Aesthetic Plastic Surgery

, Volume 43, Issue 1, pp 253–266 | Cite as

Review of Human Hair Follicle Biology: Dynamics of Niches and Stem Cell Regulation for Possible Therapeutic Hair Stimulation for Plastic Surgeons

  • Gordon H. SasakiEmail author
Original Article Special Topics


Plastic surgeons are frequently asked to manage male- and female-pattern hair loss in their practice. This article discusses the epidemiology, pathophysiology, and current management of androgenetic alopecia and emphasizes more recent knowledge of stem cell niches in hair follicles that drive hair cycling, alopecia, and its treatment. The many treatment programs available for hair loss include newer strategies that involve the usage of growth factors, platelet-rich plasma, and fat to stimulate follicle growth. Future research may clarify novel biomolecular mechanisms that target specific cells that promote hair regeneration.

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Hair follicles Hair cycle Androgenetic alopecia Stem cell niches Treatment strategies 



The author wishes to thank Evelyn Avanessian, RN, Brigette Ibarra, LVN, for technical assistance in PRP isolation and cell counting; Sharon Cuellar, CST, for surgical assistance; Melissa Avitea, MA, for her IRB assistance; and Margaret Gaston, BS, for creating the artwork and providing the statistical and photographic assistance.

Compliance with Ethical Standards

Conflict of interest

The author is an unpaid consultant to Harvest Technologies Corp and MicroAire Surgical Instrument and declares no conflicts of interest with respect to the authorship and publication of this article. The author has neither financial nor investigational interests with Cytori Therapeutics, Inc. The author received no financial or equipment support from any of the device companies in this study. No financial support was provided for the writing of the article.


  1. 1.
    Schofield R (1978) The relationship between the spleen colony-forming cell and the haemopoietic stem cell. Blood Cells 4:7–25Google Scholar
  2. 2.
    Morrison SJ, Kimble J (2006) Asymmetric and symmetric stem cell divisions in development and cancer. Nature 441:1068–1074Google Scholar
  3. 3.
    Fuchs E (2009) The tortoise and the hair: slow cycling cells in the stem cell race. Cell 137:811–819Google Scholar
  4. 4.
    Blanpain C, Fuchs E (2006) Epidermal stem cells of the skin. Annu Rev Cell Dev Biol 22:339–373Google Scholar
  5. 5.
    Voog J, Jones D (2010) Stem cells and the niche: a dynamic duo. Cell Stem Cell 6:103–115Google Scholar
  6. 6.
    Paus R, Muller-Rover S, Van Der Veen C et al (1999) A comprehensive guide for the recognition and classification of distinct stages of hair follicle morphogenesis. J Invest Dermatol 113:523–532Google Scholar
  7. 7.
    Paus R, Cotsarelis G (1999) The biology of hair follicles. N Engl J Med 341:491–497Google Scholar
  8. 8.
    Nowak JA, Polak L, Pasolli HA et al (2008) Hair follicle stem cells are specified and function in early skin morphogenesis. Cell Stem Cell 3:33–43Google Scholar
  9. 9.
    Schmidt-Ullrich R, Paus R (2005) Molecular principles of hair follicle induction and morphogenesis. BioEssays 27:247–261Google Scholar
  10. 10.
    Cotsarelis G (2006) Epithelial stem cells: folliculocentric view. J Invest Dermatol 126:1459–1468Google Scholar
  11. 11.
    Millar SE (2002) Molecular mechanisms regulating hair follicle development. J Invest Dermatol 118:216–225Google Scholar
  12. 12.
    Hardy MH (1992) The secret lift of the hair follicle. Trends Genet 8:55–61Google Scholar
  13. 13.
    Reddy S, Andl T, Bagasra A et al (2001) Characterization of Wnt gene expression in developing and postnatal hair follicles and identification of Wnt5a as a target of Sonic hedgehog in hair follicle morphogenesis. Mech Dev 107:69–82Google Scholar
  14. 14.
