Category Archives: Fibrosis

Scalp Massage, Mechanotransduction and Hair Growth

I have covered scalp massage, scalp exercises and mechanotherapy for hair growth a number of times on this blog. During the past year, I have had a few people e-mail me about Mr. Robert English and his hair loss treatment protocol. Mr. English owns the perfecthairhealth website. His regimen primarily entails mechanotransduction and scalp massage therapy.

If you do not want to read this entire post, click on the below listed names to go to their approximate sections. I have also covered most of the below people in separate posts in the past.

Important note: I do not believe that any of the below methods can possibly regrow hair on totally bald areas of the head. At best, these scalp massage and related mechanotransduction techniques may make existing thinning hair become thicker. This better quality hair is then less likely to atrophy and progress to baldness.

Also note that even as far back as 1942, a scientist by the name of Frederick Hoelzel made some of the same observations as will be discussed in this post. He came out with a “baldness and calcification of the ivory dome” observation and theory. Make sure to read my post on bald scalps being tighter and thinner.

Scalp Massages and Mechanotransduction

Robert English

Robert English has written two interesting papers on hair loss during the past one and a half years:

  1. The limitations of just focusing on DHT reduction in dealing with hair loss (February, 2018).
  2. Survey results from self-assessments of standardized scalp massages for androgenic alopecia (March, 2019).

Neither of the journals that published Mr. English’s papers seem to be prestigious. However, his medical and scientific writing quality is very good. Mr. English does not hold a Phd, and does not seem to have any biology or science background as far as I can tell.

Mr. English mentions the concept of “mechanotransduction” a few times in his first paper. This term encompasses scalp massages and many other forms of mechanical stimulation. I discuss some of these in greater detail in the second half of this post.

A 2016 study from China concluded that:

“Mechanics such as pressure, compression, friction, traction, stretch, shear, and mechanical wounding can influence hair loss or growth.”

Besides improving scalp blood flow and oxygenation, mechanotransduction can alter scalp skin and hair at the genetic level. It can theoretically also reduce hair follicle inflammation, improve nutrient delivery and increase growth factors. Some of these effects seem to occur via Wnt signaling changes. The adverse effects of dihydrotestosterone (DHT) and androgens can be prevented via scalp massage.

A 2016 study from Japan (with Dr. Rei Ogawa as a co-author) concluded that:

“Stretching forces result in changes in gene expression in human dermal papilla cells. Standardized scalp massage is a way to transmit mechanical stress to human dermal papilla cells in subcutaneous tissue. Hair thickness was shown to increase with standardized scalp massage.”


It seems like Mr. English’s methodology can only be accessed by joining his membership community and getting his e-book. I have not tried to do either myself. However, someone by the name of JD Moyer wrote a detailed testimonial in 2014 that is worth a read. It looks like Rob English’s method involves: 1) Daily scalp massage; 2) Dietary changes; and 3) Avoidance of using shampoos when washing hair.

Scalp massage during shampooing.
Scalp massage during shampooing.

I have heard the last mentioned piece of advice many times in the past. I do not believe that shampoos can directly cause scalp hair loss. Otherwise, you would also see body hair loss near your wrists, where the shampoo touches during each scrubbing of the head. Or loss of facial and chest hair, since the shampoo drips down to those areas after rinsing.

Mr. English seems to be saying that the chemicals in shampoos could alter your hormones, which makes some sense. I try not to use my dermatologist recommended dandruff shampoos more than twice a week.

Scalp Exercises, Massages and Mechanotherapy

This post covers the positive hair growth effects from scalp massages, scalp exercises and scalp wounding. Related terms and concepts include mechanotherapy, mechanotransduction and microneedling. Such techniques and treatment that involve direct prolonged contact and manipulation of the scalp are worth linking together in one post. Maybe I should also add Botox injections into the scalp for hair growth into this list.

