Restoring hair confidence

Experts share what ’s latest and popular in hair restoration techniques, including PRP, PRF, and exosome therapies.

Lately, the desire to look beautiful and stylish has become commonplace and hair restoration has also become one of its trends. The hair loss problem has continued to receive social attention every year and, with it, new technologies and techniques for utilisation have emerged. The most important aspect remains the combination of both medical and surgical treatments by aesthetic practitioners to make patients comfortable with their skin and hair.

In hair restoration, patients will have an initial assessment with a specialist with the intention of identifying the patient’s requirements, eligibility and mapping the donor and recipient sites. Once an agreement is reached between the practitioner and the patient, the hair restoration procedure takes centre-stage.

The PRP vs. PRF debate

PRP (Platelet-Rich Plasma) is widely used in the field of dermatology and trichology to treat hair loss. It is still considered to be one of the major therapies performed by trichologists, although PRF (Platelet-Rich Fibrin) appears to be more promising. When speaking about PRP, Dr Geetanjali Shetty, Director, Revitals Skin Clinic, states a clear preference towards it due to the longer effectiveness and the wider scope of its usage for the treatment of androgenic alopecia, although she also says that PRF may be more useful in treating skin issues such as acne scars.

The greatest advantage of PRP is its capacity to impact hair follicles and the general condition of the scalp skin. As Dr Viral Desai, Board-certified Cosmetic &Plastic Surgeon &Hair Transplant Surgeon; Co-Founder and Medical Director, DHI India; Medical Director, CPLSS, Desai Hospitals and Sarla Hospitals; and Founder &Medical Director, Skin Vibes Clinic, explains, the method of preparation is crucial. “If PRP is not prepared correctly, you might as well be using PPP (Platelet-Poor Plasma),” he said. He asserts that the short working window and high level of patient discomfort make PRP the superior choice for hair restoration.

Excitement is brewing around the introduction of exosomes, which contain growth factors and signaling molecules that can stimulate hair follicles in ways that traditional treatments cannot. “Exosomes are showing good results,” says Dr Viral, showcasing a series of promising cases where patients saw significant regrowth.

Dr Avinash Agrawal, Director and Partner, Acube Aesthetic Clinic, mentions growth factor concentrate (GFC) injections as a less invasive alternative to PRP. However, the consensus among the experts lean heavily towards PRP, with Dr Viral calling GFC “a poor replacement for PRP” due to its lower platelet concentration and reduced efficacy in treating hair loss. .

Microneedling with corticosteroids

Microneedling has long been used to stimulate hair growth by creating micro-injuries that promote healing and regeneration. However, as Dr Sonia Tekchandani, Co-Founder &Medical Director, Tender Skin International Mumbai and The Wedding Clinic Pune, highlights, the integration of corticosteroids like Zetaste into the microneedling process marks a significant leap forward. She explains, “We take four capsules of Zetaste, which has a strength of 0.5 mg, and infuse it into the scalp after microneedling at a depth of 1.5 to 2 millimetres. The corticosteroid accelerates the healing process, leading to enhanced hair growth.”

Dr Tekchandani’s team has conducted a study on 30 cases, which met with considerable success, earning accolades in 2023. She further notes that patients saw improved results when the depth of microneedling was increased, suggesting that the treatment can be tailored based on individual tolerance levels. This personalised approach is key to optimising results, offering patients a faster, more effective solution to hair thinning and loss.

Thread embedding therapy

While microneedling has gained widespread acceptance, thread embedding therapy remains a more contentious treatment option. The process involves inserting tiny threads into the scalp to act as a scaffolding, providing long-term stimulation for hair follicles. However, Dr Geetanjali is not a fan of the technique. “I believe microneedling alone is effective enough.

You don’t need to add the complexity or expense of threads,” she says. The primary argument against thread embedding is its high cost and associated discomfort, with some questioning its added value when compared to other available options.

Dr Viral admits that thread embedding can be useful for specific cases. “If a patient is only able to visit once a year, thread embedding might be an option. However, given the many better alternatives available, it should not be the first choice for most patients,» he states.

Dr Avinash adds another perspective, suggesting that thread embedding may hold promise in areas like the crown, which is notoriously difficult to treat. He believes that thread therapy, when combined with treatments like PRP (Platelet-Rich Plasma), could enhance outcomes in challenging cases.

The rise of exosomes

While microneedling and thread embedding are established options, exosome therapy is the latest frontier in hair restoration. Exosomes, tiny vesicles derived from stem cells, are hailed for their ability to promote cell communication and regeneration. Dr Viral has been at the forefront of this emerging treatment, having started using exosomes around three years ago. “I was skeptical at first, but after using them on four patients who had been stable on PRP for years, the results were remarkable,” he shares.

