Treating Hair Loss: A Multimodal Approach

We recently sat down with board-certified dermatologist Dr. Trisha Khanna of Premier Medical Associates, to discuss why she’s so passionate about treating hair loss, the benefits of taking a multimodal approach to treating this condition, and the importance of compliance in the patient’s hair growth journey. 

REVIAN: Dr. Khanna, thank you so much for talking with us about hair loss! We know that you have a special interest in treating hair loss. Is this a large part of what you do in your practice?

Dr. Trisha Khanna: You’re welcome! Hair loss has become a focus for my practice as I come from a culture where hair volume is tantamount to beauty.  Furthermore, hair loss is one of those conditions that affects a variety of genders and ages, so inevitably I will encounter several patients a day inquiring about hair thinning.  

R: So, one thing that we have been hearing a lot about from our dermatology partners lately is “multifactorial” hair loss. What does that mean exactly? 

TK: The dermatologist is referring to the fact that hair loss can be a result of many different factors. In fact, in most cases, hair loss is multifactorial – that is, it is the result of a combination of causes, such as genetics, hormones, aging, stress, diet and lifestyle.  

R:  Revian is clinically indicated to treat androgenetic alopecia, the most common type of hair loss in men and women. But there are many types and causes, which require different treatments. How do you determine the best approach to take for your patients? 

TK: Hair loss can be scarring and nonscarring. Within these categories are many types of inflammatory and inherited conditions. In order to target the root cause, your dermatologist will evaluate your medical history and ask questions about your lifestyle in order to help determine what is contributing to your hair loss. Then, he or she will recommend treatment options based on the results. Some people may be genetically predisposed to hair loss, meaning that there is a family history of hair thinning or balding. 

R: Dermatologists often recommend taking a “multimodal” approach to treating hair loss. What does that mean? 

TK: There is a growing trend to use multimodal treatments for hair loss. This is a comprehensive approach that employs multiple treatment methods simultaneously in an effort to mitigate all of the etiologic factors that contribute to hair loss. This approach is often more effective than using a single treatment method alone.  

R: What are some examples of these combination treatments? 

TK: Multimodal treatments include medical and surgical approaches, as well as nonsurgical methods. Diverse treatment methods include topicals, orals, low-level light therapy, platelet-rich plasma, hair transplant, and nutritional supplements.  

For example, your dermatologist may prescribe topical minoxidil and a light cap concurrently in order to get ahead of the hair loss and attempt to preserve the hairs you currently possess. If you are experiencing excessive hair loss and are not sure why this may be happening, it is a good idea to see a dermatologist who can help to determine the causes and provide treatment recommendations to help reverse or prevent further hair loss.  

R: With so many hair loss products and treatments on the market today for hair loss, it can be overwhelming and confusing for someone who is probably already stressed and frightened about losing hair. Can you share any insight or provide any guidance when it comes to over-the-counter therapies? 

TK: Regarding over-the-counter (OTC) hair loss therapies, it is crucial to consider that not all are created equal. That said, some OTC products have been shown to be valuable in promoting hair growth. Some general guidance to navigate the options includes:

1. 1. Look for ingredients such as 5% minoxidil, which have been shown in clinical studies to be effective in curtailing hair loss and promoting hair growth.  
   

2. 2. Consistency is key. OTC products typically take several months to work, so try to be patient and not give up too quickly 
   

3. 3. Consider combining OTC products with prescription methods or low-level light therapy 
   

4. 4. Consult with a dermatologist who can help you assess the OTC options  

R: During COVID we saw an increase in the number of hair loss products being promoted on social media. What do you look for when you are evaluating a new hair loss product or treatment? 

TK: When evaluating a new hair loss product, I assess various factors. These include safety, efficacy, cost, convenience and reputation. Consulting with a dermatologist can help you identify the most suitable products for your individual needs.  

R: As a dermatologist who recommends Revian, how do you see the cap working with other over the counter products or in-office procedures? 

TK: Revian is a non-invasive option that pairs harmoniously with almost all other treatments and procedures. This includes OTC products and in-office procedures. Frankly speaking, I cannot identify a reason not to use Revian.  

To enhance results, some individuals may choose to use Revian in conjunction with topical hair growth products such as minoxidil. Furthermore, individuals undertaking in-office hair restoration such as hair transplant or PRP, may choose to use Revian as a complementary treatment.  

RN: Hair growth is not overnight. It takes time, discipline, and a financial commitment on the part of the patient. Once you put together a treatment plan, how does compliance factor into patient success? 

TK: Compliance is an essential element in determining a patient’s success in achieving a positive outcome. Noncompliance can lead to perceived treatment failure and hair loss symptom worsening. 

R: I think it can be easy to underestimate the impact hair loss can have on one’s everyday life if you’re not experiencing it yourself. We know that hair loss can lower confidence and self-esteem, but it can be so much more far-reaching than that. It can change how we move through our lives, in our jobs, and in our relationships. What do you tell your hair loss patients once they begin their treatments? 

TK: Of course, because hair loss is such a profound quality of life condition, it results in patients eager for rapid results. I start by addressing my patients with empathy and a desire to understand how they have been affected by the condition.  

I am passionate about treating hair disorders as many patients feel hopeless and do not realize there are several ways to treat hair loss. Many patients will tell me they have just become resigned to their fates and their day-to-day lives are profoundly affected by thinning hair. They either may not want to go out in public or once there do not feel confident enough to wholeheartedly engage in whatever professional or social interaction they are in.  

With these patients, I remind them that the most important principle here is to be patient and subsequently compliant.  Expectation management is key, reminding people that growth can take months to years. At best, we hope to regrow loads of hair. But it is also necessary to remember that simply slowing down the rate of shedding and hair loss is valuable as well!   

Finally, I like to offer encouragement that hope is on the horizon and that hair loss is a very common complaint among many dermatologic patients.  

RN: Your patients are so fortunate to have such a caring a knowledgeable doctor in their corner! Thanks again for your time and expertise! 

TK: You’re welcome! 

If you live in the Orlando area and want to learn more about Dr. Khanna’s practice, please visit: https://pmacare.com/healthcare-providers/trisha-khanna-md-faad/