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What can Dr. Santos Stahl do about hair loss? Treatments at a glance

“Autologous blood injection twice is equally safe and effective in men and women.” [1].

“Autologous blood is a safe and simple method of treating hair loss and has few adverse effects.” [2].

Autologous blood treatment shows high efficacy in the treatment of hormonal hereditary hair loss (androgenetic alopecia) in women.” [3].

The satisfaction of our patients is underlined by the results of scientific publications. Is your hair thinning or do you already suffer from hair loss? Does no caffeine shampoo bring you the desired result either? Do you want to regain grip firm and fuller hair?

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CenterPlast is your specialist for a treatment of hair loss. Please feel free to make an appointment for your individual consultation.

During the initial consultation, Dr. Santos Stahl will create a treatment plan according to the type and severity of the hair loss. For an autologous blood treatment, we recommend three sessions at intervals of about four weeks.

The use of autologous blood in the form of concentrated platelets has played an increasingly important role in regenerative medicine for many years. Among the many areas of application (support for wound healing, the improvement of scarring, skin rejuvenation), scientific evidence of the effect of this form of treatment to combat hair loss is particularly increasing.

The cell renewal effect of autologous blood is based on the release of messenger substances from the body’s own platelets. These messengers include platelet-derived growth factor (PDGF), transforming growth factor (TGF), new blood vessel formation growth factor (VEGF), insulin-like growth factor (IGF), and interleukin 1 (IL-1) [4]. Messengers influence cell migration, cell proliferation, and new blood vessel formation [5].

Facts about the treatment with prepared own blood against hair loss

Treatment duration 30 minutes
Anaesthesia Anesthetic cream / vibration anesthesia / nitrous oxide
Hospital stay Outpatient
Costs to the price calculator
Aftercare None
Socially acceptable Immediately
Supplements or alternatives Microneedling

Does a treatment with processed own blood help against hair loss?

Treatment with your own blood stops hair loss and stimulates hair growth. There are numerous scientific studies that prove the benefits of the treatment [21] [22] [23] [24]. As a rule, the treatment should be repeated three times. The effect of own blood has already been used for many years with success as a support after hair transplantations [25].

Platelets contain numerous growth factors and stimulating mediators. Growth factors such as insulin-like growth factor (IGF-1), hepatocyte growth factor (HGF), keratinocyte growth factor, and vascular endothelial growth factor (VEGF) promote the growth phase of the hair cycle [26]. The positive effect of many of these growth factors on hair growth is scientifically proven [27].

Does microneedling help against hair loss?

Microneedling is a safe procedure for the treatment of acne scars, mouth wrinkles, crow’s feet, burn scars and pregnancy marks, either alone or in combination with other procedures [28]. Studies show that hair density and thickness increase more and faster with combined treatment with own blood and microneedling than with treatment with own blood alone [29] or for treatment with microneedling alone [30]. Microneedling is a minimally invasive procedure that uses multiple fine needles to create micropunctures in the skin. The treatment lasts about 30 to 45 minutes and is repeated three to six times at intervals of two to four weeks.

Structure of a hair and a hair organ

The follicle (hair follicle) is the cell structure in which a hair is formed and grows. Follicles extend from the hair funnel to the hair root. In the center of the follicle lies the hair, which is enveloped by the hair root sheath. The base of the follicle, also called the hair bulb or bulb lies four millimeters below the surface of the skin. The stem cells of the hair bulb give rise to the horn cells of the hair. In addition, the stem cells of a hair follicle support wound healing. Each hair follicle is associated with a hair erector muscle, a sebaceous gland, and often a sweat gland [6]. Hairs can grow singly or in groups of two to three or even four to five hair follicles.

Cross section skin
Cross section skin

The hair shaft consists of three layers: an outer cuticle, the outer cortex and the medulla. The hair fibre consists of dead horn cells, the so-called keratinocytes. These specialized cells produce the protein keratin and take up color pigments from the pigment cells of the skin [7].


The composition and complex structure of the hair determine their properties. Hair is made up of 65 to 95 percent keratin by weight and up to 32 percent water, depending on the humidity. To a small percentage, hair is also composed of lipids [8]. The spiral-shaped α-keratin is also an important component of the skin and nails. Four keratin chains together form a protofilament. Eight protofilaments in turn form an intermediate filament. These bundle into macrofibrils that coalesce into cortex cells. Several cortex cells surrounded by an outer cuticle form a hair shaft. Each scale has an average length of 60 micrometers and a thickness of about 0.5 micrometers [9].

