Medication Summary
The 2 medications that have received approval from the US Food and Drug Administration (FDA) for treating hair loss are minoxidil and finasteride. Minoxidil (Rogaine) is a liquid applied directly to areas of the scalp undergoing hair loss. Finasteride is a pill taken orally once per day.
While perioperative antibiotic use remains controversial in hair restoration surgery, some suggest that a first-generation cephalosporin such as cephalexin may be appropriate, with erythromycin being an effective alternative.
Oral sedation for the procedure can include medications such as diazepam and zolpidem. Anesthetic agents for the procedure include lidocaine, bupivacaine, and epinephrine.
Postprocedure pain-control agents can include ibuprofen, acetaminophen with codeine, hydrocodone bitartrate 5 mg/acetaminophen 500 mg, and oxycodone 5 mg/acetaminophen 325 mg, although typically only ibuprofen is needed. Additionally, some suggest prednisone helps reduce postoperative facial swelling and helps with discomfort.
Analgesics-Antipyretics
Class Summary
Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties beneficial to patients who experience pain.
Acetaminophen (Tylenol, Aspirin Free Anacin, APAP 500, Acephen, Cetafen)
This is the drug of choice for treating pain in patients with documented hypersensitivity to aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), who are diagnosed with upper gastrointestinal disease, or who take oral anticoagulants.
Codeine/acetaminophen (Tylenol #3, Tylenol #4, Tylenol with Codeine)
Acetaminophen and codeine combination is used for the treatment of mild to moderate pain.
Hydrocodone/acetaminophen (Anexsia, Hycet, Lorcet)
This combination is used for the relief of moderate to severe pain.
Oxycodone/acetaminophen (Endocet, Percocet, Primlev)
The combination of oxycodone and acetaminophen is used for the relief of moderate to severe pain. It is the drug of choice for aspirin-hypersensitive patients.
Ibuprofen (Addaprin, Advil, Motrin, Caldolor, Dyspel)
Ibuprofen is usually the drug of choice for treating mild to moderate pain, if no contraindications exist. It is one of the few NSAIDs indicated for fever reduction.
Naproxen (Aleve, Anaprox, Anaprox DS)
Naproxen is used for the relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing cyclooxygenase (COX) activity, which results in decreased prostaglandin synthesis.
Ketoprofen (Nexcede)
Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient’s response.
Antianxiety Agents
Class Summary
These agents are used to reduce anxiety.
Diazepam (Diastat, Diastat AcuDial, Valium)
Diazepam modulates the postsynaptic effects of gamma-aminobutyric acid–A (GABA-A) transmission, resulting in an increase in presynaptic inhibition. It appears to act on part of the limbic system, the thalamus, and the hypothalamus, to induce a calming effect. It also has been found to be an effective adjunct for the relief of skeletal muscle spasm caused by upper motor neuron disorders.
Diazepam rapidly distributes to other body fat stores. Twenty minutes after initial intravenous infusion, the serum concentration drops to 20% of maximum plasma concentration (Cmax). Individualize the dosage and increase cautiously to avoid adverse effects.
Sedative/Hypnotics
Class Summary
Sedative and hypnotic agents are used to induce sleep and sedation.
Zolpidem (Ambien, Ambien CR, Edluar)
Zolpidem increases neural hyperpolarization by enhancing the activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) through selective agonist activity at the benzodiazepine-1 receptor.
Topical Skin Products
Class Summary
Agents that increase cutaneous blood flow may stimulate healthy hair follicles.
Minoxidil topical (Rogaine)
Minoxidil may stimulate hair growth secondary to vasodilation, which increases cutaneous blood flow and, in turn, stimulates resting hair follicles.
5-Alpha-Reductase Inhibitors
Class Summary
Agents in this class inhibit the conversion of testosterone to dihydrotestosterone, which, in turn, significantly reduces dihydrotestosterone levels.
Finasteride (Propecia, Proscar)
Finasteride is a 5-alpha-reductase inhibitor that is approved for use in benign prostatic hypertrophy and in male-patterned alopecia. It blocks conversion of testosterone to its more active metabolite, dihydrotestosterone.
Local Anesthetics
Class Summary
Local anesthetic agents are used to increase patient comfort during the procedure.
Lidocaine anesthetic (Xylocaine, Zingo)
Lidocaine is an amide local anesthetic used in a 1-2% concentration in combination. This agent inhibits depolarization of type C sensory neurons by blocking sodium channels. It can be used in a formulation with epinephrine, which prolongs the duration of the anesthetic effects from lidocaine by causing vasoconstriction of the blood vessels surrounding the nerve axons.
Bupivacaine (Marcaine, Sensorcaine)
Bupivacaine 0.25-0.5% with or without epinephrine may be used. It decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. It can be used in a formulation with epinephrine, which prolongs the duration of the anesthetic effects from bupivacaine by causing vasoconstriction of the blood vessels surrounding the nerve axons.
Corticosteroids
Class Summary
Corticosteroid agents have both anti-inflammatory and salt-retaining properties. Glucocorticoids have profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.
Triamcinolone topical (Kenalog Orabase, Kenalog topical, Pediaderm TA)
Triamcinolone can be used topically. It decreases inflammation by suppressing the migration of polymorphonuclear (PMN) leukocytes and reversing capillary permeability.
Dexamethasone (Baycadron, Decadron, Dexamethasone Intensol)
Dexamethasone has many pharmacologic benefits, but also significant adverse effects. It stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentrations, and inhibits prostaglandin and proinflammatory cytokines.
Prednisone (Deltasone, Prednisone Intensol, Rayos)
Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing PMN leukocyte activity. It may be beneficial to use intravenous (IV) pulses; this may be associated with a lower frequency of calcinosis.
Prednisolone (FloPred, Millipred, Millipred DP)
Corticosteroids may decrease inflammation by reversing increased capillary permeability and suppressing PMN leukocyte activity.
Antibiotics
Class Summary
Empiric antimicrobial therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.
Erythromycin ethylsuccinate (E.E.S., EryPed)
Erythromycin is a macrolide used for penicillin-allergic individuals. It inhibits bacterial growth, possibly by blocking dissociation of peptidyl transfer ribonucleic acid (t-RNA) from ribosomes, causing RNA-dependent protein synthesis to arrest. Erythromycin is administered for the treatment of staphylococcal and streptococcal infections.
In children, age, weight, and severity of infection determine proper dosage. When twice-daily dosing is desired, half of the total daily dose may be taken every 12 hours. For more severe infections, double the dose.
Cephalexin (Keflex, Panixine Disperdose)
Cephalexin is a first-generation cephalosporin that inhibits bacterial growth by inhibiting bacterial cell wall synthesis. This agent is bactericidal and is effective against rapidly growing organisms forming cell walls. Cephalexin is an acceptable alternative to penicillin and may be useful in patients with minor penicillin allergies.
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Case 1. Views before and 6 months after a procedure performed by using 2000 follicular-unit micrografts.
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Case 1. Close-up view of the hairline of a patient 6 months after a procedure performed by using 2000 follicular-unit micrografts.
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Case 2. Views before and after 3500 follicular-unit micrografts performed in 2 procedures.
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Case 2. Close-up view of the hairline of a patient after transplantation of 3500 follicular-unit micrografts performed in 2 procedures.
