09 November 2019
Post pregnancy hair loss and Regenera Activa- One post pregnancy problem that doesn’t get discussed often enough is post pregnancy hair loss. Post pregnancy hair loss is a real problem and is also referred to as post partum telogen effluvium. Statistics estimate that approximately 40-50% women suffer from post partum hair loss1.
In this educational review, I’ll be sharing with you more about hair loss including post pregnancy hair loss/ telogen effluvium- why does it occur and what can be done about it? I’ll also bring you through some of the medical treatments available for female hair loss and share with you about Regenera Activa, a minimally invasive microtransplant hair treatment for hair loss. Read on to learn more about these in this review.
Let’s start with the basics.
The medical term for hair loss is alopecia. The causes of hair loss in males and females usually consist of more than 1 factor alone. An easy way to understand the causes of hair loss is to divide them into two groups: scarring hair loss and non scarring hair loss.
Scarring hair loss is due to causes that damage the hair follicle. This type of hair loss is usually irreversible. In contrast, non-scarring hair loss can be reversible. Some of the causes of non-scarring alopecia include hormone imbalances (e.g. testosterone and estrogen) that may occur after pregnancy; diet lacking in vitamins and minerals; stress, chemotherapy; autoimmune disorders; and constant hair traction.
The most common type of hair loss to afflict males and females is called androgenetic alopecia. In male pattern androgenetic hair loss, the hairline recedes and can form an ‘M’ shape. In female pattern androgenetic hair loss, there is diffuse thinning of the hair. Androgenetic alopecia in both males and females. has been attributed to a combination of genetics, hormones and age.
Now, let’s focus on post pregnancy hair loss aka telogen effluvium.
Some of the key facts of post pregnancy hair loss/ telogen effluvium:
• Post pregnancy hair loss typically occurs 2-3 months after delivery
• Occurs because of changes the levels of hormones in the body after delivery.
• The hair loss occurs in a diffuse pattern i.e. all over the scalp.
• The increased shedding of hair during post partum telogen effluvium is temporary.
• Diet, stress and lack of sleep are some of the factors that can worsen the hair loss with post pregnancy telogen effluvium.
Our hair follicles go through a normal cycle of hair growth which consists primarily of 3 stages: anagen, catagen and telogen.
Anagen is the phase of active hair growth and lasts 2-8 years. The anagen phase determines the length of the strand of the hair. About 90% of our hair is in the anagen phase normally.
Catagen is known as the transitional phase. The catagen phase lasts 4-6 weeks.
The last phase is the telogen phase or the resting phase. During the telogen phase, hair falls out and the hair follicle remains dormant. Approximately 10% of hair is in the telogen phase normally. Hence, losing some hair is normal. Following a period of time, the hair follicle becomes active again and resumes another cycle of anagen, catagen and telogen.
As our hair follicles cycle through these phases in their growth cycle, it is normal to lose between 50 to 100 strands of hair a day.
You might have noticed that during your pregnancy, your regular hair loss was reduced and you had a thicker head of hair. This is because during pregnancy, the level of progesterone increases by approximately nine fold and the levels of estrogen hormones increase by eight fold2. Estrogen has an important role in hair growth by prolonging the phase of hair growth (anagen) and reduces the phase of hair loss (telogen) 2,3.
After delivery, the levels of estrogen fall. This results in the hair in the prolonged growth (anagen) phase to enter their overdue catagen or hair loss phase2,3. Hence, the increased shedding of hair in post pregnancy hair loss seen months after pregnancy.
Studies show that the hair loss with postpartum telogen effluvium is limited to 50% of the scalp hair 3. There are several tests to objectively quantify the hair loss from scalp scans to counting the strands of hair shed with tugging. Speaking from personal experience, when you see the lost strands of hairs and the clumps of hair in the shower gutter; these scenes are enough to remind one of how agonising hair loss can be.
The hair shedding takes 6 months to cease3-5. Hair will regrow but cosmetically significant regrowth can take 12-18 months3.
There isn’t much that you need to do to treat post pregnancy hair loss/ telogen effluvium2.
This increased shedding from the changes in hormone levels after pregnancy will pass even without treatment. However, there are some choices and treatments that encourage hair growth and reduce shedding from post partum telogen effluvium.
Some of the factors that have a positive impact on post pregnancy hair loss/ telogen effluvium:
• Breastfeeding has been shown to increase the growth (anagen) phase2.
