Patients with mild-to-moderate pattern hair loss (androgenetic alopecia) are often good candidates for hair restoration using medication. The effectiveness of medication in restoring hair growth also depends on the cause of hair loss and the patient’s response to treatment. Some patients experience hair regrowth or a slowing or stopping of hair loss. However, others receive no benefit from the use of these drugs.

The following medications are approved by the U.S. Food and Drug Administration (FDA) to regrow hair:

• Minoxidil (Rogaine). An-over-the-counter topical liquid or foam designed to regrow hair and/or stop hair loss associated with androgenetic alopecia and alopecia areata (patchy baldness). Applied to the scalp twice a day, it is available in both a 2 percent and a 5 percent solution. Some evidence suggests the 5 percent solution may be more effective at treating cases of pattern hair loss, particularly in men. However, the 5 percent solution may cause side effects in women (e.g., facial hair growth) and is only specifically approved for use in men.
  
  

  Applied twice daily to the scalp, the use of minoxidil may produce longer, thicker hairs by reversing, stopping or slowing the shrinking of hair follicles (tiny, tubular structures in the skin through which hair grows) associated with pattern hair loss. New hairs grown by minoxidil treatment may be thinner and shorter than previous hairs, though they are often produced in sufficient amounts to successfully blend with existing hair and at least partially cover bald spots. Minoxidil must be used continuously to remain effective, as any hair grown as a result of use usually falls out once treatment is stopped. Not all patients grow hair with minoxidil. When it is effective, it may take six months to a year for the drug to begin working. A physician may recommend discontinuing use of minoxidil if no results or minimal results are achieved within about nine to 12 months.
  

• Finasteride (Propecia, Proscar).  A prescription medication used to treat male androgenic alopecia. Taken daily in pill form, finasteride often slows the rate of hair loss and, in some cases, may initiate new hair growth. It works by inhibiting the conversion of the hormone testosterone into dihydrotestosterone (DHT), a hair follicle shrinking hormone that contributes to hair loss in men. Like minoxidil, any hair that is regrown or maintained while using finasteride is likely to fall out after the drug is discontinued. It may also take one year or longer before results are noticeable.

Patients with mild alopecia areata may benefit from corticosteroid scalp injections and those with more extensive hair loss may require oral corticosteroids. Corticosteroids are a group of anti-inflammatory drugs similar to hormones produced by the body. Ointments and creams may also be used less frequently, though they tend to be less effective than corticosteroids.

In addition, the medication anthralin may provide some benefit for patients with alopecia areata. Usually used to treat psoriasis (a chronic condition marked by frequent episodes where the skin becomes itchy and red and develops thick, dry, silvery scales), anthralin is a tar-like substance applied daily to the scalp for 20 to 60 minutes and then washed off. Anthralin may also be used along with other hair medications (e.g., minoxidil) for better results.

Other treatments that may be used for alopecia areata include topical sensitizers (drugs that provoke an allergic reaction that eventually leads to hair growth) and phototherapy (controlled exposure to ultraviolet radiation).

Patients who are not considered good candidates for medical hair restoration may benefit from hair restoration surgery. These popular treatment methods are often effective at creating a hairline that appears natural. However, hair restoration techniques have limited potential to transplant hair to areas other than hairlines. People with diffuse or extensively thinning hair across large areas of the scalp do not typically make good candidates.

Recent technological improvements have helped create safer and easier hair restoration techniques than in years past. In some cases, a combination of techniques may be used to accomplish the best possible results. In addition to other factors (e.g., cause of hair loss, patient lifestyle), the patient’s extent and pattern of hair loss will determine which hair restoration surgery will be performed.

The most commonly used surgical method of hair restoration is hair transplantation. It involves the removal of small pieces of hair-growing scalp (grafts) from a “donor site” (usually the lower back or sides of the scalp) and moving them to a bald or balding area. Multiple surgeries over an extended period may be necessary to achieve an appearance the patient feels is satisfactory, with each surgery usually separated by a healing time of several months.  Hair color and texture may play a role in determining how much coverage is necessary. Light-colored or coarse hair typically covers better than hair that is fine or dark-colored. The number of hairs moved varies according to the type of grafting method utilized:

• Micro-graft. About one to two hairs.
  
  
• Mini-graft. About two to four hairs.
  
  
• Slit graft. Roughly four to 10 hairs each. Slit grafts are inserted into slits created in the scalp.
  
  
• Punch graft. Typically round-shaped and contain about 10 to15 hairs.
  
  
• Strip graft. About 30 to 40 hairs each. Strip grafts are done in sections that are long and thin.

Different names or descriptions of grafting techniques may be used at different facilities. Nevertheless, all hair transplant procedures involve one or a combination of these grafting techniques.

The use of mini-grafts or micro-grafts, particularly in more noticeable areas such as the hairline has become increasingly popular in recent years. Transplanting hair in small amounts creates an appearance that is more natural. Mini-grafts and micro-grafts tend to grow out like normal hair and are often undetectable. Larger grafts may be used for greater coverage behind the hairline, but may also be more noticeable.

Other hair restoration surgeries include:

• Tissue expansion. Commonly used to treat burns and injuries that cause skin loss. A balloon-like device (tissue expander) is inserted beneath hair-growing scalp next to a bald area and inflated with salt water for several weeks. This causes the skin to expand, creating new skin cells. After skin beneath the hair has been adequately expanded, an additional procedure stretches the expanded skin over the bald area where it is stitched closed.
  
  
• Flap surgery. A section of bald scalp is removed and hair-growing scalp is stretched and sewn in its place, with hair growing to the edge of the incision. The size and placement of the flap depends on the individual patient. Flap surgery is designed to cover large areas of baldness, with one flap providing roughly the same coverage as several hundred punch grafts. In some cases, it may also be combined with other restoration surgeries (e.g., tissue expansion) to provide better coverage.
  
  
• Scalp reduction. Bald scalp is removed and sections of hair-growing scalp are pulled forward to fill in a bald crown area. Scalp reduction surgery may be used to cover areas at the top and back of the head, but is generally inappropriate for covering the frontal hairline. A section of bald scalp is first anesthetized (numbed) and then removed. The pattern of the scalp removed may vary according to the extent of baldness and the goals of the patient. The skin immediately surrounding the removed scalp is loosened, pulled together and closed with stitches.

In some cases, medication may be used in conjunction with hair restoration surgery.