    Andl T, Reddy ST, Gaddapara T et al (2002) Wnt signals are required for the initiation hair follicle development. Dev Cell 2:643–653Google Scholar
  15. 15.
    Schmidt-Ullrich R, Aebischer T et al (2001) Requirement of NF-κβ/Rel for the development of hair follicles and other epidermal appendices. Development 128:3843–3853Google Scholar
  16. 16.
    Jamora C, DasGupta R, Kocieniewski P et al (2003) Links between signal transduction, transcription and adhesion in epithelial bud development. Nature 422:317–322Google Scholar
  17. 17.
    Mill P, Mo R, Fu H et al (2003) Sonic hedgehog-dependent activation of Gli2 is essential for embryonic hair follicle development. Genes Dev 17:282–294Google Scholar
  18. 18.
    Tumbar T, Guasch G, Greco V et al (2004) Defining the epithelial stem cell niche in skin. Science 303:359–363Google Scholar
  19. 19.
    Yang C-C, Cotsarelis G (2010) Review of hair follicle dermal cells. J Dermatol Sci 57(1):1–10Google Scholar
  20. 20.
    McMahon AP, Ingham PW, Tabinj CJ (2003) Developmental roles ad clinical significance of hedgehog signaling. Curr Top Dev Biol 53:1–114Google Scholar
  21. 21.
    Vidal VP, Chaboissier MC, Lutzkendorf S et al (2005) Sox9 is essential for outer root sheath differentiation and the formation of the hair stem cell compartment. Curr Biol 15:1340–1351Google Scholar
  22. 22.
    Rhee H, Polak L, Fuchs E (2006) Lhx2 maintains stem cell character in hair follicles. Science 312:1946–1949Google Scholar
  23. 23.
    Cotsarelis G, Sun TT, Lavcker RM (1990) Label-retaining cells reside in the bulge area of the pilosebaceous unit: implications for follicular stem cells, hair cycle, and skin carcinogenesis. Cell 61:1329–1337Google Scholar
  24. 24.
    Zhang YV, Cheong J, Ciapurin N et al (2009) Distinct self-renewal and differentiation phases in the niche of infrequently dividing hair follicle stem cells. Cell Stem Cell 5:267–278Google Scholar
  25. 25.
    Rendl M, Lewis L, Fuchs E (2005) Molecular dissection of mesenchymal–epithelial interactions in the hair follicle. PLoS Biol 3(11):e331Google Scholar
  26. 26.
    Blanpain C, Lowry WE, Geoghegan A et al (2004) Self-renewal, multipotency, and the existence of two cell populations within an epithelial stem cell niche. Cell 118:635–648Google Scholar
  27. 27.
    Liu Y, Lyle S, Yang Z et al (2003) Keratin 15 promoter targets putative epithelial stem cells in the hair follicle bulge. J Invest Dermatol 121:963–968Google Scholar
  28. 28.
    Ellis T, Gambardella L, Horcher M et al (2001) The transcriptional repressor CDP (Cultl1) is essential for epithelial cell differentiation of the lung and the hair follicle. Genes Dev 15:2307–2319Google Scholar
  29. 29.
    Kaufman CK, Zhou P, Pasolli HA et al (2003) GATA-3: an unexpected regulator of cell lineage determination in skin. Genes Dev 17:2108–2122Google Scholar
  30. 30.
    Peters EM, Botchkarev VA, Muller-Rover S et al (2002) Developmental timing of hair follicle and dorsal skin innervation in mice. J Comp Neurol. 448:28–52Google Scholar
  31. 31.
    Philpott MP, Paus R (1998) Principles of hair follicle morphogenesis. In: Chuong CM (ed) Molecular basis of epithelial appendage morphogensis. R.G. Landes, Austin, pp 75–76Google Scholar
  32. 32.
    Petiot A, Conti FJ, Grose R et al (2003) A crucial role for Fgfr2-III signalling in epidermal development and hair follicle patterning. Development 130:5493–5501Google Scholar
  33. 33.
