Ligature of the arteries of the scalp to prevent further hair loss?!

Every time that I think I have heard it all when it comes to potential hair loss cures or partial solutions with some merit (i.e., at least one scientific journal publication related backing), something new and totally unexpected comes along.  Recently, one of my blog readers sent me a link to the following interesting paper (published all the way back in 1977):

New Treatment for Seborrheic Alopecia: The Ligature of the Arteries of the Scalp

In essence, this doctor shut off (= ligature) two arteries near the face and scalp region, and lo and behold balding slowed down in 76 percent of the 1300 (!!) patients on whom he performed this procedure (10 percent of those were women).  Moreover, 17 percent of patients saw regrowth in previously bald regions.  The two arteries that were ligated were the temporal superficial artery and the posterior auricular artery.

The below image from wikipedia commons shows the location of those two arteries (first and third arrows from the top):

It should be noted that seborrheic alopecia is not exactly the same as androgenic alopecia.  However, the above procedure should also work for androgenic alopecia as according to the article:

“If we accept that the main androgen hormone active on the skin target cells is dihydrotestosterone, a metabolite of circulating testosterone, then the enzymatic control of the alpha-reduction
of testosterone into dihydrotestosterone is assumed by the 5-alpha-reductase.  If this enzyme can be inhibited in the scalp, seborrheic alopecia will probably be reduced.  One of the most powerful non-toxic enzyme inhibitors is hypoxia.  Through surgery, by ligature of the scalp arteries, hypoxia can be induced in the scalp (by reducing the speed of the normal blood flow through replacing the arterial flow by capillaries and by obtaining a diminished P02 in the ligated area).  By creating hypoxia in the scalp, testosterone metabolism will be reduced and the condition improved.”

Note that hypoxia means oxygen deprivation.  Besides a slowing down or reversal in balding, the conclusion of the article also states that sebum production in the study participants’ scalp was reduced, and the condition of their hair follicles was strikingly improved (reduction in dandruff, itching and greasiness).

For myself, the worst part of slowly losing hair over the past decade has been the on and off associated itching, dandruff and sebum on the scalp.  Nizoral (and probably Finasteride) has helped me a lot in combating this problem, but some days are still annoying.

One interesting thing about this artery ligation procedure is that it reduces blood flow to the scalp.  Over the years, I have read many expert and non-expert opinions that increased blood flow to the scalp can lead to better quality hair.  However, it seems like normal blood flow is causing balding (in susceptible individuals) in the first place via supplying androgens to the scalp, and reduced blood flow can in fact help the hair!  Who would have thought.

Finally, I should mention that the reader who sent me the link to the above study from 1977 also sent me another link from a more recent slightly related study from 2014:  cessation of hairline recession following open forehead rejuvenation.  I do not think that this second study entails any type of artery ligature, but have not done any research on it, nor tried to find the full study as I did for the first one.  I am guessing that this procedure does nothing for crown region balding.  The surgeon (Dr. Guyuron) who is the lead author of this second study is reviewed on yelp.  Here is Dr. Guyuron’s detailed write-up on forehead rejuvenation.

NOTE: I would never ever go for such procedures and would advise readers to not contemplate them.  Very few  doctors would have done something like this just for hair loss, and the potential side effects are significant if the surgery is performed by an inexperienced person (and even experienced surgeons can have bad results).  Moreover, there is no guarantee than your androgenic alopecia will be cured with such procedures.  Even a slowdown in the rate of balding is not guaranteed, based on the 76 percent success rate in the first study that I discussed in this post.  I would also like to find out how those of the 1300 patients who are still alive today feel about their procedure today and the condition of their scalp.  Did they get any pain or necrosis in the long term? Was it okay to have a permanent reduction in blood flow in that scalp region?

31 thoughts on “Ligature of the arteries of the scalp to prevent further hair loss?!”

  1. Hi admin! Thank you for all the time you spend with this blog 🙂 you really make me feel comfortable knowing that there are so many things that can be done (and they soon will!) for our hair loss. I think we are getting closer.

    I just have a question: is finasteride not working 100% for you? I don’t take it but I’ve heard that most of people at least keep their hair and prevent from further loss after they start taking it. Is your hair loss still progressing?

