• Steven Gabel, M.D.

    Dr. Steven Gabel
    Dr. Steven Gabel is dedicated exclusively to performing ultra-refined follicular unit hair transplantation and follicular unit extraction with excellent results performed in the Portland area.
  • Dr. Ted Miln

    Dr. Ted Miln
    Dr. Ted Miln
    Dr. Ted Miln is performing refined follicular unit grafting with incredible density, with results that are undetectable from his patient's native hair.
  • How hair loss medication can inhibit DHT and Alopecia Areata

    Propecia or Avodart

    If you are going bald you should seriously consider hair loss medication treatments to halt or even reverse your hair loss. While there is no “Hair Loss Cure”, hair loss drugs like finasteride (Propecia) and dutasteride (Avodart) can often stop or even reverse alopecia areata in most people.

    However, just like any other drug, Propecia is accompanied by a list of potential side effects, some of which have been more recently reported as potentially long term.  You can read more about this in the "What About Side Effects" section further down this page.

    Studies have shown that 80% of men using Propecia stopped or even reversed their hair loss to some degree. Preliminary clinical trials for Avodart appear even more effective than Propecia.

    However, neither Propecia nor Avodart has been proven to restore hair in the frontal areas. For reasons yet unknown these drugs, along with Rogaine, only generally work in regrowing thinning hair in crown area of the scalp. Only hair transplant surgery has been successful in restoring hair in the frontal hairline area once it has been lost.

    Propecia and Avodart are also less effective in growing hair in older men. These hair loss drugs work best for men who have been balding for less than five years.

    Women must NOT USE Propecia

    Both Propecia and Avodart are not recommended for use by women or children.

    It’s been found that these drugs can cause birth defects. More specifically, these birth defects may occur when large amounts of the drug are absorbed into the body during the period of foetal development.

    Physicians advise pregnant women to not handle Propecia tablets, as this may harm male foetuses. But as of yet, there has not been a single reported case of birth defects caused by handling these tablets.

    Furthermore, there’s also no evidence that pregnant women exposed to the semen of Propecia or Avodart patients will risk any birth defects.

    Propecia and Avodart are also not advisable for men with liver disease or prostate cancer.

    Get a Prescription for Propecia or Avodart.

    Often our member physicians will prescribe Propecia or Avodart to halt a patient’s hair loss and then restore the hair already lost with hair transplant surgery. These treatments in combination can work synergistically. The drugs work to halt the hair loss, while hair restoration surgery restores what was lost.

    To get a prescription for Propecia or Avodart schedule a free no obligation consultation with any of our quality hair restoration physicians. Find a physician in your area.

    Propecia and Avodart should be taken once a day. It has been found that after two years of treatment, Propecia effectively grows hair in about 66% of patients. Also, about 83% of the subjects receiving this treatment continue to maintain their existing hair after two years.

    Propecia (Finasteride) was originally a drug called Proscar, which was used to treat and reduce men's prostate conditions such as benign prostatic hyperplasia (BPH).

    Its parent company, Merck & Co., soon realized that the drug had a unique side effect - it grew hair on bald men's heads.

    In December 22, 1997 the FDA approved Propecia as a hair loss pill. Merck & Co. then marketed the drug as a hair loss treatment under the trade name of Propecia.

    More recently Dutasteride, sold as Avodart, has generated interest as a promising new hair loss medication. Like finasteride (Propecia) it inhibits the creation of DHT and was originally developed as a treatment for men’s prostate condition.

    However, unlike Propecia, Avodart inhibits the creation of both type one and type two 5 alpha reductase enzymes. Dutasteride has been shown to decrease levels of DHT by 90% after only two weeks, making it a more powerful and faster acting weapon against hair loss than Propecia (Finasteride).

    Dutasteride is not yet FDA approved for the treatment of hair loss. However, some hair restoration physicians also prescribe it for the treatment of hair loss. Like Propecia, Avodart is not safe for women and children.

    Sticking with the program to see results

    Losing your hair took time. So too will regrowing your hair using Propecia or Avodart. These drugs require patients to take the drug daily for at least three months before any obvious changes will be noticeable. Most physicians advise taking these drugs for a year before evaluating their effectiveness.

    At this time, Propecia and Avodart are only available by prescription. Our member physicians are available to discuss these hair loss drugs with you and prescribe them if appropriate. To find a quality hair restoration physician in your area.

    Other DHT Blockers

    Aside from Propecia and Dutasteride, there are other treatment options (all topical) that may or may not work to block the effects of DHT on vulnerable hair follicles. These include Revivogen, Crinagen, Progesterone Creams, and Xandrox (a type of minoxidil). Other DHT Blockers

    To learn more about these treatments, as well as all other topical options, visit our Topical Hair Loss Products and Treatments section.

    How hair loss drugs inhibit DHT and Alopecia Areata

    Baldness is largely the result of dihydrotestosterone (DHT) interacting with those hair follicles that are genetically vulnerable to their effects.

    DHT is essentially the active ingredient or catalyst for the hair loss process. DHT binds with the receptor sites of genetically vulnerable follicles and gradually degrades the follicles ability to produce healthy hair. This eventually results in baldness in the affected areas.

