Feature Archive

Options Abound for Hair Loss

Hair Not There?

By Jim Morelli
WebMD Feature

Reviewed By Gary Vogin

Surgery, Drugs -- Options Abound for Hair Loss

One New Product Allows You to Sprinkle on Temporary 'Hair'

By Jim Morelli, RPh
WebMD Medical News

They can range from some of the most delicate surgical procedures to some of the most drastic; from microscopic cut-and-paste jobs to scalpings of horrid dimension. They can be expensive, disruptive, and not without pain -- but that doesn't stop thousands of men each year from undergoing hair restoration surgery -- nor numerous transplantation clinics from luring them in.

But be careful what you ask for, advises a dermatologist. "There are a lot of people who think they need transplants but who are not ready or not suitable candidates," says Michael Reed, MD, who performs hair transplants in New York City. "I just had a 22-year-old come in ready for a transplant and he went out with two prescriptions."

Reed's point: Baldness is progressive. Surgery performed today stands a chance of looking ridiculous 10 years down the road -- picture a nice, healthy island of hair sprouting up from a sea of scalp. "We have to plan ahead," Reed says, no pun intended. "You can't just chase baldness around. It's worse to look unnatural than to look bald."

But even good candidates for transplant surgery can get into trouble -- if they choose the wrong doctor. "The first thing I'd try to avoid is anybody who promises to do a whole head in an entire session," says Walter Unger, MD, a New York-based hair transplant specialist. "Although it's possible to get a very nice looking result, there's good evidence that a good number of hairs have died in the process."

This happens for a couple of reasons, Unger says. First, more hair means a longer surgical session -- sometimes up to 12 hours -- and that means more handling of the grafts. They can become damaged in the process. Second, putting more grafts in means more incisions to the scalp -- and that raises the potential for damage to the blood supply.

The safer route: Plan for more than one transplant. "We routinely do 750 to 1,000 grafts per session. But you can't begin to cover an entire bald area and get good density in one session," Unger says.

He also advises consumers to be wary of multiphysician facilities, as well as those that rely on nonmedical go-betweens to discuss the procedure. And what about those splashy hair transplant advertisers? "If your work is really good you don't have to advertise as much as [you do] if your work is bad," he says.

But clearly, for the right candidates at the right facility, hair transplantation can provide dramatic and extremely natural results -- far beyond what it could achieve in its earliest days. Forty years ago, the surgery consisted of replanting fairly large, circular areas of hair follicles from one part of the head to another. These 'plugs,' as they became derisively known, gave a 'planted garden' appearance to the scalp, similar to what might be found on a doll.

Today, a hair transplant done well is a virtual work of art, with the grafts indistinguishable from surrounding hair. A new surgical technique makes it possible. The grafts used in the new procedure are often natural clusters of about one to six hair follicles taken from the man's head and used as a unit during transplantation.

The more populated follicle units -- the ones with about six hairs -- can be found on the back and sides of the head, which is why those areas serve as the main areas for finding "donor" hairs for transplantation. A strip of hair is removed from this area, split up into follicular units under a microscope, and then replanted into the balding area. The donor site, meanwhile, is stitched up leaving only a thin, 'hairline' scar.

Men with small bald spots and plenty of good, thick hair along the side and back of the head are still considered the ideal candidates for transplantation -- but today, they're not the only ones who can be helped.

"Over the years we have been able to take some candidates who weren't ideal and make them candidates for some kind of replacement surgery," says Daniel Rousso, MD, president of the International Society of Hair Restoration Surgery and a practicing cosmetic surgeon in Birmingham, Ala. "We're finding more and more patients are good candidates. Rarely do you find someone who's not a good candidate for something."

That "something" could mean a standard transplant or a procedure that's a bit more drastic, such as the "scalp reduction."

"You basically remove the area of balding on top of the scalp, then you slide or advance the good thick hair [from the side] to the top," Rousso says. Sometimes doctors will first "stretch" the area to be moved by implanting a balloon under the skin, then complete the operation about two months later.