    Botchkarev VA, Botchkareva NV, Roth W et al (1999) Noggin is a mesenchymally derived stimulator of hair-follicle induction. Nat Cell Biol 1:158–164Google Scholar
  34. 34.
    Chuong CM, Cotsarelis G, Stenn K et al (2007) Defining hair follicles in the age of stem cell bioengineering. J Invest Dermatol 127:2098–2100Google Scholar
  35. 35.
    St-Jacques B, Dassule HR, Karavanova I et al (1998) Sonic hedgehog signaling is essential for hair development. Curr Biol 8:1058–1068Google Scholar
  36. 36.
    Karisson L, Bondjers C, Betsholtz C (1999) Roles for PDGF-A and sonic hedgehog in development of mesenchymal components of the hair follicle. Development 126:2611–2621Google Scholar
  37. 37.
    Ito M, Sato Y (1990) Dynamic ultrastructural changes of the connective tissue sheath of human hair follicles during hair cycle. Arch Dermatol Res 282:434–441Google Scholar
  38. 38.
    Tobin DJ, Gunin A, Magerl M et al (2003) Plasticity and cytokinetic dynamics of the hair follicle mesenchyme: implications for hair growth control. J Invest Dermal 120:895–904Google Scholar
  39. 39.
    McElwee KJ, Kissling S, Wenzel E et al (2003) Cultured peribulbar dermal sheath cells can induce hair follicle development and contribute to the dermal sheath and dermal papilla. J Invest Dermatol 121:1267–1275Google Scholar
  40. 40.
    Feutz AC, Barrandon Y, Monard D (2008) Control of thrombin signaling through P13K is a mechanism underlying plasticity between hair follicle dermal sheath and papilla cells. J Cell Sci 121:1435–1443Google Scholar
  41. 41.
    Greco V, Chen T, Rendl M et al (2009) A two-step mechanism for stem cell activation during hair regeneration. Cell Stem Cell 4(2):155–169Google Scholar
  42. 42.
    Ito M, Kizawa K, Hamada K et al (2004) Hair follicle stem cells in the lower bulge form the secondary germ, a biochemically distinct but functionally equivalent progenitor cell population, at the termination of catagen. Differentiation 72(9–10):548–557Google Scholar
  43. 43.
    Zhang Y, Andl T, Yang S et al (2008) Activation of β-catenin signaling programs embryonic epidermis to hair follicle fate. Development 135:2161–2172Google Scholar
  44. 44.
    Horsley V, Aliprantis AO, Polak L et al (2008) NFAYcl balances quiescence and proliferation of skin stem cells. Cell 132:299–310Google Scholar
  45. 45.
    Kobielak K, Pasolli HA, Alonso L et al (2007) Defining BMP functions in the hair follicle by conditional ablation of BMP receptor IA. Proc Natl Acad Sci USA 104:10063Google Scholar
  46. 46.
    Lowry WE, Blanpain C, Nowak JA et al (2005) Defining the impact of beta-catenin/Tef transactivation on epithelial stem cells. Genes Dev 19:1596–1611Google Scholar
  47. 47.
    Waghmare SK, Bansal R, Lee J et al (2008) Quantitative proliferation dynamics and random chromosome segregation of hair follicle stem cells. EMBO J 27:1309–1320Google Scholar
  48. 48.
    Panteleyev AA, Jahoda CA, Christiano AM (2001) Hair follicle predetermination. J Cell Sci 114:3419–3431Google Scholar
  49. 49.
    Sbarti A, Accorsi D, Berati D et al (2010) Subcutaneous adipose tissue classification. Eur J Histochem 54:e48Google Scholar
  50. 50.
    Schmidt B, Horsley V (2012) Unraveling hair follicle-adipocyte communications. Expert Dermatol 21:827–830Google Scholar
  51. 51.
    Hansen LS, Coggle JE, Wells J et al (1984) The influence of the hair cycle on the thickness of mouse skin. Anat Rec 210:569–573Google Scholar
  52. 52.
    Hausman GJ, Campion DR, Richardson RL et al (1982) Adipocyte development in the rat hypodermis. Am J Anat 161:85–100Google Scholar
  53. 53.
