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Beyond the Comb-Over
To Combat 'Bald Is Beautiful,'
Hair-Loss Industry Pushes
Alternatives to Plugs and Rugs
By CHRISTOPHER WINDHAM
Staff Reporter of THE WALL STREET JOURNAL
These aren't your father's plugs.
After several years of declining business due to everything from ridicule to a new bald chic, the hair-loss industry is aggressively trying to lure back customers.
Hair transplants have been around since the 1930s, but to many people they have become a clear case of the cure being worse than the affliction. Plugs, for example, the standard procedure for decades, tend to result in a scalp that looks like a toothbrush.
Now hair-transplant doctors are pushing an alternative to plugs that is supposed to look far more natural, even undetectable. The newer procedure is thousands of dollars cheaper than plugs and requires fewer trips to the surgeon. Doctors are also experimenting with other innovations -- some of them unproven -- including various laser treatments that are supposed to make hair thicker and shinier. There's even an increasingly popular (albeit expensive) way of anchoring toupees. Finally, plagued by both the languid economy and the specter of numerous studly bald guys -- Michael Jordan, Vin Diesel and Bruce Willis to name a few -- many doctors are cutting their prices on some treatments.
About 70 million people in the U.S., most of them men, are either bald or losing their hair, according to the American Hair Loss Council. But the number of hair transplants being performed is plunging. A survey of 2,100 members of the American Society for Aesthetic Plastic Surgery found that they did 18,120 hair-transplant surgeries last year, down from 61,023 procedures in 1997.
"The economy is certainly hurting us," says Mark DiStefano, a hair-restoration surgeon from Worchester, Mass. After all, transplants cost thousands of dollars, and, because they're cosmetic, are never covered by insurance.
The alternative to plugs, known as follicular unit transplantation, involves the removal of a thin strip of hair from an area of the scalp, usually the back, which is then dissected into thousands of individual grafts and transplanted to the balding area of the head. The result is far less tufty than plugs, which involve transferring small pieces of hair-bearing skin from the back and sides of the head to balding areas.
"Nobody notices," says Joe Demello, who has paid about $7,000 for two follicular unit transplant surgeries and other hair-loss treatments in the past two years. "It's real hair. My kids can even pull on it." Mr. Demello, a 39-year-old small-business owner in Providence, R.I., says he considered hair-transplant surgery when he began losing hair in the early 1990s but declined because the plug technique seemed "scary."
Developed in 1988 but rarely used until the late 1990s, the follicular unit transplant has now become the standard of the industry. According to an annual survey conducted in September by the International Society of Hair Restoration Surgery, 94% of the 121 members polled said they use follicular unit grafts. Only 15% reported using the traditional plug grafts.
UNPLUGGED
This alternative to much-ridiculed 'plugs,' called follicular unit transplantation, is considered more natural-looking.
Before
After
? See a list of the most popular hair-replacement techniques and products.
Follicular unit transplants typically cost $5,000 to $8,000, but can range as low as $3,000 in rural areas to $18,000 in vanity states, such as California. In many cases, the new procedure can be less expensive than older plug techniques, which can cost $8,000 to $20,000 depending on the size of the area to be covered. Plug procedures usually require between three and 10 surgeries to finish, while the follicular unit approach generally involves two operations.
Prices could go even lower. To fight off competition, Blaine Lehr, a hair-transplant surgeon in Oklahoma City, slashed his fees by 25% this year, to about $6,000 for a follicular unit transplant. Nevertheless, his business is down to just 16 surgeries a month from 1997, when 35 surgeries were the norm each month.
In addition to the new approach to transplants, some doctors are using low-level laser therapy to try to thicken hair that's already there. Advocates say the technology can combat hair loss by rehabilitating weakened hair follicles and stimulating new hair growth. The Food and Drug Administration has approved laser therapy for cosmetic use (basically for making hair look thicker) but not for helping hair grow. Nevertheless, doctors can legally use it to help stimulate hair growth if they have evidence that it can work.
Laser therapy is now offered by a growing number of hair-restoration surgeons in the U.S. Robert Leonard started using it last year and now treats more than 300 patients with the laser therapy at his four hair-loss clinics in Massachusetts and Rhode Island. He says he uses it primarily on patients seeking to stop the progression of hair loss and those who want to enhance a recent hair transplant. He says the laser helps produce faster results. "The most difficult part of a transplant is waiting for something to happen."
During the procedure, the patient's head is positioned underneath a hair dryer-like device as a laser scans the scalp for a half-hour. Patients undergo such a treatment twice a week for the first five weeks, then about once every two weeks for the several months, even up to a year. The price runs as high as $3,000 a year.
Dr. Leonard says he plans to lead a study of 300 patients next year to scientifically prove the laser therapy's effectiveness. Still, some physicians question the laser's efficacy without a broad, peer-reviewed study. "This is not any different than wrinkle cream," says Kenneth A. Buchwach, a facial plastic surgeon and hair-restoration specialist in Kansas City, Mo. "I would be highly skeptical that it does anything on a long-term basis."
