Hair loss is a universal condition, affecting all ages, races, genders and nationalities. It’s estimated that “androgenetic alopecia,” or male and female pattern baldness affects 35 million men and 21 million women in the United States alone. This section examines how race, age and gender affect hair loss.

Race and Hair Loss

In physiological terms, human beings are all composed of the same bones, muscles, and everything else down to the cellular level. But there are specific differences.

Hair, in all of its variations, is one area in which human beings display their differences. Hair follicles can widely vary in terms of color, length, shape, thickness, strength and various other factors.

There are many ethnic groups to consider. But we will focus on the special considerations of Asians, Blacks (of African descent) and Caucasians.

Asian Hair Loss Considerations

Asian people typically have very straight hair. Their scalps contain fewer hairs per square centimeter, they actually have a lower hair density than that of Caucasian hair follicles. But because the individual hair follicles of East Asians are thicker, this gives the look and impression of greater hair density.

For these reasons, hair restoration techniques for East Asians, much like other races, must be sensitive to a variety of anatomic and cultural differences. For instance, East Asian females often have an increased likelihood of developing “diffuse alopecia,” or hair that thins evenly over the entire head than Caucasian females.

Even though it’s not a definite requirement, it’s very helpful for Asian patients to seek out doctors with experience in Asian hair.

Another consideration for East Asians considering hair restoration surgery is the increased chance of developing keloid scars. A keloid is a thick, irregularly shaped and elevated scar with uncontrolled growth that results from excess fibrous skin tissue. East Asians typically have a greater likelihood of keloid development than Caucasians, but less than that of people of African descent. Therefore, before undergoing surgery, East Asians may want to consider being medically evaluated for keloids.

African Hair Loss Considerations

People of African descent usually possess naturally curly hair. This curly hair gives the visual impression of increased hair density for a given amount of hair, which is beneficial in hair restoration surgery.

The hair follicles beneath the skin of people of African decent also typically curve more than Caucasians. This can make harvesting the donor hairs, without severing or transecting the hair follicles beneath the scalp, more difficult. A hair restoration physician needs to be very aware of this difference and adjust to its requirements.

As in the case of East Asians, people of African descent possess some unique hair and skin characteristics. Some of these medical conditions are more common in black skin than in white skin. This may increase the risk for post-surgical complications.

Those of African descent have a higher chance of developing keloid scarring when injured. This in turn leads to a greater chance of noticeable donor scars. Keloids aren’t a widespread problem. But those with a history of them are carefully evaluated in regard to their existing scars. The evaluation usually involves a small "test procedure" to determine if there’s a normal healing rate.

Another issue is that of postoperative skin discoloration. With darker skin, there’s often a greater risk of both increased and decreased skin color after injury or surgery. These risks can be determined by the patient’s medical and family history.

Ingrown hairs are also a more common problem in darker skin. If a patient has a history of ingrown hairs or other minor skin infections, this may signal a higher risk for ingrown hairs post-hair restoration surgery. Again, this risk can be determined by a small test procedure.

Caucasian Hair Considerations

Caucasians (white people) may have a wide range of hair and skin types. However, if someone has dense and or coarse hair, as well as skin color similar to their hair color, they will generally achieve the best results for a given amount of restored hair.

Learn more about aging and gender hair loss

Procerin is one of the top selling “all natural” hair loss products on the market today and is often an attractive alternative to drugs like Propecia (finasteride)and Rogaine (minoxidil). Procerin comes in both a tablet and topical form that can be ordered together or separately depending on your hair restoration goals.

Men and women suffering from androgenic alopecia (genetic female hair loss / male pattern baldness) have elevated levels of the hormone DHT (dihydrotestosterone) in their body.   Procerin’s claim to fame is that it naturally blocks this DHT without reacting with testosterone like the drugs Propeciaand Avodart (dutasteride).  This allegedly allows Procerin to stop hair loss and stimulate hair regrowth without unwanted sexual side effects.   Procerin is so convinced their product works, that they offer a 90 day money back guarantee if you don’t receive your desired hair growth results.  But how many balding men and women have successfully restored their hair with Procerin?

