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.

The "Active" Ingredient in Many Popular Hair Loss Treatment Products

Many popular hair loss treatment options today such as Provillus, Procerin, and Avacor contain the “active” ingredient saw palmetto. It can also be purchased as a standalone supplement in most nutritional stores. But the age old question of whether or not it can effectively treat baldness in men and women with alopecia is still heavily debated. By taking a look at the scientific evidence available we are able to draw some conclusions as to its potential benefit for those with thinning hair.

What is Saw Palmetto?

Saw Palmetto berries are a deep red fruit that grow wild on palm trees in warmer climates, typically found in the Southeastern United States. The liposerolic berry extract is typically used as an herbal supplement for the promotion of a healthy prostate.

Saw Palmetto Hair Loss Study:

Similarly to finasteride (the active ingredient in Propecia and Proscar), studies have shown that when taken orally, it may be an effective anti-androgen by lowering dihydrotestosterone (DHT) levels in the body by blocking 5 alpha-reductase enzymes. Additionally it is said to block receptor cites on cells which is required for cells to absorb DHT.

Tests have also been performed on its use in the treatment of benign prostatic disease, which similarly to androgenic alopecia, depends on the production of DHT.

It is also noteworthy to state that a small preliminary study in 2002 was performed as reported by The Journal of Alternative and Complementary Medicine(2002;8:143-52) that shows a select group of 19 men between the ages of 23 and 64 taking either (400mg of saw palmetto and 100mg of Beta-sitosterol) or a placebo orally. Those who took the herbal combination had 60% improved hair growth over those who took the placebo. There have been no studies to date indicating the efficacy of saw palmetto applied topically for male pattern baldness, female hair loss, or anything to date.

In our opinion, there are two potential difficulties with this study:

• Many scientists would argue that the control study group was too small to determine any real efficacy and improved hair growth could have happened by chance. A larger study therefore may be necessary to determine any level of real efficacy.
• “Improved hair growth” is not the same thing as newhair growth and hair regrowth, nor should it necessarily imply that it works to stop hair loss
• There are no regulations or suggested daily value as to how much saw palmetto would be required to successfully treat baldness. The appropriate dosage therefore is questionable.
• The above study was only performed on saw palmetto taken orally. Hair loss products that promote topical use for baldness are basing their belief in its efficacy on something other than published clinical evidence.

The Dosage:

But if there are no current standards on dosages of herbal medications in the United States, how do these popular hair loss treatments produce an appropriate dosage?

Clinical studies on Benign Prostrate Hyperplasia (BPH) have used a dosage of 320mg of the berry extract daily (either one 320mg pill or 2 X 160 mg pill). A daily dosage of 480 mg of saw palmetto berry extract was not found to be any more effective in a six-month study. If the entire berry was used, up to 1000mg or 2000mg would be required to reach the same goal.

The theory therefore is that if saw palmetto can successfully treat an enlarged prostate similarly to finasteride, it can effectively treat hair loss with a similar dosage Many popular “baldness cure” products contain approximately 1500mg of the berry which is equivalent to approximately 240-320mg of the berry extract.

Side Effects and Warnings:

One false assumption is that “all natural” treatments don’t have potential side effects. It is stated that use of saw palmetto has not proven to be safe for women with hair loss during pregnancy and lactation. Medical supervision is suggested for women of childbearing age. Similar warnings are listed about Propecia.

Conclusions:

Based on some anecdotal evidence, saw palmetto is said to treat baldness because of its tendency to act like finasteride by helping those suffering from BPH. However, authentic clinical studies have not been performed to date that support this claim. Dosage and how it should be used (orally or topically) therefore is based on conjecture rather that scientific evidence.

Excessive DHT in the hair follicle causes specific immune responses. These responses cause the cells to release a substance known as Superoxide. This substance combats against any viruses, cells, or foreign tissues. SOD's claim to fight hair loss by reducing the presence of Superoxide.

