Hair-Raising Scenarios

A critical look at current treatments for baldness.

Why would anyone in his right mind have hundreds of tiny surgical incisions made in his scalp to treat a nonmedical condition, and pay up to $20,000—unreimbursed by health insurance—for the privilege? Or take a prescription-only pill every day that could, as only one side effect, diminish libido and sexual function? Or slather on a topical medicine that shows mixed results and can cause skin irritation? The answer is baldness, a benign affliction that promotes a billion-dollar-a-year industry in all manner of ineffective lotions, vitamins, food supplements, gums, glues, dyes, and devices.

The medical condition known as alopecia may not carry any serious health risks, but the search for new cures and remedies—some of them actually promising—rivets the attention of 60 million affected Americans: 40 million men and 20 million women. Whether this is rational or not is almost beside the point: For the sufferer, the loss of hair often goes hand in hand with anxiety, self-consciousness, and even a loss of self-confidence. What is on top of the head becomes inextricably linked to what's inside it.

A recent report in the journal American Family Physician noted that "patient concerns about balding should be taken seriously as half of balding patients have psychological [difficulty with their condition]." A nationwide survey done in 1998 by Roper Starch Worldwide (and funded by one of the pharmaceutical companies with a deep interest in the subject) proved that unexpected hair loss at any age can have adverse effects on emotional well-being. The survey found that single, balding men regarded hair as the most important factor in their appearance. Three-fourths of both single and married men, regardless of their hair status, believed that hair loss would have an unfavorable effect on a woman's opinion of them. The poet Ovid foresaw such an attitude when he wrote in, The Art of Love, "Ugly are hornless bulls, a field without grass is an eyesore/So is a tree without leaves, so is a head without hair." Ouch.

Dr. Ken Washenik, who is director of dermatopharmacology at New York University Medical Center, puts it in less poetic terms: "It probably represents aging. I think our concept of a bald person is of an older person. I think anything that reminds us in a mirror every day of the inevitability of aging is less than optimal."

Anyone who has experienced a twinge of dread at the sight of tangled strands of his locks caught in the shower drain doesn't need to be told that hair loss is less than optimal. The question is whether anything can be effectively done about it. Is the age-old quest a waste of time and money, or is there hair in there somewhere, waiting to be stimulated to regrow?

William Shakespeare—who might have known hair loss from personal experience—took a very dim view of baldness remedies. "There's no time for a man to recover his hair that grows bald by nature," he lamented in The Comedy of Errors. The bard, who is usually depicted with a high forehead, set-back hairline, and hair that may well have been a wig, was correct about nature's involvement in the disappearance of what was once a healthy head of hair.

Heredity is by far the greatest factor in baldness for both men and women (though the sexes have different patterns of hair loss), and is responsible for 95 percent of all hair loss. A tendency toward baldness on either the mother's or father's side can cause hair to thin in men, while female-pattern baldness may be passed down from mother to daughter. (This should not be confused with the shedding of 50 to 150 hairs a day, a normal process that is part of the genetically programmed hair-growth cycle in humans.)

Contrary to popular myth, we do not go bald from wearing hats or because of dandruff or shampooing healthy hair. And while a severe allergic reaction to dye, blow-dryers on a hot setting, or rough handling can affect the follicles and sometimes even cause temporary or permanent hair loss, hair generally can take the bulk of the punishment we give it.

As for the nonhereditary factors that account for the other five percent of hair loss, beware of megadoses of vitamins A and E and crash diets (especially those low in protein). There are also medical conditions that cause hair loss, such as iron deficiency, diabetes, high fever, thyroid problems, anorexia and bulimia, malnutrition, anticancer radiation and chemotherapy, and extreme stress. In women, birth-control pills and childbirth have also been implicated.

But as bad as all that sounds, Shakespeare missed a follicle or two when he stated that none of us can get our hair back. Some of us surely can. It's true that baldness cannot be "cured," and any product on the market that claims to do so—or which claims to promote hair growth with food supplements, vitamins, shampoos, and daily scalp massage—is long on hype and short, to say the least, on results. There is, nevertheless, ample reason for those suffering from hair loss to take heart.