In order to fully evaluate the efficacy of this product, we must further explore each ingredient to determine whether or not this hair loss treatment delivers what it promises.  Below you will find a list of ingredients and information that will help you determine whether or not Procerin is right for you.

Oral Ingredients:

The Procerin tablet includes a number of alleged “all natural” DHT blockers including saw palmetto for hair loss, zinc sulfate, pyroxidine, magnesium, and a proprietary blend of gotu kola, nettles, pumpkin seed, eleuthero root, muira puma root, and uva ursi.  Many, but not all of these ingredients are also found in the highly popular hair loss treatment Provillus.

Oral saw palmettoand nettle root extracthave been used as “all natural” alternatives to treat benign prostatic hypertrophy (BPH) or enlarged prostates.  Theories have thus been produced that they might also effectively treat baldness and alopecia.

Some studies suggest that Zinc when combined with Vitamin B6 may be able to inhibit the conversion of testosterone to DHT in the skin.

Pumpkin seed oils contain the ingredient delta-7-sterine that has been said to protect the prostate by competing with DHT.  Therefore, it’s suggested that this ingredient might help reduce the risk of genetic hair loss.

Eleuthero, uva-ursi, muria puma, and horsetail are said to promote healthy hair growth, hair expansion, and a clean scalp.  However, promoting healthy hair growth is not the same as stimulating new hair growth, hair regrowth, nor does it indicate they’re effective hair loss treatments.

Topical Ingredients

The Procerin topical solution contains saw palmetto extract, gamma linolenic acid, grape seed extract, azelaic acid, avocado oil, and nettle extract.

Azelaic acid when applied topically has been conjectured to inhibit DHT.  Some anecdotal evidence suggests oral saw palmettomay inhibit DHT however; no such evidence exists for topical use.  Though nettles are typically consumed orally, some speculate nettle root extract may help fight alopecia areata when applied topically.

Possible Side Effects

One false assumption is that “all natural” hair loss products don’t have potential side effects.  Procerin reports directly on their website that reported side effects include mild stomach discomfort and from the topical formula, skin irritation.  Additionally, be sure to research each ingredient carefully as some side effects are possible in larger quantities.

Dosage

Currently there are no standards on dosages of herbal medications in the United States.  In addition, no formal clinical studies have been performed on them for treating baldness.  Therefore, the suggested daily value listed on the ingredient package is based on something other than government regulation and scientific study.

Costs

The discounted cost of the combined formula for a 1 month supply of Procerin is about $50 and is discounted when you buy in bulk.  It is also cheaper when you buy in bulk.

Conclusions and Our Opinion

Though we can appreciate the aspiration for balding men and women to use herbal products as an “all-natural” replacement for Propecia to treat androgenic alopecia, we’ve seen no third party clinical studies that support the ingredients in Procerin can successfully stop hair loss or stimulate hair regrowth.  Due to the lack of compelling evidence in these other conjectured hair loss solutions, it may be more beneficial and cost effective to spend your money on Propecia (finasteride) for men only and Rogaine (minoxidil) that has helped balding men and women worldwide for years.  For men who have experienced sexual side effects with Propecia, Procerin may at the very least, be worth trying as an adjunct treatment to Rogaine.

For many hair loss suffering men and women, topical concealers are a necessary aspect of the "daily routine." Usually composed of hair shaft adhering microfibers or darkening cream, concealers help balding men and women both camouflage areas of noticeable baldness and increase the apparent density of thinning hair. Below, we provide our readers with a product review of the new and popular hair loss concealer Caboki.

Caboki was released back in 2005 but is only just now receiving more attention, most likely due to increased advertising. Like others before it, Caboki concealer claims to be a "hair loss breakthrough". Despite ambitious promises, Caboki's claims leave several unanswered questions: is Caboki really a breakthrough concealer? How does it compare to other, similar products like Toppik, DermMatch and COUVre? Is Caboki a worthwhile product for purchasing, or will it fall from grace like other alleged "breakthrough" hair loss miracles before it?

