Laser hair loss treatments
Alopecia has many causes and is a frequent reason for patients to consult their doctors. The first thing to be done is to find the cause, so that the best treatment may be proposed. Firstly any general illness must be excluded. At present, the type of alopecia that sends most people to the doctor is androgenic alopecia or male pattern baldness in both men and women. This is why a number of hormonological studies are under way. Some blood hormone dosages are not always usable for routine treatment, but they do open up paths for research. In addition to the routine endocrine tests, it is now possible to determine amounts of 5alpha reductase or the androgen receptor, thus improving diagnosis. Therapeutic prospects have made considerable advances over the past few years: - new hormone treatments, - Minoxidil(, - New-micro-grafting surgical techniques.
	A few figures
	Anatomy of a hair
	Factors on which hair growth depends
	Examining a patient with alopecia
	Treatments proposed

A few figures

The total number of hairs on the head is around 150,000, or enough to cover an area of around 10 square metres if placed side by side, as there are around 200 hairs per square centimetre. Hair is totally renewed four times in a lifetime.

Anatomy of a hair

The hair cycle is made up of three phases that all together cover an average period of three years.

• The first or anagen phase, known as the growth phase, is when the hair becomes adult; it makes up about 80% of the cycle and lasts three years.
  
• Then comes the transition phase (1%) taking up a little under three weeks.
  
• And finally the telogen or resting phase (20%) lasting three months, during which the hair dies.

It should be noted that we all lose between 50 and 100 hairs every day.

An examination will show whether all these percentages are respected: this is called a trichogram. Some small tufts of hair, unwashed for five days, are removed with tweezers from three specific points. Each tuft is then examined under a microscope. It is possible to deduce the age of the hair by the shape and characteristics of the bulb.

Based on the formula obtained, the cause can be identified and the treatment adapted accordingly. Broadly, three formulae are distinguished:

• Telogen formula: old hairs outnumber young ones.
  
• Anagen formula with malformation: this shows a lesion of the hair matrix at the very beginning of hair growth and is most often due to medicaments (chemotherapy) or has a physical cause (X-rays).
  
• Or a combination of the two.

Factors on which hair growth depends

1) Heredity.

2) Nutrition, in the knowledge that malnutrition quickly leads to hair loss and finer paler hair. Some amino acids are indispensable for hair growth, especially those containing sulphur. Similarly, certain fatty acids, certain metals (zinc and copper) and vitamins B5 and H are also needed.

3) Hormonal factors: These are essentially the male hormones and their derivatives, the chief amongst them being testosterone. Thyroid hormones also influence the hair cycle, as do some pituitary hormones.

Examining a patient with alopecia

The first thing to be ascertained is the age at which hair loss began and how it has developed.

1. Your history and that of your ancestors

Circumstances of onset:

- Taking medicaments
- Recent illnesses
- Stress
- For women: childbirth.

2. The examination:

This is carried out on the scalp, unwashed for a minimum of five days. Tests include traction, used to assess the scale and the reality of the hair loss. They are followed by a general examination looking for associated illnesses, followed by a blood test. The doctor will then be able to consult the trichogram.

3. Causes:

The first to be excluded is the case of patients getting out of bed in a panic after seeing the loss of a few dozen hairs, unnoticed until then, as well as a seasonal increase in hair loss and other benign causes.
Newt the causes of rapid and abundant loss must be differentiated from very gradual causes.
The first case is most often the result of aggression or stress, which may be due to childbirth or an infectious disease, and more rarely to a too-rapid loss of weight or even an emotional shock.

Some well-known medicaments lie behind this type of problem, such as chemotherapy treatment for cancer, but here a diagnosis is not required because the patient has already been warned. Many other types of medicaments can also cause this type of problem, but the hair loss they cause is fortunately always reversible.

The causes of gradual hair loss are essentially common or male pattern baldness. As its name implies, it is linked to male hormones and is found chiefly in men. It is more rare in women and less clear-cut. It gets better during pregnancy and starts again after childbirth.
There are also all the causes of hair loss related to chemical attack and trauma, in a word, all the dyes, bleaches and curling or straightening products.
Even if they are applied under good conditions, if certain intervals are not respected between the various treatments, they could be responsible for hair loss due to alteration of the hair shaft.

