Options Abound for Hair Loss (cont.)

Then there's the 'flap' procedure. "It's a very efficient operation for certain types of hair loss," Rousso says. "I commonly perform this for patients with hair loss exclusively in the front." Rousso says a 'hotdog-shaped' piece of hairy scalp is loosened and then swung around to the bald area. "If it's designed properly and done properly, the flap is a beautiful operation," he says. "We call it the 'instant hair' operation."

That's to distinguish it from what happens to hair, initially, after transplantation. It falls out, and doesn't return again for about three months. It isn't that the follicles have died -- although there's a chance with any hair transplant procedure that some won't survive -- it's that they've gone into a resting phase.

These days there's little rest for transplant surgeons."[Demand has] really increased. I think the reason for that is we're getting so much better results than we used to," Rousso says.

New grafting techniques are no doubt the major reason, but other advances in transplantation surgery have made it easier to be a patient. "We use lasers to have a less bloody procedure," says Neil S. Sadick, MD. Sadick also points to computer imaging techniques which can, among other things, give the patient a better idea of what a hair transplant can and can't do. He also cites automated devices that assist the physician in placing grafts.

What's to come? "I think you will see, in three to 10 years, cell therapy that will produce unlimited amounts of hair for people," says Unger. It isn't cloning, he says, but rather a technique in which hair-producing germ cells or stem cells are isolated and reproduced.

Of course, surgery isn't the only way for men to get hair. There are some drugs, too. Long-time player minoxidil got a marketing boost when federal regulators approved over-the-counter sales of its 5% solution -- proven in some studies to work far better than the older, 2% product. But it only works for men who are balding on top. Plus, the alcohol solution it's dissolved in can sometimes cause itching.

Propecia, the first oral medication for hair loss, is probably less known for its action on the scalp and more known for its potential action on sex drive. Reed suggests that when it comes to sexual side effects, Propecia may be getting an unfair rap. "The numbers are very, very good. Only 1% to 2% experience a decrease in sexual drive and sexual performance. Of these, greater than 50% will come back to normal [while still on the drug]. There's nothing irreversible."

Because Propecia causes a rise in testosterone levels, Unger is more worried about the possible long-term side effects from the drug. "The younger you are, the more cautious you should be about using this over the long term. You're on this for your life."

At least one drug company is looking at an 'improved' version of Propecia, says John Ertel, editor of the web site Regrowth.com. "The doctors I've talked to said it had really good results ... better than Propecia." The drug is called dutasteride, and is made by the drug company Glaxo Wellcome. No word from Glaxo Wellcome on when, or if, the product might come to market.

Finally, there is an interesting non-drug option tearing up the market: -- electrically charged merino wool fibers sprinkled on as needed. That's the basic recipe behind Toppik, subject of a heavy print advertising campaign. "We wanted to find a simple, inexpensive, low-impact way to improve cosmetic appearance," says Mark Kress, president and CEO of Spencer-Forrest, Inc., maker of the product. "After a lot of research we finally came up with a particular form of keratin protein similar to human hair."

A certain kind of Australian merino wool fit the bill, Kress says. By giving the fibers a positive and negative electrical charge, they bind to existing hair in a strong, but temporary fashion. Toppik will hang on in heavy rain or perspiration -- but don't go swimming on your lunch hour unless you want to reapply it.

Does it look natural? "So much so that a doctor can walk two inches up to your hair and not distinguish where the hair ends [and Toppik begins]," Kress says.


Vital Information:

  • There are many treatment options for men who want to restore hair loss, including surgery, medications, and a sprinkled-on substance that looks like human hair.
  • When opting for surgery, patients should steer away from doctors who promise to do the entire head in one session or facilities that rely on nonmedical go-betweens to discuss the procedure.
  • Those who opt for drug treatments have a wide variety of choices, including minoxidil, an over-the-counter treatment, or Propecia, which is occasionally associated with some adverse sexual side effects.
Originally published April 6, 2000.

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