While many products, such as "Toppik" (a popular microfiber-style concealer) and "Couvre" (a concealing cream) are popular and trusted within the hair loss community, new, unproven concealers arrive on the market every day. What's more, many of these new concealers try to "best" the products currently offered and claim to camouflage hair loss in a way "never seen before." However, as with many alleged miracle cures, these products often fail to meet expectations and leave hair loss sufferers disappointed and discouraged. So let's explore how Caboki works to conceal hair loss below.

Caboki is comprised of a series of charged microfibers that, when applied to the scalp, tightly bind hair shafts and create a denser, fuller appearance. According to the manufacturer, these microfibers are comprised of two different elements: Moroccan Gossypium Herbaceum fiber and iron oxide-based natural (mineral-based) colorants. The makers of Caboki claim these elements allow the product to create a natural, healthy appearance, capable of withstanding harsh lighting conditions, sweat, wind, and rain.

However, because these elements have been used in other concealer products (Toppik particles, for example, are both charged and made from natural keratin), Caboki still must demonstrate why it's revolutionary. So, what makes Caboki a "hair loss breakthrough?" According to the manufactures, Caboki differs from other concealers in the following ways:

• Caboki particles, unlike other microfiber concealers, are negatively, not positively charged. Allegedly, positively charged particles (usually made from wool fibers) possess a greater tendency to repel and oppose not only each other, but also the positively charged hair shafts. Because of this, when the particles attach near each other on a hair shaft, they are more likely to repel and detach. According to Caboki creators, negatively charged fibers (made from Moroccan Gossypium Herbaceum fiber) do not experience this intense phenomenon, and create a much greater (200%), electronically attractive (negative to positive), bond. If this is true, Caboki microfibers should bind and adhere to hair shafts with a much stronger, more permanent affinity.
• Because Caboki particles create a stronger charged bond, the thicker, more volumized hair shafts are likely to stand erect and less non-bonded concealer will collect on the scalp. This combination, according to Caboki, will eliminate the "dull, flat" appearance associated with other concealer products.
• By only utilizing natural elements (Moroccan Gossypium Herbaceum fibers and iron oxide colorants), Caboki avoids some of the potentially harmful synthetic dyes, fillers, and artificial preservatives used in other concealer products.

So, it's now clear why the manufacturers of Caboki believe it is a superior product, but does this mean Caboki is a legitimate hair loss concealer? Does it truly outshine other concealer product currently on the market?

While the product is still fairly new, most anecdotal experiences and testimonials from real hair loss suffering men and women are positive. Most individuals believe the negatively charged Caboki particles bind strongly to the positively charged hair shafts and create a longer-lasting increase in density. Furthermore, the particles seem to be more resistant to potentially damaging elements like water, sweat, and wind. Having said that, many individuals report some common problems experienced with other concealer products – concealer wiping off on pillows and clothes, some smearing with sweat, and difficultly creating a natural appearance in the hairline. However, these same individuals claim the problems occur less frequently with Caboki. Altogether, it's likely that Caboki is both a helpful hair loss concealer and equivalent to other products currently on the market. While it is clear that Caboki does possess some advantages and interesting claims, it could be difficult to quantify whether it truly exceeds or simply meets the standard set by other available hair loss concealers. Truthfully, only time and the opinion of hair loss sufferers will determine whether Caboki lives up to its claims and defines itself as a legitimate concealer breakthrough.

Stemcelex is the newest product in a long line of hair restoration therapies claiming to “cure” hair loss via stem cell therapy. Given the recent onslaught of news regarding stem cell based hair loss treatments, injectable baldness cures, and research breakthroughs, it’s not surprising to see new therapies claiming to aggressively fight hair loss through these same mechanisms. However, is Stemcelex truly a stem cell based, regenerative hair loss cure, or is it another therapy simply riding the recent wave of interest in these types of non-invasive, revolutionary treatments?