Some of the more publicized recent work in reversing hair loss still qualifies as pie-in-the-sky optimism, such as gene therapy experiments with laboratory mice to coax dormant hair follicles into growing (see Growing Optimism), and talk of cloning hair follicles. But a few approaches are effective for many people.

The best of the hair-raisers are state-of-the-art hair-micrografting techniques that mimic a natural look, something that the clumsy earlier hair transplants could not. Next best are two drugs (the only ones approved by the U.S. Food and Drug Administration): Minoxidil, sold under the brand name Rogaine, is a topical over-the-counter medication that is massaged into the scalp, while finasteride, sold as Propecia, is orally administered and available by prescription only. Both can and do grow hair, and they may also prevent some hair loss.

It is no overstatement to say that these three approaches are the only ones, aside from a hairpiece, that candidates for hair-restorative treatment should consider, at least until some of the score or more of drugs under investigation prove to be effective. Cortisone pills or injections are sometimes effective for patchy hair loss, but pose possible health risks if taken in larger doses to counteract more extensive loss.

Before talking treatments, however, you should consider what you're treating. Hair loss starts in the follicles, saclike structures beneath the skin from which the hairs spring and where nourishment for the hairs' growth is supplied by blood vessels. Some follicles are predetermined to grow long, thick, pigmented hair, like scalp and eyebrow hair; others grow short, fine, nonpigmented vellus hair, the kind that covers most of the body and is not visible to the naked eye.

The hairs themselves are really appendages of the skin, like fingernails, and are composed of keratinized cells. The strands are formed from dying cells that are wound into a hardened, ropelike fiber. (Hair color is caused by pigment-forming cells called melanocytes; when these stop supplying the biological dye, hair turns gray.)

The average head sprouts 100,000 to 150,000 hairs, each of which grows in an independent cycle. Some 85 to 90 percent of the hairs are in a growth phase at any given time, a period that lasts four or five years for each strand. Your head hair grows about a half-inch to an inch a month, and when growth ends, the follicles go into a resting phase, after which hair is shed naturally and replaced.

Unlike other animals (dogs and cats, for example) who shed seasonally because their follicles are all on the same biological schedule, we shed slowly and continually, often without it being noticeable, because only 10 to 15 percent of the hair is in a resting phase at any one time, and it falls out at random. But if the hair loss exceeds that 100 to 150 hairs a day, or begins early in life—some 25 percent of men begin balding by age 30, two-thirds by age 60—the swath that it cuts through afflicted coiffures will be severer still.

In any event, by age 50 almost everyone loses approximately half the hair they had as children. "You might not see bald spots," dermatologist John Wolf of Baylor College of Medicine reports, "but your hair will be sparser and your scalp more visible."

It is especially visible in men. While female-pattern baldness tends to result in a more diffuse thinning on top, the hairline is left intact. Male-pattern baldness, on the other hand, is characterized by a receding hairline at the forehead, copious fallout from the crown, and generally a monklike fringe encircling the sides and back of the head. Precisely what programs top hair to fall out and the rest to stay put still baffles scientists. And while that may not make many men joyous, it does provide the basis for hair transplants—which relocate hairs from growing sites to barren ones.

The culprit in both male- and female-pattern baldness is a combination of genetic factors, age, and hormones, notably the male androgen testosterone. Ironically, it's an excess of testosterone, not an absence of it, that promotes baldness.

What happens beneath the skin centers on an enzyme, 5 alpha-reductase, which converts testosterone to the metabolite DHT (dihydroxytestosterone), which in turn can shrink the size of genetically susceptible hair follicles in the scalp. Consequently, the hair strands become shorter and thinner and, as the growth cycle slows, the follicles become inactive and more and more hairs are shed. The end result is baldness.

So how do the best hair-restoration treatments cope with the complex molecular machinations that are going on at the follicle level? What kind of success can you expect if you opt for one of the recommended approaches to hair recovery?