Hair loss due to environmental pollutants

Pollutants and environmental toxins are becoming more common. Pollutants can be absorbed in very different concentrations through the air we breathe or through food. Sudden (acute) poisoning is usually accompanied by severe, sometimes life-threatening symptoms shortly after ingestion of a large quantity of a pollutant. Long-term (chronic) poisoning is often difficult to diagnose. Non-specific and mild symptoms long after the onset of toxin ingestion over a long period of time complicate the suspicion. Hair loss can, in very rare cases, be a sign of chronic poisoning. In justified cases of suspicion, traces can be detected in the blood, urine or hair, depending on the toxin.

Mercury (heavy metal)
  • Sources of pollution in the environment with mercury: coal-fired power plants, gold washing, smelting furnaces, cement production. The use in batteries, lamps or thermometers is no longer permitted.
  • Sources of harmful substances with mercury for humans: Dental amalgam, contaminated fish, workplace exposure to pollutants. One amalgam dental filling releases 2 to 28 micrograms of mercury per day [10].
  • Mercury limits: According to WHO, two micrograms of mercury per kilogram of body weight per day (IPCS (2003) Concise International Chemical Assessment Document, World Health Organization).
  • Signs of mercury poisoning: fatigue, depression, insomnia, irritability, memory loss, hair loss. [11] .

No two hairs are alike

Head hair is as diverse as the human being. That is why the hair is often an expression of our personality. Hair is a part of our body, and its condition reflects our overall health. Hair has an important role in thermoregulation, the sense of touch, protection from the sun’s ultraviolet (UV) radiation, and wound healing. Beyond the length or color of the hair, hair can have many different characteristics:

  • Structure of the hair: the shape of the hair can be divided into categories: quite straight, almost straight, wavy, large curls, Afro curls, very small Afro curls. Curly or straight hair is usually hereditary. In rare cases, curling can be the side effect of certain medications (retinoids) [10].
  • Number of hairs: blondes have an average of 140,000 hairs, dark haired have 105,000 hairs, and redheads have 90,000 hairs [11].
  • Thedensity of hair is measured in hair fibers per square centimeter. The density is approximately 170 hairs per square centimeter in Americans of Hispanic descent, 155 hairs per square centimeter in persons of African descent, and 220 hairs per square centimeter in Europeans [12].
  • Thickness of hair: The diameter of a hair is approximately 65 micrometers in Europeans, 90 micrometers in Asians, and 75 micrometers in Africans [13].
  • Shape of the cross-section: The cross-section of a hair is oval in European and African hair, and round in Asian hair [14].
  • Surface ro ughness: The roughness of a hair is measured, among other things, as the difference in height between a peak and a valley on the surface of the hair. In European and African hair the height difference is 12 nanometers, in Asian hair 10 nanometers [15].
  • Tensile strength: Scientists talk about the tensile strength of the hair. On average, a hair can withstand a maximum tension of 80 grams per millimeter before it breaks.
  • Elasticity describes the extent to which a hair can return to its original shape after stress. A hair can be stretched by 20 to 30 percent of its length (modulus of elasticity 4.2 gigapascals) [16].
  • Hair growth: In the scalp, each hair grows evenly, around 0.3 millimeters per day or one centimeter per month continuously over two to seven years.
  • Hair loss: The proportion of growing hairs compared to falling hairs is called the anagen-telogen ratio. In healthy young people, about 90 percent of the hair is in the growth phase (anagen phase) and five to ten percent is in the resting phase (telogen phase).
  • Vellus hair (downy hair): Vellus hairs are hairs with a diameter smaller than 30 micrometers. The percentage of vellus hairs varies by 15 percent depending on age, sex, ethnicity, and scalp region [17].

Light hair and receding hairline

Alopecia is the technical term for reduced hair density, colloquially hair loss. The word “alopecia” comes from the ancient Greek word for “fox” άλώπηξ (alōpēx). The change of hair or a loss of hair in foxes due to disease may explain the origin of the word. Age-related changes in hair start to appear from the age of 30 [18]. With age, the hair becomes thinner, the density of the hair decreases, the pigments of the hair become less and the scalp as well as the hair become drier.

The first grey hairs appear in Europeans on average from the age of 35 and in Africans from the age of 44. Hormones affect the distribution, resistance and color of hair. Hereditary hair loss is often downplayed by those not affected [19]. Since hair is an expression of youthfulness, health and attractiveness, the changes have an impact on our self-image. A hereditary predisposition or diseases can lead to a reduced hair density (medical term alopecia) and thus thinning hair. The decisive factor here is the ratio of the hairs that grow back to the hairs that fall out.