    Hair loss drugs like Propecia or Avodart work by inhibiting the conversion of testosterone into dihydrotestosterone (DHT). By reducing the amount of DHT present in the scalp the hair loss process is slowed and in some cases even reversed.

    What about side effects?

    Up until a couple of years ago, side effects when taking Propecia or Avodart were only considered temporary. However, over the last several years, many me have reported ongoing side effects from Propecia even after stopping treatment.  This more permanent condition has become known as "Post Finasteride Syndrome" or (PFS). Side effects included but aren't limited to reduced semen production, a reduced libido and softer erections.

    As a result, in April of 2012, the FDA mandated labeling changes to finasteride related products.  Labeling changes to Propecia include "libido disorders, ejaculation disorders, and orgasm disorders that continued after discontinuation of the drug".  Labeling changes to Proscar include "decreased libido that continued after discontinuation of the drug".  Labeling changes to both Propecia and Proscar include "reports of male infertility and/or poor semen quality that normalized or improved after drug discontinuation".

    While most men don't experience any side effects at all, it should be known that a small percentage of men may experience persistent side effects even after stopping treatment.  Most men who experience side effects however, only experience them temporarily and stopping treatment makes them go away.

    For a list of potential side effects and more information on Post Finasteride Syndrome", visit http://www.pfsfoundation.org/.

  • Lateral Slit Technique

    Lateral Slit Technique

    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.

     

  • Avacor. Is it worth the price?

    Avacor

    One product you used to see quite often in advertising is Avacor. According to Response magazine, Avacor was the third best selling product on the Internet in April, 2002. Avacor was originally manufactured by Global Vision Products. After being taken over by new management, it is now being manufactured by Avacor Products LLC.

    Like most products that advertise 'Stop Hair Loss and Regrow Hair!', Avacor contains the only FDA approved topical drug minoxidil. Avacor, like other products with similar claims, mixes FDA approved drugs in their generic form with other ingredients in a multiple regimen of products like shampoo, lotion and vitamins.

    Avacor historically cost approximately $239 for a two to three month supply and over $1000 for a year’s worth.  New prices are much more reasonable which range from $180 for a 3 month supply to $400 for a year’s supply of the men’s and women’s formula. Note that the ingredients in Avacor can be bought over the counter at your local store at a fraction of the cost for which they are sold in Avacor. However, they do offer 24/7 customer service and a 90 day money back guarantee.

    Marketing Practices

    Avacor, like other products with similar claims, has taken a lot of slack over the years for their controversial marketing tactics. Avacor has a checkered past and has previously been the focus of lawsuits and investigative reporting by major media like ABC news. Recently however, new management has taken over and claims they are very serious about selling quality products at more reasonable prices, without the hype and controversial marketing strategies. In looking at their website, while Avacor still uses slick marketing language to promote their products, the vast majority of their claims are much more realistic.

    Avacor includes 3 distinct products that claim to provide “total hair care”. This includes a 'Scalp Detoxifying Shampoo', a 'Physicians Topical Formulation' and finally a 'Nutricap'. Avacor's Nutricap ingredients consist mainly of common herbs like saw palmetto, gingko biloba, keratin, resveratrol, and bilberry. While conjectured to inhibit the production of DHT, none of these ingredients are FDA approved or proven to stop hair loss. Avacor’s Physician’s Topical Formulation however, does contain 5% of the FDA approved hair regrowth agent minoxidil.

    Other than minoxidil, no other ingredient is proven to regrow hair. A number of studies have been done that suggest saw palmetto inhibits the production of DHT, like Propecia. But, unlike Propecia, it has never been proven to stop or reverse hair loss.

    Avacor Products

    Avacor admits on their website that the only product proven to regrow hair is the Avacor Physician’s formulation which includes the FDA approved ingredient minoxidil (5% for men and 2% for women). The other products claim to provide hair with the essential nutrients for healthy hair growth but are careful not to claim to prevent the progression of male or female pattern baldness (androgenic alopecia). Perhaps this is why the Avacor Physician’s formulation can now be purchased separately. Costs of the Physician’s Formulation are still, but only a little more expensive than Rogaine topical hair loss treatment, one of the first and most popular topical minoxidil products.

    The Avacor Study

    At this time, Avacor’s proof comes in the form of the FDA approved study showing that minoxidil can stop and reverse hair loss.  No other study is provided with their product.  Their website also is much more realistic as to what their product line can accomplish for hair loss suffering consumers.

    Confidence in Products and Services

    Before you consider spending hundreds of dollars for any product or service, do a review. Legitimate products will have legitimate studies and have been reviewed on many quality websites. Doctors with real talent and satisfied patients will be able to show you dozens of photos and allow you to talk with past patients. Proven physicians will make available their resumes along with their formal education and associations they belong to.

    It is always best to review a product or doctor for information on their background before you make a decision for something as important as hair loss and hair restoration.