    Rodeheffer MS, Birsoy K, Friedman JM (2008) Identification of white adipocyte progenitor cells in vivo. Cell 135:240–249Google Scholar
  54. 54.
    Rosen ED, Spiegelman BM (2000) Molecular regulation of adipogenesis. Annu Rev Cell Dev Biol 16:145–171Google Scholar
  55. 55.
    Festa E, Fretz J, Berry R et al (2011) Adipocyte lineage cells contribute to the skin stem cell niche to drive hair cycling. Cell 146:761–771Google Scholar
  56. 56.
    Hesslein DGT, Fretz JA, Xi Y et al (2009) Ebfl-dependent control of the osteoblast and adipocyte lineages. Bone 44:537–546Google Scholar
  57. 57.
    Sasaki GH (2015) Plastic surgery update on the biology of fat cells and adipose-derived stem cells for fat grafting. Open Access Libr J 2(e1505):1–26Google Scholar
  58. 58.
    Plikus M, Mayer J, de la Cruz D et al (2008) Cyclic dermal BMP signalling regulates stem cell activation during hair regeneration. Nature 451:340–344Google Scholar
  59. 59.
    Zhang J, He X-C, Tong WG et al (2006) Bone morphogenetic protein signaling inhibits hair follicle anagen induction by restricting epithelia stem/progenitor cell activation and expansion. Stem Cells 24:2826–2839Google Scholar
  60. 60.
    Hamilton JB (1951) Patterned loss of hair in man: types and incidence. Ann NY Acad Sci 53:708–728Google Scholar
  61. 61.
    Olsen EA (2008) Female pattern hair loss. In: Blum-Peytavi U, Tosti A, Whiting D et al (eds) Hair growth and disorders. Springer, Berlin, pp 171–186Google Scholar
  62. 62.
    Cash TF (1992) The psychological effects of androgenetic alopecia in men. J Am Acad Dermatol 26:929–931Google Scholar
  63. 63.
    Cash TF, Price VH, Savin RC (1993) Psychological effects of androgenetic alopecia on women: comparisons with balding men and with female control subjects. J Am Acad Dermatol 29:568–575Google Scholar
  64. 64.
    Ellis JA, Stebbing M, Harrap SB (1998) Genetic analysis of male pattern baldness and 5α-reductase genes. J Invest Dermatol 110:849–853Google Scholar
  65. 65.
    Griffen JE, Wilson JD (1989) The androgen resistance syndromes: 5α-reductase deficiency, testicular feminization, and related disorders. In: Scriver CR, Beaudet AL, Sly WS, Valle D (eds) The metabolic basis of inherited disease, vol 2, 6th edn. McGraw-Hill, New York, pp 1919–1944Google Scholar
  66. 66.
    Feinstein R (2003) Androgenetic alopecia. Accessed 8 August 2005
  67. 67.
    Sawaya ME, Price VH (1997) Different levels of 5alpha-reductase type I and II, aromatase, and androgen receptor in hair follicles of women and men with androgenetic alopecia. J Invest Dermatol 109:296–300Google Scholar
  68. 68.
    Kaufman KD (2002) Androgens and alopecia. Mol Cell Endocrinol 198:89–95Google Scholar
  69. 69.
    Alsantali A, Shapiro J (2009) Androgens and hair loss. Curr Opin Endocrinol Diabetes Obes 16:246–253Google Scholar
  70. 70.
    Martinon F, Mayor A, Tschopp J (2009) The inflammasomes: guardians of the body. Annu Rev Immunol 27:229–265Google Scholar
  71. 71.
    de Rovero VaccaroJ, Swaya ME, Brand F et al (2012) Caspase-1 level is higher in the scalp in androgenetic alopecia. Dermatol Surg 38:1033–1039Google Scholar
  72. 72.
    Rattew JA, Huet-Hudson YM, Marriott I (2008) Testosterone reduces macrophage expression in the mouse of toll-like receptor 4, a trigger for inflammation and innate immunity. Biol Reprod 78:432–437Google Scholar
  73. 73.
