Cosmetic Options for Hair Loss

DAVID R. MARKS, MD: If you're losing your hair, there are medications and surgical procedures that can help, but what if they don't work, or what if you just don't want to take drugs or have surgery? If that's you, there are a number of cosmetic options you should know about. Here to tell us about them are two experts.

First is Dr. Neil Sadick. He's a dermatologist and cosmetic surgeon at Weill Cornell Medical College. Next to him his Nicholas Piazza. He designs and styles hair systems here in New York City. Thanks for being here.

DAVID R. MARKS, MD: Dr. Sadick, what are the options, cosmetically speaking, for patients out there?

NEIL SADICK, MD: There are three major cosmetic options that men and women can utilize in terms of hair thinning, and those are basically hair cosmetics, creative styling and hair replacement systems. Those are the three major alternatives that people can utilize.

DAVID R. MARKS, MD: What do those terms actually mean?

NEIL SADICK, MD: Creative hair styling means utilizing the amount of hair that you actually have and having it cover areas that might be thinning or balding. Hair cosmetics are usually semisynthetic dyes that can be applied to the scalp and camouflage areas of thinning or balding scalp. Finally, hair systems are usually wigs, hairpieces that can also create the illusion that one has their own hair.

DAVID R. MARKS, MD: Nick, you deal with wigs and hairpieces a lot, and they've come a long way in the last few years.

NICHOLAS PIAZZA: Yes, they have.

DAVID R. MARKS, MD: What's new about them?

NICHOLAS PIAZZA: The materials that the wigs and hairpieces are made of resemble scalp much more than they used to, and also the methods of putting the hair in make them actually look like they're growing out of the head.

DAVID R. MARKS, MD: Can people tell when a person is wearing one of these hairpieces?

NICHOLAS PIAZZA: There are all different qualities and types of wigs. Some of the less expensive ones, it's possible that you can notice, but really good wigs are virtually impossible to detect.

DAVID R. MARKS, MD: How does someone decide which option they should choose?

NICHOLAS PIAZZA: Sometimes those types of options depend on exactly what the wig is for. If it's for a permanent situation or a long-term situation, it may be worth the investment in a really good wig or hairpiece. If it's a short-term thing or a fun thing, they may not want to spend the money, or it may not be as important to them. Sometimes the types of styles that people have will let them get away with using a much less expensive wig. If someone didn't have a lot of hair to begin with and they want something that doesn't look like a lot of hair, then a custom wig that's hand-made might be the choice that they might make.

DAVID R. MARKS, MD: How do these things actually stay on a person's head?

NICHOLAS PIAZZA: There are several ways. Custom wigs are actually fitted to the head. It's measured to the person's exact head size, and depending on if they have hair, then elastics can be used, and we have little, tiny microclips that clip into very few hairs. That will hold them on. If they don't have hair, there's a two-sided tape that's clear and it's sticky on both sides, and that will keep them on.

We also have, for people that don't want to take them off all the time, methods of bonding and weaving. Weaving is making a cornrow track and actually sewing the piece onto that track. Sometimes the cornrow track can cause problems, so that's not as popular as some of the other methods, the bonding methods that they have out now, where they actually shave some of the existing hair very close and use an adhesive that bonds the piece, and it will stay on for six weeks.

DAVID R. MARKS, MD: A lot of television commercials show these hair replacement systems as if they're permanent -- people swimming, in the wind. Is this reality?

NICHOLAS PIAZZA: In most cases, yes, it's possible with certain types of attachment. For instance, the bonding -- the piece will stay on. You can swim in it. You can go underwater with it. It's fine in the wind.

DAVID R. MARKS, MD: When a patient comes to you, how do you help them decide which way to go?

NEIL SADICK, MD: The best thing we do is to tell patients about all the options that are available, and then with that understanding and discussing their particular problem, we're usually able to make an educated decision, and then able to direct the patient in that modality that will be most effective for their particular problem.

DAVID R. MARKS, MD: Are there any medical complications from some of these procedures? Nick was talking about some of these prosthetics staying on for a long time. Can there be infections and other problems that people should be concerned about?

NEIL SADICK, MD: Certainly, there can be allergic reactions to the adhesives that are applied utilizing various hair replacement systems. In people that have the systems on for long periods of time, if inappropriate washing is performed, there is an increased chance of patients having secondary infection. With the knowledge and education that I'm sure people such as Nicholas give to patients, that's extremely rare, but it's always a concern.

In the past, with utilization of artificial implants, there has been an increased incidence of allergic reactions and infections that have been reported, so I think it's extremely important to go to a reputable person when considering this particular option.

DAVID R. MARKS, MD: But in general, it's safe and effective?

NEIL SADICK, MD: In general, it is safe and effective.

Cosmetic Options for Hair Loss