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 is still used with good results. This molecule is capable of stimulating hair growth, improving its vascularization. This prolongs the hair's growth time, making it appear thicker and denser.

There are multiple application routes, 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 has been available at low doses of 0.5-2.5mg (higher doses of 40-80mg daily are used to treat hypertension). It is a treatment that 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 well. The main side 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.

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

Antiandrogens are drugs that decrease the negative effect some hormones have on hair growth. 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 treatment method that has shown beneficial effects scientifically. Mesotherapy is used in hormone-influenced conditions and will achieve better growth, greater thickness and density, and overall better appearance, all without administering a drug systemically.

This treatment is performed in-office, under local anesthesia with minimal discomfort. Depending on the patient, it can be done monthly or quarterly. It requires no 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 made on the skin, the body sends all its artillery to repair it. This is the idea behind this treatment, which aims to make controlled micro-wounds so that the body sends growth factors. Since we perform them in the scalp area and at a depth equivalent to the hair root, an effect on hair cells is achieved. The result is improved growth capacity and greater hair density. It is usually 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-office 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 the treatment is performed, it can be associated with the topical application of active substances to improve the treatment's results. It should be repeated to observe the effects, ideally every 15 or 30 days.

Androgen hormones are called "male" hormones because they predominate in men, but they 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, so the hair eventually becomes thinner and even disappears. The multiple drugs with antiandrogen effect will slow down and reverse this effect to allow hair to grow back with better quality. It is a very effective treatment that seeks to control the hormonal effect on hair follicles that causes hair to progressively thin. They can slow down the progression of alopecia, and in many cases even improve it. These are very safe drugs whose efficacy has been scientifically proven for many years. There are different types, each indicated for different types of patients.

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. This 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. There is talk of the possibility of adverse effects in the sexual sphere, something very controversial at a scientific level, but which, however, appear in 1% of patients taking this medication and are reversible. The results of this type of treatment usually begin to be visible after 6-8 months.

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 intended to heal the body. It has been used in regenerative medicine for many years. Since the hair follicle that produces 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.

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

The technique is practically painless and is performed in-clinic. 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 4mm under the skin, at the level of the hair roots. Local anesthetic can be applied to the scalp beforehand to make it less uncomfortable.

The patient can return to normal activities immediately after, and no specific preparation is required. Although the patient may leave the clinic looking a bit messier than when they arrived, they can even return to work immediately after. Its frequency will be assessed on a case-by-case basis, depending on whether it is used as a maintenance 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 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 with 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 removed from the body, it can be compared to when other organs are transplanted. It must be handled with maximum 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.

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

– 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 brought together, 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, 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 pinpoint scars. It is especially recommended for those who do not mind cutting or shaving their hair before the procedure. It is the preferred choice for people who will wear their hair short after the procedure. The technology assisting FUE is evolving rapidly, as are increasingly efficient robots.