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A Systematic Review of Outcomes and Patient Satisfaction Following Surgical and Non-surgical Treatments for Hair Loss

  • Review
  • Facial Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Introduction

This systematic review aims to examine surgical and non-surgical treatments and identify those procedures that are most effective in terms of patient satisfaction.

Materials and Methods

A systematic review protocol was developed a priori in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. The search was conducted in accordance with the PRISMA guidelines, the Cochrane handbook. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, and Cochrane databases was performed to identify studies on hair loss causes and hair loss treatment with different surgical and non-surgical techniques

Results

Our search generated a total of 781 articles; 646 studies were excluded based on the content of the abstracts, and an additional 105 studies were excluded based on the content of the complete article. We performed a review of the 30 remaining studies, which had sufficient data for inclusion, and met all the aforementioned inclusion criteria. Of the 30 studies, four were about minoxidil, four about finasteride, two about dutasteride, three about phototherapy, six about platelet-rich plasma injection, four about follicular unit transplantation technique, six about follicular unit extraction technique, and one about patient satisfaction following surgical treatment without a specified surgical technique. Only three studies used a patient-reported outcome measurement.

Conclusions

Our study is the first comprehensive systematic review of hair loss, looking at the problem from different points of view, and focusing on finding the best solution for the patient. In the literature, there is currently no algorithm for the management of patients who go to a plastic surgeon for a solution to the problem of hair loss.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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References

  1. Schweiger ES, Boychenko O, Bernstein RM (2010) Update on the pathogenesis, genetics and medical treatment of patterned hair loss. J Drugs Dermatol 9(11):1412–1419

    PubMed  Google Scholar 

  2. Martin A, Maladry D, Esmaeli A, Gaucher S, Philippe HJ (2018) Fat grafting of hairy areas of head and neck - comparison between lipofilling and nanofat grafting procedures in a cadaveric study. J Stomatol Oral Maxillofac Surg 119(4):274–278

    Article  CAS  PubMed  Google Scholar 

  3. Rousso DE (2008) Presti PM Follicular unit transplantation. Facial Plast Surg 24(4):381–388. https://doi.org/10.1055/s-0028-1102902

    Article  CAS  PubMed  Google Scholar 

  4. Moher D, Shamseer L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4(1):1

    Article  PubMed  PubMed Central  Google Scholar 

  5. Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and 20 explanation. BMJ 349:g7647–g7647

    Article  Google Scholar 

  6. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269

    Article  PubMed  Google Scholar 

  7. Higgins J, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1. 0 (updated March 2011). The Cochrane Collaboration

  8. Terwee CB, Jansma EP, Riphagen II, de Vet HCW (2009) Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res 18(8):1115–1123

    Article  PubMed  PubMed Central  Google Scholar 

  9. Olsen EA, Dunlap FE, Funicella T, Koperski JA, Swinehart JM, Tschen EH, Trancik RJ (2002) A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol 47(3):377–385

    Article  PubMed  Google Scholar 

  10. Olsen EA, Whiting D, Bergfeld W, Miller J, Hordinsky M, Wanser R, Zhang P, Kohut B (2007) A multicenter, randomized, placebo-controlled, double-blind clinical trial of a novel formulation of 5% minoxidil topical foam versus placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol 57(5):767–774

    Article  PubMed  Google Scholar 

  11. Lucky AW, Piacquadio DJ, Ditre CM, Dunlap F, Kantor I, Pandya AG, Savin RC, Tharp MD (2004) A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. J Am Acad Dermatol 50(4):541–553

    Article  PubMed  Google Scholar 

  12. Jacobs JP, Szpunar CA, Warner ML (1993) Use of topical minoxidil therapy for androgenetic alopecia in women. Int J Dermatol 32(10):758–762

    Article  CAS  PubMed  Google Scholar 

  13. Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, Price VH, Van Neste D, Roberts JL, Hordinsky M, Shapiro J, Binkowitz B, Gormley GJ (1998) Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol 39(4 Pt 1):578–589

    Article  CAS  PubMed  Google Scholar 

  14. Leyden J, Dunlap F, Miller B, Winters P, Lebwohl M, Hecker D, Kraus S, Baldwin H, Shalita A, Draelos Z, Markou M, Thiboutot D, Rapaport M, Kang S, Kelly T, Pariser D, Webster G, Hordinsky M, Rietschel R, Katz HI, Terranella L, Best S, Round E, Waldstreicher J (1999) Finasteride in the treatment of men with frontal male pattern hair loss. J Am Acad Dermatol 40(6 Pt 1):930–937