First, remember that nothing you or anyone else can do to the hair shaft once it emerges from the surface of the scalp will influence hair growth. If it's going to fall out it's going to do just that, and if it's going to grow, it will do so according to its own timetable. Also, accept the fact that no matter which of the three treatments you choose, the results won't necessarily match your ideal.

Each of the treatments works in its own way, and since everyone is different, both in goals and in suitability for a given approach, results vary widely. Rogaine from Upjohn, originally used in treating high blood pressure, works by partially enlarging miniaturized follicles, thereby reversing the shrinking process and prolonging the growth phase of the hair cycle. With more follicles in the growth phase at the same time, it's possible to get improved coverage of the scalp.

Studies dating back to the late 1980s show that Rogaine could grow hair of moderate to dense thickness in half the patients. Put differently, results may be spotty, ranging from good growth on a few people to baby hair on others, and up to six months might have to pass before any difference is noticed. Younger men with small bald areas who start using the drug early may see better progress, and though it will never give you back all of what you once sprouted, there might be enough to comb over a bald spot or mix into existing hair.

Propecia, developed by Merck & Co., was originally approved (as Proscar) for the treatment of enlarged prostates in 1992, but raised researchers' eyebrows when it also appeared to grow hair in some balding prostate patients. Propecia recently received media attention when Merck announced that it would donate funds to charities selected by baseball players, with $25,000 going to the charity chosen by the player who grows the most hair. The jocks hoping to grow locks include Sandy Alomar Jr. of the Cleveland Indians, John Smoltz of the Atlanta Braves and Bret Saberhagen of the Boston Red Sox.

Propecia apparently inhibits 5 alpha-reductase and lowers DHT in bald scalps to a degree comparable to baseline levels in hair-containing scalps. Clinical studies in men with mild to moderate hair loss indicated that some 80 percent treated with the drug experienced a slowing of hair loss, while 60 percent showed some new hair growth. Like Rogaine, Propecia doesn't give you the coverage of a full hairpiece, but in some instances it may be preferable to the shiny alternative.

Hair transplants, when you come down to the thick and thin of it, seem to be the surest way to go. It wasn't always so. "In the early days," remarked Dr. David Narins of White Plains, New York, one of the nation's leading practitioners, "you could spot the guy with the transplant across the room. The grafts were large and placed far apart. There were rows of grafts and empty spaces in between. It looked like a hairbrush rather than naturally growing hair. Patients with scalp reduction surgery often ended up with visible scars."

Those early transplants were not the most subtle operations. One procedure cut strips of hair from one part of the head and transplanted them into the balding scalp, with results that looked like a cheap mail-order hairpiece. Or large, round donor "plugs" which held seven to 10 hairs were punched out of one part of the head with a tubelike gizmo, then stuffed into matching holes dug out of the scalp—a technique that in many cases created the appearance of unsightly cornrows.

Over the years, imaginative surgeons, eager to bring solace to the hairless, began using a "flap" operation, which is somewhat akin to transplanting turf. In one version, a section of bald scalp is sliced out, while a flap of hair-bearing skin, still attached at one end, is lifted. The flap is then swung around into its new position and sewn into place, still tethered to its original blood supply. The method, still in use, had a high rate of complications that included bleeding, scarring, and infection, until improved techniques were developed for assessing flap size and enhancing blood supply. Not to mention the fact that hair often grew in the wrong direction.

Yet another technique, which was banned by the FDA, implanted polyester or acrylic fibers into the scalp—an unsafe and ineffective method known to cause serious infection, skin disease, and even the loss of natural hair. To make matters worse, the implanted hairs fell out or broke off soon after grafting.

Today surgeons perform the job with far less risk, and with a minimum of discomfort for the patient. "Our methods are much more sophisticated now," claims Narins. "We transplant hairs in their naturally growing follicular units, two to four hairs each. Since this is the natural growth pattern, the grafts are indistinguishable from the rest of the patient's hair. There are virtually no complications."

The secret is in improved harvesting techniques that make the most of the staying power of donor areas, and the increasing use of those "follicular units," which afford tremendous flexibility in distributing hair evenly. Working with an operating microscope, a surgeon cuts a rectangular strip of hair-bearing skin, about a third of an inch thick, from the donor fringe area at the back and sides, where hair is genetically insensitive to the balding process. The rationale is that these follicles will behave just as they did in their original site.

