Mesotherapy for Hair Loss and Baldness

Mesotherapy (from Greek mesos, "middle", and therapy from Greek therapeia, "to treat medically") is a non-surgical cosmetic medicine treatment. Mesotherapy employs multiple injections of pharmaceutical and homeopathic medications, plant extracts, vitamins, and other ingredients into the subcutaneous fat. Dr. Michel Pistor (1924-2003) performed clinical research and founded the field of mesotherapy. There is no conclusive research proof that these chemical compounds work to target adipose (fat cells) specifically. Some physicians[have expressed concern over the efficacy of mesotherapy, arguing that the treatment hasn't been studied enough to make a determination. It is expressed by Rod Rohrich, M.D., Chairman, Dept. of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas: "There is simply no data, no science and no information, to my knowledge, that mesotherapy works," For experiences of Mesotherapy one can refer to this link as well: http://www.realself.com/Mesotherapy/reviews

Besides ineffectiveness the possible allergy and long term side effects of the drugs are never studied well. More over it is advised to be taken and continued at few weeks interval for maintenance


Usually by a thin needle of 30 number gauge either manually or by a mesotherapy computerized mesogun aided injection (or as some people use dermaroller which makes tiny tunnel to channel the drug in the skin) of liquid containing vitamins, minerals and hormones or in case of hair loss treatment Finasteride or Minoxidil area injected in subdermal layer in a very small quantity at say every 1 cm distance of the bald area of scalp Skin. It is said that Vit. B 6 or pyridoxine, Azailic acid and Zinc are found to be 5 alfa reductase enzyme inhibitors (and in turn DHT inhibitors) in some research and some people inject these molecules as well. There is although always a concern of Hypotension ( drop in blood pressure) if Minoxidil is directly injected as it is the Hypotensive medication when given systematically. Finsteride has not been found to be effective locally any ways. These appear to be just claims rather than good science in this treatment, so one should be cautioned about this. In case od Dermaroller the needles penetrate the stratum corneum, the hard outer surface of the epidermal layer of the scalp.It is claimed that hundreds of tiny channels are created through the stratum corneum, which facilitate the passage and absorption of Minoxidil into the dermis to maximize it’s absorption by the hair follicles. The Derma Roller also stimulates blood flow to the hair follicles via direct scalp massage. The dermal damage induces the release of growth factors that stimulate the production of new collagen and elastin and stimulates the miniaturized hairs to grow stronger.

Why male pattern hair loss occurs on the top horse shoe area of scalp?

The Pattern loss is genetic hair loss where the hairs at the top central and horse shoe shaped are is where the hairs gradually miniaturize and die because these hairs are  Genetically Hormone (5DHT) sensitive. This is the reason this hair loss is also called Andro Gentic Alopecia (AGA).

When the head is developed from embryo the frontal and parietal bone area of the head has migrated Neural crest tissue but the occipital and temporal bone area ( back and side of the head ) does not have this tissue of origin. It is believed that certain genes responsible for AGA affect only these hairs which are having Neural crest origin and the area at the back and sides escape the effect of these genes.

Turban Alopecia in Sikhs

Although Sikh men are as susceptible to other forms of hair loss as anyone else, they commonly suffer from what is known as traction alopecia. This occurs when the knotting of long hair pulls on the hair over time so that its roots are damaged. It is different from pulling hair out accidentally when taking the turban on or off. It is a

slow process but it can be irreversible.

Sikhs males have religious reasons not to cut their hairs throughout the life. The long hairs are kept hidden under their turban after winding them in a ‘Rishi knot’. It is an irony that this long hairs due to constant traction on the root due to this knot result in premature hair loss over the years. This especially happens in the frontal and temple area where the traction stress is maximum. This is common to all those Sikhs round the world may be in millions. It's a subject rarely discussed because it's relatively easily hidden, but hair loss is a big problem among Sikh men and covering it up doesn't take away the associated distress.