Light head hair is often perceived as a psychological burden and can affect quality of life [20]. In fact, bald men are rated by women as older, less attractive, less successful in the workplace and in dating [21]. It is found that both men and women with hormonal hair loss suffer from increased anxiety and depression [22].

Hereditary hair loss (androgenetic alopecia)

This is the most common form of hair loss and is influenced by genes and hormones.

What is the cause of hereditary hair loss?

The activation of the hormone receptor shortens the growth phase of the hair cycle.

Spread hereditary hair loss

In European men, thirty percent are affected by age 30, 50 percent by age 50, and 80 percent by age 70 [23]. About 15 to 20 percent of European women between the ages of 30 and 50 suffer from this form of hair loss. Up to 30 percent of post-menopausal women suffer from androgenetic alopecia [24]. Asians and Africans are less often affected than Europeans.

Symptoms hereditary hair loss

The hair becomes thinner and shorter and eventually barely penetrates the skin. In men, there is thinning of the hair in the temple area, which spreads to the crown area over the years. In women, diffuse hair loss occurs on the crown of the head.

How can the diagnosis be made?

Diagnosis is made by visual inspection (clinical examination) of the hair and scalp. The light spots and fine hair are characteristic, making it easier to identify the most common cause. The ratio of normal hair to downy hair is less than 4:1 (normal value 7:1). When the hair is pulled through (Sabouraud maneuver) or when the hair is pulled (pull test), increased hair loss (severe hair loss) is usually not observed. If diffuse hair loss, brittle hair and nails are observed and increased fatigue is complained of, a blood test of thyroid hormones may be indicated. With magnifying glass, downy hairs (vellus hairs) can be seen in the light areas during physical examination. A computer-assisted examination of the growth behaviour (TrichoScan) or the examination of the epilated hairs (trichogram) or excised hair roots (scalp biopsy) under the microscope are usually not necessary.

How can hereditary hair loss be treated?

Hereditary hair loss is usually treated with needling, a solution of the active ingredient minoxidil, processed autologous blood and finasteride tablets.

Is there anything I can do to prevent it?

Proper hair care, balanced diet, avoidance of stress, normal body weight (BMI: between 18.5 and 24.9), abstaining from tobacco consumption.

Prognosis for hereditary hair loss:

The risk of hereditary increased hair loss is significantly increased if the father, mother or grandfather have suffered from hair loss [25]. The rate of progression is unpredictable. Some men go completely bald in less than five years, but most take 15 to 25 years.

Circular hair loss (alopecia areata)

Cause Circular Hair Loss

Investigations point to an autoimmune disease in which the patient’s own white blood cells (T cells) attack the body’s own hair roots.

Distribution and occurrence

Circular hair loss occurs in 0.2 percent of the population, regardless of gender, age, and ethnicity. About two percent of the general population suffers from this form of hair loss at some time in their lives [26]. Patients with white spot disease (vitiligo) or autoimmune thyroid disease are more often affected.

Symptoms circular hair loss

Hair may fall out in batches in circumscribed areas all over the body. Most often, the scalp or beard is affected.

How to determine if I have circular hair loss?

The diagnosis can be made based on the pattern of hair loss. Occasionally, punctate indentations or grooves form on the nails. At the edge of the hairless areas, the hair can be easily plucked out. With magnifying glass magnification, typical signs of circular hair loss can be seen. The diameter of the hair shaft tapers near the hair exit duct. Because of the changed form, one speaks of piston-hairs or Kommahaaren. Black dots can be a sign that the hair has broken off immediately at skin level. Occasionally white hairs grow in the sparse areas. Because of the characteristic appearance, a biopsy is rarely necessary.

How can circular hair loss be treated?

Cortisone injection (triamcinolone, five to ten milligrams per milliliter) every two to six weeks stimulates hair regrowth in 60 to 67 percent of cases [27]. Side effects of cortisone treatment include thinning of the skin, vascular markings, and white patches [28]. Autologous blood injection is a safe and effective method with success rates of up to 76 percent [29]. Comparative studies have confirmed the efficacy and tolerability of autologous blood treatment [30].

Can I prevent against circular hair loss?

Since stress can trigger a hair loss episode, a balanced lifestyle should be aimed for.

Prognosis circular hair loss:

After an initial hair loss, hair grows back on its own in 50 to 60 percent of cases. When there is a family history of circular hair loss, episodes of hair loss often recur [31].