    Conclusion

    At the very least, the Avacor Physician’s formulation will be as effective as the Rogaine liquid formula or generic minoxidil. However, to date, both Rogaine and generic minoxidil are more cost effective than Avacor.  The nutricap, shampoo, conditioner and other products may promote healthy hair and provide it with volume, but make no claims of stopping hair loss or regrowing hair.

  • Parsa Mohebi, M.D

    Dr. Parsa Mohebi
    Dr. Parsa Mohebi
    Dr. Parsa Mohebi provides large sessions of high quality follicular unit transplantation with excellent results
  • Dr. Ratchathorn Panchaprateep

    Dr. Panchaprateep
    Dr. Ratchathorn platinum follicle award
    Dr. Ratchathorn in Thailand performs high-density FUE, and she is involved in every step of the procedure. She provides patients with top-notch quality at an affordable rate.
  • PABA – Popular Ingredient in Several Herbal Hair Loss Treatments

    Para-Aminobenzoic Acid (PABA)Para-Aminobenzoic Acid (PABA) has been called the anti-gray hair vitamin and is considered one of the lesser known members of the vitamin B complex family (despite the fact that it’s not really a vitamin at all).  PABA is a non-protein amino acid and isn’t essential in the human body.  It can be found in foods such as liver, whole grain, yeast, and kidney and is listed as an active ingredient in several popular herbal hair loss treatments such as Provillusfor women and Procerin

    The potassium salt in PABA called POTABA is available on prescription. POTABA is indicated for Peyronie’s Disease and scleroderma. The dose for Peyronie’s disease and scleroderma is very high (12 grams daily in 4 to 5 distributions) and must only be used under medical supervision. Because of the high doses needed to achieve clinical efficacy, patient compliance is typically poor.

    But can PABA actually treat male pattern baldnessor genetic female hair loss?

    Some tests conclude that PABA when combined with other elements such as folate, biotin, and pantothenic acid, may restore pre-maturely graying hair to its natural color.  Some anecdotal reports suggest it might also stop hair loss, however; there are at least as many reports that contradict this.  Moreover, we haven’t seen any evidence to suggest it can stimulate new hair growth or hair regrowth.

    PABA comes in doses of 100mg, 250mg, and 500mg as a standalone product.  However, since no formal clinical studies have been performed on PABA for hair loss, a suitable dosage is mostly speculation.  Additionally, since no regulations have been placed on herbal medication, one should proceed with extreme caution before taking any herbal supplement.  Consulting with a doctor is advised.

    Side Effects and warnings:

    Some manufacturers of herbal replacements to medication would have you believe that herbal treatments come without potential side effects.  However, this is a farce. 

    The following side effects have been reported from consumers of PABA: Anorexia, vomiting, nausea, hypersensitivity, fever and rash (particularly with larger doses). These symptoms went away when PABA is stopped.

    Ironically, Provillusonly includes PABA in the woman’s formula.  However, women should know that pregnant women, nursing mothers, and children should avoid using PABA.


    For those with renal disease, PABA should be used with caution.  PABA should be stopped if hypersensitivity develops. Those taking pharmaceutical doses of PABA must be under medical supervision.

  • Dr. Munib Ahmad MD

    Dr. Munib Ahmad
    Dr. Munib Ahmad
    Dr. Munib Ahmad in the Netherlands, performs every part of the hair transplant procedure to ensure his patients receive the highest quality. He is the first point of contact from the consultation to the aftercare. His results show aesthetic artistry with keen attention to detail.
  • Rogaine Foam for Men and Women

    The exciting new Rogaine foam has undergone its own extensive FDA trials and can rightfully boast an impressive 85% hair regrowth success rate in people who use it twice daily. This is more than 20% higher than the liquid 5% minoxidil solution at 64%. Rogaine foam also comes without the inconveniences of its liquid counterpart such as scalp irritation, flaking, and messy application. The foam dries almost instantly as opposed to the liquid's 15 minute waiting period.

    Note: Despite what the insert says, Rogaine works just as well for frontal hair loss, recession, and thinning hair.

    How It Works:

    Rogaine foam uses versafoam technology to aid the delivery of the minoxidil to the hair follicles. As the minoxidil absorbs into the scalp, it stimulates follicles, revitalizing them, promoting thicker and healthier hair growth. This promotes a thicker and fuller appearance of hair.

    Developing Realistic Expectations:

    While Rogaine foam is supreme in many ways, it's unlikely to regrow thick terminal hair in completely bald areas. For best results, men ought to consider combining Rogaine with Propecia (finasteride), the only FDA approved and clinically proven DHT inhibitor to stop hair loss. See the "recommended treatments" section below for more details.

    Don't expect immediate results. Just as hair loss is a slow process, regrowing it is too. Thus, it's recommended to use Rogaine for approximately 6 to 12 months before determining its effectiveness. Documenting your progress with bi-monthly photos can help you better evaluate the results.

    Hair shedding is a common symptom the first few months and a sign that the medication may be working for you. It's crucial to push past this stage with continued use for the recommended period of time.

    To date, only surgical hair restoration is proven to grow hair in completely bald areas. You are invited to have a free virtual consultation with one of our prescreened hair restoration physicians.