Hair Replacement: The Next Generation
Coming soon to a scalp near you?
By Denise Mann
Reviewed By Brunilda Nazario
Today's options for hair growth have gone through a major evolution since 1952 when hair transplantation surgery was first pioneered.
Treatments have shifted from unnatural-looking transplants to sophisticated new drugs and improvements in hair transplant surgery, and cloning individual hair cells. David Orentreich, MD, a professor of dermatology at Mount Sinai School of Medicine in New York City, and others who specialize in the field of hair restoration say that the future looks even brighter than the present. Orentreich's father Norman first pioneered hair transplantation surgery.
"I started practicing in 1984 and hair transplant surgery has changed completely since then too -- from large to small grafts," says Orentreich. "The large-graft technique was state-of-the-art back then," he says.
According to estimates form the U.S. Food and Drug Administration (FDA), 40 million men and 20 million women experience hair loss. In 2003, 31,737 people, 88% of them men, underwent hair transplants; up 9% from 2002, according to statistics from the American Society of Plastic Surgeons.
"The history of hair transplantation is not much different than that of cardiac surgery," he says. "First there was the coronary bypass surgery and hundreds then thousands of doctors started doing them and pretty soon the operation evolves and moves forward," he says.
To perform a hair transplant, surgeons such as Orentriech obtain skin grafts with hair follicles from places on the scalp that are still growing hair (typically the back or side of the head) and transplant them into the balding areas where it will continue to grow. Today, surgeons use smaller grafts which contain anywhere from one to five hair follicles per graft; this helps give the scalp a more natural appearance. By contrast the larger grafts had 15-20 hair follicles; they looked artificial with the appearance of rows of hairs. These are known as hair plugs.
Small or micrografts are also called follicular grafts and "look better, heal faster, and involve much less discomfort," Orentreich tells WebMD.
In the case of hair transplantation, going from large grafts of hair to small grafts "was the watershed that made this procedure so much more natural and because of this, more people doing better transplants today," he says.The Evolution Continues
"Hair transplantations have continued to evolve into smaller and smaller grafts and the next step will be to add a cell-based transplant where you can inject hair seeds into the balding area that can grow into a brand new follicle," predicts Ken Washenik, MD, PhD, the medical director of Bosley, a hair restoration practice.
In essence, this is cloning.
"Within five years, we should be able to augment and add this to the follicle-based transplant," says Washenik, who is also a researcher at the New York University School of Medicine in New York City.
"Cloning has certainly become possible in other areas, so it is very possible that there will come a time when hair can be cloned," Orentreich says.
"If we can get cloning to work that would give us the best ability to restore hair," says New York City dermatologist Bruce Katz, MD, director of the Juva Skin and Laser Center. He says it would deliver the best results, physically and cosmetically.
The Magic Bullet?
A magic elixir to treat baldness "may not be that far off if we extrapolate from existing drugs like Propecia and keep going," Orentreich says. "I am pretty confident that with further work, a medication will come along that will be so good and safe that we will be doing fewer transplants."
Finasteride (Propecia) was developed to treat an enlarged prostate and later was found to be effective in hair loss in men. It is prescribed under the names Propecia or Proscar.
"It's OK, but not so good that all men who take the drug will grow their hair back, but it's excellent if you start to use it when you first notice thinning hair," Orentreich says.
Propecia works by lowering the level of a hormone called DHT (dihydrotestosterone) in the hair follicle, a male hormone linked to hair loss. Like Propecia, another drug Avodart, was also designed to treat enlargement of the prostate by blocking DHT and may help treat hair loss.
"Sooner or later, there will be a fabulous drug which blocks DHT that will be able to prevent hair loss and we will see a much greater number of men grow their hair back," Orentreich predicts.
May the Force Be With You?
Light or laser therapy may also play a role in hair restoration of the future, says David Michaels, managing director and developer of HairMax Lasercomb, a comb that emits light energy to help stimulate hair to grow. Michaels is currently in the process of submitting further data to the FDA for approval and hopes to get clearance within a year.
In clinical studies, people who used the comb three times per week for five to 10 minutes per time saw hair growth on average of 93% within four months.
"A laser or light source can stimulate follicle to grow again and produce healthy hair," says Katz, who has no affiliation with the laser comb.
Published June 22, 2004.
SOURCES: David Orentreich's, MD, Orientreich Medical Group, New York City. Ken Washenik, MD, PhD, medical director, Bosley group, New York City. Bruce Katz, MD, dermatologist, director, Juva Skin and Laser Center. David Michaels, managing director and developer, Lasercomb.
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