You’ve likely heard about botox injections for aesthetic reasons, whether from friends and family, in regards to your favorite reality television stars, or on the news.
But even more than just reducing the appearance of fine lines and wrinkles, botox injections can also be an effective treatment for pattern hair loss.
This article will first introduce a more modern theory of hair loss – the scalp tension theory. It’ll then delve into the use of botox for hair growth, as well as the science behind this latest treatment option.
2 studies showed that botox had very similar hair regrowth results as taking finasteride, but without the potential side effects that are associated with finasteride use.
Warning: Botox for hair is still at an experimental stage and as such we don’t recommend or endorse it. It is not approved by the FDA and is unlikely to ever be so. More research is needed in this area.
By the end of this article you’ll know just how effective botox is for treating male pattern baldness, and if it could be a good option for you and approximately how much it could cost.
An Introduction to Botox for Hair Growth
Botox, also known as Botulinum Toxin (BTX), is an injection prepared from the bacterial toxin botulin (1).
Botox injections are used medically in the treatment of muscular disorders, as well as cosmetically to remove fine lines and wrinkles in the face, neck, and other parts of the body.
In more recent years, botox injections have also been found to possibly treat an unlikely condition: Androgenetic Alopecia (AGA), also known as male-pattern baldness.
To understand how botox injections may induce hair growth, however, you’ll first need to understand the scalp tension theory of hair loss.
Scalp Tension: A New Theory on Pattern Hair Loss
It’s widely believed that the androgen hormone, DHT, is the sole cause of hair loss in men and women with androgenetic alopecia.
But there’s more and more evidence coming to light which suggests that DHT may not play such a large role. In fact, it may not even be a cause of hair loss but, instead, a side effect of the true cause.
So, what’s that “true” cause? Scalp tension.
Let me explain.
According to this theory, the galea muscle (which is connected to the top-layer of skin by a “fibrous rigid subcutaneous layer”) plays a significant role in the progression of pattern balding. This is because the galea muscle is often affected by physical stressors, such as skull bone growth or tensing of the scalp, face, and neck muscles (2, 3).
Interestingly, this muscle rests right where pattern baldness tends to occur. That is, from behind the ears to the hairline and temples.
But what is it about scalp tension that seems to trigger hair loss?
According to researchers, the tension may induce a “pro-inflammatory cascade … which induces TGF-β1 alongside increased androgen activity (5-αR2, DHT, and AR), which furthers TGF-β1 expression in already-inflamed AGA-prone tissues (2).”
TGF-β1, or Transforming Growth Factor Beta 1, actually plays an important role in the hair growth process. But TGF-β has also been shown to increase the activity of an enzyme called alkaline phosphatase which contributes to scalp calcification (4).
With an increased presence of TGF-β and androgens, then, the hair follicles are unable to operate as they should (due to inflammation, lack of blood flow, and calcification) and this leads to hair thinning and loss.
The interesting thing about this model is that it doesn’t reject the idea of genetic predisposition.
It does, however, refute the belief that “AGA-prone follicles are genetically programmed to become sensitive to DHT.”
The scalp tension model also answers a number of questions which the DHT model seems to be unable to answer. These include:
- Why DHT increases in AGA-prone scalp tissues (i.e., DHT is a response to tension-mediated inflammation)
- The mechanisms by which DHT is involved in AGA progression (i.e., DHT is involved in the onset of fibrosis and calcification)
- The pattern of AGA (i.e., AGA progression matches that of where GA-transmitted scalp tension is highest, and progresses as peak tension points change during fibrosis onset)
- Why AGA is observed more often in elderly populations versus young adults (i.e., calcification and fibrosis have had more time to accumulate)
- Why DHT is associated with body and facial hair growth and also AGA-related hair loss (i.e., tension-mediated inflammation induces TGF-β1 and DHT, and remodels tissue in AGA sites – a phenomenon not observed in body and facial hair growth sites)
- Why androgen suppression stops AGA, but does not regrow all hair (i.e.; DHT inhibitors may reduce fibrosis progression in AGA, but do not reverse fibrosis already present)
It’s also worth noting that fibrosis, which occurs as a result of prolonged scalp tension, can lead to poor blood flow to the hair follicles. This may lead to poor delivery of oxygen and nutrients, both of which the follicles need to survive.
Botox for Hair Growth: A Possible Solution for Scalp Tension?
If scalp tension is the true cause of hair loss, then what’s the solution?
As suggested by recent studies on the topic, botox may be a viable treatment option.
But is botox really the answer to scalp tension-induced hair loss? There are quite a few scientists who seem to think so. And botox for hair growth is even a patented idea (5)!
Let’s look more closely on the studies that are currently available.
Study: Treatment of male pattern baldness with botulinum toxin: a pilot study (2010)
One of the first studies on the use of botulinum toxin for the treatment of male-pattern baldness was performed by Canadian researchers in 2010 (6).
Professor Freund, the lead researcher and botox expert, made a discovery when he was injecting his scalp with botox to help with his tension related headaches. He noticed his hair began to regrow.
