Hair loss is a hybrid disorder, requiring a medical foundation in how to diagnose hair loss and skill sets in procedural treatments.
Hair is a big part of daily practice for dermatologist Wendy E. Roberts, MD.
“I have two or three hair cases a day and have had a hair practice for over 20 years,” Dr. Roberts says. “If you’re committed to hair, there is nothing but benefit. But you really do have to dig in at the outset and think through what you want to do.”
New York City facial plastic surgeon Gary Linkov, MD, offers facial plastic surgery and surgical and nonsurgical hair restoration. He says blending the two specialties make for an exciting and lucrative practice.
“Hair restoration is not unidimensional. There’s a lot to it, and it’s rewarding,” he says. “But to start a practice, you need to first learn how to do hair. Just like anything else, hands-on training is best with leaders in the field.”
Dr. Roberts, who practices in Rancho Mirage, Calif., says hair loss is a generational concern. Practices catering to 20-something patients don’t have the demographics for a hair practice. Practices on the other end of the demographic spectrum primarily with patients in their 70s and 80s aren’t the best hair practice candidates, either.
“But if you are in a demographic with Boomers, Gen Xers and Millennials, you have the makings of a great hair practice,” Dr. Roberts says. “Gen Xers are very interested in hair. Millennials are extremely interested in hair because they’re at that stage—especially the guys—when they are just starting to lose it and don’t like it.”
The local market also dictates what a provider who offers hair restoration services can charge, according to Dr. Linkov.
Hair loss is interesting because it’s a hybrid disorder, requiring a medical foundation in how to diagnose hair loss and skill sets in procedural treatments, according to Dr. Roberts.
For example, androgenetic alopecia is the most common cause of hair loss, according to the American Academy of Dermatology. The hereditary thinning or baldness affects an estimated 80 million Americans, including 30 million women with female pattern baldness. Treatment may include both medical and procedural treatments, such as FDA-approved topical minoxidil and platelet-rich plasma (PRP) or exosome scalp injections. Other causes of hair loss that are not androgenetic range from harsh hair care practices to diseases, such as thyroid disease or lupus, according to Dr. Roberts.
“The 55-year-old woman who has half the head of hair that she used to does not have an aesthetic condition. You have to do a very thorough medical exam because she may be on medicines that are contributing to her hair loss. Hormone therapy can be contributing. Emerging medical problems like iron deficiency anemia or connective tissue disorders might be the cause,” Dr. Robert says. “You do have to have a good knowledge base of medicine and medical dermatology.”
Dr. Roberts recently posted on Instagram about actress Alyssa Milano’s well-publicized hair loss due to COVID-19 infection. The diagnosis: Milano has telogen effluvium, meaning her hair cycle is out of sync. This can happen with the body is under extreme stress. It may occur in a variety of clinical situations. The aim is to treat the effluvium, but the provider would first have to diagnose the cause, Dr. Roberts says.
Providers should know how to do a good medical hair examination, including performing and analyzing hair pulls and imaging instrumentation, such as dermoscopy, she says.
Dr. Linkov, who offers hair services that range from medical management to surgical hair transplantation, says finding out why a patient is losing his or her hair is key. In addition to the examination, Dr. Linkov might do bloodwork or take a biopsy.
Once he has a diagnosis, Dr. Linkov will often start with nonsurgical or less invasive options, including vitamins and medications, steroid shots, or platelet-rich plasma (PRP) treatments for certain types of hair loss.
“With PRP, we do a blood draw and spin down the blood in a centrifuge to get the platelets from the blood. We put the platelets, which have growth factors, into the scalp. The growth factors help the hair grow. It’s not a permanent cure, it’s a medical therapy so you have to repeat it,” he says.
Providers can inject PRP or use a new device JetPeel, which according to Dr. Linkov is a needle-less technology for delivering PRP to the scalp.
Other options include scalp micropigmentation, a medical tattooing strategy, which can be used to camouflage areas of hair loss before or even after a transplant, according to Dr. Linkov.
“On the surgical side, I do hairline lowering surgery, which is not a transplant. It’s actually surgery to bring down the hairline,” he says. “Then, there are hair transplants. I do not just do scalp to scalp, but body hair, which involves taking hair from somewhere on the body and putting it on the scalp. In other cases, it’s actually transplanting to the eyebrows, the beard.”
The sign of a healthy hair practice is people return and patients refer, Dr. Roberts says.
Providers who are not committed to learning everything about hair, need not open a hair practice because patients will not come back and they will not refer, she cautions.
It’s important for providers to know that hair practices are cash services for the most part. Dermatologists can bill insurance for things like an office visit for alopecia but cannot bill insurance for PRP injections to treat hair loss, according to Dr. Roberts.