Hair Loss

Male Pattern Hair Loss

There are many conditions that contribute to or cause hair loss, but the most common cause, by far, is androgenetic alopecia.

Androgenetic alopecia is hair loss that is caused by a combination of genetics and hormones. It affects both sexes and is responsible for approximately 95 percent of hair loss in men and thinning in women. It starts at puberty, may not be noted for many years, and progresses over many years. The hair loss that is seen on the top of the scalp has basic patterns of loss with individual variations. These were first described by Dr. Hamilton, and then by Dr. O’tar Norwood. The Norwood Classification system is most commonly used to describe “male pattern baldness.” In a Norwood I, there is no indication of hair loss and this progresses to a Norwood VII, which has the most advanced hair loss pattern.


In androgenetic alopecia, hair on the top of the scalp is genetically programmed to thin and die when exposed to the hormone dihydrotestosterone (DHT), which is a breakdown of the natural occurring hormone testosterone. The hair on the sides and the back of the head is genetically programmed to resist the effects of DHT. Transplant surgeons realized early on that hair moved from the back of the scalp to the balding areas would grow indefinitely. This concept, called donor dominance, revolutionized the theory of surgical hair transplantation.

Female Pattern Hair Loss

Female pattern hair loss is relatively common and affects about 40% – 50% of women with some degree of thinning in their lifetime. Female pattern hair loss is different from male pattern loss and tends to be more diffuse. Psychologically, the effects of hair loss for women can be significant and negatively affect their self-confidence in both personal and professional environments.

There are a number of causes of hair loss in women. Most commonly, female pattern hair loss is caused by the actions of two enzymes: aromatase (found predominately in women), and 5-alpha reductase (found in both men and women). In many cases, there is no clear etiology for the hair loss in women and an experienced physician should perform a thorough workup. There are several causes of hair loss in women such as thyroid or iron deficiency, hormone imbalances, gynecologic conditions such as polycystic ovary disease, or stress. In some cases, a scalp biopsy may need to be done for the diagnosis.

The pattern of hair loss in women tends to be more diffuse then men. The Ludwig scale is typically used to classify hair loss patterns in women. Additionally, some women develop significant hair loss in the frontotemporal angles, which limits them from pulling their hair back.


Type I: In this stage, the hair loss is considered mild, and most women have difficulty noticing that the hair loss has occurred. Most of the time, the frontal hairline is unaffected.

Type II: Type II hair loss is considered moderate, and women may notice more pronounced shedding, thinning, and a general decrease in hair volume centrally.

Type III: In this stage, the hair loss is considered significant with hair thinning which is difficult to camouflage. Unfortunately, women with this stage of hair loss may not be good candidates for surgery.

Medical Solutions

Minoxidil (2% and 5%)
Minoxidil was originally used to treat hypertension and found to have beneficial effects on hair growth. When used properly, it has been found to slow down hair loss and strengthen existing hairs. It has been approved by the FDA for hair loss. Minoxidil will not resurrect dead hair follicles, however. Should living follicles be in the dying phase, minoxidil might sustain their lives for several extra months or even years. Once the medication is discontinued, though, its effects will usually disappear within six to twelve months.

Finasteride is an oral medication that was approved by the FDA in 1997 for hair loss in men. Research determined that the hormone, dihydrotestosterone (DHT), causes hair to miniaturize. Finasteride blocks the conversion of testosterone to DHT by inhibiting the enzyme 5 alpha reductase. By limiting the amount of circulating DHT, finasteride has been shown to slow down hair loss, and in some individuals, even stimulate hair growth. Recently, the five-year data was published and finasateride was shown to be quite safe. Only 1-2% of men have had sexual side effects such as decreased libido and erectile dysfunction. A one milligram tablet is taken daily; however, if the medication is stopped, the beneficial effects of finasteride diminish significantly.

Herbal Medications, Shampoo, and Lotions
There are many herbal medications on the market that claim beneficial effects for hair loss. The active ingredients in these medications include minoxidil or other properties that inhibit 5 alpha reductase. Apart from finasteride and minoxidil, however, none of these products is approved by the FDA. They are, therefore, not recommended by the Gabel Hair Restoration Center.

Hair Restoration Surgery
Hair restoration surgery is the only treatment option that can restore a significant amount of real, growing hair to balding areas of the scalp. Dr. Gabel specializes in Follicular Unit Transplantation, one of the most advanced micrografting hair restoration techniques available. This technique makes use of the patient’s own natural hair to create a full, natural looking appearance that will last a lifetime. If you would like to learn more about hair restoration surgery or meet with Dr. Gabel for a free, no obligation consultation, contact Gabel Hair Restoration Center today.

At the Gabel Hair Restoration Center, we are pleased to offer our Portland patients the newest, safest, and most advanced hair loss treatment options. In addition to hair transplant surgery, our patients have access to leading non-surgical hair restoration options like low light laser therapy (LLLT). We are excited to offer LLLT treatment with the Capillus Laser Cap, model Capillus272, a portable laser cap that can be used in the convenience of your own home.

What is the Capillus272™ Laser Cap?