As a result, the body is less prone to reject any offending hair follicles, which helps to ward off hair loss. SOD's actually treat hair loss in more than one way. Besides reducing Superoxide, they also stimulate growth and they have anti-inflammatory properties. SOD’s are topical, as well. They include Tricomin, Proxiphen, Proxiphen-N and Folligen.

Click to learn more about Anti Inflammatories

A Viable Alternative to Propecia in Treating Hair Loss?

Folexen S-equol , produced by Australian manufacturer Eclipse Nutraceuticals is considered an "all natural" hair loss treatment that boasts an impressive 87% success rate for preventing and reversing the effects of male pattern baldness with virtually no side effects.  Folexen S-equol has also been a hot topic of discussion on our popular hair loss forum. But, does this self-described "nutraceutical" live up to its hair growth hype?  Is Folexen a viable alternative to Propecia for treating the effects of male pattern baldness?

What is Folexen S-equol?

According to the FAQ on Folexen's website, the active ingredient S-equol is "a metabolite of a natural isoflavone called daidzein, which occurs in soybeans and some other food products".

Isoflavones are an organic compound produced almost exclusively by various bean types. In populations that consume large quantities of soy protein, studies have shown a lower incidence of breast cancer and other common cancers because of its role in influencing sex hormone metabolism and biological activity.

As a metabolite, S-equol is the product that remains after the isoflavone is broken down or "metabolized" by the body.

In addition to its active ingredient, Folexen contains the following GRAS (generally recognized as safe) inactive ingredients: starch, maltodextrin, allantoin, propionic acid. It may also contain hypromellose (vegetarian capsule).

But is there any evidence that S-equol  works to treat hair loss?

How Folexen S-equol Allegedly Works to Treat Baldness

In the body, testosterone is converted to the hormone dihydrotestosterone (DHT) via the enzyme 5-alpha-reductase (5AR). It's widely known that androgenic alopecia (genetic hair loss) results when genetically vulnerable hair follicles are exposed to DHT which then binds to the receptor sites of these follicles causing them to weaken and shrink over time. This shrinking process is known as miniaturization.

The recognized leader in the battle against the balding effects of DHT is the clinically proven and FDA approved drug Propecia (finasteride). Propecia works by inhibiting the conversion of testosterone to DHT, potentially slowing or even reversing the effects of androgenic alopecia. However, approximately 2% of males who take Propecia experience debilitating sexual side effects.

Unlike finasteride, Folexen's rumored ability to suppress hair loss and potentially regrow hair is based on the theory that S-equol can bind strongly to free DHT molecules, prohibiting them from binding to the hair follicles' receptor sites. Because Folexen does not suppress the conversion of testosterone to DHT, there is no resulting increase of testosterone in the body and therefore, no sexual side effects. But are there any clinical studies supporting that S-equol can truly prevent DHT from binding to hair follicle receptor sites and prevent hair loss?

Clinical Studies

Folexen's website references four articles in peer reviewed journals. Two of these studies center on S-equol's effect on prostate health while the other two don't appear to reference S-equol at all.

At this time, there appears to be no scientific data presented supporting Folexen's efficacy as a hair loss treatment.

Side Effects

The company claims that the product is virtually side effect free: specifically noting that it does not cause gynecomastia (enlarged breasts), erectile dysfunction or any of the other side effects that are experienced with some other treatments.

Some users however, did report mild diarrhea that dissipated within one week of commencing treatment.

What is the Recommended Dosage?

The recommended dosage of Folexen is 4 capsules per day (two every 12 hours), totaling 10mg of the active ingredient. Eclipse claims that the product has been tested safe at much higher concentrations (up to hundreds of milligrams) and there is some speculation based on available data that it may, in fact, require a dose as high as 100mg to match the Propecia's hair growth results.

Where to Buy Folexen S-equol

Folexen is only available by mail order from Australia. A bottle of 100 2.5mg capsules (25 day supply) costs approximately $40 USD + shipping but there is a discount for purchases exceeding 4 bottles and again for 9+ bottles. However, it's easy to see that even in bulk this treatment is several times more expensive than purchasing generic 5mg finasteride and quartering the tablet, as many finasteride users do.