At first glance, Stemcelex seems quite impressive. The product website is filled with scientific explanations, graphs, charts, and diagrams explaining the science behind stem cell based hair restoration. Stemcelex even states its affiliation with Dr. George Cotsarelis, a researcher at the University of Pennsylvania Medical Center who, along with a talented research team, recently discovered that the bald scalp does not suffer from a lack of stem cells, but rather a dysfunction in the pathway to properly activating stem cells to produce hair. The finding was significant and Dr. Cotsarelis’ involvement and the seemingly detailed science look promising, but what about Stemcelex itself? Does it utilize these scientific breakthroughs and offer an effective treatment for hair loss?

Unfortunately, despite the impressive name recognition and detailed explanations, Stemcelex doesn’t appear to live up to its lofty hair restoration claims. Despite claiming to “activate” the dormant stem cells described by Dr. Cotsarelis, Stemcelex does not offer any sort of feasible molecular/stem cell based therapy. The website cleverly explains the science behind stem cell inactivation and the promise of reversing the dysfunctional pathway, but instead of reinforcing Dr. Cotsarelis’ view that cures for reversing the inactivation pathway are not yet understood, Stemcelex claims to actually fix the stem cell inactivation through a series of unproven homeopathic and herbal treatments for hair loss.

So, what is actually inStemcelex? The treatment involves a three day cycle of different lotions and topical treatments for baldness applied twice a day.

Day1: On the first day of the hair restoration cycle, a topical lotion made from Jaborandi Pilocarpus is applied twice after washing and thoroughly drying one’s hair. According to Stemcelex, Jaborandi Pilocarpus is a parasympathetic activator (it excites the nerves that cause the body to “rest and digest” during periods of relaxation) that rids the scalp of excess oils and dandruff that impede healthy follicular hair growth. Furthermore, Stemcelex claims that Pilocarpus naturally darkens and thickens existing, native hairs. According to the experts, Pilocarpus has no reproducible pharmacological applications and any evidence that it actually thickens and darkens hair is anecdotal.

Day 2: The second day of the cycle involves Veratrum Lobelianum, a family of herbs commonly used in Chinese medicine.  Stemcelex claims these herbs can penetrate the scalp and activate the necessary molecular signaling to “regenerate” the hair follicle stem cells. Furthermore, Veratrum allegedly down-regulates or prevents the production of Dihydrotestosterone (DHT), the hormone directly responsible for male pattern baldness. According to the research, members of the Veratrum family have been used in everything from a Native American poison to a drug researched in human blood pressure.  Currently, they are used in cancer treatments. Although the science behind cancer therapies indicates that the drug could have some molecular benefit in signaling cell activation and inactivation, there has been no research or evidence suggesting that Veratrum is useful in fighting, reversing, or preventing the effects of male or female hair loss.

Day 3: During the third day of the Stemcelex cycle, a kelp based topical extract is applied twice daily to provide nutrients to the “new hair growth” and also ensure that the scalp remains clean and healthy. This step of the treatment doesn’t claim to be more than a simple dose of nutrients useful in good scalp hygiene.

After reviewing the active ingredients behind Stemcelex, there is no evidence to suggest that Stemcelex is an effective hair loss treatment at this point in time. The idea of activating the dormant stem cells is important to finding a molecular cure to hair loss, but despite understanding this importance, Stemcelex doesn’t offer any concrete stem cell reactivation agents. It’s possible that Veratrum may prove useful in cell signaling and reactivating dormant cells, but the current research and evidence simply don’t support its use at this time.  Furthermore, Stemcelex charges a hefty $99.85 for a month supply of the treatment which may keep even the most curious and enthusiastic hair loss suffering men and women away.

Altogether, the idea of reversing dormant hair follicle stem cells is important, but therapies for effectively stopping and rewiring this pathway do not seem to exist at this point in time. Unfortunately, this seems to nullify the claims made by Stemcelex and prevent it from becoming a stem cell hair loss cure.

Balding men and women considering any hair loss treatment should take caution to believe the many magnificent claims made by today’s advertising. Far too often, a lot of time and money is wasted on questionable treatments with little or no proof of success.
Nourkrin hair nutrient claims to promote hair growth and strengthen thinning hair in 80% of men and women suffering from almost any hair loss condition other than the self-inflicted trichotillomania (hair pulling) or traction alopecia. Below we evaluate Nourkrin, the "clinical study", and its ingredients to find out whether or not this hair loss treatment lives up to its promises.