Next, with the patient seated in a chair such as the one in your dentist's office, and with the scalp numbed by a local anesthetic, the surgeon makes hundreds of tiny slits, or sometimes needle holes, in the bald areas, drawing surprisingly little blood with his blade. The minuscule units are then cut from the donor strip and implanted into the incisions. Scars from the donor site are covered by the remaining hair, and temporary dressings are applied to the new sites. The procedure can take up to six hours, and care must be taken to ensure that the hairs are all growing in the same direction and not packed in too closely.

Special attention is also paid to the hairline, because it's one of the first things people notice during face-to-face contact. And that zone has to continue to look normal as you grow older. To achieve that, delicate single-hair and two-hair grafts are painstakingly inserted in an irregular pattern to mimic the natural hairline. (Micrografting is particularly suited to women because it allows the placement of grafts in thinning areas without removing potentially long-lasting hairs.)

The length of the entire hair transplant process is determined by the extent of the baldness, the needs of the individual patient, and the fact that there's a limit to how many grafts can be implanted in any area at one time. From start to finish, getting a new head of hair usually takes less than eight months, with the first two sessions scheduled no less than six weeks apart. There may be noticeable results after a single session, but most patients require several to produce the natural look they want. Discomfort is usually limited to the first 24 hours after each session, and patients generally return to their normal activities in one to four days.

Even so, "It's not the same as when your garden pachysandra takes root and spreads all over the place," cautions Narins. "But patients can now enjoy a natural-looking and full head of hair that they can comb, shampoo, style, color, permanently wave, and cut. The hair retains its genetic characteristics and will continue to grow for the rest of one's life."

But because hair transplants alone can't always provide the desired coverage, particularly in patients with extensive forms of baldness, other techniques may be used at the same time. One is scalp reduction, in which portions of the bald scalp are surgically removed and the hair-covered scalp adjacent to them stretched over the opening, thereby expanding areas where hair grows. This also makes for fewer bald areas to transplant and allows for more efficient use of a precious commodity, donor hair. If the scalp is too tight, stretching devices may be used to extend a hair-covered area. Needless to say, the success of stretching depends on the amount of hair that has been lost, and on the elasticity of one's scalp.

It's also important to remember that the amount of coverage one notices is partly dependent on the color and texture of the hair. Coarse, gray, or light-colored hair generally offers a better perception of coverage than fine, dark hair.

Age is ordinarily not an issue. The majority of hair-transplant patients are in their twenties to forties, but a few in their late sixties qualify for this type of restorative surgery, provided they have good hair growth on the back and sides for harvesting. However, age is a consideration if the transplant patient is in the very early stages of pattern baldness; this is so simply because the pattern may progress.

"With a man in his twenties," Narins explains, "I have to consider that he might lose some or most of his hair over a 25-year period. It's difficult to predict what his thinning process might be, so I have to plan with the assumption that he'll be totally bald, and start from there."

As with all surgery, there are some concerns. One is that with some transplants the hair falls out a few weeks later, especially if grafts are placed close together. But, according to the American Society of Plastic Surgeons, such loss is considered quite normal, and new hair growth will resume in another five or six weeks. Whether all of it will grow back is another matter, and some surgeons believe that a 100 percent graft survival probably is not likely.

There's also the important issue of who does the surgery. There are fine practitioners of the art, but also mediocre ones who will be more pleased with the results than you will—and some who should have stuck to the specialty they left to pursue bigger bucks. Hair-restoration groups, clinics, and centers abound, some of them franchised, as evidenced by their advertisements in everything from glitzy promotional brochures and newspaper ads to the Internet.

Unfortunately, hair grafting isn't a board-certified specialty, which means that any qualified surgeon can try his or her hand at it. Dermatologists and plastic surgeons are in the forefront, and the best of them have developed their techniques after extensive extracurricular study that includes specialty training in microsurgery. Their hasty wannabe surgeon counterparts may have learned the trade at a day-long seminar or from a video on transplant techniques.

