Integrating Nonsurgical Hair Restoration Into an Existing Plastic Surgery Practice

The recent hair restoration panel demonstrated that hair restoration has a broad application to a plastic surgery practice. Hair restoration includes many opportunities for the plastic surgeon well beyond that of just hair transplantation. Plastic surgeons provide many non-surgical services to their patients today. This is especially true regarding facial aesthetics. In the same light, there are numerous treatments related to hair restoration that the plastic surgeon can provide in their office without performing hair transplantation. The panel provided details of the potential opportunities for the plastic surgeon and the various treatments that can benefit our patients (Video, available online at www.aestheticsurgeryjournal.com).

When I began performing hair transplantation 30 years ago, I had a very narrow view related to the field of hair restoration. If a patient was not a candidate for a transplant, I did not present them with any alternative treatments. This limited my hair restoration practice and also limited the treatments available to my patients. Fortunately today we have many options in the hair restoration field.

In the past, hair transplantation was essentially a treatment for male pattern baldness. Very few procedures were performed on women, because many of them were not candidates for a hair transplant. With the advent of numerous therapies, today women have become ideal candidates for nonsurgical hair management.

Most plastic surgeons have a predominantly female practice, and ignoring hair issues in these patients is missing an opportunity not only for the doctor but for the patient. Today, we have products such as minoxidil, platelet-rich plasma (PRP), nutraceuticals, finasteride, light treatments, and other forms of therapy.

Each of these treatments has different mechanisms of action. By having different mechanisms, it is more likely that the patient will clinically benefit. Nutrition is an extremely important factor associated with hair growth. This is readily demonstrated in patients with malnutrition, for whom hair loss is a common occurrence. This is why treatments with nutraceuticals can offer a significant benefit. The introduction of these important factors can not only stabilize hair loss but can also be associated with significant improvement in hair stability and growth. PRP, which requires injections in the scalp, works directly on the follicle by providing growth factors associated with concentrated platelets. There are numerous controlled studies documenting the efficacy of PRP. Minoxidil, which was originally developed as a blood pressure medication, works by enhancing blood flow to the follicle with the goal of enhancing growth. Light therapy works in a similar method by providing energy to promote vascularity and blood flow to the scalp. Frequently, a patient will ask which is the best treatment or how do I know which one is causing the most improvement. My philosophy has always been that one cannot conduct a controlled study on an individual patient, and if there is an improvement, it really is not that relevant which was the critical factor. The key issue is that the patient has benefited. Another important issue is that none of these factors give a permanent improvement. This is where patient education is so important, because they must understand at the onset of therapy that recurring treatment will be necessary to maintain the effect.

The critical factor is appropriate application of these numerous non-surgical treatments and proper patient selection. The other key factor, obviously, is patient education. Non-surgical treatments have varying results from dramatic to marginal. It is important that patients understand that a degree of unpredictability is associated with these therapies. However, if the doctor becomes knowledgeable about all aspects of hair restoration, patient satisfaction is usually high. By creating realistic expectations and educating the patient, the physician can develop a course of action in the patient’s best interest. Treatment of hair loss, especially in women, is usually a multi-factorial issue. Metabolic disorders, such as thyroid disease and others, are frequently a cause of hair loss, and appropriate medical treatment is a key factor in managing these patients. However, hair loss is diffuse in many women as they age, so they are not candidates for a transplant. This does not mean they are not candidates for non-surgical intervention. Over the years I have found that a multi-prong approach is often the best. Once women have a proper medical evaluation to rule out issues like thyroid disease, then the combination of nutraceuticals, PRP injections, minoxidil, and light therapy can either arrest their hair loss or possibly regenerate and thicken the existing hair.

Our colleagues with busy facial aesthetic practices often ignore the issues of hair loss in their patients. The doctor may not be aware of it or its significance, and the patient may not be aware it as an issue to point out to the plastic surgeon. When evaluating a patient for possible facial aesthetic procedures, addressing any issues related to hair is just as important as the other factors being considered. Unless the doctor mentions this, it is often overlooked for many patients. That is why this is a great opportunity to bring these modalities into one’s plastic surgical practice.

Finally, the panel provides great detail regarding the different forms of therapy and how they should be utilized. Hair restoration is just as important in a facial aesthetic practice as any of the other issues we frequently address.

Acknowledgments

The authors thank Dr Fisher for writing the Introduction to this Video Roundtable. They also thank Dr Foad Nahai for moderating the Video Roundtable.

Disclosures

Dr Fisher serves as a consultant to PhaseOne Health (Nashville, TN) and Vero Hair (Vero Concept, North York, Ontario, Canada). Dr Nahai receives a stipend from The Aesthetic Society for his role as Editor-in-Chief of Aesthetic Surgery Journal. Drs Glat and Hazen declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

This Video Roundtable was sponsored by Nutraceutical Wellness Inc. (New York, NY), which had no influence on the opinions or views of the moderator and the speakers. None of the participants received payment from Nutraceutical or any third party (including Oxford University Press) to take part in this activity.