• Balanced diet of nutrients is crucial as deficiency of nutrients like vitamins can cause hair loss too3.
Most of the research and data for treatment options was largely based on studies for female hair loss in general, rather than for post pregnancy hair loss/ telogen effluvium specifically. This is likely to be because the hair loss after pregnancy hair loss/ telogen effluvium reverses even without any treatment. Another reason is that some hair loss treatments are not safe for women who are pregnant or lactating, so women who are experiencing post pregnancy hair loss/ telogen effluvium are not included in these studies. This means that short of breastfeeding and having a healthy diet- no other treatment options have been studied for post pregnancy hair loss/ telogen effluvium.
However, I’ll use this review to explain some of the common treatment options in Singapore for female hair loss (including post partum telogen effluvium) that you might have across.
Related post: A Doctor’s Guide to Pregnancy Safe Skincare
One of the most commercially popular supplements for hair loss is Biotin. Biotin is also known as vitamin B7 or vitamin H and can be found in foods like salmon, eggs and sunflower seeds. Though Biotin is very commonly used as a hair growth supplement, definitive data and research to support use of Biotin to treat hair loss is lacking2,5,6.
Nutrafol is a hair growth supplement that contains ingredients such as saw palmetto, Biotin and marine collagen. There are newer nutritional supplements for hair loss such as Viviscal and Nutrafol; both of which are sold in clinics in Singapore.
Nutrafol is an oral pill that consists of a mixture of non-drug ingredients ( ‘Synergen Complex’) such as Biotin and other ingredients like marine collagen, saw palmetto and biocurcumin. Viviscal is another oral supplement that contains marine that aims to prolong the growth phase.
No review on hair loss would be complete without discussing Minoxidil. Minoxidil is a medication that is commonly used to treat hair loss and is available in both oral and topical forms (also called Rogaine). Minoxidil works by prolonging the growth (anagen) phase of the hair cycle. Minoxidil has been shown to be effective for female hair loss and topical minoxidil is the only US FDA approved drug for the treatment of hair loss in women.
Minoxidil is a safe treatment for hair loss. Some of the side effects of Minoxidil such as scalp irritation and headache9. Another drawback of Minoxidil is that it is not to be used during pregnancy and breastfeeding women.
Platelet Rich Plasma (PRP) needs no introduction. Dubbed the ‘vampire facial’, platelet rich plasma (PRP) garnered attention when celebrities like Kim Kardashian shared their bloody faces on Instagram. More recently, Kourtney Kardashian underwent Platelet Rich Plasma (PRP) therapy for her hair loss woes on her reality show, Keeping Up with the Kardashians.
Platelet Rich Plasma (PRP) therapy involves drawing your own blood from a vein; this blood sample is then spun to separate the part of blood that is platelet rich (hence the name, Platelet Rich Plasma). I’ve shared in detail about how Platelet Rich Plasma (PRP) works and the safety concerns and controversies surrounding this treatment in Vampire Facial and Platelet Rich Plasma (PRP).
Essentially, platelets in our blood contain numerous growth factors11. Growth factors are proteins that stimulate the growth of stem cells and other cells in our bodies that help with healing and repair. For hair loss treatments, this Platelet Rich Plasma (PRP) mixture is injected into the scalp. Platelet Rich Plasma (PRP) is sometimes combined together with hair transplant.
The results of Platelet Rich Plasma (PRP) for treatment of female hair loss have shown to be promising. Hair loss decreased and hair thickness increased with Platelet Rich Plasma (PRP) therapy, especially with sequential treatments10. There is relatively little downtime for Platelet Rich Plasma (PRP) injections into the scalp; however, caveat emptor: get it done with a doctor in a clinic. As my blogpost on PRP highlighted, there has been 2 reported cases of HIV transmission in the US just this year after these patients underwent PRP therapy in a spa.
One drawback of Platelet Rich Plasma (PRP) for hair loss treatments is that it lacks a standardised protocol in the international medical community. There is no consensus among doctors globally about the best way to administer Platelet Rich Plasma (PRP) therapy for hair loss. Some doctors advocate monthly injections for three months followed by maintenance every 6 months; while some doctors advocate three monthly injections for best results.