What is Nourkrin?

Nourkrin recommends using their complete regime of products for at least 6 months for the best results. This includes extra strength, Man, and Maintain oral tablets, a shampoo, a conditioner, and a scalp lotion.  Nourkrin claims their products can promote hair growth in men and women suffering from androgenic alopecia (genetic baldness), alopecia areata, alopecia totalis, alopecia universalis, and telogen effluvium. This is a very bold claim considering each balding condition occurs for varying reasons.

Ingredients

The active ingredients in the extra strength tablet include shark cartilage and shellfish extract containing glucosamine.  Other active ingredients include silica kieselguhr (a natural form of silica), horsetail extract, acerola cherry extract with vitamin C, microscyrstaline cellulose, immunogloblin G protein, and fatty acids. In addition to the above, the Man product contains Omega 3 fatty acids and Fenugreek designed to improve scalp circulation. Maintain includes additional marine life proteins, minerals, silica, and vitamin C. The scalp lotion contains marine life protein extract compounds and aloe vera.

Nourkrin claims that the primary active ingredient glucosamine can rebuild and grow new tissue, including dormant hair follicles - suggesting successful hair regrowth. Though clinical studies prove that glucosamine might be effective in reducing joint pain, increasing joint lubrication, preserving joint space, protecting cartilage breakdown by inhibiting specific enzymes, stimulating cartilage matrix repair, and other anti-inflammatory actions, we couldn't find any evidence to support claims that it can stop hair loss or promote hair regrowth.

Clinical Study

Nourkrin conducted a clinical study of 60 people who took their products for 12 months. All subjects were over 18 years of age and suffered from at least some form of hair loss for at least one year prior to the study. During a 6 month double blind clinical study, 30 subjects took Nourkrin while the other 30 took a placebo. After 6 months, the 30 participants taking Nourkrin continued taking it for another 6 months while the 30 on the placebo were switched to Nourkrin for 12 months.

In the first 6 months, Nourkrin reports that 77% taking their hair loss treatment experienced an increase in hair growth and shaft thickness. After 12 months, 75% reported a decrease in overall thinning hair. 90% of women in the study reported overall hair improvement after 12 months. The hair counting method showed an average increase in hair count of 45 percent during the clinical study.

Though the above study sounds impressive, we don't know a lot about the participants nor can we be certain of the reliability of the study. All participants suffered from some form of thinning, but its cause for each patient hasn’t been disclosed.  Additionally, clinical studies are considered more credible when they've been conducted or verified by third parties not interested in its financial success.

Another problem is that none of the active ingredients in Nourkrin are proven to stop hair loss. Therefore, their study is the only one balding men and women have to support such claims.

Possible Side Effects

Anyone allergic to shellfish should avoid using Nourkrin. Women who are pregnant or breast feeding should not use Nourkrin hair loss products. Consulting with a doctor before using this treatment is advisable.

Dosage

Nourkrin recommends taking 2 tablets daily for at least 6 months. Men and women over 176 lbs or those who smoke are advised to take 3 tablets daily. After 6 months, dosage can be cut down to one a day. Nourkrin also recommends using the shampoo, conditioner, and scalp lotion daily. The scalp lotion may be best applied in the evening and left on overnight.

Cost

60 tablets of the extra strength tablet costs about $75, the Man $65, the shampoo and scalp cleanser $12, the conditioner $13, and the scalp lotion $30. All in all, the Nourkrin Hair Recovery Program can get pricey after 6 months. FDA approved products like Rogaine (minoxidil)only runs approximately $15 a month or less and male treatment Propecia (finasteride)costs approximately $60 per month, not as expensive as Nourkrin.

Conclusions

Nourkrin boasts a big game, claiming high rates of success in reversing hair loss in men and women caused by varying conditions. Their clinical study also confirms its success rate however; the reliability of this study has not been verified by third parties uninterested in its financial success. Additionally, no clinical proof exists that any of the ingredients found in Nourkrin work to treat baldness.

