Aesthetics explores the use of a new artificial hair treatment for balding patients
Hair loss can be a devastating occurrence for both men and women. According to a study of 1,536 men in 2005, 62% said hair loss would affect their self-esteem, with the biggest concern being that they would lose whatever attractiveness they had.1 For women, a study on the psychological impact of alopecia suggested that around 40% of alopecia sufferers have had marital problems, and around 63% claimed to have career-related problems, linked to the hair loss condition.2 With this is mind, treatments for hair loss have a firm place in the aesthetics specialty. Surgical treatments, such as follicular unit extraction (FUE) and follicular unit transplantation (FUT), are generally accepted as the most common ways to treat hair loss. However, there are less invasive treatments now available; one being a newly-launched procedure that uses a polyamide artificial hair implant, Biofibre.
Biofibre can be used in hair restoration procedures when FUE or FUT may not be suitable, such as when there is a lack of donor hair, the patient has an atrophic or cicatricial scalp, or burn sequelae.4 Dr Al Bzour Bogdan Morad, the UK trainer for the automatic Biofibre Hair Implant System, which aids the implantation of Biofibre, says, “It is also recommended for patients pursuing fast results with minimally-invasive intervention and fast healing post procedure. In addition, it can be used as a combined technique with other hair treatments, with the aim of achieving a higher level of hair density.”
There are 13 different shades available, which can be blended to create a unique and tailor-made colour match for the patient
A large or small quantity of Biofibre hair can be fixed and the device can implant between 800 and 1,200 hairs per hour. Dr Bogdan explains that, “Biofibre hairs are fibres with identical aesthetic aspect and thickness of normal hair, made out of polyamide and inorganic pigments. The pigment is melted with the polyamide to ensure medical safety and to avoid migration to the tissue.” There are 13 different shades available, which can be blended to create a unique and tailor-made colour match for the patient. Different lengths and various styles can be obtained, including straight, wavy, curly, or afro, to satisfy patient requests.
Most patients are suitable for the procedure, according to Dr Bogdan, with the exception of patients that suffer from scalp autoimmune diseases such as psoriasis and active alopecia areata. He notes, “Before the procedure, the patient should be consulted by a specialist doctor to address any autoimmune diseases on the scalp, check blood pressure and take a HIV blood test, as patients at an advanced stage of the virus would be unsuitable for treatment.”3
After a consultation, the first step before the procedure is a patch test. Dr Bogan explains, “This is where we do a small implantation session of 100-200 fibres to observe the patient for one to two months in order to check for any possible rejection or allergy to artificial hair that may occur. If there is no reaction or a controllable reaction after one to two months, then we can proceed with a full session.” The most likely reaction is inflammation, which can be treated with an ointment steroid.
One day before the procedure, smoking and alcohol are to be avoided, and the patient should start taking a systemic broad-spectrum antibiotic.4 Biofibre hairs are implanted one by one in a 45° radius, leaving a space of 2mm between each implant, following the natural pattern of the hair. The implantation is performed by an automatic implant machine, which fires the Biofibre through the epidermis, dermis, subcutaneous layer and into the galea capitis. “This is where fibrosis occurs,” explains Dr Bogdan. “After the formation of fibrosis around the knot, located at the end on the fibre implanted into the scalp, the fibres will become strongly fixed and will be able to handle 350-450 grams of traction. Fibrosis can take between one to two months.”4
At the end of the procedure, the implanted area is cleansed and disinfected with an antiseptic solution, avoiding any traction on the fibres that might produce unwanted hair loss. An ice pack is applied for five to ten minutes and if necessary, an analgesic may be administered. The number of treatments needed will depend on the size of the implanted area and how many fibres the patient requires. Dr Bogdan says, “The protocol recommends that for the first session, 1,500-2,000 fibres should be implanted and for the following sessions up to 3,000 fibres each time, spaced between two and two and a half months.”
Follow-up sessions can be performed after three to four weeks. According to a study by Ramos et al., the elapsing time between sessions is said to allow for a gradual change of image and better psychological acceptance both by the patient and by other people.4
Some patients can develop localised infection in the implanted area due to lack of personal hygiene or aftercare negligence, but it can also be controlled with antibiotic ointment. Dr Bogdan says, “There is a haircare line specially made for Biofibre patients to use post procedure to maintain the results and guarantee longevity of the fibres. It consists of a sanitising spray, pH neutral cleansing foam and anti-sebum lotion.”
After the hair implant, the patient receives systemic antibiotic therapy for a week, sometimes together with antihistamines. The first shampoo can be performed after three to four days with gentle motions and it is advised that hair should not be cut for two weeks to avoid risk of infection. The patient can lead a normal active lifestyle, with results seen to last five to seven years on average.4
A study on the efficacy and safety of Biofibre followed 133 patients for three years’ post procedure. The study involved 98 males and 38 females with alopecia or baldness, who were deemed to have good health, a healthy scalp, and were diligent with scalp cleaning.
A clinical evaluation was carried out at one month, four months, and every four months thereafter. The fibre loss was no more than 10% per year in 91.4% of cases, 15% in 7.8% of cases and 20% in 0.8% of cases. When asked about the results, patient satisfaction was 96.2%. As for post-implantation tolerability and complications, 90.3% of patients recorded no pathology after surgery, 5.9% presented mild infection pathologies and 3.8% presented inflammation pathologies. The resolution of the septic and chemical pathologies occurred in 97.9% of the cases within an average of 15 days using a systemic antibiotic and/or steroid local therapy. In 2.1% of the cases, it was necessary to remove the fibres, which took place without leaving any lasting scar.4
There are currently few treatments for scalp scars that provide sufficient results, but the implantation of artificial fibres could be a viable alternative. An analysis of the utility of Biofibre hairs to treat scalp scars looked at 54 scars from 44 patients. There were no complications in 49 of the scars (90.7%), mild adverse outcomes in four scars (7.4%), and moderate adverse outcomes in one scar (1.9%). Occasional minor skin reactions, sebum plugs, and hyperseborrhea were successfully controlled and were well accepted by patients. The rate of which the fibres were lost was 20% on average per annum.5
Biofibre is the result of more than 20 years of investigation and is approved as an implantable hair prosthetic medical device by CE 0373 certification. Supported by clinical data, the Biofibre hair implant treatment indicates positive cosmetic results, which in turn, according to researchers, could lead to psychological benefits.6 Training is available for qualified doctors only.
1. Alfonso M, Richter-Appelt H, Tosti A et al. The psychosocial impact of hair loss among men: a multinational European study, Current Medical Research and Opinion, (2005) <https://www.ncbi.nlm.nih.gov/pubmed/16307704>
2. Hunt N, McHale S. Understanding alopecia. London: Sheldon, 2004.
3. O Ramos, G Tchernev, A.A. Chokoeva et al. Biofibre Hair Implant – Impact on the Quality of Life, Journal of Biological Regulators and Homeostatic Agents, Vol. 30 no.2 (2016)
4. N Serdev, A.M D’ Erme, J Hercogova, Z Zarrab et al. Polyamide Hair Implant (BIOFIBRE): Evaluation of Efficacy and Safety in a Group of 133 Patients, Journal of Biological Regulators and Homeostatic Agents (2015)
5. Mariangela Santiago, Roberto Perez-rangel, Angelo D’ugo et al. Artificial Hair Fiber Restoration in the Treatment of Scalp Scars, Dermatologic Surgery, (2007)
6. Implant or Transplant? Biofibre (2017) <http://www.biofibre.com/en/hair-implants/implant-or-transplant/?>