    Article  CAS  PubMed  Google Scholar 

  15. Roberts JL, Fiedler V, Imperato-McGinley J, Whiting D, Olsen E, Shupack J, Stough D, DeVillez R, Rietschel R, Savin R, Bergfeld W, Swinehart J, Funicella T, Hordinsky M, Lowe N, Katz I, Lucky A, Drake L, Price VH, Weiss D, Whitmore E, Millikan L, Muller S, Gencheff C et al (1999) Clinical dose ranging studies with finasteride, a type 2 5alpha-reductase inhibitor, in men with male pattern hair loss. J Am Acad Dermatol 41(4):555–563

    CAS  PubMed  Google Scholar 

  16. Iorizzo M, Vincenzi C, Voudouris S, Piraccini BM, Tosti A (2006) Finasteride treatment of female pattern hair loss. Arch Dermatol 142(3):298–302

    Article  CAS  PubMed  Google Scholar 

  17. Stough D (2007) Dutasteride improves male pattern hair loss in a randomized study in identical twins. J Cosmet Dermatol 6(1):9–13

    Article  PubMed  Google Scholar 

  18. Gubelin Harcha W, Barboza Martínez J, Tsai TF, Katsuoka K, Kawashima M, Tsuboi R, Barnes A, Ferron-Brady G, Chetty D (2014) A randomized, active- and placebo-controlled study of the efficacy and safety of different doses of dutasteride versus placebo and finasteride in the treatment of male subjects with androgenetic alopecia. J Am Acad Dermatol 70(3):489.e3–498.e3

    Article  CAS  Google Scholar 

  19. Bernstein EF (2005) Hair growth induced by diode laser treatment. Dermatol Surg 31(5):584–586

    Article  CAS  PubMed  Google Scholar 

  20. Leavitt M, Charles G, Heyman E, Michaels D (2009) HairMax LaserComb laser phototherapy device in the treatment of male androgenetic alopecia: A randomized, double-blind, sham device-controlled, multicentre trial. Clin Drug Investig 29(5):283–292

    Article  PubMed  Google Scholar 

  21. Jimenez JJ, Wikramanayake TC, Bergfeld W, Hordinsky M, Hickman JG, Hamblin MR, Schachner LA (2014) Efficacy and safety of a low-level laser device in the treatment of male and female pattern hair loss: a multicenter, randomized, sham device-controlled, double-blind study. Am J Clin Dermatol 15(2):115–127

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gentile P, Scioli MG, Bielli A, De Angelis B, De Sio C, De Fazio D, Ceccarelli G, Trivisonno A, Orlandi A, Cervelli V, Garcovich S (2019) Platelet-rich plasma and micrografts enriched with autologous human follicle mesenchymal stem cells improve hair Re-growth in androgenetic alopecia. Biomolecular pathway analysis and clinical evaluation. Biomedicines 7(2):27

    Article  PubMed Central  Google Scholar 

  23. Gentile P, Garcovich S, Bielli A, Scioli MG, Orlandi A, Cervelli V (2015) The effect of platelet-rich plasma in hair regrowth: a randomized placebo-controlled trial. Stem Cells Transl Med 4(11):1317–1323

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Cervelli V, Garcovich S, Bielli A, Cervelli G, Curcio BC, Scioli MG, Orlandi A, Gentile P (2014) The effect of autologous activated platelet rich plasma (AA-PRP) injection on pattern hair loss: clinical and histomorphometric evaluation. Biomed Res Int 2014:760709. https://doi.org/10.1155/2014/760709

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Lee SH, Zheng Z, Kang JS, Kim DY, Oh SH, Cho SB (2015) Therapeutic efficacy of autologous platelet-rich plasma and polydeoxyribonucleotide on female pattern hair loss. Wound Repair Regen 23(1):30–36

    Article  PubMed  Google Scholar 

  26. Tawfik AA, Osman MAR (2018) The effect of autologous activated platelet-rich plasma injection on female pattern hair loss: a randomized placebo-controlled study. J Cosmet Dermatol 17(1):47–53

