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Losing Battles
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When it comes to hair, being thin isn’t in. A dermatologist talks about what works for thinning hair— and what doesn’t
By Dr. E. Kent Taylor
Why do the good guys always have great hair? Prince Charming never has a receding hairline. Barbie is the totally-hair heroine. Thinning on top is reserved for the losers like George Costanza on Seinfeld. Our culture is obsessed with hair and the bad hair day means everything is going wrong. No wonder people get depressed and frustrated when faced with the prospect of losing their hair.
Hair loss is linked to the natural aging process and is caused by two factors – genetic predisposition and the presence of male hormones. Hair genes come from both parents and what you’re born with is what you get. The only physiological way to arrest hair loss, then, at least in the male, is to cease the production of testosterone. With the exception of chemical or physical castration which, needless to say, is not a popular option, there’s not much that will stop testosterone production. Even though it’s the very presence of that manly testosterone that’s responsible for their hair loss, for many men, fading hair is a constant reminder of the loss of youth and attractiveness. And for women, it’s even worse. The cosmetic reality of hair loss can be psychologically damaging. Lots of good options are available but, as with any group of desperate people willing to try anything, snake oil gets lots of customers. Here’s a run-down of what actually works and what just wastes your money.
Shampoos, conditioners and scalp potions
These products can only affect the surface hair shafts and outer follicle. Unfortunately, hair loss happens under the skin and these products have no access. Furthermore, the idea that hair loss is a result of clogged pores, or calcium and/or dead skin build-up, are clearly false. Hair follicles do not ‘breathe’ from the surface of the skin, but instead receive nourishment via nearby, small blood vessels. Blood supply remains strong in a balding area of the scalp – witnessed by the profuse bleeding from a scalp laceration. So, wash and condition as often as you like but don’t expect this to grow your hair.
Drugs
The best known hair restorer is minoxidil 2% solution (Rogaine), a drug that’s been used extensively in North America since 1986. Initially it was found to be effective at growing hair in early balding men and women. However, experience has shown it to be of only moderate use in maintaining a thinning head of hair and then, more so on the back of the male scalp than on the front. Higher concentrations of this drug may produce better results, but unfortunately come with heart-related side effects.
Finasteride (Propecia), a drug used primarily to treat an enlarged prostate, is currently being tested in Canada for its possible role in slowing hair loss. Taken orally, it stops testosterone from acting on the cells of the hair follicle and in initial studies, has shown a mild improvement in slowing down hair loss in genetically prone males. While this drug may prove to have a hair maintenance role, (rather than a hair-growing, restorative one), further research must be conducted to ensure its safety and identify any side effects before it will be released to the public.
Wigs, hairpieces and toupees
Human or artificial hair, attached to cloth on a synthetic base, have been glued, taped, clipped or woven into existing hair for generations. While the quality of wigs has dramatically improved, even so, they wear out and must be replaced regularly. The much advertised, more technologically seductive, so-called hair systems are also tempting customers. What you need to understand is that frequent adjustments must be performed on any hair weave system – often every six to eight weeks – and to produce a natural look, they must be made to appear to age along with the patient. The most difficult area to camouflage with any wig or system is the front hairline. Too often hair pieces end abruptly, making them obvious to the rest of the world. As everyone knows, there’s only one thing worse than a bad hair day and that’s a bad hair-piece day. (Burt Reynolds take note.)
Surgery
Of all the current options, surgical hair replacement has undergone the greatest changes. Surgical hair restoration is really a redistribution of existing hair, rather than the addition of new hair. Micro- and mini-grafting are the most popular techniques today and have replaced the more aggressive surgeries such as scalp flaps and scalp reduction that involve cutting and moving the scalp around.
Pinch or ‘plug’ graft transplantation has been performed successfully in North America since 1959. This process enables redistribution of hair on the male scalp and frequently on the female scalp as well. Aesthetic problems with early transplants included the “doll’s hair” or “toothbrush” effect. Today’s results are better, but the end look may still be less than natural.
Major surgical improvements occurred in the 1990s employing much larger numbers of much smaller grafts. These mini- or micro-grafts provide an undetectable front hairline. Individual hair follicles are genetically programmed to be either sensitive or insensitive to circulating testosterone. In most men, and in some women, insensitive follicles are found in a wreath around the back and sides of the scalp and these insensitive follicles are naturally programmed to live a lifetime. Micro-grafting makes use of the fact that up to one half of these insensitive, or permanent, hair follicles may be removed and transplanted to thinning areas without visible thinning of the donor area.
Interestingly, these transplanted hairs will not grow immediately, but seem to go through a period of shock and don’t increase in length until about two or three months after the transplant. Once they do grow, however, they remain insensitive to testosterone and continue to grow in their new location for a lifetime.
The advantages of mini- and micro-grafting include a very natural hairline, minimal surgery performed under local anesthetic, and lack of detectable scarring. Plus the patient can return to work two to three days following surgery. Some disadvantages include a thinner look than that achieved with a hair weave, the necessity of undergoing two to three sessions, and the inability to cover large areas of bald scalp densely – as the process borrows from a limited donor area on the back and sides of the patient’s own scalp. Because the surgeon is trying to recreate an attractive appearance, the overall results of mini- and micro-grafting can vary greatly depending upon the artistic skill of the transplant surgeon. Also, any potential surgery patient must be healthy and as with all aesthetic procedures, must have realistic expectations of surgery.
While there is currently no perfect method for treating male and female aging hair loss, hope lies in future research. One day we may be able to turn off the gene causing hair loss or even clone a patient’s hair follicles to provide an unlimited supply to transplant. But for today, the best approach to thinning hair is a positive attitude. Bald can be beautiful – just ask Michael Jordan!
— Dr. E. Kent Taylor is a dermatologist specializing in hair replacement in Burlington, Ontario.
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