Traction alopecia can be exacerbated by the ritual combing of the hair. This can be alleviated by straightening out the hair and working through tangles with the fingers before combing, thereby reducing the pull of the comb. It's important to keep the hair soft and in good condition even if you're not worried about other people seeing it.

To prevent this problem, I would advise avoiding unnecessary stress on the hair by winding the

‘Rishi’ knot less tightly. The problem is not with wearing the turban, but with improper hair care.  Hair must be combed down at night and then joora retied in the morning. Keeping joora tied all the time does not allow hairs to relax properly.

Use a light fabric and only use as much fabric as is absolutely necessary to contain the hair. The weight of extra fabric will put added strain on your hair. Be careful not to bind the turban too tightly - it's better to secure it with grips further back on the scalp if necessary, as hair is most vulnerable toward the front of the head. With Be careful to position your hair directly on top of your head before you bind it. This will enable your head to support most of the weight of your hair directly when you are upright. If you tend to lean backwards when sitting, be careful to keep your head upright.

Some Sikhs who suffer from traction alopecia choose to give up on wearing turbans altogether and to keep their hair in pony tails instead. If you do this, make sure that you don't draw it back too tightly from your head and that you secure it loosely.

It is interesting to note that traction alopecia often occurs as a result of various headwear and hair styles, including hair extensions, wearing tight ponytails and wearing tight fitting-hats.

But if you take care to look after your hair and bind it appropriately, you are likely to be able to keep much of the length of it at the back for most of your life.

As a permanent solution to restore hair, hair Transplant is recommended as it is not possible to medically restore lost hair as shown in one of my patients.

Turban Alopecia in Sikhs

Although Sikh men are as susceptible to other forms of hair loss as anyone else, they commonly suffer from what is known as traction alopecia. This occurs when the knotting of long hair pulls on the hair over time so that its roots are damaged. It is different from pulling hair out accidentally when taking the turban on or off. It is a slow process but it can be irreversible.

Sikhs males have religious reasons not to cut their hairs throughout the life. The long hairs are kept hidden under their turban after winding them in a ‘Rishi knot’. It is an irony that this long hairs due to constant traction on the root due to this knot result in premature hair loss over the years. This especially happens in the frontal and temple area where the traction stress is maximum. This is common to all those Sikhs round the world may be in millions. It's a subject rarely discussed because it's relatively easily hidden, but hair loss is a big problem among Sikh men and covering it up doesn't take away the associated distress.

Traction alopecia can be exacerbated by the ritual combing of the hair. This can be alleviated by straightening out the hair and working through tangles with the fingers before combing, thereby reducing the pull of the comb. It's important to keep the hair soft and in good condition even if you're not worried about other people seeing it.

To prevent this problem, I would advise avoiding unnecessary stress on the hair by winding the

‘Rishi’ knot less tightly. The problem is not with wearing the turban, but with improper hair care.  Hair must be combed down at night and then joora retied in the morning. Keeping joora tied all the time does not allow hairs to relax properly.

Use a light fabric and only use as much fabric as is absolutely necessary to contain the hair. The weight of extra fabric will put added strain on your hair. Be careful not to bind the turban too tightly - it's better to secure it with grips further back on the scalp if necessary, as hair is most vulnerable toward the front of the head. With Be careful to position your hair directly on top of your head before you bind it. This will enable your head to support most of the weight of your hair directly when you are upright. If you tend to lean backwards when sitting, be careful to keep your head upright.

Some Sikhs who suffer from traction alopecia choose to give up on wearing turbans altogether and to keep their hair in pony tails instead. If you do this, make sure that you don't draw it back too tightly from your head and that you secure it loosely.

It is interesting to note that traction alopecia often occurs as a result of various headwear and hair styles, including hair extensions, wearing tight ponytails and wearing tight fitting-hats.

But if you take care to look after your hair and bind it appropriately, you are likely to be able to keep much of the length of it at the back for most of your life.