Currently, Platelet Rich Plasma therapy for hair loss is banned in Singapore by the Ministry of Health. Recently in 2018, an alternative treatment to Platelet Rich Plasma (PRP) called Regenera Activa was launched in Singapore. Now, moving along to talking about this novel treatment for hair loss in Singapore!
Moving on to sharing about Regenera Activa, a new minimally invasive treatment that uses the same principles behind Platelet Rich Plasma (PRP) for the treatment of hair loss and hair thinning.
Regenera Activa is a non-surgical treatment for hair loss and hair thinning in females and males. It involves the injections of your own stem cells, progenitor cells and growth factors back into your scalp- hence the name autologous micrografts. These stem cells and progenitor cells are harvested from micrografts extracted from your own scalp.
In our bodies, stem cells have a very important role in cell repair and regeneration to treat damaged, diseased or dead cells. One example is the use of bone marrow transplants to treat leukemia.
In Regenera Activa, micrografts are taken from the scalp, which is rich in adipose tissue. The scalp is a source of stem cells and growth factors. Because of this, Regenera Activa is also referred to as autologous micrograft hair loss treatment; which is far less invasive than hair transplants. During the preparation of the micrografts, growth factors are also released from the grafts to further stimulate hair growth.
The beauty of Regenera Activa is that the micrograft injections can be customised for different patterns and severity of hair loss. In my case of post pregnancy telogium effluvium, my hair loss was greatest over the top and sides of my scalp (frontal and parietal regions), so those regions were where I had the autologous micrografts injected.
Anyway, this might hard to visualise, so allow me to share with you my experience with Regenera Activa for my hair loss.
Trigger warning: you might get squirmy at seeing my scalp and micrografts. If you do, you can skip pass this section of pictures of steps of Regenera Activa to continue reading more about hair loss and an FAQ on Regenera Activa.
Disclosure: My Regenera Activa hair loss treatment was done by Dr Gerard Ee from The Clifford Clinic. He has a detailed write up on Regenera Activa here.
Scalp is disinfected.
Local anaesthesia is infiltrated into the scalp to numb the scalp before extracting the micrografts and injections for Regenera Activa.
Once the scalp is numbed, punch biopsy is done on the scalp to extract micrografts. Each punch biopsy is approximately 2.5mm in diameter. I had 5 biopsies taken.
This is my biopsy site immediately after 5 grafts were taken.
Preparation of the scalp tissue micrograft for Regenera Activa. The scalp tissues were cut into smaller strips.
The prepared scalp tissues are then processed using a device called Regeneracons. The Regeneracons device has received approval from Singapore’s HSA; US’s FDA and European Union’s CE.
After the scalp tissues have been processed by the Regeneracons device, a cell suspension is formed for Regenera Activa. In this cell suspension, the progenitor cells and growth factors have been isolated. This cell suspension is then collected.
The cell suspension is injected into the scalp. The treatments can be optimised for different patterns of hair loss as the cell suspension can be injected into focal areas of the scalp.
The punch biopsies from the scalp contain stem cells or progenitor cells. Progenitor cells are a subtype of stem cells that are programmed to form specialised cells like hair cells, blood vessels…etc.
The stem cells and progenitor cells have to be separated from the biopsy tissues to isolate these cells. The Regeneracons device does just that. The suspension of cells isolated by the Regeneracons device also contains growth factors. Growth factors, as alluded to previously, are proteins that are naturally present in our bodies. They are necessary for the stimulation of cell growth, repair and normal function. Growth factors in the scalp have been shown to aid hair growth as well as improve the outcomes of hair loss treatments such as hair transplants 12,13.
So if I could use an analogy, growth factors are akin to fertilisers in a plantation where the hair grafts or micrografts are the seeds for crops. So hair transplants are similar to planting crops and injection of growth factors or Platelet Rich Plasma (PRP) into the scalp is like providing fertilisers to the scalp for healthier growth of hair.
This, to me, is the advantage of using Regenera Activa- it marries both strengths of providing micrografts and optimising the conditions of the scalp for hair growth. This was one of the reasons why I chose to do this for my post pregnancy hair loss. Of course, treating transient hair loss due to pregnancy is controversial as it reverses itself even without treatment. But dealing with this massive hair fall out made me bite the bullet to look for a treatment that would be effective and safe for breastfeeding. That threw minoxidil and hair loss supplements (e.g. Nutrafol and Viviscal) out of the window for me as these treatments are not recommended for breastfeeding women .
