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.

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.

Crinagen is an all natural alcohol-free topical scalp spray clinically backed to reduce the amount of DHT (dehydrotestosterone) in the scalp. It contains no alcohol, and has displayed no side effects. Crinagen is also equally safe for men and women and is most effective in men and women with thinning hair. In addition to blocking scalp DHT, they both are reported nourish the scalp’s hair follicles. Crinagen usually displays its effects on average in five months.

How It Works:

The product's main ingredients are Saw Palmetto, Zinc, and Azelaic Acid. All 3 ingredients are reported to reduce the production of scalp DHT and nourish the scalp's hair follicles.

Developing Realistic Expectations:

Crinagen has not been clinically proven nor approved by the FDA. Thus, like Revivogen and Tricomin, Crinagen should be used only after seriously considering proven treatments like Propecia (finasteride) and Rogaine (minoxidil).

Don't expect immediate results. It's recommended to use Crinagen for at least 6 to 12 months before determining its effectiveness. Documenting your progress with bi-monthly photos can help you determine whether or not Crinagen is working for you.

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.

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.

Viviscal's hair growth vitamin and dietary supplement taken twice daily promises to "reverse hair loss" and grow thicker hair in both men and women experiencing balding and thinning hair.  Its primary activeingredient, AminoMar C™ Marine Complex, is said to be a proprietary blend of ingredients and proteins that "provides the essential nutrients needed to nourish thinning hair and promote existing hair growth".

The entire Viviscal product line includes an "all natural" dietary supplement, a shampoo and conditioner, and a scalp lotion.  Viviscal is promoted as being 100% natural, drug-free, gluten-free and safe from harmful side effects. But can Viviscal deliver on its promises to reverse hair loss and grow new hair?

In 2011, Viviscal advertisement was banned in the United Kingdom by the Advertising Standard Authority (ASA) who deemed that its claims to maintain optimum hair health were unproven. The ASA concluded:

"Because the evidence sent did not show that the ingredients in Viviscal had been shown to have a positive effect on hair health, we concluded the claims that the product could 'nourish hair follicles' had not been substantiated' and ruled the advert cannot be broadcast until it is changed."

However, as with many similar products promising to grow hair, substantiating their hair growth claims may not be a simple task.

Viviscal’s manufacturer does reference a number of studies that seem to support their claims of growing thicker hair. For example, the results of "Scientific Pilot Study #1" on 40 hair loss suffering females with an average age of 35 concluded, "Viviscal was well received by test subjects and the analysis of hair counts showed a mean reduction in hair loss of 46% in only 10 weeks." Additional studies are cited on Viviscal’s website.

Recently, we learned that Dr. Glenn Charleshas publicly endorsed Viviscal.  Dr. Charles has an outstanding reputation for performing state of the art hair transplant surgery and is a highly esteemed member of the Coalition of Independent Hair Restoration Physicians.When asked to comment on his public endorsement of Viviscal, Dr. Charles stated:

"I have never had any hair loss patients display any negative effects. I describe it to my patients as a natural supplement that can promote a healthier scalp and hair. It may also, in turn, slow down the hair loss process. I tell all my patients that there are no guarantees with this product.  Although most patients believe that they did have improvement after using this product, I admit that some patients do not see any noticeable changes that either they or I can identify."

Other hair loss experts are not as optimistic regarding Viviscal’s hair growth potential. Coalition member Dr. Bill Rassmanof Los Angeles states:

"I am skeptical of the photographs (results) and the changes shown make me doubt what the Viviscal marketing department wants me to see. Viviscal reportedly contains ‘special marine extracts and a silica compound’ - and yet I’m to believe this will regrow hair? If these photos were real, the product would have taken over the market years ago."

It's also important to note that Viviscal does notmake any claims on their website that their products can reverse the effects of genetic hair loss.  Instead, it simply states, "Viviscal works to reverse hair loss due to stress, poor nutrition, and many health related ailments".

So is Viviscal an effective hair loss treatment? More research may be needed before this question can be effectively answered. 

While there may be no harm (potential side effects) in trying it, at an average cost of $600 per year there are certainly more affordable and proven treatments available. The only clinically proven and FDA approved medical hair loss treatments currently available are Rogaine (minoxidil) and Propecia (finasteride). While Rogaine may be used by both male and female patients, Propecia is safe and approved only for male hair loss sufferers. Always consult your physician before adding any treatment to your hair loss regimen.

This hair loss product, meant for women, is a synthetic form of Progesterone, a hormone and steroid that occurs naturally in the ovaries. The body uses the Progesterone treatment to control a variety of functions. These include the regulating of the menstrual cycles, anticancer properties, the slowing and prevention of bone loss and ensuring the female sexual organs’ health. Another important function of Progesterone is to maintain the hormone balance of estrogen.

But in regards to hair loss, Progesterone treatment is an effective DHT-inhibitor. However, there has not been much research conducted as to Progesterone’s impact to male and female pattern baldness (MPB, FPB). What research was conducted showed that it may be effective at stopping hair loss, but not at hair regrowth.

Nevertheless, topical Progesterone has been used by some European dermatologists in Europe to treat MPB and FPB. For this, they only used 1% or 2% topical concentrations, and no more than 40mg a day. Researchers believe that higher doses could cause menstrual irregularities.

Topical Progesterone is available as capsules, vaginal creams and suppositories. Patients use the medication by rubbing it into the body’s soft areas, such as the breast, abdomen, inner thighs and the palms of the hands (which is thought to be the most effective area).

It’s advised that women use about 1/8-1/2 teaspoon, once to twice daily, for 21days. Physicians also advise women to stop using the medication for 5-7 days each month. They also advise women to change the application areas periodically.