Every year, more than 33 million men and 22 million women in America have that "Uh oh" moment while looking in the mirror. Maybe they've already noticed more hair than usual on their combs, or the texture of their hair seems to be changing. But then comes that day when they can't ignore the signs any longer. They see their scalp peeking through, and they realize with a shock, "I'm going bald."
When that happens, the first thing they do is start paying more attention to the ads and TV commercials about hair loss treatment: shampoos, chemicals, even things like laser combs.
"I feel bad for those people," says Dr. Thomas Chu, a Memphis dermatologist and member of the American and International Society of Hair Restoration Surgery. "People will spend a fortune on these products, because they feel very self-conscious about their hair loss."
The problem, says Chu, is that most of these gimmicks don't work.
"Salons will often sell deep-cleansing treatments that claim they clean the root, which is what causes hair loss, and that is completely false," he says. "There's also a whole line of products that supposedly contains whale sperm, but it would take an entire aquarium of whales to have an effective amount in shampoo."
Only two nonsurgical treatments work, and not very well. A medicine called Propecia was developed to treat benign prostate enlargement, and patients reported an interesting side effect: It caused hair growth. A few years later, similar results were reported for the blood-pressure medication minoxidil, now marketed under the brand name Rogaine.
"I trained in internal medicine," says Chu, "and we used to reserve minoxidil for patients with malignant hypertension, because whether you gave it to men or women, it caused hair to grow everywhere. It turned them into werewolves."
Eventually, the pharmaceutical company Upjohn realized it could make millions promoting a diluted (usually 2 percent) version of this medication for hair loss.
But do these medicines work? It depends on the patient's genetics, hair texture, and many other factors.
"Propecia is effective in about 30 to 40 percent of patients, but it won't grow a full head of hair," says Chu. "Rogaine will keep what hair you have, to some degree in some people, but any new hair will be very fine — like peach fuzz. In most people, it doesn't make any appreciable change."
Another problem with the medications is the cost — $3 a day — and patients have to continue them for the rest of their lives, or the hair loss will recur.
A more permanent treatment is hair restoration surgery — or hair transplants. This process was developed in the 1980s, and the early transplants were very crude because doctors took rather large "plugs" from the scalp and planted them in rows.
"The result looked like baby-doll hair, with clumps here and there," says Chu. "People had hair, but it didn't look very natural."
The other problem was the hairline. "If you look at a patient's forehead," says Chu, "you don't see a straight line, like somebody just drew a marker across it. In reality, everyone has a "fringe line" a half-inch wide, where the hair gradually gets thicker. But with the early hair plugs they would 'build a fence' — and then later fill in the gaps." Today, doctors like Chu have improved the procedure with micro transplantation. Instead of dozens of plugs, he will harvest and then implant as many as 400 to 800 hairs per session in tiny grafts. The technique is now possible thanks to advances made in the surgical tools used.
"Micro hair transplantation is the only method to restore and maintain a natural-appearing frontal hairline," says Chu. "It is effective for patients of any age who are experiencing hereditary hair loss."
It's a very demanding procedure. "Technically you have to do a good job on the harvesting and implantation so the grafts survive," says Chu. "But it also has to do with aesthetics. You have to re-create a hairline that matches the patient's scalp and shape of their face. Otherwise, it doesn't look natural."
And it's not for everyone. People who have lost their hair from medical problems or chemotherapy won't benefit, and doctors can only do so much. "People who are very bald and want a full head of hair are not good candidates," he says.
Finally, Chu warns patients to be cautious about products and services they see on TV, or the hair restoration clinics that have opened up in other cities: "I see people who have gone to these chains, and they have to wear hairpieces just to cover up the scars. If you can't get a good transplant, don't get one at all. You're better off bald."