He then lead the 2010 study which aimed to find out if the same thing would happen across a variety of 50 male patients with stage II to stage IV hair loss on the Norwood/Hamilton scale.
The study was 60 weeks in total, and this included a 12-week baseline period and two 24-week treatment periods.
During the treatment periods, the men were injected with a total of 150 units of BTX A. These injections were divided equally to the frontalis, temporalis, periauricular, and occipitalis scalp muscles.
The study used specified parameters to accurately gauge the efficacy of the treatment. They were 1) change in hair counts in a 2-cm scalp area; 2) changes in hair loss counts collected by lint roller from the subject’s pillow; and 3) patient responses to a questionnaire.
So, what did the results of the study indicate?
A total of 40 patients completed the study. In those 40 patients, mean hair counts increased by 18 percent from baseline to the end of week 60.
(That’s about the same as finasteride, but without the side-effects.)
Even more, hair loss was significantly reduced by an average of 39 percent.
And best of all, the treatment response rate was 75 percent.
So, what did these results look like in real life? Let’s take a look:
As is very clear, the botox injections had a significant positive effect on men with classic pattern hair loss. This includes an increase in mean hair count and a reduction in average size of bald patch.
Study: A pilot study to evaluate effectiveness of botulinum toxin in treatment of androgenetic alopecia in males (2017)
In a more recent study on the use of botox injections for pattern hair loss, the researchers recruited 10 male patients with androgenetic alopecia (7). These patients range anywhere from a stage II to stage IV on the Norwood scale for hair loss (similar to the first study).
In the study, the men were injected with 5 U of botulinum toxin in 30 sites across the scalp for a total of 150 units.
To determine the efficacy of the treatment, pre-procedure photographs were taken and a professional evaluation was performed.
The photographs and the evaluation were repeated at 24 weeks, which marked the end of the study.
And here’s a visual breakdown of the results, as per photographic assessment, after 24 weeks:
According to the photographic assessment, eight out of 10 patients showed good to excellent responses to the treatment:
As concluded by researchers: “[b]otulinum toxin was found to be safe and effective therapy for the management of androgenetic alopecia in this pilot study.”
To learn more about the study, and to see before and after photos, please go here.
Are Botox Injections Approved for Use as a Hair Growth Stimulant?
There is no official FDA approval for the use of botox injections to treat hair loss.
That doesn’t mean, however, that a licensed and knowledgeable medical professional cannot perform the procedure at your request.
Interestingly, a patent application for the use of botulinum toxin to treat hair loss has been filed (5).
The application was first filed in April of 2000 by Marvin Schwartz and Brian Jeffrey Freund. These are actually the lead researchers from the 2010 study outlined above.
The application was then officially granted in October of 2010.
In the patent filing, the two researchers describe their recommended method for botox injections as a treatment for hair loss.
More specifically, they recommend “approximately 0.1 ml of botulinum toxin diluted to 10 units per 0.1 ml [injected] in a pattern whereby a radius of 1.5 cm drawn from the center of the injection site overlaps a similar radius of the adjacent injection site.”
How Does Botox Compare to Other Hair Loss Solutions?
There are many hair loss “solutions” on the market that tout themselves as the best option.
The fact is, there is no such thing as a “best” option. But there are some which may treat the issue at a deeper level and, therefore, target it more effectively.
Botox is one such option.
So, how does botox compare to other solutions, such as minoxidil and finasteride?
Minoxidil, more commonly known as Rogaine, is a topical formula that’s applied directly to the scalp.
While its mechanisms for hair growth are still unknown, there are some theories.
Minoxidil was initially developed as a drug to treat hypertension, or high blood pressure.
The way it works is by dilating the blood vessels and, as a result, reducing blood pressure and improving blood flow throughout the body (8).
The drug has also been shown to open potassium channels, so as to deliver potassium to the cells more efficiently (9).
The topical formulation of minoxidil is believed to do the very same things.
So, how does this contribute to hair growth?
I’ve mentioned above that, according to both the DHT model and scalp tension model for hair loss, inflammation can significantly reduce blood flow to the hair follicles. The follicles are then unable to receive the oxygen and nutrients they require.
It’s believed that minoxidil works to increase blood flow even in spite of the follicle miniaturization that occurs during the progression of pattern baldness.
How does botox compare?
Unlike minoxidil, which increases blood flow without treating the underlying issue, botox targets the problem (scalp tension).
The immediate result – increased blood flow to the follicles – is the same.
But botox is better for the scalp and hair in the long run, as it resolves the underlying problem.
Of the drugs that are currently approved by the Food and Drug Administration (FDA) to treat hair loss, there are two. The first of which is minoxidil, and the second is finasteride.
Finasteride, also known as Propecia, is an oral drug that works by inhibiting the enzyme 5-alpha-reductase (10).
5-alpha-reductase is an enzyme that works alongside testosterone to produce the androgen hormone DHT. This is the hormone which is believed to trigger male-pattern baldness, at least according to the DHT theory.