As a natural product and not a drug, there are no shipping restrictions. Estimated delivery time is two weeks.

Conclusion

Time will tell if Folexen S-equol proves to be an effective weapon in the fight against androgenic alopecia or simply another product in a long line of expensive disappointments.

Our physician members perform a very refined hair transplant procedure called "Follicular Unit Hair Transplantation". Today there are two methods for doing this procedure. They differ only in the methods used to harvest and prepare the grafts.

Follicular Unit Extraction Video is provided courtesy of Dr. Alan Bauman.

How the follicular unit extraction (FUE) hair transplant procedure is different than standard strip excision hair transplant surgery.

How the minimally invasive hair transplant procedure known as Follicular Unit Extraction or FUE is performed.

How follicular unit grafts are created under microscopic dissection and then placed into tiny incisions in the balding areas.

Scalp Med TV infomercials, like many hair loss products, claim to sell FDA approved hair loss products. Pictures, videos, and testimonies on television show hair loss sufferers regrowing hair even when men and women were completely bald. Is this really what balding people can expect from Scalp Med? Below we examine Scalp Med and unlock the mystery ingredients and whether or not any clinical proof exists that this hair loss solution can treat baldness.

Scalp Med includes 3 distinct products including topical Vitadil-5A for men or Vitadil-2A for women, topical NutriSol-RM, and Cortex Enlarger hair thickening spray.

Vitadil-5A for men or Vitadil-2A for women is a topical solution that contains the proven hair regrowth solution minoxidil, also found in Rogaine and Xandrox. It's also said to include a unique delivery agent formulated to increase the absorption of 5% minoxidil for men, 2% for women.

Scalp Med is a bit more vague as to the ingredients found in the NutriSol-RM topical and the Cortex Enlarger thickening spray. While NutriSol-RM topical is designed to add essential nutrients to the scalp for healthier hair, the Cortex Enlarger hair thickening spray's primary purpose is to temporarily fatten the hair follicles making hair appear thicker.

Scalp Med is upfront that the ingredients found in the NutriSol-RM shampoo and Cortex Enlarger hair thickener will not stop hair loss or cause hair regrowth.

Scalp Med also offers a detoxifying cleanser kit which includes a detoxifying shampoo called Panthenol-DX Scalp Detoxifier. This shampoo is designed to deeply cleanse the scalp without stripping the hair of its natural oils and nutrients. Unless your thinning hair is due to pollutants or toxins affecting natural hair growth, Panthenol-DX Scalp Detoxifier won't stimulate new hair growth. Scalp Med's Panthenol-DX does nothing to stop the natural progression of genetic female hair loss and male pattern baldness.

To supplement Scalp Med's hair loss treatment program, Scalp Med offers a Mega-Multi Vitamin to increase overall body health.

Scalp Med can legally claim that it's product contains an FDA approved ingredient since Scalp Med does contain minoxidil, which is a FDA approved topical treatment for hair loss. However, Scalp Med its self has not been granted FDA approval. Though Scalp Med's other products may work to promote healthy hair, it's the minoxidil that gives balding men and women any hope of restoring their hair.

Unfortunately, Scalp Med's marketing infomercials makes it appear that completely bald men and women have hope of regrowing a full head of thick and healthy hair. However, the words “Results seen are not typical” can be seen in small fine print at the bottom of your television.  Additionally, Scalp Med's website FAQ makes it clear that no non-surgical hair loss solution is proven to grow hair in completely bald areas.

There are several proven success stories that minoxidil can stimulate hair regrowth in areas of thinning hair. Therefore, Scalp Med's Vitadil-5A should be as effective as 5% minoxidil just as Vitadil-2A should be as effective as the 2% solution.

Scalp Med is about 3 times the cost of minoxidil. A two month supply of Scalp Med is approximately $160.00. Discounts are available if you buy in bulk. However, even in bulk, the net cost ends up around $64 per month as opposed to the $20 per month cost of Rogaine. Generic minoxidil costs even less.

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.