The treatment for alopecia par excellence. Its history is curious, because it is a treatment for hypertension. When high doses were given, it was observed that patients' hair grew a lot, and it began to be studied for use solely for hair. 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 time, 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 the hair look greasy.

For several years now, treatment can be administered orally 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 adverse effect is hair growth in other body areas, which is reversible when the dose is lowered. Many of my patients are so happy with their 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 treatment is performed in the clinic every 15 days. It is practically painless. Since injections are performed, I usually combine it with vitamins or other components depending on the patient's characteristics.

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 transplants to be performed faster with optimal results.

Its success is based on taking hair from a healthy area (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 we remove it from the body, it could be compared to when other organs are transplanted. It must be treated with maximum care so that it is not damaged 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 individual follicular unit extraction technique (FUE).

– STRIP Transplant

The strip technique is based on the surgical removal of an area of scalp skin with all its hair follicles. Once extracted, the two ends of the skin are joined without leaving a trace other than a minimal linear scar. The follicular units from the strip are separated microscopically to be able to implant them 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 transplant.

– 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 intervention. It is the choice for people who will wear their hair short after the intervention. The technology assisting FUE is evolving by leaps and bounds, as are increasingly efficient robots.

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 in regenerative medicine many years ago. 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, hair shine, its consistency, and its shedding.

Being components from 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 is performed in the 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 anesthesia can be applied to the scalp beforehand to make it less uncomfortable.

The patient can return to normal activities immediately afterward, and no specific preparation is required. Although the patient may leave the clinic with their hair a bit more disheveled than when they entered, they can even return to work immediately afterward. Its frequency will be assessed in each case, depending on whether it is used as a sustained treatment for a pathology or as a cosmetic treatment to improve hair quality.