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Interview of Dr Alexander for “Die Beeld” Newspaper - 17 Aug 2010

Are there any new developments in the fight against hair loss? (new products and/or treatment techniques?)

Yes, the general public is unaware of the fact that the latest prescription medical treatments, (topical lotions and tablets), can deliver excellent re-growth results in a high percentage of men and women.

The last ten years has been a very exciting time to be involved in the medical treatment of hair loss as it is the field in which the biggest strides have been made. At my Hair Loss Clinic in Bedfordview, we are using these latest prescription treatments in specific combinations to great effect.

We are also one of the first medical hair loss clinics in the world to show proof that the re-growth can be sustained for more than a decade.

•  Do the cosmetic hair growth stimulants that one can buy in salons and supermarkets really work?

No, as with most things, there will be a few people who will claim that they have had success with products such as these, but the vast majority will be disappointed.

Remember that there are certain hair loss conditions which can spontaneously correct themselves and if you happen to be using a product at the time that this happens, you will be convinced that this product solved your problem. Since these are cosmetic products and not medicines, there is no requirement for clinical trials to prove safety and efficacy so we are forced to accept the manufacturer's claims which, in most cases, are greatly exaggerated.

I have met hundreds of people who have told me that they have tried products such as these without success.

•  What is your opinion on laser treatments and hair plugs?

Laser treatment for hair-regrowth in my opinion is totally ineffective. Laser can get rid of unwanted hair, but there is no facility in the world that has ever been able to show documented clinical proof that it can influence hair re-growth.

Laser has been used in South Africa to treat hair loss, amid a lot of hype, for the last seven years and has proven to be an expensive dismal failure.

The only time that anyone has had any success with laser treatment was when the laser treatment was combined with clinically-proven topical lotions such as minoxidil. In all cases, it was the minoxidil which grew the hair back and the laser was simply the “window dressing” or “smokescreen of high technology” which was created to justify the exorbitant prices that were charged.

Hair plugs are no longer used as a method of hair transplant as they were unsightly and gave the patient the appearance of “doll's hair”. The latest technique is called “microfollicular implanting”. In this technique, 3 or 4 harvested hairs are implanted into the same root to gain density as the implants have to be spaced a certain distance apart.

Hair transplant does have its place in the field of hair loss treatment, but it is something that I would only recommend to a patient if he/she has tried the medical option for at least one year and found that it was not completely successful.

Hair transplant is limited by the amount of donor hair at the back of your head and the size of the area that you want to cover. If you have a large area to cover, you will very likely be disappointed with the results. Even in the best transplants, at least 30% of the transplanted hairs fail to develop a blood supply and are lost.

Bear in mind that the average top part of a human head contains about 70 000 hairs.

Remember, that even if you do go the transplant route, you would still need to continue using the medical treatment to prevent further loss of your hair. If the medical treatment is completely successful, you will never need the transplant.

•  How expensive are the different treatments and what would you recommend?

Hair transplant would be the biggest outlay in terms of cost. Prices do vary, but one is looking at about R15 000 - R25 000 to harvest and implant about 1000 hairs.

Medical treatment would cost initially between R440 – R880 per month for a male, or between R270 – R580 per month for a female for the initial 6 -12 month re-growth phase of treatment. Thereafter, the re-growth can be maintained in 83% of males for a minimum of R180 per month (the remaining 17% would need to spend a minimum of R440).

Maintenance in female patients can be achieved for a minimum of between R250 - R365 per month.

Hair replacement i.e. hairpieces and wigs vary from cheap, obvious wigs made from synthetic fibre for between R600-R1000 (which can be bought off the shelf), to expensive , custom- built units made from real hair which can cost between R8000- R16000 each. These hair-pieces or wigs would need to be replaced annually as they wear out.

•  Are there any supplements you can take from a young age to fight hair loss?

Unfortunately, the most common form of hair loss which is genetically-inherited, cannot be prevented by taking supplements such as vitamins. The prescription medicines that we use at my Hair Loss Clinic are very effective in terms of preventing hair loss if they are used from a young age when the first signs of hair loss appear.

•  How can you avoid/ curb hair loss?

This of course depends on the cause of the hair loss problem of which there are many. One could avoid becoming deficient in iron or overdosed on Vitamin A. One could also check the thyroid hormones regularly as both an over-active as well as an under-active thyroid gland can lead to hair loss.

When it comes to the most common form of hair loss which is the genetic type, also referred to as male or female pattern baldness, then the only way to avoid or prevent hair loss would be to take the latest prescription medicines on an ongoing basis.

•  What causes hair loss in men and women (is there a difference?)

The most common cause of hair loss in both men and women is the inherited condition of alopecia androgenetica. This is also referred to as male pattern baldness or female pattern baldness. The inheritance of the genes for this condition is equal in men and women, but because men have four hundred times the amount of testosterone in their bodies, the severity of the condition is far worse in men.

In women it is more slowly progressive and involves a diffuse thinning of the hair virtually all over the head (except maybe at the base of the skull). In men with this condition, the hairs on the sides and back of the head are spared, and the hair is thinned only on top.

Other causes of hair loss would include Thyroid gland problems, iron deficiency anaemia, fungal scalp infections, specific hormonal problems and there are numerous other less common causes such as alopecia areata where hair is lost in patches due to an antibody attack on the hair follicle. With all of these conditions, men and women are equally affected

•  Is there a certain age in men and women when hair loss starts to occur?

Generally, the most common cause of hair loss viz. Alopecia androgenetica (Male or Female pattern baldness) starts just after puberty. It progresses at different rates in different people according to the degree of inheritance as well as environmental and stress factors, so people will present themselves for treatment at different ages.

I have treated several teenagers, both males and females who are already showing visible signs of this condition.

In women after the menopause, the balancing effect of oestrogen on the male hormones is lost and the condition tends to accelerate.

•  What is your treatment strategy?

At my clinic, I am very thorough in terms of making the correct diagnosis and implementing the correct treatment.

With all of our patients, we take a careful medical history, after-which the hair and scalp is examined clinically. If necessary, blood tests are done to exclude hair loss causes such as over or under-active Thyroid gland problems, iron deficiency anaemia or hormonal problems.

Once the diagnosis has been established, a treatment strategy is advised to the patient which may involve applying prescription lotions, swallowing of tablets or injections to the scalp.

•  I have seen the results on your webpage - what do you think makes you successful?

I am somewhat of a pioneer in the field of medical treatment of hair loss, having been involved in this field for about 18 years now. The techniques which we employ today to grow people's hair back are the result of many years of painstaking research and development and were not discovered overnight.

This research and development led to breakthroughs which placed my clinic at the forefront in terms of technology for medical treatment of hair loss on a global scale.

We are presently ahead of Europe and the United States as far as the development of new medical technology to achieve re-growth of hair is concerned and consequently we are in the privileged position to be treating patients from all over the world.