The Capillus272 is a low level laser cap designed to stop hair loss and help regrow hair. The device works well in men and women who suffer with androgenic alopecia. The product is cleared by the U.S. Food and Drug Administration (FDA). Capillus features clinical trials that demonstrate up to 51% increase in hair counts over a placebo device.

Capillus: Easy, Safe, and Effective

Watch the video below as Dr. Gabel explains how hair lasers like the Capillus272 are helping men and women reclaim a youthful head of hair.

“I recommend low light laser therapy—specifically the Capillus system because it is very easy to use, it’s safe for patients, and it has been shown to be effective for the treatment of hair loss. Many patients that we have treated have been very happy with the results of using this system.”

 Why Capillus Laser Hair Therapy?

Patients often ask, Why choose the Capillus system over other laser caps and laser combs? Does laser hair therapy work?  Dr. Gabel explains:
“There are all sorts of devices out there for low light laser therapy. I feel Capillus is one of the better units because it has so many individual lasers. What the studies have shown, is that you have to have a certain amount of energy delivered to the scalp. It is this energy from the lasers that makes it so effective. Since the Capillus unit has over 270 individual lasers, it’s able to deliver that amount of energy to all the areas of the scalp that have hair, which eventually translates into a thicker result [head of hair].”

Do I Need a Physician for LLLT with Capillus?

Products like the Capillus272 hair growth laser are designed to be used at home and on-the-go, but it is important to consult a hair loss professional prior to beginning use. There are many reasons why LLLT treatment should always be guided by an experienced hair restoration surgeon, including the following:

  1. Treatment will begin with a personalized hair loss diagnosis and restoration recommendation. When visiting a physician, each patient receives a personalized evaluation and treatment plan to ensure individual needs and expectations are met. Treatment with Capillus is flexible and convenient, usually consisting of 30 minute sessions a few times each week.
  2. Physicians can help you verify the FDA clearance of your product. Although many products online claim to be “cleared by the FDA,” few actually live up to that promise. Physicians can help verify clearance of your laser cap.  They can provide information on the manufacturer and 501(k) clearance number assigned by the FDA. This ensures both safety and efficacy long before treatment begins.

Not all laser caps are created equally. Patients are cautioned against purchasing any laser helmet or comb online, without the guidance of a medical professional. For more information on verifying the Capillus laser cap authenticity and efficacy, please read the following consumer warning from Capillus (this page will open in a new window).

Learn More About Laser Hair Restoration with Capillus

At the Gabel Hair Restoration Center, our goal is to provide a comprehensive treatment plan in a comfortable, pleasing environment. As an authorized Capillus physician, Dr. Gabel is happy to answer any question you may have about laser hair restoration, at-home treatment, and long-term results.

For more information on laser hair therapy with the Capillus272, please contact our office at 503-693-1118 or visit the following page to complete an Online Consultation Form.


Tricopigmentation is a  technique aimed at mimicking hair in hair-deficient areas. Tricopigmentation involves the placement of tiny amounts of colored pigment to simulate the appearance of newly grown stubble on the head. It requires the use of specialized equipment and pigment to simulate the most natural appearance of hair.

The most highly demanded use for tricopigmentation is to help individuals suffering from pattern baldness (androgenic alopecia) restore the appearance of fullness on their scalp.
Tricopigmentation can be performed to create the following two types of effects:

  1. Shaved effect
  2. Look of improved density

In other words, the procedure may be done to simply render the appearance of having some hair growth on the scalp through a diffused placement of the pigment. Alternatively, tricopigmentation may be performed in thinning areas to help produce the look of fuller density. This would be achieved by creating a greater concentration of pigment points.

Trico Before2

These three photographs illustrate the before (above) and after (below) results of tricopigmentation for a shaved effect.

Trico After2

The technique of tricopigmentation is applicable to almost any degree of hair thinning or loss, and will appear as tiny hair stubble, although a person may have a completely bald head.

Scalp Micropigmentation

Scalp micropigmentation is a non-surgical solution for male and female patients of tattooing the scalp with tiny dots to replicate the natural appearance of the hair shaft or stubble. Using specialized microneedles, tiny deposits of pigment are placed in the dermis layer of the skin to give the appearance of shaven skin.

Scalp micropigmentation is utilized in several circumstances: in patients who desire a shaved, full appearance, this technique can be performed over the entire scalp. In patients who have had prior scalp surgery, scalp micropigmentation is an excellent method to help camouflage the scars. Lastly, in patients who have thinning hair, scalp micropigmentation can be used to “thicken” their appearance instead of using powders to cover the scalp.

Scalp micropigmentation usually requires several sessions to complete, depending upon the amount that needs to be performed. Prior to starting the procedure, the exact area will be marked out and approved by the patient and Dr. Gabel. An ointment is applied to the area to alleviate any pain associated with the tattoo. Using specialized pigments matched to the patient’s own hair color, Dr. Gabel will use microneedles to tattoo the scalp or scar in a random pattern that mimics the patient’s own hair. This process may last only a few minutes for a very small area, or several days for the entire scalp. Once the procedure is finished, Dr. Gabel and his staff will provide a detailed instruction sheet for patients to follow.

These two photographs illustrate the immediate results of scalp micropigmentation into scars in the back of the scalp.

ACell+PRP Injection Therapy

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