    Bergsbaken T, Fink SL, den Hartigh AB et al (2011) Coordinated host responses during pyroptosis: caspase-1-dependent lysosome exocytosis and inflammatory cytokine maturation. J Immunol 871:2748–2754Google Scholar
  74. 74.
    Norwood O (1975) Male pattern baldness: classification and incidence. South Med J 68:1359–1365Google Scholar
  75. 75.
    Leavitt M (2008) Understanding and management of female pattern alopecia. Facial Plast Surg 24:414–417Google Scholar
  76. 76.
    Yip L, Rufaut N, Sinclair R (2011) Role of genetics and sex steroid hormones in male adrogenetic alopecia and female pattern hair loss: an update of what we now know. Australas J Dermatol 52:81–881Google Scholar
  77. 77.
    Hernadez BA (2004) Is androgenetic alopecia a result of endocrine effects on the vasculature? Med Hypotheses 62:438–441Google Scholar
  78. 78.
    Orme S, Cullen DR, Messenger AG (1999) Diffuse female hair loss: are androgens necessary? Br J Dermatol 141:521–523Google Scholar
  79. 79.
    Price VH, Roberts JL, Hordkinsky M et al (2000) Lack of efficacy of finasteride in postmenopausal women with androgenetic alopecia. J Am Acad Dermatol 43:768–776Google Scholar
  80. 80.
    Gordon KA, Tosti A (2011) Alopecia: evaluation and treatment. Clin Cosmet Investig Dermatol 4:101–106Google Scholar
  81. 81.
    Messenger AG, Sinclair R (2006) Follicular miniaturization in female pattern hair loss: clinicopathological correlations. Br J Dermatol 155:926–930Google Scholar
  82. 82.
    Blume-Peytavi U, Blumeyer A, Tosti A et al (2011) S1 guideline for diagnostic evaluation in adrogenetic alopecia in men, women, and adolescents. Br J Dermaol 164:5–15Google Scholar
  83. 83.
    Whiting DA (1996) Chronic telogen effluvium: increased scalp hair shedding in middle-aged women. J Am Acad Dermatol 35:899–906Google Scholar
  84. 84.
    Trueb RM (2000) Das idiopathische chronische telogen effluvium der frau. Hautarzt 51:899–905Google Scholar
  85. 85.
    Rebora A (2004) Pathogenesis of androgenetic alopecia. J Am Acad Dermatol 50:777–779Google Scholar
  86. 86.
    Inoue K, Aoi N, Sato T et al (2009) Differential expression of stem-cell-associated markers in human hair follicle epithelial cells. Lab Invest 89:844–856Google Scholar
  87. 87.
    Rittie L, Stroll SW, Kang S et al (2009) Hedgehog signaling maintains hair follicle stem cell phenotype in young and aged human skin. Aging Cell 8(6):738–751Google Scholar
  88. 88.
    Garza LA, Yang C-C, Zhao T et al (2011) Bald scalp in men with androgenetic alopecia retains hair follicle stem cells but lacks CD200-rich and CD34-positive hair follicle progenitor cells. J Clin Invest 121(2):613–622Google Scholar
  89. 89.
    Ohyama M, Terunuma A, Tock CL et al (2006) Characterization and isolation of stem cell-enriched human hair follicle bulge cells. J Clin Invest 116:249–260Google Scholar
  90. 90.
    Olsen EA, Messenger AF, Shapiro J et al (2005) Evaluation and treatment of male and female pattern hair loss. J Am Adad Dermatol 52:301–311Google Scholar
  91. 91.
    Ross EK, Shapiro J (2005) Management of hair loss. Dermatol Clin 23(2):227–243Google Scholar
  92. 92.
    Ding QQ, Sinclair R (2007) Female pattern hair loss and treatment options concepts. Clin Interv Aging 2(2):189–199Google Scholar
  93. 93.
    Ziering C (2014) Experience with robotic surgery in hair transplantation. In: Programs and abstracts. XX Orlando Live Surgery Workshop; Orlando, Fl, USA, April, 2014Google Scholar
  94. 94.
