A Hairy Situation: The latest on hair loss and restoration
Illustration by Stephen Sauer
Is there anything that can be done? Triggers for hair loss are often out of our control, with heredity accounting for 98 percent of hair loss cases, says Robert Leonard, M.D., FAACS, founder and chief surgeon of Leonard Hair Transplant Associates in Nashua, which also has offices in Massachusetts and Rhode Island. Hereditary hair loss affects a whopping 50 percent of men and 25 percent of women, Leonard says, and the undesirable genes can come from maternal or paternal sources.
Hair loss can also be chalked up to factors such as medical conditions and trauma, but there are some instances in which we can influence the likelihood of our locks remaining firmly planted in our head. Repeatedly making hair conform to our whims - forcing curly hair to be straight through chemical warfare, for instance - can cause hair to give up the ghost, says Mark DiStefano Sr., M.D., ABHRS, of DiStefano Hair Restoration Centers, located in Bedford and in Massachusetts, Rhode Island, Connecticut and New York. Other beautifying techniques can take their toll as well, such as wearing tight braids and ponytails, or hair extensions, which can be damaging because of the weight they exert on hair, DiStefano says.
Getting it back
Fortunately, even for hair loss sufferers who are balding through no action of their own, there are ways to stop or at least slow the loss and restore missing hair. But don't delay. Male and female pattern hair loss are progressive conditions; if you don't do anything to stop hair loss, it will continue and can add up quickly, especially given that most people don't notice that their hair is thinning until 50 percent of their hair has already fallen out, Leonard says.
Patients should steer clear of "snake oil" hair loss treatments, Leonard says, and stick to the following four:
Rogaine, a minoxidil foam that slows balding in 70 percent of patients and stimulates new growth of hair in 50 percent of patients, Leonard says. It works its magic all over the scalp, he says.
Propecia, a medication in pill form that is FDA-approved for men only, Leonard says, and effective only for hair growth on the back of the head. Propecia stops further hair loss in 83 percent of men and regrows hair 66 percent of the time, he says.
Low-level laser therapy, a relatively new treatment involving clinical units that slows or prevents hair loss in 90 percent of male and female patients and sparks regrowth of hair 50 percent of the time, Leonard says.
Hair transplant surgery, "the gold standard for hair restoration," Leonard says. "Donor" hair is obtained from the sides and lower back of the patient's head, where hair is genetically programmed to grow life-long. Surgery is the only way to gain hair that will grow long, since growth sparked by Rogaine, Propecia and laser therapy will max out at about three-quarters of an inch, Leonard says.
And while transplantation is a permanent solution to hair loss, Rogaine, Propecia and laser treatments are not; they must be continued in order to put the brakes on hair loss, whether the patient has undergone transplant surgery or not - although laser therapy with a clinical unit is complete, for the vast majority of patients, after one year. Patients might be advised to sign up for all three non-surgical methods since each affects hair follicles via a different mechanism, Leonard says. Transplant surgery patients should rely on the non-surgical treatments for maintenance because non-transplanted hair on the top of the head could otherwise continue to thin and fall out, he says.
Some patients balk at the idea of hair transplant surgery, fearing that they will end up with the doll-like, tufted appearance that plagued some transplant recipients in the surgery's earlier days, but today's transplantation methods have evolved drastically, Leonard says. Whereas surgery used to feature "plugs," or transplanting a pencil-eraser sized area consisting of 25-30 hairs, now surgeons plant smaller grafts of one to three hairs very close together, resulting in a more natural look.
More good news: potential side effects are typically not an issue. Laser therapy has no side effects, Leonard says, and itchy, red or scaly skin occurs in only two percent of Rogaine users. Side effects associated with the for-men-only Propecia - decreased erection hardness and sex drive - occur in 0.3 percent of patients, he says.
Like other cosmetic procedures, hair restoration might strike some as an opportunity to fritter away money on vanity. But hair loss can strike a deep emotional chord. "Hair loss goes to a deeper level of self-confidence," Leonard says. "It bothers people terribly," to the point where "it distracts them from living their lives," he says. For women, hair loss can be especially devastating, Leonard says. "People think, 'Well, it's hair. How important is hair?' Hair is very important. People don't feel good about themselves without it," he says.
Hoping for hair
While some people wax and zap to rid themselves of unwanted hair (albeit not usually what's on their scalp), others desperately want hair to grow where it does not, from their eyebrows and eyelashes to sideburns and chest, says Mark DiStefano Sr., M.D., ABHRS, of DiStefano Hair Restoration Centers. Sometimes the desire for more hair is simply the end result of over-plucking; other times it might be part of a transgender patient's efforts to enhance a new look, he says. "Usually everybody who comes in has a story that goes along with why they want to have a [restoration] procedure. They've gotten divorced, they want to get married, they want to look younger for their jobs. Certainly there are burns, injuries and those kinds of things, but the most common case is the average person who just wants to look better."
And then there was none
Some weight loss methods might slim your waist, but be careful that they don't cause your hair to thin as well. "Diet can have a significant effect" on hair, and poor nutrition can trigger hair loss, says Mark DiStefano Sr., M.D,. ABHRS, of DiStefano Hair Restoration Centers. More extreme measures, such as stomach stapling and related procedures, also generally cause hair to fall out at least initially because vitamin stores become depleted. He says, "There's malabsorption as a result of those therapies, and until the body acclimates itself, you can definitely get shedding and loss of hair."Edit Module