Diffuse hair loss (telogen effluvium)

Cause of diffuse hair loss

The hair follicles enter the resting phase (telogen phase) prematurely. In about one third of the cases no trigger can be found. Known triggers include: Medications such as the contraceptive pill (birth control pills), vitamin A (retinoids), blood pressure medications (beta blockers, ACE inhibitors), antidepressants and anticoagulants (heparin), hyperthyroidism or hypothyroidism, kidney or liver failure, childbirth, Physical stress such as severe illness, inflammation, autoimmune disease, surgery, a radical diet, emotional stress.

Distribution and frequency

Exact figures on the frequency of diffuse hair loss are not known. Both men and women are affected.

Symptoms of diffuse hair loss:

Hair loss can occur suddenly or gradually. Hair loss usually occurs about two to three months after a triggering event. There is thinning of the hair and diffuse hair loss throughout the scalp. The loss is usually not more than 50 percent of the hair on the head.


The diagnosis can be made on the basis of the characteristic complaints and the examination findings. Gradual diffuse hair loss and hereditary hair loss can appear very similar. In contrast to diffuse hair loss, hereditary hair loss in women mainly affects the crown region and produces more downy hair. The ratio of normal hair to downy hair is greater than 8:1 (Normally 7:1). In case of doubt, the diagnosis can be confirmed by a tissue sample of the scalp. Depending on the symptoms, further tests may be ordered, such as a blood test to determine thyroid levels, vitamin B12 and vitamin D3 levels, as well as iron levels and zinc levels.

Treatment of diffuse hair loss:

In the case of sudden diffuse hair loss, normal hair growth resumes after the trigger is removed. If an autoimmune disease is the trigger of chronic diffuse hair loss, a local application of cortisone is useful. The treatment is safe and well tolerated and can be helpful in chronic diffuse hair loss. In chronic course, minoxidil solution can be used [32].

Prevention of diffuse hair loss:

The risk of diffuse hair loss is reduced by gentle hair care, a balanced diet and a healthy lifestyle.

Prognosis diffuse hair loss

If diffuse hair loss starts suddenly and a trigger can be identified, it can be assumed that the hair will grow back completely.

Pattern of hair loss

Hormonal hereditary hair loss (androgenetic alopecia) affects both men and women. As the name suggests, hair loss in this case is related to hormonal changes and genes. However, the regions of hair loss differ between the two sexes. In men, hair loss occurs on the temples and forehead, while in women, hair thinning occurs on the crown of the head. Various classifications provide guidance on the pattern and severity of hair loss.

Simple classifications are often imprecise, while complex classifications include transitional forms and gradations. However, complex classifications are less reliable. This means that when applying the same classification to the same case, different users may arrive at different classifications. Due to their user-friendliness, the Norwood-Hamilton classification is widely used for male pattern hair loss and the Ludwig classification for female pattern hair loss. Classifications are of practical use when a consistent treatment recommendation can be derived from the stage of hair loss. However, scientific evidence for the benefits of a stage-specific treatment concept is currently still lacking.

Scheme of male pattern hair loss (Hamilton-Norwood classification)

James B. Hamilton in 1951 classified the hair loss of 300 men into eight stages [33]. The American physician O’Tar Norwood added to Hamilton’s classification in 1975 rare patterns in which hair loss on the temples and forehead progresses simultaneously [34]. In the classic pattern of hair loss, the temples are affected first and later the crown of the head, until the bald area covers the entire top of the skull, leaving hair only at the back of the head. This pattern of hair loss can rarely occur in women.

  • Type 1: The hairline at the temples has receded minimally.
  • Type 2: The hair thins above the temples. The so-called receding hairline develops.
  • Type 3: Side-identical depressions develop on the temples. In vertex type III vertex, a bald spot develops early on the back of the head, also called the crown of the head or tonsure (“plate”).
  • Type 4: The depressions are pronounced. There are only a few hairs in the crown area. The hairy zone in the vertex is wider than in stage V.
  • Type 5: The hairy zone in the crown area becomes narrower and the hair density has further decreased. The hairline of the temples and forehead has shifted further towards the back of the head.
  • Type 6: The bald area spans the temporal regions and the crown.
  • Type 7: This is the most severe form of hair loss. All that remains is a narrow, horseshoe-shaped hair band on the sides and back of the scalp. The hair at the back of the head is also thin and the hair density is low.

Scheme of hair loss in women (Ludwig and Sinclair classification).

In women, hormonal hereditary hair loss (androgenetic alopecia) leads to a reduction in the volume of hair on the top of the head. The thinning starts at the crown and spreads to all sides over time. As with men, the hair in the affected areas becomes thinner and shorter until finally downy hair (vellus hair) develops. The scheme of hair loss in women was first divided into three stages in 1977 by the physician Erich Ludwig from Hamburg [35].



