Hair loss and thinning, or alopecia, is no trifling matter: according to the Journal of Clinical and Diagnostic Research, eight million women (and 6.5 million men) in the UK are suffering from it.

Shedding more hair than is normal is traumatic for anyone, so it’s no wonder that the market for hair growth supplements and hair growth-boosting scalp treatments is thriving. The world of minimally-invasive clinical treatments is not far behind, with increasingly sophisticated and promising ‘tweakment’ options for hair loss.

Why is your hair falling out?

The reasons for your hair falling out vary from dietary deficiencies, childbirth, hormonal upheaval and major stress to genetics, hard-pulling hairstyles, gut microbiome imbalances, and more. “Even post-Covid alopecia has been identified,” says cosmetic physician Dr Sophie Shotter, whose Luscious Mane bespoke hair loss package launches in August.

There are various types of hair loss. The main one is hormone-related androgenetic alopecia, while other forms include alopecia areata, which is linked to the immune system, telogen effluvium, which can happen after major shock or after childbirth, and traction alopecia, which is due to excessive tension on the follicles through compulsive hair pulling or punishingly tight hairstyles.

How do you find the best hair loss treatment for you?

In order for your treatment to work, you should determine the cause and type of your hair loss. It is hard to self-diagnose so seeing a dermatologist, trichologist or a doctor specialising in scalp issues is absolutely worth it. There are some instances where follicles are damaged beyond repair. But in most cases, your specialist may prescribe hair growth drugs such as Minoxidil, hormones such as oestrogen or nutrients such as iron or zinc, either as a standalone treatment or alongside a clinical follicle-stimulating procedure.

Relatively cheap blood tests are a reliable way, used by hair loss experts, to detect nutritional and hormone deficiencies, which may mean you can avoid plumping for a pricey treatment and opt for a bespoke supplementation or lifestyle programme instead.

Image: Shutterstock

Should you have a genetic test to help you choose a hair loss treatment?

Trichotest, a genetic hair loss (mouth swab) test that most doctors charge £350 for, can help dig a bit deeper as it identifies which treatments are more likely to work for you than others, based on your genetic information. “By showing us, in percentages, how likely it is that you’ll respond positively to treatments including PRP, growth factors, vitamins and medications, it can help us put together a bespoke plan, based on each client’s DNA,” says hair restoration and scalp micropigmentation specialist Kelly Morell of Scalp Confidential, a hair loss treatment consultancy in London.

The experts I spoke to admit that the success of some of the injectable or microneedling-induced options, such as polynucleotides, is possibly dependent on the patient’s genetic susceptibility to the product, so pre-treatment testing can ensure you don’t waste your money. “I see a future where all patients will have genetic profile testing to have optimum, tailored outcomes and reduce side effects,” says cosmetic physician Dr Dev Patel, of Perfect Skin Solutions in Portsmouth.

However, “at this point, the cost of comprehensive genetic testing can outweigh the cost of the treatment itself,” says cosmetic physician Dr David Jack. “Since the majority of people are likely to have a satisfactory response from their treatment, for now these tests could be overkill in terms of costs and hassle.”

5 hair restoration treatments for hair thinning and hair loss

Growth factor microneedling with Calecim Advanced Hair System. Expert – Kelly Morrell at Scalp Confidential

Kelly Morrell

What is it? Calecim is a serum derived from stem cells replicated from those in in red deer umbilical cords. Massaged into your scalp after some vigorous microneedling, it feeds and nourishes the hair, and increases cell signalling in your hair’s roots. The serum also dampens scalp inflammation – any inflammation inhibits healthy growth.

How does it work? These stem cells are very rich in compounds that stimulate fresh cell growth. The microneedling opens channels in your scalp to allow the serum to penetrate as deeply as possible. A professional treatment is likely to have more dramatic effects than Calecim’s (nevertheless effective) at-home Professional Advanced Hair System, £315, which you needle into your scalp with a small needling stamp. “The home needle stamp is 0.5mm for safety reasons, however in clinic we microneedle much deeper,” says Morell.