Given all that, what is the best advice for someone contemplating a hair transplant? First, remember the words of Hippocrates: "Physicians are many in title, but very few in reality." What can help in your decision-making are: seeking referrals from your family doctor; consulting with board-certified dermatologists and plastic and cosmetic surgeons; talking to someone who's had the procedure done by the doctor you're thinking about; and checking with local and state medical boards for complaints filed on a particular doctor's work.

Or maybe, just maybe, you should consider letting sleeping hairs lie. There are plenty of admirable bald men—Yul Brynner, Robert Duvall, Patrick Stewart, Hector Elizondo, and George Foreman among them—who have managed quite well without covering up a shred of a head shy of hair.

It is also worth recalling the wise words of the first-century Roman poet, Martial: "You collect your straggling hairs on either side, endeavoring to conceal the vast expanse of your shining bald pate by locks which still grow on your temples. . . . Be content to seem what you really are, and let the barber shave off the rest of your hair." *



There are three main types of hair loss, notably androgenetic alopecia, which is pattern baldness; alopecia totalis, or total baldness; and alopecia areata, a common disease that usually causes smooth, round bald patches and most often begins in childhood. Three medications are currently available to treat these problems:

Rogaine (minoxidil)
Made by Upjohn, it works by prolonging the hair-growth cycle. First made available in 1988 in a two percent concentration, it is now sold over the counter in a new five percent formula (Rogaine Extra Strength) that has shown better results. It still won't work for everyone, but when it does, hair growth runs the gamut from thin to dense. A liquid, Rogaine must be rubbed into the scalp twice a day, for life, and stops working when treatment is stopped; it costs around $200 to $350 a year. Four months may elapse before any results are seen with the two percent solution. The extra-strength formula, which can reportedly generate 45 percent more hair regrowth than regular Rogaine, should produce results in two months. It's also generally more effective in young men and in those who have only recently started to lose hair. Possible side effects: itchy, dry scalp.

Propecia (finasteride)
A prescription drug taken every day in pill form, Propecia was only recently approved by the FDA to treat male-pattern baldness. (It was previously used for treating enlarged prostates.) Studies have shown it can stop hair loss and/or stimulate new growth in some people. It also has to be taken indefinitely, and costs around $40 to $50 a month. Possible side effects: decreased sexual drive and/or impotence, which disappear when the drug is halted. One drawback: It can result in a falsely low PSA (prostate-specific antigen) test. The drug hasn't yet been approved for women because of fears it might cause birth defects.

Injecting this steroid into bare skin patches is the most common treatment for mild, patchy alopecia areata. The shots are repeated once a month, and if new hair growth occurs, it does so within two months. Few side effects, except for possible weight gain and a few temporary depressions at the injection site. Where hair loss is greater than 50 percent, cortisone pills—much stronger than injections—may be prescribed. The possible side effects of oral cortisone vary—from weight gain to kidney failure. One other drawback: Regrown hair is likely to fall out when the pills are stopped.

Other Drugs Several, in use in Canada and in Europe but not yet in the United States, have been prescribed for www.merck.comalopecia areata. Known generally as topical immunotherapy, the treatment involves chemicals like DPCP, DNCB, and SADBE, potent "contact sensitizers" that produce an allergic rash on the bald area. Through some not fully understood local immune mechanism, the chemicals have reportedly regrown scalp hair within six months in some 40 percent of patients; those who do regrow hair must continue the treatment until the alopecia abates. Side effects include an itchy rash on the scalp.


Growing Optimism

Researchers are carrying on the centuries-old quest to find a cure for baldness, but aside from a few spottily successful drug treatments, the follicles they seek to rejuvenate have stubbornly refused to cooperate. But now, several new avenues of research may change all that.

Recently, scientists at several laboratories have been able to manipulate genes to grow hair follicles in mice and, in one instance, even to grow hair on a woman by transplanting donated scalp cells. In one experiment, at the Weill Medical College of Cornell University, researchers harnessed a gene—vital to the embryonic development of several organs, including hair follicles—to a modified cold virus and injected it into young mice whose hair follicles were then in the resting phase and whose black fur had been dyed blond. The cold virus, as expected, made copies of the gene it carried, and a few days later the new genes directed the growth of substantial tufts of black hair around the injection sites.