As a permanent solution to restore hair, hair Transplant is recommended as it is not possible to medically restore lost hair as shown in one of my patients.

FUE and lateral damage

FUE Technique is sufficiently advanced now so that to avoid less trauma to not only the follicular unit to be extracted but also to the follicles around that. The strip method in fact while cutting out the strip and then while making the slivers and then cutting the individual grafts from the slivers can damage more number of grafts than done by individual follicular extraction.

1. When follicular units are extracted the cut is only made till the level of sebaceous glands and the part of the follicle below that level which is harboring stem cells and is important for the growth is not touched with knife by the techniques that we use so not only the follicle to be extracted but follicles around that are not damaged. 
2.The  lower part of the follicle is any way loosely attached  to the surrounding and easily come out without cutting.
3. More over we use tumescence ( inflate tissue with saline) this separates the follicular units from one another so that while extracting one the other does not come in the way.
4. We use smaller punches with 0.75 to 1mm diameter which which avoids the lateral trauma to the surrounding follicles check the attachment.

FUE or FUT which method is better?

There are 2 methods of Hair Transplant as per the latest evidences following are our views:

1. FUHT or Strip method ( a conventional method that requires stitches  at the back and leaves a permanent linear scar which at the back that does not make it possible to wear a short hair style and sometimes gives pain and numbness for a few weeks to few months. Healing time is longer due to a long cut at the back)

2. FUE (With recent advances this modern and stitch less method that does not leave a linear scar on the back of the head and heals faster and practically pain free post operatively. Final outcome is better). We use 0.75 to 1 mm micro punch with depth control and use Lorenzo technique for extraction.

The difference between the 2 methods is essentially in harvesting the roots from the back side of the head and the method of grafting and the final outcome of both methods in the area of hair loss (recipient area) is the same. We now strongly believe that FUE is except for the cost is superior method than the FUT (Strip method).

                                         Enlarge the picture below by double click to read

Shock loss or Reactive loss or Post surgery effluvium

Shock Loss , Reactive Loss or Telogen effluvium, Shock fall out:
It is reaction to the surgery esp. that on the scalp because the scalp is stressed by surgery and some of the hairs may fall out in 2 to 12 weeks some are permanent and some can be temporary. Most likely the miniaturized hairs are likely to fall out.  This can happen mostly in recipient area but can rarely also happen in the donor area esp. in the FUT or strip method and less commonly in FUE method due to its minimally invasive nature. The Shock loss is unpredictable although factors to be considered are:

Age: young ( <30) more with active inadequate stabilization of hair loss it is common but in Older age patients with stabilized hair loss has les chances of shock loss.
Sex: male more common than female but it is more significantly visible in females
            Male more likely to be permanent in female more likely to regrow
Miniaturized hairs (i.e. the hair that is at the end of its lifespan due to genetic balding): more likely to be permanently lost unless Finasteride supported
Terminal Hairs ( Healthy) : more likely to grow back in 4-6 months
Transplanted hairs: shock loss is less common but can grow back in 4-6 months
Temporary Loss: The terminal or healthy hair shock fall out is usually tempoaray and they grow back by 4-6 m9onths
Permanent loss: usually of the miniaturized hairs or of the terminal hairs that is damaged or transected while making the incision for grafting in between the hairs.
Protection: by starting Finassteride 1mg ( or Dutaseride 0.5mg) per day at least 2 weeks before until the at least 6 months post op in males. In females Finasteride is useless and Minoxidil may be useful to some extent.
How can one minimize Shock loss:

1         by using smaller incisions for recipient area ( using smaller grafts rather than using minigrafts)

2         Limiting the depth of incisions

1.       Minimizing the adrenaline use in recipient area

2.       Reducing the packing between the existing hairs

3.       Minimizing the tension of the donor area

4.       Using Finasteride from at least 2 weeks before the procedure and for 6 months after the procedure.

5.       Spacing the 2 sessions of transplant at least 1 year apart

6.       Avoid operating on the young patients who are in the actively losing state and have high miniaturization. Put them on Finasteride & or Minoxidil for a few months before contemplating transplant.