    Article  PubMed  Google Scholar 

  27. Rodrigues BL, Montalvão SAL, Cancela RBB2, Silva FAR, Urban A, Huber SC, Júnior JLRC, Lana JFSD, Annichinno-Bizzacchi JM (2019) Treatment of male pattern alopecia with platelet-rich plasma: a double-blind controlled study with analysis of platelet number and growth factor levels. J Am Acad Dermatol 80(3):694–700

    Article  CAS  PubMed  Google Scholar 

  28. Uebel CO, da Silva JB, Cantarelli D, Martins P (2006) The role of platelet plasma growth factors in male pattern baldness surgery. Plast Reconstr Surg 118(6):1458–1466

    Article  CAS  PubMed  Google Scholar 

  29. Shao H, Hang H, Yunyun J, Hongfei J, Chunmao H, Zhang J, Shen H, Zhu F, Jia M, Wang Y, Guo X (2014) Follicular unit transplantation for the treatment of secondary cicatricial alopecia. Plast Surg (Oakv) 22(4):249–253

    Article  Google Scholar 

  30. Huang YL, Lee MC, Chang SL, Hu S, Chang CS, Lin YF, Cheng CY (2019) Harvested vs estimated follicular units in hair transplantation. J Cosmet Dermatol 18(3):902–907

    Article  PubMed  Google Scholar 

  31. Park JH (2017) Association between scalp laxity, elasticity, and glidability and donor strip scar width in hair transplantation and a new elasticity measuring method. Dermatol Surg 43(4):574–581

    Article  CAS  PubMed  Google Scholar 

  32. Park JH, You SH, Kim NR (2019) Nonshaven follicular unit extraction: personal experience. Ann Plast Surg 82(3):262–268

    Article  CAS  PubMed  Google Scholar 

  33. Humayun Mohmand M, Ahmad M (2018) Effect of follicular unit extraction on the donor area. World J Plast Surg 7(2):193–197

    PubMed  PubMed Central  Google Scholar 

  34. Bernstein RM, Wolfeld MB (2016) Robotic follicular unit graft selection. Dermatol Surg 42(6):710–714

    Article  CAS  PubMed  Google Scholar 

  35. Kim DY, Choi JP, Hwang YJ, Kim HS (2016) Hidden transection of follicular unit extraction in donor site. Dermatol Surg 42(4):485–488

    Article  CAS  PubMed  Google Scholar 

  36. Liu Y, Liu F, Qu Q, Fan ZX, Miao Y, Hu ZQ (2019) Evaluating the satisfaction of patients undergoing hair transplantation surgery using the FACE-Q scales. Aesthet Plast Surg 43(2):376–382

    Article  Google Scholar 

  37. Ors S, Ozkose M, Ors S (2015) Follicular unit extraction hair transplantation with micromotor: eight years experience. Aesthet Plast Surg 39(4):589–596

    Article  Google Scholar 

  38. Liu F, Miao Y, Li X, Qu Q, Liu Y, Li K, Feng C, Hu Z (2018) The relationship between self-esteem and hair transplantation satisfaction in male androgenetic alopecia patients. J Cosmet Dermatol. https://doi.org/10.1111/jocd.12839

    Article  PubMed  Google Scholar 

  39. Barber B, Kaufman K, Kozloff R, Girman C, Guess H (1998) A hair growth questionnaire for use in the evaluation of therapeutic effects in men. Journal of Dermatological Treatment 9(3):181–186

    Article  Google Scholar 

  40. Klassen AF, Cano SJ, Scott AM, Pusic AL (2014) Measuring outcomes that matter to face-lift patients: development and validation of FACE-Q appearance appraisal scales and adverse effects checklist for the lower face and neck. Plast Reconstr Surg 133(1):21–30

    Article  CAS  PubMed  Google Scholar 

  41. Rosenberg M (1965) Society and the adolescent self-image. Princeton University Press, Princeton

    Book  Google Scholar 

  42. U.S. Food and Drug Administration. Guidance for Industry (2006) Patient-reported outcome measures: use in medical prod- uct development to support labeling claims. FDA web site. https://www.fda.gov/cder/guidance/index

  43. Assessing health status and quality-of-life instruments (2002) At-tributes and review criteria. Qual Life Res 11:193–205

