Loose scalp = no balding

SlowMoe

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Treatment of Male Pattern Baldness with Botulinum Toxin: A Pilot Study

Freund, Brian J. D.D.S., M.D.; Schwartz, Marvin D.D.S., M.Sc.


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Crown Institute; Pickering, Ontario, Canada
Correspondence to Dr. Freund, 49 Main Street South, Uxbridge, Ontario L9P 1J4, Canada, freund@crowninstitute.com
This clinical trial has been registered as “Treatment of Male Pattern Baldness with Botulinum Toxin” at http://www.clinicaltrials.gov/ClinicalTrials.gov with identifier NCT00965640.



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Sir:


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We would like to present the results of an open-label pilot study using botulinum toxin type A (Botox; Allergan, Inc., Irvine, Calif.) for the treatment of androgenetic alopecia. This form of alopecia is believed to be caused by a genetically predisposed sensitivity of hair follicles to the toxic effects of dihydrotestosterone, a metabolite of testosterone. Medical treatment of androgenetic alopecia has previously only been moderately effective using systemic drugs such as finasteride, a 5α-reductase inhibitor.[SUP]1[/SUP]
In this ethically approved study, 50 male subjects aged between 19 and 57 years with Norwood/Hamilton ratings of II to IV participated.[SUP]2[/SUP] The study was 60 weeks in duration, with 12 weeks of run-in followed by two treatment cycles of 24 weeks each. Subjects were injected with 150 units of Botox (5 units per 0.1 ml saline) into the muscles surrounding the scalp, including frontalis, temporalis, periauricular, and occipitalis muscles in equally divided doses over 30 injection sites. The primary outcome measure was a change in hair count in a fixed 2-cm area using a method described by Canfield.[SUP]3[/SUP] Secondary outcome measures included hair loss, measured by having subjects collect loose hair from their pillow with a sticky lint roller, and subjective efficacy using a validated questionnaire. Statistical analysis entailed paired t tests of group means.
Forty subjects completed the study, and no adverse effects were reported. The treatment response rate was 75 percent. Mean hair counts for the entire group showed a statistically significant (p < 0.0001) increase of 18 percent between baseline and week 48 (Table 1), similar to the results reported with Propecia (Merck, Whitehouse Station, N.J.).[SUP]1[/SUP] Hair regrowth was objectively visible in some subjects (Fig. 1). Secondary outcome measures were also significantly improved. The reduction in hair loss and increase in hair count did not show a statistically significant correlation. This suggested that longer retention of terminal hairs did not account for the increase in hair count.

Table 1
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Fig. 1
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Mechanistically, the scalp behaves like a drum skin with tensioning muscles around the periphery. These muscle groups—the frontalis, occipitalis, and periauricular muscles and to a minor degree the temporalis—can create a “tight” scalp when chronically active. Because the blood supply to the scalp enters through the periphery, a reduction in blood flow would be most apparent at the distal ends of the vessels, specifically, the vertex and frontal peaks. Areas of the scalp with sparse hair growth have been shown to be relatively hypoxic, have slow capillary refill, and to have high levels of dihydrotestosterone.[SUP]4[/SUP]
Conceptually, Botox “loosens” the scalp, reducing pressure on the perforating vasculature, thereby increasing blood flow and oxygen concentration. The enzymatic conversion of testosterone to dihydrotestosterone is oxygen dependent. In low-oxygen environments, the conversion of testosterone to dihydrotestosterone is favored; whereas in high-oxygen environments, more testosterone is converted to estradiol.[SUP]4[/SUP] Blood flow may therefore be a primary determinant in follicular health. Strategically placed Botox injections appear able to indirectly modify this variable, resulting in reduced hair loss and new hair growth in some men with androgenetic alopecia.
 

squeegee

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DHT promotes Fibrosis and hardening of the tissues. Just like enlarged prostate.
 

IDW2BB

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I wonder if the galea region was composed of muscle instead of tendon if that would impact male pattern baldness? Perhaps the contraction of the muscle would keep the scalp lose and the blood circulating.
 

SlowMoe

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^ I doubt it. Themajor areteries that feed the top of the scalp lie in loose connective tisue beneath the galea. When the muscles tighten, it compresses them and causes a bottleneck, choking off the blood supply. If it were soft tissue up there, it probably wouldn't be able to compress the vessels near as much..

There are doctors in europe performing "galeotomies" where they cut the muscles attached to the galea and re-route some blood vessels so they don't get compressed.
 

squeegee

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I've been saying for years that male pattern baldness is just results of an endothelial dysfunction.
 

boobyinspector

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I have a loose scalp and obviously had balding. Luckily finasteride almost completely reversed vertex and receding line is moving forward.
 

squeegee

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botox
 

Baldie101

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I agree to this. I used to have loose scalp but that changed when I started to lose my hair. The scalp became hard...I was surprised to feel that my scalp was quite tight. Yes, I was losing lots of hairs.

My father used to tell me things related to this topic such as "Message your head so your scalp isn't too tight because stressing, worrying and thinking too much will make it tight" or "Stand on your head/hands or lie on the floor and raise your legs so the blood can flow into your head and give energy to your hair". Now this sounds mumbojumbo bu hearing about this research makes it make sense. Well...the european in me wants research results before believing.

My scalp these days seem to be loosening up again. It's much better than how it was years ago. It could be Finesteride which I began 11 months ago or the regaine which I started 14 days ago. I think it's the minoxidil since I apply it twice a day and massage it into my scalp. "Massage" being the keyword here.

