone acetate, spironolactone, bicalutamide... These work to reduce the final effect of hormones on hair follicles. Like the others, pregnancy should be avoided while taking them. They will generally be associated with contraceptives.

Finasteride and Dutasteride:

They are called 5-alpha reductase inhibitors, which is the molecule that allows hormones to transmit their information to the hair follicle. That is why they act selectively on the hair, causing few adverse effects on the rest of the body. They can be taken orally, as well as applied topically or by microinjections (dutasteride mesotherapy). The way they are taken will be chosen based on the patient's type of alopecia and other characteristics. These drugs have shown a good safety profile and the patient can lead a completely normal life during treatment. Dutasteride is more potent, reserved for more advanced cases. The results of this type of treatment usually begin to be visible after 6-8 months. During treatment with these drugs and up to 1 month (finasteride) or 6 months (dutasteride) afterward, women should avoid pregnancy.

PRP is a treatment that stimulates hair growth and controls inflammation. Blood contains platelets, which are cells responsible for healing wounds. When activated, they release growth factors, originally to heal the body. It began to be used many years ago in regenerative medicine. Since the hair follicle that originates hair is a continuously growing structure, these locally applied growth factors will improve and stimulate its function. This stimulation of the hair root results in improved hair growth, shine, consistency, and reduced hair loss.

Being components of the patient's own blood, it is considered a natural treatment suitable for pregnant women, patients with oncological conditions, vegans and vegetarians, etc.

The technique is practically painless and performed in the office. Blood is drawn from the patient (just like for a blood test) to isolate the platelet-rich portion through specific and meticulous centrifugation and separation. This separated portion, which is the platelet-rich plasma itself, is activated with a substance so that the platelets release their growth factors. Once prepared and activated, it is injected into the scalp at 4mm under the skin, the height of the hair roots. Local anesthesia can be applied to the scalp beforehand to make it less uncomfortable.

The patient can return to normal activities immediately afterward and does not require specific preparation. Although the patient leaves the consultation a bit more disheveled than when they arrived, they can even return to work immediately afterward. Its frequency will be assessed on a case-by-case basis, depending on whether it is used as a sustained treatment for a pathology or as an aesthetic treatment to improve hair quality.

In some patients, alopecia must be treated surgically to obtain optimal results. When hair is no longer able to grow on its own, we will have to "place" it surgically. Transplant techniques are constantly evolving and improving. Currently, the micrograft technique is used, which allows for completely natural results in expert hands, as the hairs are placed one by one. The technology used is increasingly efficient, allowing for faster transplants with optimal results.

Its success is based on taking hair from an area where it is healthy (donor area) and placing it in an area where there is alopecia (recipient area). Hair does not grow in isolation but in the form of a hair follicle. This structure includes stem cells that give rise to hair but also the sebaceous gland. Therefore, when we remove it from the body, it could be compared to transplanting other organs. It must be treated with utmost care to avoid damage and placed in its final location as soon as possible. Then the stem cells adapt to their new location and begin to grow.
There are several transplant techniques for extracting hair from the posterior region of the scalp. Nowadays, there is also the option of transplanting hair from any part of the body and also placing it in practically any area.

The extraction options are the strip technique (or FUT) and the follicular unit extraction technique (FUE).

– STRIP Transplant

The strip technique is based on the surgical removal of a scalp skin area with all its hair follicles. Once extracted, the two ends of the skin are joined, leaving no trace other than a minimal linear scar. The follicular units from the strip are microscopically separated to be implanted one by one. The benefit of this technique is that it does not require shaving the donor area and many very healthy follicular units can be obtained for transplantation.

– FUE Transplant

In FUE, the follicular units are extracted individually, with a small circular scalpel called a punch. Recovery is much faster because the surgical extractions are microscopic and will leave minimal, almost invisible punctate scars. It is especially recommended for people who don't mind cutting or shaving their hair before the procedure. It is the choice for people who will wear their hair short after the procedure. The technology assisting FUE is evolving rapidly, as are increasingly efficient robots.