5 New Hair Restoration Treatments You Should Really Know About

Today I want to take a break from debunking hair myths to go over 5 new (ish) hair restoration treatments that I talked about on the channel recently. 

Each year it seems we’re inundated with news of ‘cutting-edge’ hair restoration and anti-aging treatments that insist they’re the next best thing. They come in like a marketing hurricane; a lot of hype and lofty promises, but often without proven benefit.

Read on to find out which cutting edge treatments I think might be worth your time ( and hard-earned money!) and which I’d hold off on.

1. Tretinoin 

The first ‘new’ hair restoration treatment on this list has been resurrected from the 80s, and it’s worthwhile to talk about why. 

Tretinoin, or all-trans retinoic acid, is best known for its use as a topical, prescription acne and wrinkle medication. Chances are you’ve heard of it for its uncanny ability to normalize cell turnover and encourage cells to behave more like their healthier, younger counterparts. So, what is it doing on a hair treatment list? 

Back in the 1980s (circa: Back to the Future - think Marty McFly and primary colored puffer vests) researchers stumbled onto an odd ability of topical retinoic acid; it made topical minoxidil work better when both were applied together. In scientific terms, tretinoin enhanced the efficacy of minoxidil, so much so that patients found they could get the same results with a once a day application of tretinoin (0.01%) and minoxidil (5%) as they had with two daily applications of 5% minoxidil. 

Neon cellophane, MTV, cassette tapes, and tretinoin as a hair treatment all happened in the 80s.

So why didn’t pairing retinoic acid with minoxidil become standard practice? Well, for a couple of good reasons. First off, no one at the time really understood the mechanism; they didn’t understand why tretinoin was helping. Of course, there were some good theories, including that retinoic acid might increase the absorption of minoxidil, or perhaps it improved vascular proliferation and consequently blood flow. Theories are great, but scientists and doctors get trigger shy when they don’t understand why something works. Paired with the small sample sizes of the studies and tretinoin’s propensity to cause skin irritation, it’s use just never really took off. 

Fast forward (or time travel!) to 2023, and (not unlike an 80s tune) tretinoin as a treatment for hair loss is making a comeback – but this time, we know why it works. Tretinoin enhances the minoxidil response in androgenic alopecia by upregulating follicular sulfotransferase enzymes (SULT 1A1), the enzyme in hair follicles needed to activate topical minoxidil. 

Cool! Should I try it? Maybe. Tretinoin enhances the effects of topical minoxidil, and it works best for androgenic alopecia. If you currently use topical minoxidil, it might be worth a try to see if you can enhance your results, or if you just want to try a 1X/day application. Just be aware that tretinoin can be irritating to the skin. 

Interestingly, for some people, tretinoin seems to work really well on its own. In the original 1986 study, one participant found that tretinoin alone worked to reverse hair loss she’d been struggling with for more than 20 years. These are what we call outliers. We still don’t know why some people respond so well to tretinoin alone and can’t predict it, so don’t count on this being you. 

What about if you’re on oral minoxidil? Well, minoxidil needs SULT 1A1 to activate, so applying tretinoin while taking oral minoxidil could help, but probably not. Oral minoxidil is mostly activated by SULT enzymes in the liver and blood platelets, so adding topical tretinoin probably won’t have a significant effect. 

2. Botox

The next new treatment for hair loss making the rounds is botulinum toxin (better known as Botox). Famous for relaxing muscles in the face, it turns out that relaxing the muscles in your scalp might just help combat hair loss. 

How does it work? We’re not entirely sure. One theory is that when the frontalis, temporalis, periauricular, and occipitalis muscles are relaxed with Botox, vascularity in the region is enhanced and blood flow increases. A popular theory that’s been making the rounds for years is that increased blood flow could help ‘flush out’ DHT, thereby reducing the signal for miniaturization of the hair follicle in people who are susceptible.

Could Botox be the next great treatment for hair loss?

The theory does have legs (so to speak). It’s a known phenomenon that increased androgen activity is seen in tissues under chronic inflammation, contraction, and pressure, so there is logic behind the treatment. 

Should you try it? Recent, small pilot studies indicate botulinum toxin can be an effective therapy for androgenic alopecia management. However, larger studies with double blinds and controlled drug trials are needed to see if it really does make a difference. 

Why are the small studies a concern? Because hair loss therapies are particularly prone to patients rating placebos (no treatments) as effective. People are very invested in having hair treatments work. 

