Treatment of Androgenetic Alopecia with Botulinum Toxin

Hair loss and especially androgenetic alopecia, otherwise known as male pattern hair loss, affects a significantly large proportion of the population. The associated psychological distress that accompanies hair loss of this nature, particularly, in those who suffer the heartache of losing their hair at a young age, can be severe. Treatment for hair loss is widespread and varies from topical solutions containing minoxidil, to oral medication such as finasteride and spirinolactone, low level laser therapy, platelet rich plasma and ultimately to hair transplantation in the form of the strip method or indeed follicular unit extraction. No single method has been shown to be the gold standard and provide long lasting aesthetically pleasing results. Hence, for successful treatment and addressing of hair loss, a combination of methods is essentially mandatory.

At Rejuvence Clinic we consider the treatment of hair loss to be our forte and are unique in bringing to the table new innovative treatment solutions, that have an established evidence base and at an affordable price. We provide numerous solutions for hair loss incorporating platelet rich plasma in combination with unique mesotherapy cocktails that can aid in the cessation of alopecia and help to regenerate hair follicles and reverse hair miniaturisation.

Over the last 5-7 years there has been a suggestion that botulinum toxin maybe a potential adjunct for the treatment of hair loss. Botulinum toxin is widely recognised by many as the gold standard treatment for frown lines and crow’s feet. However, a theory has been coined for the potential beneficial effects of botulinum toxin in the treatment specifically of androgenetic alopecia in men and women.

In 2010 Brian Freund and Marvin Schwartz, based at the Crown Institute, Ontario, Canada, published the preliminary results of a trial in which they treated 50 male subjects suffering with androgenetic alopecia. The males were between 19 and 57 years of age and were suffering with male pattern baldness ranging from grade II to grade IV on the Norwood Classification. They received three treatments over a period of 60 weeks and of the 50 subjects 40 completed the trial. These patients received injections of 150 units of Botox (Allergan) over 30 injectection sites (5 units per site). The injection sites were strategically placed over specific muscles spanning the surface area of the scalp.

Their theory was that by relaxing the muscles of the scalp they would ease muscle tension in the scalp and hence improve the blood supply. Freund and Schwartz drew an analogy of the scalp behaving in many ways like a drum skin. Drum skins are normally wound up very tight in order for them to produce the desired sounds. The tightening occurs at the edges of the drum. In the scalp there are numerous muscle groups situated around the sides of the head that can result in increased muscle tension and tighten the scalp. This is of significance because the main blood supply to the scalp enters from the peripheries i.e. along the sides of the head and from the back. If these muscles are quite tense this may result in increased tension in the scalp and hence a physical pressure and restriction of blood entering the scalp.

Male pattern hair loss has been found to be the result of the conversion of testosterone to dihydrotestosterone, otherwise known as DHT. The conversion of testosterone to DHT is exacerbated in a low oxygen environment. Low oxygen environments are particularly prevalent in regions of poor blood supply. Hence it has been hypothesised that the use of botulinum toxin to relax tensioning muscles wound around the scalp can result in an improved blood supply. Muscle groups concerned include the frontalis, occipitalis and periauricular muscles.

Freund and Schwartz demonstrated a significant increase in hair count amongst the 40 male subjects who completed the trial. They identified an 18% increase in hair count between the start of the trial and week 48 (having completed three treatment sessions). They also identified a significant reduction in hair loss.

More recently Dr Philippe Hamida-Pisal in conjunction with Dr Jan Nel, Dr Michelle Westcott and Pam Cushing published the preliminary results of a new protocol devised for alopecia consisting of a combination of a mesotherapy cocktail and botulinum toxin. Their findings were published in Aesthetics – an online monthly journal for medical aesthetic professionals. Dr Hamida-Pisal’s protocol consisted of mixing 125 units of botulinum toxin with 3ml of Filorga NCTF 135HA mesotherapy cocktail. NCTF 135HA stands for New Cellular Treatment Factor and is a cocktail of 13 vitamins, 23 amino acids, 6 minerals, 6 coenzymes, 5 nucleic acids and 2 reducing agents. This mesotherapy cocktail has been used predominantly for facial rejuvenation.

Dr Hamida-Pisal treated 20 subjects consisting of 5 males and 15 females. All patients taking part in the study had concerns relating to seborrhoea (oily scalp), thin, damaged and dry hair and one suffered from allergies to product dyes. They each received a single treatment with this unique combination of 125 units of botulinum toxin and NCTF 135HA. At weekly intervals, over a period of 4 weeks, they were asked to provide an assessment of the level of hydration, thickness, strength, flexibility and shine of their hair using a scale from 0 (no effect) to 10 (results beyond expectations). All participants in the study recorded significant improvements in all regions of interest and this has prompted Dr Hamida-Pisal and his colleagues to carry out a larger study.

At Rejuvence Clinic we are always looking to provide cutting edge treatments and pride ourselves on providing our clients with upto date treatments with a sound evidence base. We provide a variety of platelet rich plasma (PRP) packages for hair loss and are already combining PRP with NCTF 135HA. We have had excellent results thus far and are now considering also including botulinum toxin therapy in the 1st and 4th PRP sessions included in the Rejuvence Regrow Package for hair loss. For further details and to book a consultation please take a look at our website:


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