    Thank you

    1. Thanks Viviane. We are definitely getting closer.

      I take around half the dose of Finasteride that you are supposed to (I take 1.25 mg every two days instead of 1mg per day). I am certain it has helped me, especially in the crown region. However, I still lose some hair, and none of my hair can grow long any more. I am reluctant to increase the dose because I think Finasteride might have made me gain some weight, although I am not certain about that (could just be getting older and sitting on a computer a lot throughout the day).

      Maybe I will raise my dose later this year if I can commit to eating less and exercising more:-)

      1. I’ve never heard of people who gained weight from finasteride but it seems that anything can happen when you take this drug! Anyway I think you should give it a try and see how it goes. You can lower the dosage again if you need to. 🙂

        Good luck!

        1. Its actually reported by a lot of men on forums…since you get more circulating estrogen (i.e., you become slightly more feminine) when on Fin, and women tend to have a bit more fat than men. Some men get gynecomastia from Fin — i.e., fatty breasts!

          In any case, I will not know for sure until I exercise more and reduce my caloric intake. Could very well just all by my lifestyle and have nothing to do with Fin or even age.

  2. This is crazy ,they should check those patients again for similar diseases.
    Procedure cant be healthy at all.

    1. They did a check up. If you read to the end of the article you will see a histologist study which showed the operation improved the cellular life of hair follicles a year after surgery.

        1. I had ligatures of my temporal and occipital scalp arteries ligated thirty years ago, back in 1985, and my hair loss stopped. I only receded and thinned a bit in the frontal hairline, while the rest of my scalp remained extremely thick and full. I had both my temporal and both my occipital scalp arteries ligated. The occipital arteries go to the crown, where men also go bald, but my crown is as thick as it was as a teenager, I even still have the Dennis The Menace hair sticking up from the swirl. I would advise having ligatures, but from what I was told, doctors are no longer doing this procedure. Ciao

          1. Ligatures of the scalp arteries definitely works for male pattern hair loss. I had my ligatures done 31 years ago, and I stopped losing my hair, but I didn’t regrow lost frontal hairline hair. The rest of my scalp is as thick as when I was a teenager, and I am now 55 years old. The crispy orange frontal hair I had turned back to supple dark brown. Ligatures definitely works, and I am living proof

  3. 5-10 years. There has been way too many advances in the last 8-10 years for a new safe and effective AGA reversal to not be here before long. It’s a race to be the first to the market for hair loss . Bimatoprost, Replicel, Histogen, Setipiprant, numerous cloning advancements…

  4. Have you looked into the areas relating DHT to bone growth? I have noticed skull expansion in many people with hair loss, certainly my head shape has increased over the years leading to a tighter scalp / trapped sebum etc.. The only thing to stop my hair loss and improve my scalp condition has been massaging to keep my scalp loose and increased blood flow. I wonder if this study prevented DHT from doing its androgenic job localised to head, or even maybe promoted new micro networks to make up for this ligature..

    1. Very interesting observation. My head has definitely grown a bit since I started balding, but I am not sure about the skull… the face for sure.

  5. Hello, I had the ligatures of superficial scalp arteries done thirty years ago, in June of 1985, and my hair loss stopped. I only had a receding hairline, with some thinning in the peak, but it has stopped. At almost age 55 I still have about 90 percent of my hair, and it’s extremely thick and virtually no gray. I had both my temporal and both my occipital scalp arteries ligated, the occipital go to the crown where men also bald. My crown is as thick as when I was a teenager, I still have the Dennis The Menace hair sticking up from the swirl. I still communicate with the doctor who sent me to Houston, Texas for the ligatures, and he assures me that transplants for the frontal hairline would work well for me. But, I am disabled and have not worked in 16 years, so I cannot afford transplants. If, one day, I can afford transplants, I will have them done. I only need about 1,000-1500 grafts to restore my frontal hairline. I wanted to share my ligature experience here. Ciao

    1. Peter thanks a lot for your interesting comment! So you had this procedure done just to stop hair loss? Very bold (and a bit reckless) of you I suppose, but congratulations on the success. Is your doctor still active?

      1. The surgeon who did my ligatures is in his late eighties now, if he’s still alive. His name is Paul Wintle Des Ruisseaux, and he works out of Houston, Texas.

  6. I read in a study somewhere that the T to DHT metabolism is actually increased in hypoxic condition. Is it possible that Peter Renardo would not have gone bald anyways with or without the operation?

