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Zen Vuong/MEDILL

Male pattern baldness is best if treated before there is a perceivable bald spot.

Hair now, gone tomorrow

by Zen Vuong
Feb 23, 2012

Americans spend about $800 million a year on hair-restoration procedures, according to the International Society of Hair Restoration Surgery.

This number increased by nearly 15 percent between 2004 and 2010, the society reported. Transplants are a growing restoration option.

Dr. Christopher Varona, a hair-transplant specialist, received a follicular-unit extraction in his early 30s. The extracted follicles were transplanted to project his hairline, the Chicago physician said.

“I didn’t like looking like someone else when I looked in the mirror,” said Varona, now 39. A receding hairline or hair-loss pattern “throws the proportions of your face off. I felt like I looked a little older than I was, and I didn’t feel as attractive as I used to,” he said.

Follicular-unit extraction doesn’t require stitches because individual follicular units are harvested from areas such as the base of the head. Hair in this area doesn't suffer the same effects as those in the front, said Dr. Maria Colavincenzo, a dermatologist at Northwestern University’s Feinberg School of Medicine. The harvested hair is divided and then transplanted onto the bald or thinning area.

Chicagoan Bob Fasenmyer, a 53-year-old medical operations director at a hair-transplant center, received his first of four follicular-unit extractions when he was 42 because he had a pronounced receding hairline, he said.

“Over-the-counter products just slow down the process of it falling out, but hair transplants give you healthier, thicker hair. And it remains forever,” Fasenmyer said.

Kathy Smith, the president of Nu/Hart Hair Transplants, said 90 percent of her clients are men. The average hair-transplant session is an outpatient procedure with local anesthesia taking three to four hours, done while the patient is watching a movie, said Smith.

If the patient is young, say a 26-year-old man, he may lose more hair as he ages, so he may need to return for more follicular grafts, she said. A 62-year-old may have stopped progressive hair loss, thus the older man may only have to go in for one treatment, she added.

The industry standard is follicular-unit transfer via dissection from a strip, said Varona, a physician for the Hair Club, a provider for hair-restoration procedures.

“A strip of tissue with intact hair is excised from the donor area and dissected into single grafts under a microscope. These grafts are then placed in the bald or thinning areas,” Varona said.

Transplant patients can expect the area to be dry and scabby for a while, but they may go to work the next day if they have a sedentary job, Varona said. After about two weeks, doctors will remove the stitches. It’ll take about four months for hair to start to grow and about 12 to 16 months before final results are realized, he said.

Even though “strip surgery” will leave a larger linear scarred area, follicular-unit extraction also produces puncture-mark scarring in the donor area, Varona said.

Hair loss happens to both men and women, but men have two Food and Drug Administration-approved pharmaceutical options, whereas women only have one.

The first one for men, finasteride,inhibits dihydrotestosterone, a testosterone metabolite that attaches to hair follicles and shrinks them, making hair wispy, Colavincenzo said.

Women also have testosterone because their ovaries produce it along with estrogen. Baldness affects women differently from men: They generally have overall thinning. Men go through pattern baldness.

The FDA only allows doctors to prescribe finasteride (in brand name products such as Propecia) to their male patients. It is the most popular treatment option among doctors, the International Society of Hair Restoration Surgery reported. But a few men experience side effects such as the inability to have or maintain an erection, lowered libido, and breast tenderness or enlargement.

A topical treatment, minoxidil – it's the main active ingredient in Rogain – dilates blood vessels and works for some people, Colavincenzo said. Women who are not pregnant could use it, but they need to be wary because up to 10 percent of women notice increased facial-hair growth, she said.

Minoxidil could cause hair thickening or growth in some, but it may not work for everyone. It will probably not produce desirable results for people who wait until they have a noticeable bald spot. This option is most effective if used while hair is still in the vellus or newly wispy stage.

“Most of my hair patients are actually female because so much of their identity is tied to their hair,” Colavincenzo said.

Those who stop using the drugs will begin to shed hair in excess, so the monthly expenditure could be a concern for some, she said.

The Food and Drug Administration has also approved low-level laser therapy; however, only a few studies have shown that it might be helpful, Colavincenzo said.

“It’s FDA approved as a device,” she said. “When the FDA approves a medication, it has to prove that it works. For a device, it just has to prove that it’s safe,” she added.

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