Exosomes offer a quicker response time than traditional methods like PRP, with visible results in just a few weeks. Dr Viral notes that exosome therapy has shifted about 30-35 per cent of his PRP patients to this newer option. The treatment is particularly appealing because it is less invasive and yields faster outcomes. While PRP might require several months to show results, exosome therapy accelerates the process, making it an attractive choice for patients seeking quick, noticeable improvements.

While most exosomes are derived from placental or umbilical cord stem cells, others are obtained from adipose (fat) tissue or even plants. “The source matters because exosomes from younger cells, like those from umbilical cords, tend to be more effective,” Dr Viral explains. Despite concerns about the safety of animal-derived exosomes, he maintains that plant-based exosomes are generally considered safer due to the lower risk of disease transmission.

Although exosome therapy shows great promise, it remains in a relatively experimental phase, akin to where PRP was two decades ago. Legal restrictions also limit its use in many countries. For example, while the UK and Korea allow exosome injections, in most parts of the world, including India, the treatment is only approved for use with microneedling.

FUE vs. FUT

The field of hair restoration is still evolving, with two major techniques dominating the market: Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). While FUE has gained popularity in recent years, many experts believe FUT continues to be relevant for certain cases, especially in patients with advanced hair loss.

Dr Vinay Chouksey, Chief Hair Transplant Surgeon, Wow Cosmetology Centre and Richfeel Hairforever, a seasoned hair transplant surgeon, explains that FUT, though older, remains indispensable for specific indications. “FUT is never dead. There are grade 6 and 7 cases with tiny donor areas where FUT offers better quality grafts than FUE. The number of grafts you can get from the central area is far better in quality and numbers.”

Although FUE is now more common due to its less invasive nature, it has its limitations. The technique involves extracting individual follicular units, which can be time-consuming and sometimes less effective for patients requiring a large number of grafts. For those cases, FUT offers a viable alternative by removing a strip of scalp tissue from the donor area, which is then dissected into individual grafts.

The role of medical management

One of the most critical aspects of hair transplantation today is integrating medical management with surgical procedures. Many patients come to clinics after years of unsuccessful medical treatments, expecting immediate results from transplants. However, experts caution that the medical line of treatment should always be the first course of action before considering surgery.

Dr Vinay emphasises the importance of not rushing into surgical procedures, particularly for advanced hair loss. “Patients come to us after trying numerous medical therapies for years. If they have absolutely no follicles left, a transplant is the only option. But in many cases, they still have some follicles, and medical management can improve the situation.”

For patients in the early stages of hair loss, medical therapies such as minoxidil and finasteride remain the gold standard. Dr Avinash stresses the importance of “earning” a transplant through a commitment to medical treatments. “I always tell my patients, ‘You earn your transplant by showing trust in medical management first.’ When patients follow the medical line, it can significantly reduce post-transplant issues like shock loss, making the entire process smoother.”

Shock loss and female hair transplants

A problem frequently associated with hair transplantation in female hair transplantation is shock loss. One of the possible psychological concerns of patients is the issue of shock loss that may arise when a patient has to go back to work shortly after undergoing surgery. This problem affects women most due to the fact that about 5 per cent of transplant candidates are women. Dr Vinay advises a phased approach for female patients to minimise shock loss. “You should not do too many grafts at once for women. It is better to spread the procedure over two to three sessions. This approach makes the shock loss less evident and gives the patient time to recover between surgeries.”

In addition to spreading out the grafts, Dr Viral suggests starting medical management three to six months before the transplant. “If you worry about shock loss, especially in female patients, starting them on medical therapy beforehand can help mitigate the problem. This way, the shock loss becomes a non-issue.”

Evolving restoration techniques

As hair transplantation continues to evolve, so do the instruments and techniques used by surgeons. Starting from the time-tested PRP therapy to the more recent option of exosome therapy, patients are presented with several choices that can suit their requirements. There are still different techniques used today, such as FUT or FUE, but there are more innovative treatment options like microneedling with corticosteroids. Appropriate medical management especially during times when surgery is anticipated will guarantee good results with minimal complications such as shock loss. Therefore, keeping up with the latest developments in the industry and collaborating with experienced professionals will ultimately be critical for hair restoration.

The above article has been extracted with excerpts from the panel discussion on ‘Journey in hair restoration and latest breakthroughs in regrowth technology’ that was held at the Aesthetic Medicine India Conference 2024.