    Article  Google Scholar 

  44. Phillips TG, Slomiany WP, Allison R (2017) Hair loss: common causes and treatment. Am Fam Physician 96(6):371–378

    Google Scholar 

  45. Piraccini BM, Alessandrini A (2014) Androgenetic alopecia. G Ital Dermatol Venereol 149(1):15–24

    CAS  PubMed  Google Scholar 

  46. Imperato-McGinley J, Guerrero L, Gautier T, Peterson RE (1974) Steroid 5alpha-reductase deficiency in man: an inherited form of male pseudohermaphroditism. Science 186:1213–1215

    Article  CAS  PubMed  Google Scholar 

  47. Kaufman KD, Girman CJ, Round EM, Johnson-Levonas AO, Shah AK, Rotonda J (2008) Progression of hair loss in men with androgenetic alopecia (male pattern hair loss): long-term (5-year) controlled observational data in placebo-treated patients. Eur J Dermatol 18(4):407–411

    PubMed  Google Scholar 

  48. Paus R, Cotsarelis G (1999) The biology of hair follicles. N Engl J Med 341:491–497

    Article  CAS  PubMed  Google Scholar 

  49. Pierard-Franchimont C, Pierard GE (2001) Teloptosis, a turning point in hair shedding biorhythms. Dermatology 203:115–117

    Article  CAS  PubMed  Google Scholar 

  50. Levy-Nissenbaum E, Bar-Natan M, Frydman M, Pras E (2005) Confirmation of the association between male pattern baldness and the androgen receptor gene. Eur J Dermatol 15:339–340

    CAS  PubMed  Google Scholar 

  51. Zouboulis CC, Degitz K (2004) Androgen action on human skin from basic research to clinical significance. Exp Dermatol 13:5–10

    Article  CAS  PubMed  Google Scholar 

  52. Stenn KS, Paus R, Dutton T, Sarba B (1993) Glucocorticoid effect on hair growth initiation: a reconsideration. Skin Pharmacol 6:125–134

    Article  CAS  PubMed  Google Scholar 

  53. Deplewski D, Rosenfield RL (2000) Role of hormones in pilosebaceous unit development. Endocr Rev 21:363–392

    Article  CAS  PubMed  Google Scholar 

  54. Roh C, Tao Q, Lyle S (2004) Dermal papilla-induced hair differentiation of adult epithelial stem cells from human skin. Physiol Genom 19:207–217

    Article  CAS  Google Scholar 

  55. Randall V (2000) The biology of androgenetic alopecia. In: Camacho F, Randall VA (eds) Hair and its disorders: biology, pathology and management. Martin Dunitz, London, pp 123–136

  56. Hibberts NA, Howell AE, Randall VA (1998) Balding hair follicle dermal papilla cells contain higher levels of androgen receptorsthan those from non-balding scalp. J Endocrinol 156:59–65

    Article  CAS  PubMed  Google Scholar 

  57. Randall VA, Thornton MJ, Messenger AG (1992) Cultured dermal papilla cells from androgen-dependent human hair follicles (e.g. beard) contain more androgen receptors than those from nonbalding areas of scalp. J Endocrinol 133:141–147

    Article  Google Scholar 

  58. Inui S, Itami S (2011) Molecular basis of androgenetic alopecia: from androgen to paracrine mediators through dermal papilla. J Dermatol Sci 61:1–6

    Article  CAS  PubMed  Google Scholar 

  59. Poor V, Juricskay S, Telegdy E (2002) Urinary steroids in men with male-pattern alopecia. J Biochem Biophys Methods 53:123–130

    Article  CAS  PubMed  Google Scholar 

  60. Zouboulis CC (2004) The human skin as a hormone target and an endocrine gland. Hormones 3:9–26

    Article  PubMed  Google Scholar 

  61. Inui S, Itami S (2013) Androgen actions on the human hair follicle: perspectives. Exp Dermatol 22:168–171

    Article  CAS  PubMed  Google Scholar 

  62. Nakanishi S, Adachi I, Takayasu K (1996) Expression of androgen receptor, type I and type II 5a-reductase in human dermal papilla cells. In: Neste D (ed) Hair research for the next millennium. VREPB, Amsterdam, pp 333–337

  63. Liang T, Hoyer S, Yu R, Soltani K, Lorincz AL, Hiipakka RA, Liao S (1993) Immunocytochemical localization of androgen receptors in human skin using monoclonal antibodies against the androgen receptor. J Investig Dermatol 100:663–666