What type of hair loss can it treat? Calecim is intended for the treatment of androgenetic alopecia, alopecia areata and telogen effluvium; all conditions where the follicles are dormant as opposed to basically dead. Morell has seen Calecim work for people unresponsive to hair growth treatment Minoxidil and men wanting an alternative to hair growth drug Finasteride (one of its possible side effects is erectile dysfunction).

How many treatments are needed? A course of six is great for anyone experiencing short-term hair loss due to illness or stress, says Morell, while post-partum hair loss that does not rebalance itself may need six to 12 treatments to help the hair cycle recover. For early-stage androgenetic hair loss, six sessions will help but “if hair loss or thinning have progressed, you’re looking at east 12, with regular maintenance sessions.”

Maintenance: One session every three to six months or an at-home kit for maintenance.

Cost: Calecim Advanced Hair Therapy with Kelly Morell is £1,900 for six treatments and £3,000 for 12. Single maintenance treatments are £350. For your nearest provider, search calecimprofessional.com. The Professional Advanced Hair System Kit is £315

PRP (platelet-rich plasma) and PRF (platelet-rich fibrin) hair restoration: Expert – Dr Ophelia Veraitch

Dr Ophelia Veraitch

What is it? PRP takes your own blood and extracts its plasma. Rich in growth factors, it is injected or micro-needled back into the scalp to boost follicle activity and healthy growth. PRF is a more advanced version of this treatment, known as ‘second-generation PRP’ and takes the more concentrated liquid from the bottom of the centrifuged plasma. PRF has a higher concentration of growth factors than PRP, which are released into the system in a slow and more prolonged fashion, making it more effective.

How does it work? Plasma (or fibrin, a more concentrated plasma) is extracted from your blood sample using a special centrifuge. Numbing cream is often used so there is no pain. Both PRP and PRF can improve blood circulation, nourish the follicles, thicken existing hair while encouraging the growth of new strands, and calm inflammation.

“There is plenty of solid, peer-reviewed published clinical evidence for PRF and PRP,” says consultant dermatologist Dr Ophelia Veraitch. Morell, who offers PRP in her clinic, says some (but not all) patients respond well to it, and she feels this is likely to do with the client’s health and lifestyle, which affects the quality of your plasma: “If you smoke, drink, eat badly and don’t keep hydrated, among other factors, results will be less good,” she says.

To mitigate this in the case of PRF, Veraitch routinely combines her treatments with hair vitamins, hair growth drugs or HRT.

Ricardo Vila Nova, known as The Hair Whisperer, who has a clinic in London’s Harrods, does not use numbing cream as he believes it can cause scalp irritation. After a DNA hair scan to assess whether you are right for the treatment, he will apply a sanitising treatment under steam. Then the PRP is needled in with dotting rather than an injecting technique which is less painful (see the video below).

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What type of hair loss can PRP or PRF treat? Any type resulting from dormant or sluggish follicles which aren’t irreparably damaged.

How many treatments are needed? Four treatments, spaced one month apart. Results should be noticeable two months after the last treatment.

Maintenance: Ongoing maintenance therapy is key for Veraitch, who says that most of her patients are on topical hair growth solutions such as finasteride (for men) or melatonin, or oral hair growth medications. Results from the PRF course itself last between one and two years.

Cost: PRF Hair Restoration with Dr Ophelia Veraitch costs from £960 per treatment with any meds or supplements extra. PRP hair restoration treatments are widely available in clinics and cost from about £275 per treatment, with three to six sessions advised.

Polynucleotides for hair restoration. Expert – Dr David Jack

Dr David Jack

What is it? Polynucleotides are the buzzy treatment for the face (known as the ‘salmon sperm facial because of the source of the molecules) but can be used practically anywhere in need of regeneration, including the scalp. Here, they can help improve hair growth and quality by stimulating cell and follicle regeneration, boosting blood supply to the follicles, and enhancing your scalp’s hydration and elasticity, which creates an optimal environment for hair growth. But, says Dr David Jack (who uses Nucleofill polynucleotides for hair regeneration alongside other treatment options such as PRP), studies on polynucleotides are still relatively small-scale.

How does it work? You receive a series of small, stingy injections directly into the scalp. Results are varied, which may point to individual genetic susceptibility to the molecules.