7.       Plan to use enough FU and transplant through the highly miniaturized hairs rather than avoiding that area so that in case of shock loss of highly miniaturized hairs the area is sufficiently compensated with the healthy transplanted hairs. In areas of extensive miniaturization, it may be appropriate to transplant follicular units in the same density as one would if the area was totally bald ass the miniaturized hair may be lost by the time transplants grow.

However, regardless of the “claims” of a particular surgeon, the process is a natural response of hair follicles and the risk cannot be eliminated completely.

Saw palmetto for hair loss

·    Saw palmetto (Serenoa repens or Sabal serrulata) is a dwarf palm plant native to North America. It grows to about two to four feet in height, with fan-shaped leaves and berries. The oil of saw palmetto is medicinally active.

·    Saw palmetto was a popular folk remedy used by Native Americans to treat urinary conditions in men and breast disorders in women.  It primarily grows along the Atlantic coast in Georgia and Florida. The active ingredients are found in the plant's brown-black berries. It contains two types of oils, fatty acids and sterols. It has also been marketed for prostatic (BHP- Benign Hypertrophy of Prostate) and urinary problems besides for the prevention of Hair Loss.

·    Many popular hair loss treatment options today such as Provillus, Procerin, Trochomax Ag and Avacor contain the “active” ingredient saw palmetto.

Mechanism of Action

 Although we still don't know exactly how it works, it's believed that it may block an enzyme (5-alpha-reductase) from allowing the hormone testosterone from being converted to another hormone, dihydrotestosterone. Dihydrotestosterone is considered a key contributing factor to the onset and progression of androgenic alopecia and benign prostatic hyperplasia. There are no well-designed clinical studies showing that saw palmetto can cause hair growth, or stop hair loss or baldness from progressing.

The Dose:

But if there are no current standards on dosages of herbal medications. 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.  Dosage and how it should be used (orally or topically) therefore is based on conjecture rather that scientific evidence.

  Side effects:   

One false assumption is that “all natural” treatments don’t have potential side effects. 

The most common side effects associated with saw palmetto use are mild digestive distress, including stomach pain, constipation, diarrhea, nausea, vomiting, or bad breath.

There have been rare case reports describing liver inflammation, pancreatitis, jaundice, headache, dizziness, insomnia, depression, breathing difficulties, muscle pain, high blood pressure, chest pain, abnormal heart rhythm, blood clots, and heart disease, but they haven't been clearly caused by saw palmetto.

Some men taking saw palmetto have reported erectile dysfunction, breast tenderness or enlargement, and changes in sexual desire. Although it hasn't been well-demonstrated in humans, saw palmetto may influence levels of sex hormones such as estrogen and testosterone. Until we know more, people with hormone-sensitive conditions, such as breast cancer, should use caution.

At least two case reports have linked saw palmetto with severe bleeding. People with bleeding disorders or who are taking anticoagulant or antiplatelet medications ("blood-thinners") such as warfarin (Coumadin), aspirin, or clopidogrel (Plavix) should avoid taking saw palmetto unless under medical supervision. It should also be avoided at least two weeks before or after surgery.

The safety of saw palmetto for pregnant or nursing women, children, or people with kidney or liver disease hasn't been established.

The most common side effects are gastrointestinal, some of which may be reduced by taking the extract with food. Beta-sitosterol, one chemical present in saw palmetto extract, is chemically similar to cholesterol. High levels of sitosterol concentrations in blood have been correlated with increased severity of heart disease in men who have previously suffered from heart attacks

When using saw palmetto for hair loss one option is using it as an external treatment ( oil extract or ointment) by massaging it into the scalp and hair. This may work because of its  lipophilic nature. This means they are well extracted into the oil base typically used, and are easily absorbed by the skin, therefore providing a more productive treatment.