    Article  CAS  PubMed  Google Scholar 

  64. Tadokoro T, Itami S, Hosokawa K, Terashi H, Takayasu S (1997) Human genital melanocytes as androgen target cells. J Investig Dermatol 109:513–517

    Article  CAS  PubMed  Google Scholar 

  65. Cobb JE, Wong NC, Yip LW, Martinick J, Bosnich R, Sinclair RD, Craig JM, Saffery R, Harrap SB, Ellis JA (2011) Evidence of increased DNA methylation of the androgen receptor gene in occipital hair follicles from men with androgenetic alopecia. Br J Dermatol 165:210–213

    Article  CAS  PubMed  Google Scholar 

  66. Fujimoto N, Yeh S, Kang HY, Inui S, Chang HC, Mizokami A, Chang C (1999) Cloning and characterization of androgen receptor coactivator, ARA55, in human prostate. J Biol Chem 274:8316–8321

    Article  CAS  PubMed  Google Scholar 

  67. Inui S, Fukuzato Y, Nakajima T, Kurata S, Itami S (2007) Androgen receptor co-activator Hic-5/ARA55 as a molecular regulator of androgen sensitivity in dermal papilla cells of human hair follicles. J Investig Dermatol 127:2302–2306

    Article  CAS  PubMed  Google Scholar 

  68. Garza LA, Liu Y, Yang Z, Alagesan B, Lawson JA, Norberg SM, Loy DE, Zhao T, Blatt HB, Stanton DC, Carrasco L, Ahluwalia G, Fischer SM, FitzGerald GA, Cotsarelis G (2012) Prostaglandin D2 inhibits hair growth and is elevated in bald scalp of men with androgenetic alopecia. Sci Transl Med 4:126ra34

  69. Heilmann S, Nyholt DR, Brockschmidt FF, Hillmer AM, Herold C, Becker T, Martin NG, Nöthen MM (2013) No genetic support for a contribution of prostaglandins to the aetiology of androgenetic alopecia. Br J Dermatol 169:222–224

    Article  CAS  PubMed  Google Scholar 

  70. Lolli F, Pallotti F, Rossi A, Fortuna MC, Caro G, Lenzi A, Sansone A, Lombardo F (2017) Androgenetic alopecia: a review. Endocrine 57(1):9–17

    Article  CAS  PubMed  Google Scholar 

  71. Itami S, Kurata S, Takayasu S (1990) 5 Alpha-reductase activity in cultured human dermal papilla cells from beard compared with reticular dermal fibroblasts. J Investig Dermatol 94:150–152

    Article  CAS  PubMed  Google Scholar 

  72. Gupta M, Mysore V (2016) Classifications of Patterned Hair Loss: A Review. J Cutan Aesthet Surg 9(1):3–12

    Article  PubMed  PubMed Central  Google Scholar 

  73. Wirya CT, Wu W, Wu K (2017) Classification of Male-pattern Hair Loss. Int J Trichol 9(3):95–100

    Article  Google Scholar 

  74. Hamilton JB (1951) Patterned loss of hair in man: Types and incidence. Ann N Y Acad Sci 53:708–728

    Article  CAS  PubMed  Google Scholar 

  75. Norwood OT (1975) Male pattern baldness: Classification and incidence. South Med J 68:1359–1365

    Article  CAS  PubMed  Google Scholar 

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No intramural or extramural funding supported any aspect of this work.

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Authors and Affiliations

  1. Piero Rosati Clinic, Via Piangipane, 141, Ferrara, Italy

    P. Rosati

  2. Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy

    M. Barone, M. Alessandri Bonetti, V. Panasiti, R. Coppola & P. Persichetti

  3. Institute of Philosophy of Scientific and Technological Activity, Campus Bio-Medico University of Rome, Rome, Italy

    M. Barone & V. Tambone

  4. Research Group “To be and to appear: Objective indication to Plastic Surgery” of Campus Bio-Medico University in Rome, Rome, Italy

    M. Barone, V. Tambone & P. Persichetti

  5. Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy

    R. Giorgino

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  1. P. Rosati
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Rosati, P., Barone, M., Alessandri Bonetti, M. et al. A Systematic Review of Outcomes and Patient Satisfaction Following Surgical and Non-surgical Treatments for Hair Loss. Aesth Plast Surg 43, 1523–1535 (2019). https://doi.org/10.1007/s00266-019-01480-9

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