Category Archives: Botox and Hair

Thinner and Tighter Scalps in Balding Men

Update: A study from January 2020 concluded that androgenetic alopecia is associated with increased scalp hardness.

Over the years, I have read a number of articles and studies that discussed how balding men’s scalps are tighter and thinner than scalps of non-balding men. In tandem with fibrosis, this leads to permanent hair loss once the male hormones have started the damage.

Scalp Fat Loss and Fibrosis in Hair Loss Sufferers

Even in 1954, there were already theories that perhaps fat loss on the scalp was to blame for hair loss. Maybe dihydrotestosterone (DHT) spurred androgenetic alopcia affected some people more than others? Depending on how susceptible individual scalps were to losing fat layers and fat cells. Even further back, in 1942, Dr. Frederick Hoelzel postulated a baldness and calcification of the ivory dome theory.

Another old study from 1972 concluded that in advanced stages of baldness, all skin layers of the scalp other than the galea exhibit significant thinning. Fibrosis, calcification and increased scalp tension are all part and parcel of male pattern hair loss.

Kerastem, ADSC, AAPE and SVF

I have covered the issue of fat cells and hair growth numerous times on this blog in the past. Kerastem is perhaps the most important company in relation to this area of hair loss treatment. Stromal vascular fraction (SVF) enhanced adipose transplantation is the more technical name of this method of trying to regrow hair.

Also make sure to read my posts on adipose derived stem cells (ADSC) and hair growth; and the related AAPE for hair growth. Sooner or later, I think that these technologies will become better and more reliable. They will probably never regrow hair on completely bald regions of the scalp. However, anything that can permanently maintain and strengthen existing hair is a huge success.

Could Botox Stop Further Scalp Thinning and Fibrosis?

After I wrote my last post on Botox and hair growth, I received an interesting email from a surgeon named “Gabriel P”. I am pasting it verbatim below, and hope to hear back from him in the next few months.

“I wanted to share with you my story as a surgeon with hair loss maybe it could help our community.

Ok Hear me out.

Preface: Been losing hair for a number of years 10+. I am now 32 years old. I even went through a few hair transplants utilizing body hair and beard hair. I’m a surgeon myself so I tried everything I could in terms of medical literature defined what could help me with my hair loss. I didn’t want to try Propecia because of side effects and I like my sex life. So here’s what I’ve tried that has only marginally helped.

  • Metanx (prescription grade vitamin b12/ b6).
  • Nizoral (helps scalp inflammation in the very short term).
  • Hair transplant (my donor hair in the new transplanted areas also starts to thin so i transitioned to beard and body hair to some success).
  • Scalp massage using a cheap Wahl body massager (helps break down fibrosis in the scalp and promote blood flow).

That is about it. I’ve had this theory for a while now. With scalp hair loss and decreased blood flow.In a type lower extremity surgery I do, we bring blood flow to the legs utilizing an angio. The leg skin then goes from thin and shiny and no hair growth, to more malleable and better quality thicker skin.

If you look at patients with peripheral vascular disease, their skin on the legs will be very thin shiny and there will be almost no hair growth in the foot and ankle area.

The same goes for the balding scalp; most bald men in the Galea Aponeurosis area have thin and shiny skin and you can almost see the demarcation. people who aren’t bald don’t have this phenomenon on their scalps.

I thought to myself- “Why is it that my scalp itching started when my skin started getting shiny, thin and super tight- and why is it that when my blood pressure goes up my hair feels better? Or why my scalp itch goes away after a good nights rest when I’m in supine position, only to return during the day?”

The frontalis, temporal and occipital muscles all pull at the scalp and galea from different directions. We’ve had DHT pumping in our blood since puberty but my hair loss didn’t start then so whats the deal? I believe that as this skin gets tighter fibrosis occurs and the hair starts to miniaturize because the DHT or whatever it might be is not able to be washed out. This is only one factor, but I think its a key factor to fighting hair loss.

Back to botox: Botulinum toxin prevents muscle contraction for a very long time. To my knowledge there is only one study that studied the effectiveness of botox on the scalp- here it is:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782443/

Relatively small study, with good results. Apparently women have been using botox to keep their hair straight, but what I wanted to do was inject in the areas of the muscle tendon attachments to see if I can restore blood flow to the area as a result of loosening the scalp and the galea apopneurosis.