Treatments proposed

1. Medical treatments

These start with bodily hygiene including washing the hair. Frequency of cutting has no effect on growth and does not remove split ends. If good quality non-detergent shampoos are used, the hair may be washed as often as desired, but care must be taken to avoid mixing two types of shampoo that do not have similar surfactants, as this could lead to serious problems in the hair texture that can be corrected only by a cut.

A number of specially formulated pharmaceutical preparations are supposed to stimulate hair growth.
They are used regardless of the cause and the result is more than uncertain. Similarly, well-tolerated products to counter hair loss remain the most popular solution among the public, even if the results are not always successful.

Minoxidil(, used locally or generally, is one of the effective treatments that have been available for several years.

A hormonal by-product, Propecia(, has also been shown to slow the rate of hair loss.

Hair loss is seen to stop between four and six months after the start of treatment and in the best causes growth begins in the same period. This is currently one of the most effective medicines for male pattern baldness.
Among supplements that are generally taken, mention must be made of:
- Vitamin B5 or pantothenic acid,
- Vitamin H or biotin
- Vitamin B6 and the sulphur amino acids.
It appears that zinc also has a beneficial action.

Hormones:

- These include anti-androgens, because they oppose the role played by male hormones in hair loss. Unfortunately, they can be prescribed only for women because they would lead to feminisation in men.

- Certain diuretics known as spironolactones also counteract male hormones, which means that they cannot be used to treat alopecia in men.

2. Surgical baldness treatment

a) Micro-grafts

Renewed interest is being shown in hair grafting with the arrival of new techniques that have revolutionised a practice that has already existed for a very long time.
Until now, practitioners were faced with two obstacles:

- Firstly, making the graft effective; for this it must treat a sufficient number of hairs (there are around 100,000 to 150,000 in an average head of hair),

- Secondly, the graft must be invisible to the observer, even when very close; the "doll's hair" look must be avoided at all costs. Moreover, the border between the top of the forehead and the beginning of the hair, called the anterior line, has up to now been the weak point of grafting, and it was here that there was a risk of producing an appearance typically resembling ears of corn. With today's micro-implant techniques, it is possible to obtain a naturally thinner appearance and the anterior line may be shaped as the patient desires.

For this purpose, a strip of scalp is removed under local anaesthetic in an area that will never suffer from baldness, generally the back of the head or occiput. Anaesthesia and vasoconstrictors are infiltrated into the occiput, thus averting any bleeding.
The scalp transplant area is incised with a special scalpel with three inclined parallel blades, making it possible to obtain two fine regular strips.
Each strip is then carefully incised again.

Then the recipient zone is prepared with the same type of infiltration. Several methods are now used to implant the grafts:

- either a fine scalpel makes small incisions (a few millimetres) and the graft is inserted in the slit formed,

- or a special instrument removes a cylinder of scalp with a diameter of 1 to 2 millimetres, leaving a hole for insertion of the transplant graft.
The operation, which is completely painless, lasts an average of three hours. Two or three sessions are normally needed for a natural looking result.

b) Bald patch reduction

This involves removing a bald area of the scalp and sliding areas with growing hair into the space left. A wide area for retraction???decollement??? must be left on either side of the incision.
Several reductions may be envisaged, carried out six weeks apart.

c) Strips

This technique involves cutting out a strip of scalp and rotating it about itself so that it occupies a bald patch.
Advantage: immediate transfer of an entire hair growing area (with hair that will not fall out after the operation). A line is created between the top of the forehead and the beginning of the hair growth, to conceal regrowth of any grafts behind the strip.
Drawback: aesthetically this technique is now out of fashion with the clientele. Risk of necrosis (loss of a portion) due too a lack of revascularisation.

d) Cutaneous expansion

Under general anaesthesia, a silicone balloon with an inflation valve is inserted under the skin.
The balloon is inflated with physiological serum, which distends the strip donor zone. It is inflated once a week over a period of three months.
This makes the bald patch much easier to reduce.

3. Conclusion:

The treatment of Alopecia begins with a very detailed and personal analysis of the problem. The patient's attitude will then be carefully considered in each individual case:

- Delaying???temporiser??? by means of the absence of therapeutic treatment or regularly controlled taking of medicines or

- Initiating a surgical strategy associating several grafting sessions and/or more substantial operations such as bald patch reduction or the transfer of complete strips of hair-growing scalp.