Dr. Ronald G. Crystal, who led the Cornell research, said the newly produced hair shafts had normal structure, both microscopically and to the naked eye. Dr. Crystal believes that this approach may be relevant to therapies for hair loss.

In another first, a research team at the University of Chicago got new hair follicles to form in mature mice, a surprising result in that scientists have long believed that follicles arose only during embryonic development. The research—reported in the Howard Hughes Medical Institute Bulletin and titled, rather optimistically, "Move Over, Rogaine?"—involved genetically altering mice so they would carry an extra copy of a gene for a protein that plays a role in follicle development. The result: The mice grew entirely new follicles between the existing hair-growing follicles, making the animals super-furry. There's more here than a remedy for baldness. The findings give scientists a better understanding of how certain benign skin tumors form, according to the report—and they may also suggest a way to create woolier sheep.


Covering It Up

They're called "nonsurgical additions," and they include any hair-bearing device that can be added to existing hair or to the scalp, as well as masking lotions and fiber additives, all of which are designed to create the appearance of a fuller head of hair. Here's a brief description of some of them:

As the FDA characterizes them, "All are not created equal. Just as the transplant is only as good as the surgeon, the hairpiece is only as good as the person creating it and the materials used." They're generally made with human or synthetic hairs that have been implanted one at a time into nylon netting. Costs range from around $300 for partial hair additions like bangs and other "integrated units" to $2,500 and up for a custom-made, fuller look.

All hairpieces have to be anchored, either to the skin or to existing hair. Adhesives, such as two-sided tapes, metal clips, and new waterproof glues, are common. Most are safe, but the American Hair Loss Council says that it's best to have a patch test done first by a dermatologist, especially if you happen to have a history of allergies.

Another method is tunnel grafting: Small skin grafts are taken from a donor site and made into a loop that can be affixed to removable inserts that in turn are attached to a hair addition. Suturing methods, which sew the hairpiece in place, are not recommended due to discomfort, possible infection, and scarring.

Hair Weaves
Hair weaving, which involves stitching a wig into existing hair, is another way of keeping your hairpiece from flying off in a stiff breeze or during a strenuous workout. The technique is dependent on growing hair, so the weave has to be reattached and tightened as the hair grows. There are many variations on the theme, using either synthetic or real hair. So-called braiding hair additions, which are used to add length, involve braiding fibers into existing hair. Hair bonding requires gluing the fibers to existing scalp hair with a hot gun or adhesive. Hair integration hand-knots real or fake hair filaments to a crocheted web, after which existing scalp hair is pulled through the openings.

There is a downside. Hair can fall out if the additions are pulled too tightly, or if they're too heavy. "Also, if a person's natural hair and the addition are not properly cleansed," warns Dr. Zoe Draelos, formerly a dermatologist at the Wake Forest School of Medicine, "scalp diseases like seborrheic dermatitis can occur." Indeed, the scalp under any hairpiece should be washed regularly.

Other Cover-ups
Cosmetic cover-ups are an option as long as you don't get taken in by products that claim to thicken or grow hair. With some products, thickening is simply a waxy, oily, or polymer buildup on hair, an illusion that is not what Mother Nature intended. It's all a matter of electricity. A polymer's positive charge on a hair's negative one sticks the polymers to the hair shaft, which makes it shine and swell—but only for the day.

Other cover-ups are like camouflage paint. A typical masking lotion might tint a bald spot to match surrounding hair color (they come with a color chart) and thicken the hair at the same time. Others might contain hair fibers that bind to existing hair via static electricity, thereby hiding the barren expanse of a balding scalp.

The problem with many of these products is that once you're in the shower, the swimming pool, or a driving rain, they give away your secret. And, as one official of the American Hair Loss Council noted, "Get any closer than twenty feet from an individual, and you're going to see that the head's been spray-painted or covered with powder."