    Perez-Meza D (2009) Complications in hair restoration surgery. Oral Maxillofac Surg Clin North Am 21(1):119–148Google Scholar
  95. 95.
    Rogers NE, Avram MR (2008) Medical treatments for male and female pattern hair loss. J Am Acad Dermatol 59(4):547–566Google Scholar
  96. 96.
    Lengg N, Heidecker B, Seifert B et al (2007) Dietary supplement increases anagen hair rate in women with telogen effluvium: results of a double-blind, placebo-controlled trial. Therapy 4(1):59–65Google Scholar
  97. 97.
    Glynis A (2012) A double-blind, placebo-controlled study evaluating the efficacy of an oral supplement in women with self-perceived thinning hair. J Clin Aesthet Dermatol 5(11):28–34Google Scholar
  98. 98.
    Hornfeldt CS, Holland M (2015) The safety and efficacy of a sustainable marine extract for the treatment of thinning hair: a summary of new clinical research and results from a panel discussion on the problems of thinning hair and current treatments. J Drug Dermatol 14(9):15–22Google Scholar
  99. 99.
    Avram MR, Leonard RT Jr, Epstein ES et al (2007) The current role of laser/light sources in the treatment of male and female pattern hair loss. J Cosmet Laser Ther 9:27–28Google Scholar
  100. 100.
    van Zuuren EJ, Fedorowicz A, Carter B (2012) Evidence-based treatments for female pattern hair loss: a summary of a Cochrane systematic review. Br J Dermatol 167(5):995–1010Google Scholar
  101. 101.
    van Zuuren EJ, Fedorowicz A, Carter B et al (2012) Interventions for female pattern hair loss. Cochraine Database Syst Rev 5:CD007628Google Scholar
  102. 102.
    Irwig MS (2015) Safety concerns regarding 5α reductase inhibitors for the treatment of androgenetic alopecia. Curr Opin Endocrinol Diabetes Obes 22(3):248–0253Google Scholar
  103. 103.
    Jacomb RG, Brunnberg FJ (1976) The use of minoxidil in the treatments of severe essential hypertension: a report on 100 patients. Clin Sci Mol Med Suppl 3:579–581Google Scholar
  104. 104.
    Dargie HJ, Dollery CT, Daniel J (1077) Minoxidil in resistant hypertension. Lancet 2:515–518Google Scholar
  105. 105.
    Burton JL, Marshall A (1979) Hypertrichosis due to minoxidil. Br J Dermatol 101:593–595Google Scholar
  106. 106.
    Olsen EA, Dunlap FE, Funicella T et al (2002) A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of adrogenetic alopecia in man. J Am Acad Dermatol 47:377–385Google Scholar
  107. 107.
    Lucky AW, Picquadio DJ, Ditre CM et al (2004) A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. J Am Acad Dermatol 50:541–543Google Scholar
  108. 108.
    Avram MR, Cole JP, Gandelman M et al (2002) The potential role of minoxidil in the hair transplantation setting: roundtable consensus meeting of the 9th annual meeting of the International Society of Hair Restoration Surgery. Dermatol Surg 28:894–900Google Scholar
  109. 109.
    Buhl AE, Waldon DJ, Baker CA et al (1990) Minoxidil sulfate is the active metabolite that stimulates hair follicles. J Invest Dermatol 95:553–557Google Scholar
  110. 110.
    Dooley TP, Walker CJ, Dietz AJ (1991) Localization of minoxidil sulfotransferase in rat liver and the outer root sheath of anagen pelage and vibrissa follicles. J Invest Dermatol 96:65–70Google Scholar
  111. 111.
    Meisheri KD, Cipkus LA, Taylor CJ (1998) Mechanism of action of minoxidil sulfate-induced vasodilation: a role for increased K + permeability. J Pharmocol Exp Ther 245:751–760Google Scholar
  112. 112.