  • Grad 1: Am Oberkopf ist das Haar dünner. Die betroffene Zone befindet sich ein bis drei Zentimetern hinter dem Haaransatz der Stirn.



  • Grad 2: Die Haardichte ist am Oberkopf deutlich vermindert und lässt die Kopfhaut durchschimmern.



  • Grad 3: Bei dieser schwersten Ausprägung ist der Oberkopf kahl.


Australian physician Rodney Sinclair has divided the severity and pattern of hair loss into five stages [36].

  • Grade 1: Hair density and diameter in healthy women.
  • Grade 2: The crown widens slightly.
  • Grade 3: Beyond the crown, the hair lightens and becomes thinner.
  • Grade 4: On the entire top of the head, the density and diameter of the hair is reduced.
  • Grade 5: Hair loss is far advanced and allows the scalp to show through clearly.

Care tips that will make her hair look younger

Thin hair:

Avoid long hairstyles. Long hair is straightened by its own weight. Perms can make hair look thicker and give it more volume.

Gray hair:

Gray hair that has thinned feels thicker with hair color. Another technique is a step cut. In this technique, the hair on the top of the head is cut shorter than the hair on the bottom of the head. For women, this can give the appearance of long hair, even though the top part of the hair is quite short.

Brittle hair:

Use shampoos and conditioners that contain natural oils (coconut oil, olive oil, jojoba oil) to smooth the hair. Avoid damaging your hair with straightening treatments, hot tools, and frequent coloring. Conditioners form a protective layer around the hair. However, broken hair or split ends cannot be repaired. Panthenol is absorbed into the hair shaft and has a moisturizing effect. Conditioners and shampoos can add moisture and body to hair [37].

Choosing the right shampoos

The cosmetics industry recommends a suitable shampoo for every need. A distinction must be made here as to whether the manufacturer promises an effect on the hair root or on the hair shaft. A shampoo that is supposed to stimulate hair growth with caffeine claims to have an effect at the hair root. There is no independent scientific evidence for a hair growth promoting effect of shampoos. Apart from the effectiveness of the active ingredients, it is doubtful that the substances can act in sufficient concentration and for a sufficiently long time when washing the hair. Nevertheless, high quality shampoos can improve hair resistance and the appearance of damaged hair by forming a protective layer [38].

A shampoo contains washing-active substances (surfactants), water, care substances and additives (preservatives, fragrances, dyes, thickeners). On average, a hair shampoo is composed of 10 to 30 ingredients [39]. The surfactants dissolve the fats in the water and form the foam. Washing-active substances are divided into four groups according to their water-binding charged portion:

  1. Non-charged nonionic surfactants
    Representatives: Fatty alcohol alkoxylates, sorbitan esters, alkyl polyglucosides.
    Properties: Good cleaning properties, but foams poorly.
  2. Negatively charged anionic surfactants
    Representatives: Sodium lauryl sulfate, alkyl ether sulfates, alkyl ether carboxylates, sulfosuccinates, olefin sulfonates, vegetable soaps.
    Properties: Good cleaning power, produce a rich foam.
  3. Positively charged cationic surfactants
    Representatives: Stearalkonium chloride, Behentrimonium methosulfate, Cetrimonium chloride.
    Properties: Acts as an antistatic, cleans poorly and does not foam well. Use therefore rather in hair conditioners and hair treatments.
  4. Negatively and positively charged amphoteric surfactants (zwitterionic surfactants)
    Representatives: Betaine, amphoteric acetate and diacetate.
    Properties: Good skin compatibility.

On average, three different surfactants are used in a shampoo. Sodium lauryl ether sulfate, coco betaine (cocamidopropyl betaine) and glycol distearate are the most common. So-called “baby shampoos” and normal shampoos do not differ in this respect [40].

Coco betaine (Cocamidopropyl Betaine) is well tolerated by the skin and is made from coconut oil and dimethylaminopropylamine. Skin allergies that may occur with the use of coconut betaine are due to contamination with reaction intermediates (amidopropylamines) [41].

Shampoo ingredients you should avoid

The detergent active substances ammonium lauryl sulfate and sodium lauryl sulfate (sodium laureth sulfate) are considered skin irritants and should be avoided [42].

Certain additives in shampoos can trigger hypersensitivity reactions. These substances are also called allergens. Particularly frequently used allergens are the fragrances linalool, limonene, citronellol, hexyl cinnamaldehyde, benzyl salicylate and benzyl alcohol. The most common preservatives in shampoos include sodium benzoate, phenoxyethanol and benzoic acid. Interestingly, most “baby shampoos” and normal shampoos also do not differ in terms of preservatives used [43].