Another thing, I noticed that many fat, obese or bigboned people got their hair on their head. It could be because their scalp isn't as tight as thin people. Yes, I know there are some baldies too hence the "many" and not "all".
 

Sparky4444

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Well, this doesn't explain why I have a few dark, strong hairs surrounded by bald scalp on my frontal temple area...I pluck that hair, it grows back..I shave it, it grows back right away...My forehead and scalp is not has loose as it used be, but this alone does not get to the heart of the matter
 

kenny-k

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I know this is old, but this is funny because I'm from uxbridge originally haha small town so it's surprising to see this
 

long hair

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well ...this is what mr. maliniak talking about before but people will not believe it unless it come from a researchers ....
 

Slid

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I know im replying to an old thread but I feel like I need to because there might be someone else looking for an answer.Ive got a really loose scalp skin,it literally looks like michelin logo when i squeeze it,bit spongy,and I have some weird lines but that must because of my skull shape(dad also has them).Anyways,Ive got a pretty loose scalp skin but if I dont use finasteride and minoxidil im screwed,so this theory sucks ***.Again again and again,only genetics.
 

LITUATUI

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I know im replying to an old thread but I feel like I need to because there might be someone else looking for an answer.Ive got a really loose scalp skin,it literally looks like michelin logo when i squeeze it,bit spongy,and I have some weird lines but that must because of my skull shape(dad also has them).Anyways,Ive got a pretty loose scalp skin but if I dont use finasteride and minoxidil im screwed,so this theory sucks ***.Again again and again,only genetics.


The study published in 2010 that this topic refers to is already backed by others studies that came later.

Study in 2010: https://journals.lww.com/plasrecons..._Male_Pattern_Baldness_with_Botulinum.79.aspx

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Then this study in 2017: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782443/ (24 weeks results)

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Botox injections relaxes the muscles tied to the galea aponeurotica (Frontalis, Temporalis and Occipitalis). With a loose galea your scalp's blood flow and oxygen levels will be normal and healthy.

"This helps improves Androgenetic Alopecia as low-oxygen environments favor the conversion of testosterone to DHT, while in high oxygen environments it is converted to estradiol."

https://www.researchgate.net/publication/271112246_Androgenetic_alopecia_An_update

When we have normal blood flow in our scalps, DHT levels are also normal and healthy.


"Reduced blood flow and oxygen pressure in the balding areas are also involved in male pattern baldness. It has been shown that decreased blood flow and lower partial pressure of oxygen occurs in the balding scalp compared with nonbalding areas and with controls [66]. The decreases found in partial pressure of oxygen and blood flow are ~ 40 and 62%, respectively."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339524/


For example, the most successful treatment used today is minoxidil combined with derma needling. Minoxidil is a well know vasodilator and derma needling improves the blood flow by creating new blood vessels (angiogenesis).
While you might think that this treatment doesn't not address DHT, it does, because "low-oxygen environments favor the conversion of testosterone to DHT, while in high oxygen environments it is converted to estradiol".

Nonetheless, hair loss does have something to do with genetics. Some people are more prone to produce more cortisol and have tight muscles for example. Genetics also dictate how well your blood vessels handle inflammation - if they get easily calcified or not.
 

arnoldd

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The study published in 2010 that this topic refers to is already backed by others studies that came later.

Study in 2010: https://journals.lww.com/plasrecons..._Male_Pattern_Baldness_with_Botulinum.79.aspx

View attachment 112229

Then this study in 2017: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782443/ (24 weeks results)

View attachment 112230

View attachment 112231

View attachment 112232

View attachment 112233

View attachment 112234


Botox injections relaxes the muscles tied to the galea aponeurotica (Frontalis, Temporalis and Occipitalis). With a loose galea your scalp's blood flow and oxygen levels will be normal and healthy.

"This helps improves Androgenetic Alopecia as low-oxygen environments favor the conversion of testosterone to DHT, while in high oxygen environments it is converted to estradiol."

https://www.researchgate.net/publication/271112246_Androgenetic_alopecia_An_update

When we have normal blood flow in our scalps, DHT levels are also normal and healthy.


"Reduced blood flow and oxygen pressure in the balding areas are also involved in male pattern baldness. It has been shown that decreased blood flow and lower partial pressure of oxygen occurs in the balding scalp compared with nonbalding areas and with controls [66]. The decreases found in partial pressure of oxygen and blood flow are ~ 40 and 62%, respectively."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339524/


For example, the most successful treatment used today is minoxidil combined with derma needling. Minoxidil is a well know vasodilator and derma needling improves the blood flow by creating new blood vessels (angiogenesis).
While you might think that this treatment doesn't not address DHT, it does, because "low-oxygen environments favor the conversion of testosterone to DHT, while in high oxygen environments it is converted to estradiol".

Nonetheless, hair loss does have something to do with genetics. Some people are more prone to produce more cortisol and have tight muscles for example. Genetics also dictate how well your blood vessels handle inflammation - if they get easily calcified or not.

I had only temporalis hypertrophy when i suffered bruxism from constant chenching my teeth..did i speed my hair loss ?
 

Mandar kumthekar

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I had only temporalis hypertrophy when i suffered bruxism from constant chenching my teeth..did i speed my hair loss ?
Its all about head shape ,a box shaped head distribute masculer forces very well all over the scalp but scalp above rounded skull would be under more pressure. So it is all about shape of the skull,hence I have opened a thread about skull shape a week ago.
 
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