    Wester RC, Maibach HI, Guy RH et al (1984) Minoxidil stimulates cutaneous blood flow in human balding scalp: pharmacodynamics measured by laser Doppler velocimetry and photopulse plethysmography. J Invest Dermatol 82:515–517Google Scholar
  113. 113.
    Lachgar S, Chareron M, Gail Y et al (1998) Minoxidil upregulates the expression of vascular endothelial growth factor in human dermal papilla cells. Br J Dermatol 138:407–411Google Scholar
  114. 114.
    Han JH, Kwon OS, Chung JH et al (2004) Effect of minoxidil on proliferation and apoptosis in dermal papilla cells of human follicle. J Dermatol Sci 34(2):91–98Google Scholar
  115. 115.
    Rietschel RL, Duncan SH (1987) Safety and efficacy of topical minoxidil in the management of androgenetic alopecia. J Am Acad Dermatol 16:677–685Google Scholar
  116. 116.
    Dawber RP, Rundegren J (2003) Hypertrichosis in females applying minoxidil topical solution and in normal controls. J Eur Acad Dermatol 17(3):271–275Google Scholar
  117. 117.
    Abell E (1988) Histologic response to topically applied minoxidil in male-patterned alopecia. Clin Dermatol 6:191–194Google Scholar
  118. 118.
    Roberts JL, Fiedler V, Imperato-McGinley J et al (1999) Clinical dose ranging studies with finasteride, a type2 5-α reductase inhibitor, in men with male pattern hair loss. J Am Acad Dermatol 41:555–563Google Scholar
  119. 119.
    Headington JT, Novak E (1984) Clinical and histologic studies of male pattern baldness treated with topical minoxidil. Curr Ther Res. 36:1098–1106Google Scholar
  120. 120.
    Finasteride Male Pattern Hair Loss Study Group (2002) Long-term (5 year) multinational experience with finasteride 1 mg in the treatment of men with androgenetic alopecia. Eur J Dermatol 12:38–49Google Scholar
  121. 121.
    Leyden J, Dunlap F, Miller B et al (1999) Finasteride in treatment of men with frontal male pattern hair loss. J Am Acad Dermatol 40(6 Pt.):930–937Google Scholar
  122. 122.
    Drake L, Hordinsky M, Fiedler V et al (1999) The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia. J Am Acad Dermatol 41:550–554Google Scholar
  123. 123.
    Whiting DA, Waldstreicher HA, Sanchez M et al (1999) Measuring reversal of hair miniaturization in androgenetic alopecia by follicular counts in horizontal sections of serial scalp biopsies: results of finasteride 1 mg treatment of men and postmenausal women. J Investig Dermatol Symp Proc 4:282–284Google Scholar
  124. 124.
    Tosti A, Piraccini BM (2000) Finasteride and the hair cycle. J Am Acad Dermatol 42:848–849Google Scholar
  125. 125.
    Me Sawaya, Blume-peytavi U, Mullins DL et al (2002) Effects of finasteride on apoptosis and regulation of human hair cycle. J Cutan Med Surg 6:1–9Google Scholar
  126. 126.
    de Rivero Vaccari JP, Sawaya ME et al (2012) Caspase-1 level is higher in the scalp in androgenetic alopecia. Dermatol Surg 38:1033–1039Google Scholar
  127. 127.
    Libecco JF, Bergfelde WF (2004) Finasteride in the treatment of alopecia. Expert Opin Pharmacother 5(4):933–940Google Scholar
  128. 128.
    Thompson IM, Goodman PJ, Tangen CM et al (2003) The influence of finasteride on the development of prostate cancer. N Engl J Med 349:215–224Google Scholar
  129. 129.
    Goldstein J, Valerie H (2012) Home sweet home: skin stem cell niches”. Cell Mol Life Sci 69(15):2573–2582Google Scholar
  130. 130.
    Kilroy GE, Foster S, Wu X et al (2007) Cytokine profile of human adipose-derived stem cells: expression of angiogenic, hematopoietic, and pro-inflammatory factors. J Cell Physiol 212:702–709Google Scholar
  131. 131.