Additives from the group of ethanolamines are used in shampoos to adjust the pH value. This group of substances includes monoethanolamines (MEA), diethanolamines (DEA) and triethanolamines (TEA). The substances can cause allergies, skin irritations and asthma-like symptoms and are suspected of having a carcinogenic effect [44]. Minor but measurable side effects can be detected at concentrations hundreds of times higher than use in cosmetics (Lim D.S., Roh T.H., Kim M.K., et al., 2018, J Toxicol Environ Health A.). Nevertheless, we recommend to avoid shampoos with MEA, DEA or TEA.

Phthalates are used in hair care products to make hair more supple. Representatives of this group include: Benzyl Butyl Phthalates (BBP), Diethylhexyl Phthalates (DEHP), Diethylhexyl Terephthalates (DEHTP), Dimethyl Phthalates (DMP), Di-Isobutyl Phthalates (DiBP), Di-n-Butyl Phthalates (DBP), Di-Isononyl Phthalates (DiNP). Phthalates are considered to be toxic for reproduction and can cause allergies and asthma in children [45].

Bisphenols especially Bisphenol A (BPA) is used in the manufacture of plastics and can transfer from the packaging to the contents of the packaging [46]. Bisphenol A has hormone-like effects in the human body. Exposure to bisphenol A can affect fertility in males, disrupt thyroid function, cause hypertension, diabetes mellitus, and obesity and breast cancer [47].

The sustainability of shampoos should also be a selection criterion, given that a European uses on average 2kg of shampoo per year. Beyond ingredients, packaging, manufacturing and transport have an impact on CO2 emissions and water pollution [48]. The active washing substances (surfactants) in conventional shampoos are usually petroleum-based (ammonium lauryl sulfate and sodium lauryl sulfate). Better biodegradable are soaps on vegetable basis.

Silicones make the hair smooth, supple and easier to comb. Silicones include dimethicone, dimethiconol, cyclomethicone, phenyltrimethicone, octamethylcyclotetrasiloxane (D4), decamethylcyclopentasiloxane (D5) and dodecamethylcyclohexasiloxane (D6) and amidomethicone. Silicones are long-lasting and can accumulate in the environment. Alternative ingredients include coco caprylate, lauryl glucoside, coco glucoside, glyceryl oleate and PEG (polyethylene glycol) derivatives.


Hair Antiageing

Certain preparations, especially in combination, can counteract hereditary hair loss (androgenetic alopecia). Whether medication and which medication is suitable will be discussed with you during the examination. As with any treatment, the pros and cons must be carefully weighed.

Non-prescription drug

Minoxidil was patented in 1971 by the Upjohn company for the treatment of hypertension. What was initially a side effect led to its approval in 1988 by the U.S. Food and Drug Administration as a hair-growing agent in men and women over the age of 18.

Mechanism of action:

Minoxidil regulates the exchange of electrically charged particles of certain body cells (potassium channel blocker). As a result, the blood vessels dilate, allowing more oxygen and nutrients to reach the hair roots. The exact mechanism of action is still unclear. The solution contains alcohol and propylene glycol to increase the uptake of minoxidil into the tissues [49].


Minoxidil is available over the counter in two concentrations (two and five percent). Minoxidil is available as a solution (liquid form) or as a foam and should be used morning and night.

Side effects:

The most common adverse effects are a burning sensation, itching and flaking. The latter is mostly due to the alcohol and propylene glycol in the solution. Minoxidil causes a shortening of the resting phase (telogen phase) of the hair cycle. Therefore, temporary hair loss may occur at the beginning of treatment. Allergic skin reactions to the minoxidil or propylene glycol are possible. In case of an allergic reaction to propylene glycol, the minoxidil foam can be used without propylene glycol.

Prescription drugs

One drug was approved in 1992 for the treatment of benign prostatic hyperplasia at a dosage of five milligrams by the U.S. Food and Drug Administration. The occurrence of increased hair growth under the treatment, led in 1998 to the approval for the treatment of hereditary hair loss (androgenetic alopecia) in a dosage of one milligram.

Mechanism of action:

The active ingredient (N-tert-butyl-3-oxo-4-aza-5α-androst-1-en-17β-carbamide) inhibits a type II and III enzyme (5-alpha-reductase isoenzymes) that controls the conversion of testosterone to dihydrotestosterone (DHT). Type II enzyme is found in the hair root, outer root sheaths of hair follicles, epididymis, vas deferens, seminal vesicles, and prostate [50]. The drug increases hair growth, especially in the area of the vertex. The maximum effect is achieved after one year.


