The Sweet Hair After
Future Hair-Loss Treatments Promise What's not Hair Today will Be Hair Tomorrow.
Today's Hair-Loss Treatments: Drugs continued...
"Two-thirds of men do get acceptable hair growth --
moderate to very good hair growth," Andrew Kaufman, MD, tells WebMD.
Kaufman, a hair-transplant surgeon, is assistant professor of clinical
dermatology at UCLA, and medical director of the Center for Dermatology Care,
Thousand Oaks, Calif.
"Minoxidil definitely has an effect in most men,"
Cotsarelis agrees. "It is not something a bald person would use, but
someone starting to go bald would use it. The goal is to maintain the hair you
The other currently approved drug for hair loss is Propecia
(generic name, finasteride). It works only for men. Why? It keeps the male sex
hormone testosterone from forming its DHT by-product. DHT signals shorten the
growth phase -- and lengthen the rest stage -- of hormone-sensitive
One side effect of Propecia can be loss of libido. But it
usually goes away over time, Cotsarelis says.
Testosterone replacement is becoming popular for men.
Cotsarelis warns that this may accelerate hair loss. Propecia might help -- but
because it prevents testosterone breakdown, it might affect the dose of male
hormone replacement therapy. Cotsarelis warns men taking both Propecia and
testosterone replacement to make sure their doctor carefully monitors their
Many men use both minoxidil and Propecia for maximum effect.
The drugs can also be combined with hair replacement surgery.
"It's possible to take one or the other or both,"
Kaufman says. "But if a person isn't going to use Rogaine twice every day,
or take the Propecia pill once every day, he shouldn't use them."
Why? Once treatment with either minoxidil or Propecia stops,
hair loss resumes -- and any gains soon are lost.
What About Surgery?
One way to combat hair loss is to transplant hair follicles
from the sides and back of the head to the top of the head. This surgery has
evolved over the years, Kaufman says.
"In the late 1980s, the standard of care was to take large
grafts, plugs of 12 to 20 hairs, and implant them," he says. "It would
give either a very good or acceptable result. But some men, as they got older
and lost some more hair, they got that doll's-hair or corn-row phenomenon:
Little poles of hair jutting out."
Today's hair grafts are called follicular unit hair transplants
of one to four hairs, transplanted very close together for a more natural
Another mostly out-of-favor technique is scalp reduction.
"Scalp reduction is to cut balding scalp out and suture the
remaining skin together to reduce the bald area," Kaufman says. "After
several of these, you have a smaller area to transplant. But you leave a scar
that is visible and needs to be transplanted into to be invisible."
Similarly out of fashion are flap-type procedures, where a flap
of hair from a hair-bearing area is partially removed, swung around, and
attached to a frontal area. But this can lead to scarring or death or a portion
of the scalp.
How well do hair transplants work? That depends. It depends on
how much healthy hair a person has available for transplant. And it depends on
a person's expectations.
"The best candidate for hair restoration surgery has had
hair loss for a number of years but has stabilized and is not losing more hair
quickly," Kaufman says. "A person needs to have realistic expectations
of what can be done to give them a natural appearing hair line."
Although most people who seek hair replacement surgery are men,
Kaufman says women make excellent candidates.