First-Person Account

Guy Chandler's first clue that his treatment had gone awry was lying on the floor in front of him. "It was a clump of my hair—hair that had just been transplanted—and it had fallen out." In a panic, Guy phoned his surgeon. "He wasn't bothered at all," Guy recalled. "Said it was normal, that it would grow back, and all I had to do was just pick it up and push it back in again."

Guy asked that we not use his real name, presumably because, as another hair transplant patient we tried to interview observed, "Asking a man if he's had one is like asking a woman if she's had cosmetic surgery. Don't ask, don't tell."

Guy runs a carpentry business in a New York City suburb. He is 57 and has been plagued with pattern baldness for years. "Hair means a lot to me, and it's normal to want to look good.I do lots of teaching in my trade, adult classes, and standing up there without hair in front of a lot of people made me feel enormously self-conscious. I tried Rogaine for two years and nothing happened. You could say that all it gave me for my head was an ache."

Guy decided on a hair transplant, picked a number out of a newspaper ad, and made an appointment. He never met the doctor whose name was on the door, but was interviewed by a receptionist, and then by the associate surgeon who would do the work. "I saw a lot of 'before' and 'after' photos, but as I recall, we never really talked much about what I could and could not expect, how they'd do the surgery and so on—all the things I suppose I should have asked. I probably made the decision too impulsively."

Guy's grafts took the form of hair plugs, chunks of hair removed from the back and sides of his head and implanted into his balding crown. "He did it the old-fashioned way, as I understand it—punching out the plugs instead of taking a strip, as I gather they do today with this sort of surgery. Anyway, it was when I took the bandages off that some of it fell out. There were a lot of spaces, bloody spots, scabbing, and to say the least, it all looked lousy. I wore a baseball cap for five months because there were red blotches all over my head."

Guy went back for another try, this time with a surgeon who did micrografting. "This man did all of the things that hadn't been done my first time around. He took a detailed medical history, some pre-op diagnostic tests, and he explained every step of the procedure. He also asked me why I wanted it done, and even made me consider whether I should have it done. He talked a lot about whether I'd be happy with just enough hair, and emphasized several times that someone with pattern baldness isn't cured of that with a graft."

The operation itself was "no big deal," Guy recalled. "Local anesthetic, a lot of cuts that I had a sensation were being done, but there was no pain; listening to a lot of music while sitting in the chair for several hours, taking a break now and then. I was back the next day for a follow-up and some touch-up, and there were several back and forth telephone calls over the next few weeks."

Guy opted for a limited treatment, mostly because his donor area was fairly limited. "My son, who's 27, is going through it now, and the doctor says because he's got plenty of curly backup hair he'll end up with a full head when it's over. He'll be paying a lot more than I. My tab was $4,500; I think it's worth it for what's been accomplished. He filled in all the spots, and while I'm no Elvis, it's very passable. Proof of that came recently when one of my students was kidding me and said, "You'd better watch it, you're starting to lose your hair."



Following are listed some of the organizations that interested individuals can contact for further information about hair-restoration techniques, recommended treatments, and references:

American Hair Loss Council
30 Grassy Plain Street, Bethel, CT 86801;
888-873-9719; *

American Academy Of Cosmetic Surgery
401 North Michigan Avenue, Chicago, IL 60611;
312-527-6713 *

American Society For Dermatologic Surgery
930 North Meacham Road, Shaumburg, IL 60173;

American Academy Of Facial Plastic And Reconstructive Surgery
310 South Henry Street, Alexandria, VA 22314;
800-332-3223; *

American Academyof Dermatology
930 North Meacham Road, Shaumburg, IL 60173;
888-862-3376; *

Plastic Surgery Information Service
800-635-0635; *

National Alopecia Areata Foundation
710 C Street, Suite 11, San Rafael, CA 94901;
415-456-4644; *

Joseph Fleischer (Hairpieces)
14 East 38th Street, New York, NY 10016;
212-686-7701 *

Wig America
270 Oyster Point Boulevard, South San Francisco, CA 94080;
650-266-6862. *

John Langone wrote about longevity treatments in the May/June 1999 issue of Departures.