The tablets are available only on prescription. For the treatment of hair loss, a dosage of one milligram once a day is recommended. It may take four to six months before increased hair growth is noticed.

Side effects:

During the first few weeks, there may be a temporary increase in hair loss. The drug should not be used in women who are pregnant, as it may interfere with the development of sex if they become pregnant. The drug may decrease the desire to have sexual intercourse and cause erectile dysfunction. Depression has also been described. As a rule, these complaints decrease with time. Isolated cases of persistent side effects after discontinuation of the tablets have been observed. The drug also decreases the PSA level, a value used for early detection of prostate cancer. There is therefore a risk that prostate cancer may be detected later while taking the tablets.

Another drug has been approved by the U.S. Food and Drug Administration since 2001 and in Germany since 2003 for the treatment of benign prostatic hyperplasia. The drug has only been approved for the treatment of hereditary hair loss in South Korea and Japan since 2009.

Mechanism of action:

The drug inhibits a type I and type II enzyme (5-alpha reductase isoenzymes) that controls the conversion of testosterone to dihydrotestosterone (DHT). Type I enzyme is found in the sebaceous glands of the adult face and scalp, epidermis, sweat glands, hair follicles, hair roots of the occipital hair, liver, adrenal glands and kidneys. Several studies show that this drug increases the diameter and number of hairs more than the drug developed in 1998 [51][52][53].


This drug is not approved for the treatment of hair loss in Germany. In South Korea and Japan, the tablets are used in a dosage of 0.5 milligrams once a day to treat hereditary hair loss.

Side effects:

The side effects of this enzyme inhibitor are similar to the side effects of the drug approved in 1998.

Vitamins and dietary supplements for hair loss

About one in two U.S. residents take dietary supplements [54]. Approximately $7 billion is spent annually on dietary supplements worldwide ((—Growth-Trends-Key-Players-Competitive-Strategies-and-Forecasts—Research-and-Markets)). Despite its popularity, it must be noted that there are no high-quality and independent studies that prove the benefits of supplements [55].

Unlike medicinal products, proof of efficacy is not required for their manufacture and marketing. There are also no laws protecting consumers from misleading advertising promises, as is the case with prescription drugs. Nevertheless, dietary supplements are not free side effects or interactions. Many providers make misleading advertising promises or misleading claims about the actual daily requirement of vitamins and trace elements [56]. Enclosed you will find an overview of dietary supplements that are often offered to strengthen hair growth:

vitamin A

Vitamin A describes a group of substances that has numerous functions in the body, including in the renewal of the epidermis, vision and body defenses [58]. Two forms of this vitamin are ingested with food: retinol and beta-carotene. Retinol is found in dairy products and calf’s liver, for example, and beta-carotene is found in sweet potatoes and pumpkin, among other things. Vitamin A deficiency can be ruled out with a balanced diet of fruit and dairy products. The recommended daily amount of vitamin A is expressed retinol activity equivalent (RAE), where one RAE is equivalent to 1 μg of retinol. The daily requirement varies between 400 and 1300 RAE depending on age and gender. Vitamin A poisoning can occur in the long term if more than 10,000 RAE are ingested per day [59]. Vitamin A overdose can lead to hair loss and eyelash loss [60]. Other symptoms include fatigue, malaise, weight loss, nail growth disorders and scaly skin [61]. Simultaneous administration of vitamin E increases the risk of vitamin A poisoning [62]

Home remedies for hair loss

There are almost countless home remedies, natural remedies and shampoos that are offered for hair loss. Unlike prescription drugs, manufacturers are not required to prove an effect. The effects of the sleeping berry (Withania somnifera, in Sanskrit Ashwagandha), of turmeric and of capsaicin on congenital hair loss have not been scientifically proven. Also, there are no studies showing the benefits of pumpkin seed oil or saw palmetto for androgenetic alopecia [57]. There is no scientific evidence for the hair growth promoting effect of Schüssler salts and fenugreek. The reports on positive effects of horsetail (Equisetum) and the dietary supplement dimethylsulfone (methylsulfonylmethane) on hair growth are not free of conflicts of interest. The studies were conducted by employees of or were funded by the companies that manufacture and market these foods [58] [59] [60].

Our hair loss treatment testimonial

Numerous patients who suffer from hair loss and wish to have a full head of hair again have already made use of the various treatment methods at CenterPlast and shared their experiences. Patient testimonials as well as reviews can be found in the popular online portals for grading doctors. You will also find a separate category on the topic on our website. In addition, several patients who have had treatments at CenterPlast have agreed to tell interested parties about their experiences. Talk to us about this possibility during your personal consultation.