The benefits of Regenera Activa treatment for hair loss are namely 14,15:
• Reduced hair loss
• Increased hair density
These results were shown on patients who had Regenera Activa treatment alone, without hair transplants. The studies that these results were obtained from are based on small studies though. The manufacturers of Regeneracons will tell you that there are at least 6000 cases and counting (at time of me writing this) of satisfied patients, but it’s still a relatively new technology and protocol that needs more validation.
I was still willing to get my post pregnancy hair loss treated with Regenera Activa because I wanted a medical treatment that was safe (I was breastfeeding) and had no downtime. Regenera Activa satisfied these two criteria for me.
According to one of the clinical studies for Regenera Activa, some of the subjects noticed some improvement at the 1 month mark after their treatment15. Some clinics also quote this statistic. Another study shows that results are visibly obvious at 23 weeks14.
Hair grows at a rate of approximately 1cm per month; so I’m somewhat skeptical whether visible results are really appreciable to a patient at the 1 month mark, if you take into account the entire process of kickstarting scalp regeneration. The microscopic changes in the scalp can be seen as early as 1 month after treatment based on these studies so if the results are visible at 23 weeks, that would be plausible.
As far as safety is concerned, Regenera Activa is approved for hair loss treatments almost globally. Secondly, by doing it in a reputable and legitimate clinic by a doctor with sterile and safety protocol observed, the risks of infections and cross contamination is almost negligible.
One of the major concerns with stem cell therapy for hair loss is whether the stem cells or pluripotent cells have been genetically engineered and whether these cells can cause problems like rejections or grow into tumors. The cells and growth factors harvested by Regenera Activa are not in anyway manipulated or genetically engineered; hence there is no risk of genetic modification.
A closer look at the cell suspension for Regenera Activa that was harvested from my scalp micrografts. This mixture contains cells and growth factors that have been isolated. This mixture was injected into my scalp.
Secondly, these cells are autologous-i.e. Your very own cells are injected back into your scalp; so the risk of your immune system rejecting the cells due to incompatibility is negligible.
In my opinion, Regenera Activa is a safer alternative to medications like Minoxidil for breastfeeding mothers. In addition, some of the side effects of these medications include scalp irritation and growth of unwanted facial hair can be bypassed with Regenera Activa.
There is of course the big question of whether Regenera Activa is safe for pregnant and breastfeeding women that is still unanswered. I could not find any safety data for Regenera Activa for pregnant and breastfeeding women.
My take is that since the micrografts and growth factors that are released from your own scalp; there is no manipulation of the cells; and the pluripotent cells and growth factors harvested are injected back into the same scalp- the steps in Regenera Activa are safe in my opinion, even though I was breastfeeding. Since the safety data for this treatment in pregnant and breastfeeding women is lacking, I would advise that you consult with your doctor about your concerns before your hair loss treatment.
Please remember that this educational post does not substitute a formal consultation with your doctor and the opinions and decision to proceed with Regenera Activa are solely my own.
There are no reported side effects for Regenera Activa so far according to the small studies that have been done for this treatment. I would take this with a pinch of salt because any medical treatment has its risks and potential side effects.
Having undergone the Regenera Activa myself, I would say that the major potential complication that can occur is infection, either through contamination of the micrografts during the preparation or infection of the sites of the scalp where the punch biopsies were done. There might be also scarring of the biopsy site where the grafts were taken, especially if these sites became infected or the patient has poor wound healing.
You might recall that in my post on Platelet Rich Plasma and Vampire Facials, I shared a very recent news that two patients in the US contracted HIV after undergoing PRP injections in spa. Moral of the story is this: even though the technology and science of the treatment may be safe, the administration may not be. So it’s best to seek your treatment from doctor/clinic to minimise your risk of complications.
The punch biopsies on the scalp to obtain the grafts were not painful as local anaesthesia was injected to numb that area of the scalp. However, I found that the injections of the micrografts into my scalp to be painful. I’d rate it as 4/10 on the pain scale. Thankfully the injections lasted only for a couple of minutes. The pain was over after that but my scalp felt slightly sore for the rest of the day.
Was the pain worth it? Yes in my opinion and no regrets there for me. For breastfeeding mothers dealing with postpartum hair loss, there are only a few treatment options that are safe. For the record, post pregnancy hair loss reverses by itself without treatment, but I was very upset about my hair loss so I decided to try out Regenera Activa.