    Uebel CO, da Silva JB, Cantarelli D et al (2006) The role of platelet plasma growth factors in male pattern baldness surgery. Plast Reconstr Surg 118(6):1458–1466Google Scholar
  132. 132.
    Takikawa M, Nakamura S, Nakmura S et al (2011) Enhanced effect of platelet-rich plasma containing a new carrier on hair growth. Dermatol Surg 37:1721–1729Google Scholar
  133. 133.
    Li ZI, Choi HI, Choi DK et al (2012) Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg 38:1040–1046Google Scholar
  134. 134.
    Kang JS, Zheng Z, Choi MJ et al (2014) The effect of CD34 + cell-containing autologous platelet-rich plasma injection on pattern hair loss: a preliminary study. J Eur Dermatol Venereol 28(1):72–79Google Scholar
  135. 135.
    Eppley BL, Petrzak WS, Blanton M (2004) Platelet-rich plasm: a review of biology and applications in plastic surgery. Plast Reconstr Surg 114:1502–1508Google Scholar
  136. 136.
    Weibrich G, Kleis SWK, Hitzler WE et al (2002) Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count. J Craniomaxillofac Surg 30:97–102Google Scholar
  137. 137.
    Bir SC, Esaki J, Marui A et al (2009) Angiogenic properties of sustained release platelet-rich plasma: characterization in vitro and in the ischemic hind limb of the mouse. J Vasc Surg 50:870–879Google Scholar
  138. 138.
    Kakudo N, Minakata T, Mitsui T et al (2008) Proliferation-promoting effect of platelet-rich plasma on human adipose-derived stem cells and human dermal fibroblasts. Plast Reconstr Surg 122(5):1352–1360Google Scholar
  139. 139.
    Cervelli V, Scioli MG, Gentile P et al (2012) Platelet-rich plasma greatly potentiates insulin-induced adipogenic differentiation of human adipose-derived stem cells through a sere/threonine kinase Akt-dependent mechanism and promotes clinical fat graft maintenance. Stem Cells Transl Med 1(3):206–220Google Scholar
  140. 140.
    Fukaya Y, Kuroda M, Aoyagi Y et al (2012) Platelet-rich plasma inhibits the apoptosis of highly adipogenic homogeneous pre-adipocytes in an in vitro culture system. Exp Mol Med 44(5):330–339Google Scholar
  141. 141.
    Itami S, Kurata S, Takayasu S (1995) Androgen induction of follicular epithelial cell growth is mediated via insulin-like growth factor-1 from dermal papilla cells. Biochem Biophys Res Commun 21:988–995Google Scholar
  142. 142.
    Jindo T, Tsuboi R, Takamori K et al (1998) Local injection of hepatocyte growth factor/scatter factor (HGF/SF) alters cyclic growth of murine hair follicles. J Invest Dermatol 110:338–342Google Scholar
  143. 143.
    Guo L, Degenstein L, Fuchs E (1996) Keratinocyte growth factor is required for hair development but not for wound healing. Genes Dev 10:165–175Google Scholar
  144. 144.
    Giusti I, Rughetti A, D’Ascenszo S et al (2009) Identification of an optimal concentration of platelet gel for promoting angiogenesis in human endothelial cells. Transfusion 49:771–778Google Scholar
  145. 145.
    Hausauer AK, Jones DH (2018) Evaluating the efficacy of different platelet-rich plasma regimens for management of androgenetic alopecia: a single-center, blinded, randomized clinical trial. Dermatol Surg 44(9):1191–1200Google Scholar
  146. 146.
    Lee GR, Sasaki GH (2014) PRP for hair loss. MedEsthetics 10(6):28–32Google Scholar
  147. 147.
    Perez-Meza D, Ziering C, Sforza M et al (2017) Hair follicle growth by stromal vascular fraction-enhanced adipose transplantation in baldness. Stem Cells Clon Adv Appl 10:1–10Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Loma Linda Medical UniversityLoma LindaUSA
  2. 2.Private Practice: # 319PasadenaUSA

Personalised recommendations