Botox is comparatively less expensive than many less promising hair loss treatments out there. It’s also incredibly safe when administered by a professional. For those reasons, if you’re looking to add something new to the mix, this newer, off label use for Botox could be for you (though it’s best paired with other hair loss treatments and proven medical therapies). 

3. Alma Trans Epidermal Delivery (TED)

Our third new treatment for hair loss is a device, the Alma TED, which claims that targeted ultrasound will help hair regrow. 

Alma TED uses low frequency ultrasound to promote hair regrowth, and Alma claims it’s effective against non-scarring alopecia.

How does it work? Like with Botox, no one is entirely sure how ultrasound might work to increase hair growth. The current front running theory plays (once again) on ultrasound causing vascular dilation, thereby increasing blood flow to the area and ‘flushing out’ DHT. This theory is far from proven. 

Does it work? Well, some people claim it’s as effective as PRP but without the invasiveness, but remember that hair loss treatments are prone to a placebo effect (ie: where sugar tablets are rated positively by patients thinking they’re taking a medication). It hasn’t been around as long as PRP, and it’s a device currently without peer-reviewed research results. A lack of peer-reviewed research brings out my inner skeptic. 

The things Alma promotes about the device on the product page also isn’t confidence inspiring; easy to use (delegable), fast, and painless. Efficacy and patient safety are what I want at the forefront of new treatments. And although some of Alma’s before and after images might seem to show increased hair growth, it’s not as impressive as I’d like to be seeing at the price point. Alma TED is expensive ($1000+/treatment), with 3 treatments recommended to see results. It’s a big investment for something that may not work for you.  

A read through reddit shows a lot of anecdotal claims from patients saying that, yeah, it worked, but didn’t live up to expectations. 

There’s no harm in trying this one if your heart is set on it, and you might see results. But it’s not a replacement for medical therapy, nor is it a needle free alternative to PRP. I’d wait and see.  

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4. SCUBE3

I left the best for last. The fourth and fifth new treatments I want to discuss are newly discovered signalling molecules, SCUBE3 and Osteopontin, both discovered by the Plikus Lab at UC Irvine. 

Last year, Dr. Maksim Plikus, made international headlines after his team discovered a signalling molecule, SCUBE3, that restored hair growth in bald mice, and preliminary results suggest it can do the same thing with human hairs. How? SCUBE3 is a Transforming Growth Factor Beta (TGF-β) ligand that is secreted by papilla fibroblast cells in resting hair follicles. The message SCUBE3 is sending out? For neighbouring hair stem cells to start dividing! The result is the onset of new hair growth.

Could hair growth pathways in mice hold the secret to future hair growth treatments? Conserved signalling molecule SCUBE3 suggests they just might.

5. Osteopontin 

Our second potential hair growth therapy from the Pilkus lab is also a naturally derived signalling molecule, Osteopontin. It’s responsible for hair growth in hairy nevi.

A hairy nevus is a type of mole that you’re born with. It’s typically dark, the pigment derived from a high concentration of melanocytes, and is covered in course hair. Osteopontin is the signaling molecule produced by senescent (non-dividing and proliferating) melanocytes (pigment producing cells), that cause normally dormant and diminutive hair follicles to activate their stem cells resulting in robust growth of long and thick hairs.

Osteopontin is the signalling molecule responsible for hair growth in a hairy nevus mole. Could it be the next breakthrough hair therapy on the horizon?

The Plikus Lab is using a really clever strategy to search for new hair therapies. They’re looking for naturally occurring molecules that already regulate hair growth, then seeing if they have the potential for therapy. It’s great science, which is exciting to see in the world of hair regrowth. 

But what about treatments? 

The next phase for Osteopontin and SCUBE3 are clinical trials. Human trials on SCUBE3 are expected to begin later this year and trials with Osteopontin will likely follow. 

What would a potential treatment with SCUBE3 and Osteopontin look like? Most likely, both proteins would be microinjected beneath a person’s skin in a “fairly painless” process that would have to be repeated periodically to maintain hair growth.

A lot of people are very interested in these two molecules as therapies. UC Irvine has filed a provisional patent application for the use of SCUBE3 and its related molecular compounds for hair growth stimulation. Dr. Plikus has also co-founded a biotechnology company, Amplifica, to potentially commercialize the breakthroughs. 

Hopefully we’ll see the results of these clinical trials in the very near future. What really excites me is that the research behind these potential treatments is robust and heavily peer-reviewed – it really doesn’t get much better than that.

In the meantime, if you're someone who is considering proven medical therapies for hair loss treatment, visit feelconfident.com to explore our current options!

 

The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.