Scalp massages, stretching and wounding can all perhaps reverse or slow down further progression in scalp calcification and scalp skin fibrosis. Note that the key word here is “perhaps”. I trust the veracity of some of the studies that support these techniques. However, I also have major doubts.

Hair loss is much harder to reverse once calcification and fibrosis pathogenesis have progressed too far. So anything that can reverse or slow down these processes is worth looking into. Scalp tension via the galea aponeurotica is also known to be greater in those suffering from androgenetic alopecia. A number of papers and theories suggest that mechanical stress is involved in male pattern hair loss.

On a side note, there have been many anecdotal reports of people in casts and bandages reporting greater body hair once the cast is removed after several months. Perhaps this is also due to mechanotransduction type reactions?

Of importance, before there was Robert English, there were many others who have discussed similar concepts. Among the main ones that I have covered on this blog in the past include:

Hagerty, Foote, Ogawa and Dhurat

  • Tom Hagerty

    The first one that I heard about was Tom Hagerty. He owns one site on scalp muscle control techniques and hair growth; and another site on face shaping exercises. Mr. Hagerty must be close to 80 years old by now and is still active on his forums. Me and Mr. Hagerty first emailed each other over 15 years ago. His recent videos seem to be done by a younger person:

  • Stephen Foote

    Around the same time or shortly thereafter, I started reading posts from Stephen Foote on various hair loss forums. In 2019, I wrote a post on Stephen Foote and his hydraulic theory of hair loss. His original paper was published in 1995. Mr. Foote makes no income from selling his ideas or any products. He is just a citizen scientist who is now into his 60s.

  • Rachita Dhurat

    Then came various findings from around the world in recent years that concluded that microneedling and wounding benefit scalp hair growth. Perhaps the most famous scientist associated with microneedling and wounding is Dr. Rachita Dhurat from India. Both microneedling and massaging can effect some identical hair growth related pathways and signaling.

  • Rei Ogawa

    Then came Dr. Rei Ogawa and his mechanotherapy theory of hair regeneration. Dr. Ogawa and his Japanese co-researchers have published a number of well regarded papers on scalp massages and mechanotherapy. They seem to have proven that scalp massage can change gene expression at the hair follicle level. I covered both Dr. Rei Ogawa and Mr. Tom Hagerty in a combined post in 2014.

Detumescence Therapy of the Scalp

Hyon-Sook Choy
Head shape, detumescence therapy and hair loss.
Head shape, detumescence therapy and hair loss.

One person that I never mentioned in the past is Dr. Hyon-Sook Choy. In 2012, he wrote an extremely interesting paper on detumescence therapy of the scalp for hair regrowth. It has some funky photos in there that are well worth a look. After reading Dr. Choy’s work, you might start staring at the shapes of the scalps and foreheads of strangers! I never really thought much about dome shaped heads before reading this paper.

Note: If none of the above works, there is always ligature of the scalp arteries to prevent further hair loss. FYI — I am being sarcastic.

Thinner and Tighter Scalps in Balding Men

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

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

Scalp Fat Loss and Tightening 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 alopecia affected some people more than others? i.e. It depended on how susceptible individual scalps were to losing fat layers and fat cells and becoming thinner. Even further back, in 1942, Dr. Frederick Hoelzel postulated a baldness and calcification of the ivory dome theory.

Scalp Thickness Males Females
Scalp thickness differences in males and females. Epidermis, Galea, Dermis and Hypodermis. Source: Journal of Investigative Dermatology, June 1972.

Thinner Scalp Layers in Balding Men and Women

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. In the image above from that study, the scalp thickness at different layers is shown in men versus women. The four main layers are the epidermis, galea, dermis and hypodermis.

Fibrosis, calcification, thinning and increased scalp tension are all part and parcel of male and female pattern hair loss. In addition, this entire inflammatory process can often lead to increased dandruff and skin flakes.

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. In effect, you want to make thinner scalps thicker again.

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:

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.