Our before and after pictures for hair loss treatment

It is not allowed by law to publish before and after photos of hair loss treatments on the internet. However, you are welcome to view such pictures during the consultation to get an impression of the expected result. In our menu category Service you will find further information on the subject under the item Before and After Pictures.

Costs of hair loss treatment at the CenterPlast practice in Saarbrücken

If you would like to know the price of a hair loss treatment at the CenterPlast practice in Saarbrücken, simply try our online price calculator now.

Frequently asked questions

What can I do against hair loss?

Treatment of hair loss should begin with avoiding harmful effects on hair growth. Key measures include:

  • Stop smoking cigarettes. Smokers have been shown to have thinner hair than non-smokers [61]. Smoking reduces the blood supply to the hair root, damages the genetic material of the hair root, promotes the release of pro-inflammatory messenger substances and alters the hormone balance [62].
  • Regular exercise is beneficial to health and prevents hair loss [63]. There are several explanations for this. On the one hand, toxins and waste products are excreted through sweating [64]. Sporting activity promotes stress reduction and increases blood circulation to the skin. Exercise regulates hormone balance, improves sugar metabolism and blood pressure [65].
  • Eat raw vegetables (lettuce, raw carrots and tomatoes) and fresh herbs (rosemary, sage, parsley, basil) at least three times a week. A Mediterranean diet protects against hair loss [66]. The observation is explained by the antioxidant and anti-inflammatory effects of secondary plant compounds. The abundant evidence for the health-promoting influence of the Mediterranean diet underscores this observation [67].
  • Watch your body weight. Being overweight leads to thinner hair. This can be explained by the fact that high-fat diet leads to the release of inflammatory signals in the stem cells of hair roots [68].
  • Avoid stress and make sure you get enough sleep. A part of the diencephalon (hypothalamus) releases more of a certain hormone (corticotropin-releasing hormone) during stress. This hormone causes the release of histamine from defense cells at the base of the hair follicles. Histamine eventually initiates the regression phase (catagen phase) of hair follicles [69].
  • Protect your hair from excessive sun exposure. Sun exposure (UV-A radiation) causes a decrease in stem cells and pigment cells in hair roots [70]. Certain degradation products of normal skin germs (propionibacteria) can be cell-damaging (light-activated porphyrin) when exposed to sunlight [71]. Free radicals generated by the sun lead to a reduction of hair pigments. Lighter hair provides less protection from UV light [72].
  • Take targeted action against dandruff. Various microorganisms colonize the scalp and form a natural protective shield (propionibacteria, staphylococcus bacteria and malassezia yeasts). The yeast fungus Malassezia accounts for 45 percent of skin germs in healthy people. Oily skin can cause yeast to proliferate more, trigger an inflammatory response, and promote hair loss [73]. In people with dandruff, the proportion of yeast in the skin flora increases to 75 percent [74]. Both in seborrheic dermatitis, psoriasis and atopic dermatitis, the yeast Malassezia is involved in the disease process. Shampoos containing the active ingredients zinc pyrithione (for example Head & Shoulders®), ciclopirox olamine (for example Stieproxal®) or ketoconazole (for example Ketozolin®) reduce Malassezia colonization [75].

The author

Unsere Fachärzte für Plastische Chirurgie Saarbrücken
Dr. Adelana Santos Stahl

“Our goal is to provide the best, most discreet and precise treatment based on our extensive expertise in plastic surgery. „

Dr. Adelana Santos Stahl is distinguished by a unique international perspective with a feminine view of plastic surgery. Her personalized and detailed approach is key to the beautiful and natural results she achieves. Having trained in Brazil, one of the largest and most well-known countries for aesthetic and reconstructive plastic surgery, she understands her patients’ desire to look and feel their best. She completed her medical studies and her training as a specialist for plastic and aesthetic surgery in Brazil. In 2009, she also successfully passed the German equivalence examinations for the medical state examination. Two years later, in 2011 she received the German and in 2012 the EU specialist recognition (EBOPRAS) for plastic surgery. From 2009 to 2013, she deepened her knowledge of aesthetic and reconstructive facial surgery with world-renowned representatives of plastic surgery such as Professor Gubisch at the Marienhospital and Madame Firmin in Paris. A VDÄPC Fellowship (continuing fellowship for graduate students) in Switzerland, France and the USA has further enriched her professional experience. Dr. Santos Stahl is active in several prestigious professional societies. Besides the DGPRÄC and DGBT, she is also a member of the Brazilian Society of Plastic Surgery – SBCP. She is also the author of several scientific articles and, together with her husband, is dedicated to research and clinical studies in the field of plastic surgery.


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