Whether or not Nourkrin is the "real deal" is hard to determine with little evidence to support its claims. Therefore, those considering this treatment should proceed with caution and may want to consider exhausting proven treatments like Propecia and Rogaine first.

Over the past several years surgeons have used various techniques to perform follicular unit hair transplantation. One such technique is the Lateral Slit Technique, also known as Coronal or Perpendicular Grafting. This technique’s name is derived from the angle and direction in which the graft incisions are made.

While there are other techniques for performing densely packed and highly refined follicular unit transplantation, the lateral slit technique offers a high degree of control over the angle and direction in which the transplanted hairs will ultimately grow.

The lateral slit technique has been used both intuitively and systematically for years by hair restoration physicians. However, it has recently gained popularity as a systematic and precise way of performing follicular unit hair transplantation.

How our member physicians use the Lateral Slit Technique.

Many of our physician members use the Lateral Slit Technique exclusively or in combination with other techniques for creating graft incisions. The lateral slit technique enables a surgeon to create graft incisions at varying angles (ranging from 10 to 90 degrees to the scalp), including very acute angles that will make the transplanted hair grow out lying flatter to the scalp. The ability to create incisions at very acute angles is particularly useful in areas such as the front temples and sides where the hair normally grows out lying flat on the scalp.

The graft incision determines the direction of the hair growth

The lateral slit technique also helps enable a surgeon to determine the direction of the graft incisions. This then determines the ultimate direction of the transplanted hairs growth. Thus a surgeon can use this technique to control and vary both the direction and angle at which the transplanted hair will grow in order to mimic the subtle changes in hair direction that occur naturally.

Each graft incision is created by analyzing the neighboring hair so the surgeon can reproduce the correct hair pattern. As a result, as each transplanted hair emerges from the scalp it will grow and lay in a similar direction as its neighboring non-transplanted hairs.

Lateral slits can enable denser packing of grafts

Lateral slit incisions also tend to be more parallel to the scalp and thus more superficial and less invasive to the scalp’s underlying vascular structure. This parallel alignment also enables a physician to place more grafts per square centimeter with out the grafts compressing or popping up since the pressure exerted on the grafts does not push them upward from the scalp.

Using blades cut to the size of the grafts

Some of our members use custom blade cutters to create tiny blades to make incisions that match the size and depth of each follicular unit graft being transplanted. This enables a surgeon to safely dense pack more grafts into a given area during a surgical session. Healing time is also more rapid, with minimal scarring.

Typically most clinic’s blades range from 1.5mm to 2mm in size. However, by using the custom blade cutter our physicians can create blades as small as .7mm for a single hair graft and .9mm for a multi hair graft.

In addition, the blades created by the custom cutter are squared off to match the shape of the bulb end of a hair follicle. Non custom cut blades are typically spear pointed which requires them to be inserted deeper thus causing more trauma to the scalps vascular structure.

The ability to control the depth of the incision each blade makes is also critical. Each blade is placed in a blade holder that is set to not allow the blade to go any deeper than required for the graft to being placed in the incision. This minimizes unnecessary trauma to the deep vasculature of the scalp, thus enabling close tight incisions, minimal tissue swelling, and quick healing that leaves no visible scaring, pitting, or cobble stoning of the scalp.

Placing grafts to maximize their aesthetic result and coverage

The plane and direction in which each follicular unit graft is placed on the scalp can also impact the ultimate appearance of density that can be produced with a given number of grafts. This is because hairs within a follicular unit are typically next to each other inline.

Therefore by arranging each multiple hair graft on the scalp in a linear fashion to the line of sight, each follicular unit will provide the maximum appearance of fullness and scalp coverage. This also mimics how hair is normally aligned on the scalp.

Special thanks to Dr. DeYarman, Dr. Sharon Keene, Dr. Jerry Cooley, Dr. Alexander, and Dr. Glenn Charles for contributing their expertise and photos for this section.