And while finasteride has been shown to slow the progression of hair loss, and even triggers hair growth in some users, it does have its side effects.
DHT, while it’s often demonized by the hair loss community, is actually crucial to many secondary sexual characteristics. This means that inhibiting 5-alpha-reductase and, as a result, reducing DHT levels, can have an impact on sexual performance (11).
Now, let’s compare finasteride to botox.
Just like minoxidil, finasteride treats just a single piece of the problem.
Botox, on the other hand, treats the root cause so as to produce long-term results.
Botox is also advantageous because you don’t need to remember to do it everyday. One visit to the clinic and you’re all done.
Botox would also work very effectively in conjunction with FDA approved drugs like minoxidil and finasteride for even better results.
The main disadvantage with finasteride is that your hair follicles sensitivity to DHT will likely increase with use, so if you ever stop taking it there could be a lot of hair shedding to deal with.
The Advantages and Disadvantages of Botox Injections for Hair Growth
It’s good to know the benefits and risks of any given hair loss treatment. Let’s take a look at the pros and cons of botox injections for hair growth.
The greatest pro to botox injections for hair growth is that it treats the underlying cause of pattern hair loss, which is scalp tension.
This means that you’re unlikely to require other drugs or treatment interventions, and you may even be able to prevent the need for a hair transplant or other such procedure.
The treatment can be combined with other hair growth techniques, including scalp massage and even with the use of a tension-relief device like the Growband. In fact, it’s recommended that you perform these techniques to prevent re-calcification of the scalp due to scalp tension.
An unlikely benefit of botox is a reduction in scalp oil production. This can mean if you struggle with an oily scalp, botox injections may help to reduce sebaceous hyperplasia and similar conditions.
It’s always better to fix something at the root cause. For example, if you have a rash from a shellfish allergy you wouldn’t try and use a cream to deal with the rash, you’d remove the shellfish from your diet.
The same goes for male pattern baldness. By reducing the scalp tension you attack hair loss at the root cause.
One massive advantage is that this is a ‘set it and forget it’ procedure.
That means once you’ve visited the clinic you won’t even need to think about it again.
You don’t have to worry about forgetting to take a pill or use a topical every day.
Chances are, most days you’ll forget you even had it done.
So if you’re one of those people who starts a new hair care regime but has trouble sticking with it for 6 months then botox could be a good option for you, because once it’s done there’s literally nothing else you need to remember to do.
The biggest disadvantage of this method is the price tag of botox.
Botox is a larger investment than many other treatments on the market, including minoxidil and finasteride. But the treatments aren’t needed on a daily basis (like the previously mentioned drugs) and, if budgeted for monthly, they can be affordable.
It will also require a visit to a clinic, not to mention finding the right clinician to do the procedure.
No one enjoys being injected, and this procedure involves injecting in 30 different sites across the scalp. Luckily the needle needed is very small and the intramuscular injections aren’t painful at all.
The entire procedure should take about half an hour.
After that you’ll just need to relax for an hour or so to make sure the botox absorbs into the muscle and that’s it. You’re all done.
It’s important not to get the injection site area not too hot for 2 days after the procedure. This simply means avoiding hot showers on your hair (which you should be avoiding anyway) and avoiding saunas.
Within about 3-5 days the botox starts to take affect, relaxing the muscles, and that lasts for about 3-6 months.
As with any injection, there’s a small risk of infection. However, done correctly, it’s very unlikely there will be any complications.
How Much Would it Cost?
Botox is not cheap.
Cosmetic procedures are known to be expensive and generally involve less botox than is needed in a hair regrowth treatment (because the muscles in the scalp are bigger than those in the face.)
In both studies they used 150 units of Botox.
Now if a clinic purchases Botox directly from the manufacturer (Allergan) they’ll be charged approximately $180 for 100 units of Botox.
So, 150 units would cost around $270.
This is just the cost of the botox though, and doesn’t even include syringes, saline water, or even the cost of the medical professional’s time and clinic overheads.
To make this a commercially viable procedure, clinics would have to charge at least $600 per treatment to cover all the expenses
The good news is that the botox lasts for around 5-6 months, and may have an on-going positive effect due to the muscles in the scalp having atrophed and the scalp tension being reduced.
Durand et al state that there can be “a significant increase in efficacy of botulinum toxin type A over time.”
And that “with repeated treatments of botulinum toxin, duration of response may be increased thus minimizing frequency of reinjection.”
This is good news, as it means overtime the amount of botox needed to relax the muscles by the same amount can be reduced and therefore the cost of each subsequent procedure would go down.
Is Botox for Hair Growth Right for You?
Botox is a promising treatment for MPB due to it working at the root cause, and has been proven similarly as effective as finasteride in studies.
As of yet though, demand from consumers is not high enough for clinics to start offering the procedure.
Most men typically associate botox with wrinkles and facelifts and have been put off because of this.
However, times might be changing as people realise how effective this method can be although further studies are required on this subject to confirm efficacy over a larger swathe of the population.