Is topical minoxidil recommended for patients who are going to have or who have had hair transplants?
Unquestionably, yes. Earlier this month (11-15 August 2004), I attended the 12th Annual Scientific Meeting of the International Society of Hair Restoration Surgery in Vancouver, B.C. and I was gratified to learn that the use of topical minoxidil was almost always routinely recommended for patients having hair restoration procedures and that the use of topical minoxidil was shown to be beneficial when it was used both before and after hair restoration surgery. Minoxidil reduces shedding from transplant trauma and shortens recovery from surgery. It is not advised to use minoxidil on the transplanted areas immediately after surgery until the incisions have been allowed to heal.
The following results from clinical trials substantiate these assertions:
In a study of 12 male patients with MPB, 3% topical minoxidil was administered twice a day to the transplant area starting 48-72 hours after hair transplant surgery. Two patients demonstrated hair growth without the usual shedding 2-4 weeks after surgery and two additional patients had regrowth within 4 months after post-surgical telogen effluvium.
In another uncontrolled trial of 16 male hair transplant patients with MPB, minoxidil 2% was administered for 4 weeks prior to surgery, interrupted for 3 weeks, then restarted and continued for 3 months after surgery. The study found that in 71% of grafts, partial or total hair was still growing without the usual shedding that occurs 2-4 weeks after surgery.
The effectiveness of administering topical minoxidil prior to hair restoration surgery was also documented in a double blind study in which 12 males with MPB were randomized to have either minoxidil 2% topical solution or placebo applied to the donor area for 6 weeks prior to transplantation and to recipient areas for 17 weeks after surgery. After 17 weeks, significantly less grafted hair was shed by minoxidil-treated patients as compared with placebo-treated patients (22 vs. 52%).
The reported benefits of regular topical minoxidil administration following hair transplant surgery included (1) an increase in the number of anagen hairs, (2) promotion of hair growth in the transplanted grafts and surrounding areas, and (3) reduction of post-surgical shock and telogen effluvium.
Most surgeons advise their patients to stop using minoxidil at least 2-3 days prior to surgery (range 1-14 days) to minimize skin irritation and to reduce a theoretical risk of increased intraoperative bleeding secondary to vasodilatation. Similarly, most surgeons prefer to reinitiate the use of topical minoxidil between 2 and 14 days after surgery. This allows time for the epithelium to heal and minimizes the potential for theoretical damage to the transplanted grafts from propylene glycol based vehicles. However, the use of glycerin based minoxidil solutions could vitiate this potential problem.
Kassimir JJ. Use of topical minoxidil as a possible adjunct to hair transplant surgery. J Am Acad Dermatol 1987;16:685-7 Bouhanna P. Topical minoxidil used before and after hair transplantation. J Dermatol Surg Oncol 1989; 15:50-53 Roenigk HH, Berman MD. Topical 2% minoxidil with hair transplantation. Face 1993; 4:213-6 Avram M. The potential role of minoxidil in the hair transplantation setting. Dermatol Surg 2002; 28: 894-900
Richard Lee, M.D.
Regrowth, LLC
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