Laurie began to feel self-conscious about her fine "see-through" hair during high school. By 30, she was having hair extensions sewn into her natural hair. That worked for awhile, but the pressure on existing strands eventually led to bald spots.
"I knew what was in store for me," says Laurie (not her real name), a sales executive in her mid-40s. "My sisters both have thin hair. My mother wears a hairpiece. Baldness is in our family genes."
She spotted a notice for a talk by a dermatologist who specialized in hair transplants for men and women. Laurie skipped the lecture and headed straight for a consult. "Getting a hair transplant had never occurred to me. I didn't even know a woman could have one." Not that a hair transplant seemed like a desirable thing -- all the men she'd ever seen with them looked "so, well, pluggy."
No More "Pluggy" Look
Gone are the days when a hair transplant made a middle-aged scalp look like a field of newly planted corn. New technology and improved surgical techniques are transforming the hair transplant industry.
"Large grafting procedures that gave transplants their plug-like appearance are a thing of the past," says Michael Reed, MD, who has been performing hair transplants at New York University Medical Center's hair clinic since the early 1970s.
The new methods allow for more hairs in each skin graft to be placed between existing hairs, promoting greater hair density, says Reed. At the same time, more precise instrumentation permits surgeons to work faster with less worry about tissue injury. This has turned hair transplants -- one of the most tedious and labor-intensive of cosmetic surgery procedures -- into minor day surgery. A typical session, or "megasession" (as dermatological surgeons call it), lasts two to three hours. Other techniques to reverse hair loss include laser surgery, scalp reduction, and scalp expansion and extension.
Quicker, more effective procedures have made hair transplants a more attractive option for women. In the 1990s, women made up less than 5% of Reed's hair transplant practice. Today, says Reed, an assistant professor of clinical dermatology at New York University School of Medicine, women represent up to 30% of his clients.
Laurie was nervous when she had her first transplant in 1997 but was pleasantly surprised to find the procedure quite painless. "I was given a local anesthetic. It was no worse than the dentist's office. I hardly felt a thing," she says.
Next, her surgeon removed a tiny strip of skin (1 x 1.5 x 12 centimeters) from the back of her scalp, an area of relatively dense hair for even the baldest people called the "donor site." In one session, she was able to have about 400 grafts of skin -- containing two to four hairs each -- redistributed from the back of her head to the front and top. "It took awhile for regrowth, " Laurie says. (Typically, transplanted hair sheds within the first weeks or months and has to grow back). "But within four to six months, I saw a huge difference."
Losing Hair Differently
The best candidates for hair transplants are those who have common male-pattern or female-pattern baldness, a genetic condition. Hair loss also can be caused by variety of factors, including thyroid abnormalities, iron deficiencies, and autoimmune diseases. Childbirth can cause hair loss as well. But the most common reason people lose their hair is heredity. And, contrary to common myth, the trait is not passed from your maternal grandfather. Nor does it skip a generation. The propensity is passed down from all your relatives.
"The more bald people in your family, the greater your chances of going bald. If you look at a family of ten siblings -- there will be variations in amount of hair and its distribution," says James Arnold, MD, a dermatologist and hair transplant specialist in San Jose, California.
Women lose hair differently than men. Where men have bald spots in the front or back of their heads, women tend more toward diffuse thinning. They lose hair gradually, and after awhile, they get that "see-through" scalp of which Laurie complained.
Arnold, who limits his practice exclusively to hair transplants, also treats women. But he has not seen such dramatic increases. Partly, he says, because he hasn't advertised to women. "Women are more challenging to treat than men. Their expectations are higher. You treat a man, he sees he has a little more on top -- maybe he looks a few years younger -- and he's satisfied. Women want thick hair."
Laurie agrees that women may be tougher clients. After all, she's had three transplants. But she says hair transplants may be actually simpler for women because they're better able to hide them. "A woman can easily wear a scarf, and because women's hair is generally longer, it's harder to see the incision." Plus, when new hair comes in, the effect on a woman's scalp is more subtle. "People notice your hair looks better but they're not quite sure why."
A Hair-Raising Price Tag
Nature's cure for baldness isn't cheap. Despite improvements, transplants are still labor-intensive and require the skill of a trained hair transplant surgeon -- whether a dermatologist or plastic surgeon.
"Mega-megasessions" that are capable of delivering 3,000-4,000 grafts (these can take 10 hours and involve the work of several technicians) can cost $10,000 or more. The more typical two-to-three-hour session, where 400-500 grafts are removed, runs about $5,000.
Add in the cost of drugs that augment hair growth. Propecia is routinely prescribed after transplants to prevent further hair loss in cases of male pattern baldness. The drug, which costs about $50 a month, is often combined with extra strength minoxidil, an over-the-counter baldness remedy. (Minoxidil should not be used by women of childbearing age as it can cause abnormalities in the growth and development of a fetus.) Other drugs to treat hair loss include Retin-A for male pattern baldness used in combination with minoxidil or Xandrox, which combine various doses of minoxidil, Retin-A, and azeliaic acid.
Are hair transplants for everyone? "Absolutely not," says Laurie. "But for me, it's been wonderful. It's changed my life. Some people might say, $15,000 -- are you crazy? But you can't imagine what it's like to be able to go into a swimming pool, play water sports, shake your head, and not be embarrassed. I feel so much more comfortable with myself."