    1. There’s no way of knowing if I would have continued to bald, unless they were to go into my DNA and see if I am genetically predisposed to extensive pattern hair loss. All I know is I stiopped losing my hair and the frontal hair got stronger, darker and less brittle. I did not regrow my receded hairline, but the hair loss evolution completely stopped. My crown is as thick as when I was an adolescent. I lose 2 or 3 hairs when I wash my hair in the sink, and they’re long pigmented hairs. I have absolutely no hair miniaturization anywhere on my scalp. At age 55, I still have about 90 percent of my hair

  7. I am one of the individuals who had ligatures of my superficial scalp arteries. I had both my temporal and both my occipital scalp arteries ligated, way back in 1985. After more than thirty years, I can honestly say that the ligatures worked. At age 55, I still have 90 percent of my hair, and it’s very thick, healthy and shiny. I did not regrow the loss in my frontal hairline, but the evolution of male pattern baldness stopped completely. My crown is still as thick as when I was an adolescent. I even still have the Dennis The Menace hair sticking up from the swirl

  8. The ligature procedure was very simple, and the pain was not bad at all. It only took about 90 minutes to ligate all four arteries, and I went back to work the next day. The two incisions in front of my sideburns you cannot see now, 31 years later, and only two occipital incisions can be found if my hair is combed and parted open, but they’re thin lines and the thickness of my hair makes it impossible to see. This was the best thing I did to stem my pattern hair loss. At age 55, I still have about 90 percent of my hair, and I only need fue transplatns to strengthen the frontal hairline, maybe 1,500 grafts. I cannot afford fue transplants because I am disbled for life from a severe spinal injury. Since 2000 I’ve had 19 major surgeries, including nine spinal surgeries, including two-level fusions into my sacrum, the implant and reveision surgeries of a spinal cord stimulator for Arachnoiditis neuropathic pain, both hips replaced, my right knee replaced and my right shoulder replaced. So, I cannot afford fue transplants. I am hoping to find a hair transplant doctor who will offer me gratis fue transplants. Maybe one day I can find one

  9. maybe the ligature of the temporal veins brings more blood to flow through the veins that lead to the crown and forehead

    1. Mike, what do you want to know? This procedure was very easy and post-surgical pain is minimal. The surgeon who did my ligatures said I had large arteries, and he said the procedure would work better for me. No, I did not regrow lost hair, but the remaining hair stayed fairly strong and healthy. I used to have red, dry, crispy frontal hair, but it returned to dark brown and silky. Like I said, I did not regrow lost hair, but my hair loss is minimal. I still have about 90 percent of my hair, and my crown area is as thick as when I was an adolescent. My pattern hair loss stopped, as it’s been over 31 years, and at age 55 I still have a thick head of hair. I am looking into getting fue transplants in the hairline area, I only need about 1,500 grafts.

  10. It has been 31 years since I had my superficial scalp artery ligatures, and I can honestly say this procedure worked for me. I did not regrow any lost hair, but my hair loss stopped. At age 55 I still have about 90 percent of my hair. The overall scalp circulation is reduced only 20 percent, as the arterial irrigation is replaced with capillary irrigation, so hair transplants will work.

  11. I had temporal and occipital scalp artery ligatures done 31 years ago, and my hair loss stopped. I did not regrow lost hair, but my remaining hair stayed very thick and healthy. The reduction of circulation is only 20 percent, but capillary irrigation replaces arterial irrigation. This procedure definitely works

  12. The doctor who sent me to the surgeon in Houston, Texas told me that they are not doing ligatures anymore, because transplants have improved since 1985, but this procedure does work, if you can find a surgeon who still does this procedure. Scalp artery ligatures is a legitimate surgery, it has a CPT code because it is done to improve seborrheic dermatitis, and hair loss reduction was noticed. We all know that Testosterone causes the sebaceous glands to overproduce sebum, which causes hair loss. If a man is castrated, he will not go bald. Testosterone is the culprit with male pattern hair loss.

  13. I had ligatures of my temporal and occipital scalp arteries back in 1985, and my hair loss stopped. It’s a very simple procedure, it only takes about 90 minutes, and the pain is minimal. While I did not regrow any hair, my hair lose completely stopped, and I still have about 90 percent of my hair. This procedure also improved the fronal hair quality, making it more supple and dark brown, when some of my frontal hair was crispy and orange. I am very happy with this procedure

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