So I did. I have a plastic surgeon who I work with who I punted this idea to and we injected my scalp with botox loosely following the protocol in the paper. I wont go into the details, but its been a week so far and my scalp itch is COMPLETELY GONE. I cannot emphasize how this is NOT placebo and something definitely changed.

Whether it will last I will keep you updated. So far my scalp itch is gone and shedding has gone down a bit, but no regrowth bc its too soon for that. My hair feels significantly less limp as well. Botox lasts around 3 months so this should feel good for about the same time. I doubt I will get regrowth, but if I can keep what I have, its a win.”

Botox for Hair Growth

For several years, I have thought about writing a post on Botox and hair growth. A few sources have in the past suggested that the Botulinum toxin (which is what Botox is made from) can grow hair.

After all, Botox is a multifaceted magic-like poison with numerous potential approved uses as of 2019. It is no longer solely a product to reduce wrinkles.

We should also remember that there is some scientific evidence that surprising procedures such as mechanotherapy and scalp exercises can benefit hair growth; as can dermarolling and microneedling; as can the ill advised, but likely effective ligature of arteries.

Botulinum Toxin for Hair Loss

Botulinum Toxin (Nabota Brand)
Botulinum Toxin Nabota.

However, both research and evidence to date on this subject of Botox and hair growth have been scant. Yesterday, reader “Alek” posted an interesting new article from South Korea regarding the testing of botulinum toxin Nabota brand for hair loss on male patients with androgenetic alopecia. This brand is manufactured by Daewoong Pharmaceutical.

The Phase II-b trial will entail 180 units of the toxin delivered via 6 injections to the scalp once per month. It will be led by Dr. Park Byung-cheol, a professor of dermatology at Dangook University Hospital. Note that the less costly Nabota only hit the US market in 2019, and is facing a lawsuit from Botox manufacturer Allergan.

Botox vs Botulinum vs Botulism

It should be noted that the capitalized BOTOX® is a brand name (or trade name) for Botulinum toxin. The latter is a neurotoxic protein produced by the bacterium Clostridium Botulinum. “BOTOX®” is a trademark of Allergen (Ireland). Botulism is a serious, albeit rare, paralytic food poison illness caused by the Botulinum toxin.

Botox is classified as Botulinum Toxin Type A (BTX-A), the most popular variety. Botulinum Type B (BTX-B) received FDA approval for treatment of cervical dystonia in the US in December 2000. The main Botox Type B product sold in the US is Myobloc (known as NeuroBloc in the EU). The scientific name for Myobloc is rimabotulinumtoxinB.

Botox and Hair Growth

In 2010, an interesting study from Canada found Botox injection to the scalp to be successful in growing new hair in 40 test patients. The authors postulated an interesting theory as to why BTX-A succeeded so well in growing hair. The Botox injections induce scalp muscle paralysis, which in turn:

“Enhances blood flow to the scalp by reducing the tension on the scalp skin. Because the conversion to dihydrotestosterone (DHT) is enhanced in a low-oxygen environment, oxygenated blood reduces this conversion and increases conversion to estradiol.”

In 2017, an article in Vogue magazine had an encouraging quote from dermatologist Dr. Dendy Engelman:

“Preliminary studies for Botox in the scalp are showing that 50 percent of patients are growing new hair.”

Botox for Hair Growth
Botox injections: before and after hair growth.

Also in 2017, a study from India found that 8 of 10 male patients with androgenetic alopecia who were treated with Botox injections ended up with good to excellent results. The before and after image on the right is of one of the excellent responders to the Botox treatment.

Other Brands of BTX-A

Besides Allergen, other companies also product their version of Botulinum.

  • Companies in Western Europe produce the well known brands Dysport and Xeomin.
  • In South Korea, BTX-A is produced under the names Botulax, Innotox, Meditoxin (Neuronox) and Nabota.
  • In Russia, Botulinum toxin is sold as Relatox.
  • China also produces various strains of BTX-A.

Botox is technically known as onabotulinumtoxinA; Dysport is known as abobotulinumtoxinA; and Xeomin is known as incobotulinumtoxinA.