A Review of Medical and Surgical Treatment Options for Androgenetic Alopecia

IMPORTANCE Androgenetic alopecia is a highly prevalent condition that can profoundly impair the quality of life in both men and women. OBJECTIVE To provide the up-to-date medical and surgical treatment options for patients with androgenetic alopecia. EVIDENCE REVIEW A Medline search of scientific literature was conducted from 1997 to 2013. Search terms included androgenetic alopecia, hair restoration, follicular unit transplantation, and follicular unit extraction. FINDINGS Oral finasteride and topical minoxidil are the 2 mainstream medical treatments for androgenetic alopecia. These medications have different mechanisms of action and should be combined to have an additive effect in men. Follicular unit transplantation is the gold standard for surgical management. There are 2 types of graft harvest technique: donor strip and follicular unit extraction. Each technique has its own advantages and disadvantages and should be tailored to the individual patient. Understanding of the anterior hairline design is essential to achieving a natural-appearing result. CONCLUSIONS AND RELEVANCE Medical treatment should be used in conjunction with surgery to achieve a synergistic effect. For the right candidate, follicular unit hair transplantation can lead to a long-lasting, natural result with appearance of dense scalp hair.