There are some key differences between Platelet Rich Plasma (PRP) vs Regenera Activa. First of all, Platelet Rich Plasma (PRP) is a mixture of growth factors obtained from your own blood. Regenera Activa treatment for hair loss consists of growth factors AND micrografts obtained from your own scalp.
The treatment protocols are also different for Regenera Activa and Platelet Rich Plasma (PRP). For Regenera Activa, it is recommended that this treatment is repeatedly yearly. The steps and preparation techniques for Regenera Activa are also standardised. For Platelet Rich Plasma (PRP), although the steps are largely the same across clinics, the precise settings in the preparation differ from institution to institution.
Does this make Regenera Activa better than Platelet Rich Plasma for treating hair loss?
Perhaps so, if we base this argument on the fact Regenera Activa contains micrografts and growth factors versus Platelet Rich Plasma (PRP) contains growth factors alone. There is no study available that compares Platelet Rich Plasma to Regenera Activa for hair loss head to head at this point, so objectively speaking, it’s hard to say if one treatment is better than the other. So far, we don’t have enough data to know whether micrografts or growth factors play a bigger role in hair regeneration and there is a lot of variability in the preparation of Platelet Rich Plasma (PRP), so across different clinics, the amount and concentrations of growth factors in the preparations will differ.
There is no downtime after getting Regenera Activa and injections into my scalp. My hair did not have to be shaved and neither was my scalp swollen or bleeding. My hair was definitely messy from all the cleaning and disinfecting, but nothing a comb through could not fix. I went for my lunch appointment immediately after getting Regenera Activa.
So far, the treatment protocol suggested by the manufacturers of Regenera Activa and most clinics is to repeat the treatment yearly. That is most likely applicable to patients with ongoing hair loss like androgenetic alopecia.
The results of Regenera Activa for hair loss last for 1-3 years. Before and after Regenera Activa for hair loss & my results.
So this is what I look like immediately after getting Regenera Activa done for my post pregnancy hair loss. No bleeding, swelling or bandages. Not as scary as a hair transplant! It’s been about 2.5months since I underwent Regenera Activa. I felt that my hair loss stabilised after about 6 weeks after Regenera Activa treatment and I’m seeing obvious new baby hair growth. It will take at least another 4-6 months more for the hair follicle to grow out to a sizeable length.
The results of my Regenera Activa may be confounded by the natural history of post pregnancy hair loss. Post pregnancy hair loss resolves without treatments 6 months from now my post pregnancy hair loss would have reversed by itself so that would confound results from my Regenera Activa hair loss treatment. This would be about the time that I would see the results of hair growth from Regenera Activa, so there might be some overlap. Honestly, I don’t have a good answer to this question. I’ll be monitoring my results nonetheless and will update this blogpost to show you.
Post pregnancy hair loss/ telogen effluvium is a common condition that affects up to 50% of females after their pregnancy. It usually occurs 2-3 months after delivery. Although post pregnancy hair loss/ telogen effluvium is temporary and typically resolves without treatment in approximately 6 months, the cosmetic and psychological impact can be immense. At least it was significant enough for me to seek treatment.
Two things that you can do to reduce the fallout of post pregnancy hair loss is breastfeeding and having a balanced diet. Not all Nutritional supplements and medications are safe for breastfeeding mothers; so if you’re looking to treat your hair loss, natural, non-medication treatments are a consideration . As I have emphasised throughout this review, post pregnancy hair loss/ telogen effluvium will pass even if you do not get any treatment.
This review on female hair loss has given you an insight and evidence for some of the common treatment options. Regenera Activa is the latest treatment to enter the foray of hair loss in Singapore and is based on the principles of regenerative treatment. This hair loss treatment intrigued me- even though the concept of using micrografts and stem cells is not new, it is one of the first to be approved in Singapore for hair loss.
I hope that you found this educational review useful. Remember that you are not alone if you are experiencing post pregnancy hair loss and that this too will pass!
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15. Microscopic and Histologic Evaluation of the Regenera® Method for the Treatment of Androgenetic Alopecia in a Small Number of Cases. Xavier et al. International Journal of Research Studies in Medical and Health Sciences. Volume 2, Issue 8, 2017, PP 19-22.
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