Hair loss solutions sprout

Plugs are out; drugs add options; future might offer cloning

December 21, 2004

BY JEAN PATTESON
ORLANDO SENTINEL

No more rugs, no more plugs. That's the new mantra of the hair-replacement industry, which has undergone huge changes during the past few years -- and anticipates even more momentous change in the next decade.

Hairpieces are virtually a thing of the past. Much ridiculed hair plugs, which sprout from bald pates like tufts of sawgrass on desert dunes, are being replaced with transplanted hair follicles, for a more natural look. At least one new hair-growth drug is being tested. And within a decade, scientists predict, hair cloning will be a reality.

For Bernie Cylc, a 36-year-old computer programmer from Orlando, Fla., these advances are most welcome.

"I was about 27 when I started losing hair at a rapid rate," says Cylc. "I looked in the mirror, and I looked a lot older than 27. It just wasn't me."

Three years later, balding from his forehead to his crown, he had his first hair transplant. A second followed four years later. Total cost: $14,000.

"I'd do it all over again," says Cylc. "You can't put a price on the confidence I feel now."

In the United States, about 35 million men younger than 50 have discernible hair loss -- and 90 percent of those men say losing their hair bothers them, says Ken Washenik, a dermatologist and medical director at the Bosley Medical Institute, a national hair-restoration company with a consulting office in Orlando.

"You know how they say a woman can never be too rich or too thin? Well, a man can never be too rich or have too much hair on his scalp," says Washenik.

At the local Bosley office, men considering hair transplants range in age from 18 to 84, says Shiba Winston, a senior counselor who explains the procedure to prospective clients.

"They tell me they hate the way they look," she says. "At family gatherings, their relatives tease them. In the boardroom they're distracted because they're sure everyone is staring at their balding heads. They say they're not getting dates because they're losing their hair. If they have young kids, people say, 'Are these your grandkids?' It's devastating for them," says Winston.

As a result, hair restoration has become a big business. Last year, almost 32,000 hair transplants, about 90 percent on men, were performed in the United States, at a cost of almost one-third of a billion dollars, according to the American Society of Plastic Surgeons. That's up from 29,000 in 2002.

And U.S. sales of Propecia, one of the most popular hair-growth medications, totaled $111 million in 2003, up 13 percent from 2002.

Medications such as Propecia and Rogaine, which slow or halt hair loss, are generally effective but only while they're being used, says Washenik.

They're also expensive. A year's prescription of Propecia costs about $600, he says. A new drug called dutasteride, which is expected to be more effective than Propecia, is being tested, he adds, but it probably won't be available for a few more years.

Hair transplantation isn't cheap either. The typical transplant uses 1,000 follicles, at a cost of about $10 per follicle--or $10,000 per transplant.

Though some people may consider hair restoration frivolous or vain, for the man who elects to have the procedure, it's a great confidence booster, says Bob Keating, director of counselors at Bosley.

Of course, if men's expectations are unrealistic, they risk being disappointed, he cautions.

"We can't give them back the hair they had at 16. We explain the benefits and realities. After that, it's up to the patient to decide if it's worth it," he says.

Transplants evolve

The root cause of baldness in men is dihydrotestosterone, or DHT, a byproduct of the male hormone testosterone. DHT speeds up the growth cycle of hair at the temple and crown. As a result, new hair never gets a chance to mature before falling out, and the follicles that produce the hair weaken and die.

However, the hair on the back of the head continues to grow because it is genetically programmed to resist the ravages of DHT.

This prompted scientists to wonder whether hair from the back of the head would survive if transplanted to the front.

The breakthrough came in 1952, when Norman Orentreich, a dermatologist at New York University, transplanted circular plugs of hair-bearing skin from the back of the scalp to the front.

The result wasn't pretty, but it was a start.

Through the years, surgeons transplanted smaller and smaller plugs in more natural, scattershot patterns -- until 1988, when Bobby Limmer, a dermatologist in San Antonio, Texas, showed that individual follicles could be transplanted and grow hairs.

The process is virtually painless, and the risk of serious complications is rare, doctors say. In some cases, there may be minor problems, such as swelling of the forehead for a day or two and numbness of the scalp for about six months. Antibiotics eliminate the minimal risk of infection.

During the procedure, the scalp is numbed using a topical anesthetic such as Novocain. The surgeon removes a strip of follicle-rich skin from the back of the head. Assistants cut the strip into smaller sections, then into individual follicles, each sprouting one to three hairs. The surgeon implants each follicle into a tiny incision in the scalp.

"It felt like someone taking a Bic pen and poking me lightly on the head," recalls Cylc, the Orlando computer programmer.

"It took about six hours. Basically, I was awake the whole time and watching movies. It got a little unpleasant toward the end when I started to feel sick" -- a reaction to the anesthesia, he says. "But they used a different medication the second time, and I was fine."

It took almost a year for his new hair to grow in.

"People who hadn't seen me since before" the transplant "didn't recognize me," Cylc says. "My family was really impressed, especially my father, who pitched in a little money for it. Every time I see him, he still remarks on it."

Cloning hair

The next big step in hair restoration is cloning, says Washenik.

"Right now, there's a limit to the amount of hair a man has left to use for a transplant," he explains. "But if we can take scalp tissue, isolate the follicular stem cells, grow the cells in a matrix, and then inject them back into the scalp of the donor, we'll be able to grow new follicles."

Earlier this year, George Cotsarelis, director of the University of Pennsylvania's hair-and-scalp clinic, reported in the Journal of Biotechnology that the cloning of follicular cells has been successful in mice. The process could be used to generate follicle growth in humans within the next decade, Cotsarelis said.

For now, though, follicular transplants are considered state-of-the-art. And that's good enough for Ricardo Rodriguez, a Web-content producer who plans to undergo hair restoration later this month at Bosley's clinic in Boca Raton, Fla.

"I'm getting thin on top and in the front," says Rodriguez, 33. "I've consulted my wife, and she doesn't have a problem with the way my hair looks. But it bothers me."