Novel Combination Scalp Therapy for Androgenetic Alopecia: A Preliminary Retrospective Case Series with an Illustrative Four-Year Case

Background/Objectives: Androgenetic alopecia (AGA) responds only partially to pharmacologic monotherapy. Combination procedural regimens incorporating platelet-rich plasma (PRP), stromal vascular fraction (SVF), and botulinum toxin (BTX) have been reported, but objective quantitative trichoscopic data on multimodal single-session protocols are limited. We retrospectively quantified the trichoscopic response to a four-component single-session scalp procedure used in routine clinical practice. Methods: Fifty-one consecutive AGA patients underwent a single-session procedure combining partial temporalis muscle resection with silicone implantation, negative-pressure scalp stimulation, and BTX, PRP, and SVF injections; 28 completed ≥ 4-month follow-up. Standardized 60× videodermoscopy at five predefined scalp locations was archived for paired quantitative analysis in six patients (30 location pairs, of which 28 were analyzable after excluding two pairs for motion artifact), with one additional patient imaged at four years. Six trichoscopic outcomes were derived by automated image analysis (Otsu thresholding, skeletonization, distance-transform shaft thickness); the primary analysis was performed at the patient level (n = 6) and a supporting analysis at the panel level (n = 28), each using paired Student’s t-tests. Results: In the primary patient-level analysis (n = 6 patients), five of six trichoscopic outcomes improved significantly at 3–4-month follow-up, each with a large effect size: median shaft thickness +54% (p = 0.025), terminal-hair proportion +52% (p = 0.028), vellus-hair proportion −33% (p = 0.011), diameter heterogeneity −14% (p = 0.017), and mean shaft thickness +33% (p = 0.029); hair coverage increased but did not reach statistical significance (+11%, p = 0.125). The supporting panel-level analysis (n = 28 paired panels) was concordant in direction and significant for all six metrics. In a single illustrative case followed for four years (n = 1; exploratory), mean shaft thickness gain (+41%, p = 0.039) and vellus reduction (−36%, p = 0.025) were sustained, while the transient coverage gain at 3–4 months (+38%, p = 0.007) partially receded. Conclusions: In this preliminary case series, the integrative procedure was associated with quantifiable trichoscopic re-thickening rather than gross densification, with sustained shaft-caliber gain at four years in the long-term case. Causal attribution to any single component is not possible from this single-arm design; prospective controlled trials are required.