What type of hair loss can polynucleotides treat? Polynucleotides have been shown in some studies to be effective in reducing shedding and increasing hair shaft thickness in androgenetic alopecia (male and female pattern hair loss),” says Jack, who adds it is yet unknown how effective they are in other forms of hair loss.

How many treatments are needed? Three to six, spaced two weeks apart, with results after a few months.

Maintenance: A top-up treatment every six months is advised, but many doctors feel that for sustained results, having one every three months is more effective.

Cost: Nucleofill for the scalp at Dr David Jack Clinics nationwide costs from £650 per syringe (one to two are needed for each of three treatments). Prices can vary widely depending on the clinic, practitioner’s experience and location.

Exosomes for hair restoration. Expert – Dr Dev Patel

Dr Dev Patel

What is it? Exosomes are tiny, cell-derived capsules full of proteins, genetic material, signalling molecules and growth factors, that play a crucial role in cell communication and regeneration. In the scalp, they improve blood flow, regulate inflammation, stimulate growth in the follicles and uniquely, says Dr Dev Patel, stimulate hair follicle stem cells to form new follicles, which can result in faster and more noticeable increases in hair density compared to other injectables.

How does it work? The capsules’ membrane matches that of our own cells, allowing them to penetrate and deliver their contents with ease. Exosomes are not licensed for injectable use so, says Patel, they’re applied topically in conjunction with microneedling (which feels stingy and can leave the scalp feeling sore for a few days). He also uses a device which uses CO2 jet propulsion to turn the exosome solution into microscopic ‘icicles’ that are blasted (painlessly) into the scalp.

“Microneedling directly triggers the hair follicle stem cells just under the scalp,” he says. “The exosomes then diffuse down, delivering their growth factors to the entire hair follicle, including the shaft and bulb.” Injections, he says, typically stimulate only the bulb or surrounding areas.

Dr Jack thinks that the high concentration of growth factors means exosomes show promise, “but the body of evidence is smaller than for PRP”.

What type of hair loss can exosomes treat? Apart from types of alopecia linked to dormant follicles, “exosome therapy has shown effectiveness in even challenging conditions like scarring alopecia,” says Patel.

How many treatments are needed before seeing results?

Patel’s protocol is two treatments, two weeks apart, and then one monthly treatment for three months. Patients can see results as soon as two weeks after the first session.

Maintenance? Patel advises a top-up treatment (from £395) every three to four months.

How much does it cost? Exosomes for Hair Loss/Thinning at Dr Dev Patel’s Perfect Skin Solutions in Portsmouth costs from £1595 for the course.

Micrografting non-surgical hair regeneration. Expert – Dr Marco Nicoloso

Dr Marco Nicoloso

What is it? Scalp micrografting is the process of taking tiny skin grafts from the hairline area where your strongest follicles are located. These are placed in a device that extracts follicle progenitor cells, growth factors, exosomes and extracellular matrix, which together are “vital for hair follicle regeneration,” says Dr Marco Nicoloso, medical director at London’s Ouronyx clinic. The serum is injected back into the scalp in places where hair is thinning or naturally fine and sparse.

What type of hair loss can hair micrografting treat? This treatment specifically targets androgenetic alopecia, so male and female-pattern hair loss, by restoring the hair growth cycle.

How does it work? Even though androgenic alopecia means your follicle cells are damaged, the stem cells remain intact so can be used to help reinstate healthy growth. They won’t create new follicles but existing ones will be encouraged to function optimally, resulting in thicker and fuller hair.

As with PRP and PRF, the decade-old micrografting technology method is backed by extensive independent clinical proof. Also similarly to PRP/PRF, the biological age of your cells and tissues (not the age in your passport, but the one influenced by your lifestyle, body inflammation and active diseases) does impact the potency of these stem cells, and the results of the treatment.

Micrografting is carried out under local anaesthetic so the one-hour treatment is pain-free, although your scalp can be rather sore afterwards for a few days.

How many treatments are needed before seeing results? Just the one, with results visible after six months. “If needed, results can be boosted with a course of three Calecim or polynucleotide treatments,” says Nicoloso.

Maintenance: With results lasting between 12-18 months, the treatment can be repeated after 18 months.

Cost: Ouronyx Micrografting Technology is £2950. Calecim and polynucleotide sessions are extra.