Some physicians also claim results for the HairMax LaserComb, made by Lexington International LLC, a hand-held device that incorporates the same low-level laser therapy but can be used at home. A study of 35 patients, published this year in the International Journal of Cosmetic Surgery and Aesthetic Dermatology, claimed the LaserComb increased the hair count by 93%. The study didn't use any placebo treatment.
More than 15,000 LaserCombs were sold via mail and at clinics last year for $645, its manufacturer says. The FDA has approved the LaserComb for cosmetic benefits, such as making hair shinier and fuller, and Lexington is seeking FDA approval to market it as a hair-growth product. Canada has already approved the LaserComb for the additional claims.
If none of these options sounds appealing, there's always a hairpiece. According to the American Hair Loss Council, more than 360,000 people wear them. Hair specialists say more people are asking for bonding techniques that use medical adhesive to attach thin hairpieces to the scalp, instead of the traditional tape, glue or hair clips. The wig is made of human hair and usually is readjusted each month. The cost is as much as $500 a month, but clients can change hairstyles easily.
"It's like leasing hair," says Peggy Thornhill, a hair-replacement specialist in Hattiesburg, Miss.
Getting It Back
Here's a rundown of some of the most popular hair-replacement techniques and products:
TECHNIQUE: Follicular unit transplantation
PROCESS: Hairs are divided and then transplanted into the thinning areas for results that come near replicating the patient's natural hair-growth patterns.
COST: $5,000- $8,000
PRO: Patient can usually achieve desired density in one or two surgeries. Hair looks more natural. People leave without bandages.
CON: Only a limited amount of hair a patient can donate from other areas before they run out of hairs to transplant.
COMMENT: Has become the standard in hair transplant surgery within the past five years.
* * *
TECHNIQUE: Plugs
PROCESS: Eraser-sized pieces of hairbearing skin are moved from the back and sides of the head to balding areas.
COST: $8,000-$20,000
PRO: Easier to perform.
CON: Is less natural looking because of the space between the transplanted hair. Can have poor growth after surgery. Requires between three and ten surgeries.
COMMENT: Far fewer doctors now perform the technique. Was the standard hair transplant procedure for more than 30 years, beginning around 1960.
* * *
TECHNIQUE: Low level laser therapy
PROCESS: Laser/light wavelength emitted is supposed to repair tissues and increase the blood flow and oxygen to the scalp.
COST: $1,750-$3,500 a year
PRO: Doctors say laser therapy can reduce hair loss and spur hair growth in some cases.
CON: Scarce and questionable scientific data.
COMMENT: Used by people in early stages of losing their hair and those who want to maintain the status quo.
* * *
TECHNIQUE: Rogaine
PROCESS: Clear liquid rubbed in the scalp twice a day to revitalize hair follicles.
COST: $25-$35 a month
PRO: FDA-approved to regrow hair in men and women. Has been known to stop the progression of hair loss.
CON: Side effects include itching, scalp irritation and dryness.
COMMENT: Has been sold over the counter since 1996.
* * *
TECHNIQUE: Propecia
PROCESS: Once-a-day pill.
COST: $45-$60 a month
PRO: FDA-approved to stop hair loss. Hair growth also happens in majority of its users. Known to make hair shafts look thicker.
CON: Though rare, has been linked to decreased sexual desire, partial impotence and other reductions in sexual performance.
COMMENT: Derived from Finasteride, a prostate drug sold as a prescription under the name Proscar. Both drugs are manufactured by Merck & Co.
* * *
TECHNIQUE: Microfiber hair solutions
PROCESS: "Hair-building" fibers are sprinkled from a container onto the scalp to create the appearance of hair over thinning areas. They bond to existing hairs through static energy.
COST: About $20 for a month's supply
PRO: Creates the look of hair in the balding area. Can also make hair appear thicker. Will not run, melt or stain.
CON: The more hair a person has the better the product works. Looks more noticeable on balder people and doesn't work as well. More obvious up close.
COMMENT: A popular product with many entertainers.
Write to Christopher Windham at christopher.windham@wsj.com
Updated November 11, 2003 3:51 a.m.
To Combat 'Bald Is Beautiful,'
Hair-Loss Industry Pushes
Alternatives to Plugs and Rugs
By CHRISTOPHER WINDHAM
Staff Reporter of THE WALL STREET JOURNAL
These aren't your father's plugs.
After several years of declining business due to everything from ridicule to a new bald chic, the hair-loss industry is aggressively trying to lure back customers.
Hair transplants have been around since the 1930s, but to many people they have become a clear case of the cure being worse than the affliction. Plugs, for example, the standard procedure for decades, tend to result in a scalp that looks like a toothbrush.
Now hair-transplant doctors are pushing an alternative to plugs that is supposed to look far more natural, even undetectable. The newer procedure is thousands of dollars cheaper than plugs and requires fewer trips to the surgeon. Doctors are also experimenting with other innovations -- some of them unproven -- including various laser treatments that are supposed to make hair thicker and shinier. There's even an increasingly popular (albeit expensive) way of anchoring toupees. Finally, plagued by both the languid economy and the specter of numerous studly bald guys -- Michael Jordan, Vin Diesel and Bruce Willis to name a few -- many doctors are cutting their prices on some treatments.
About 70 million people in the U.S., most of them men, are either bald or losing their hair, according to the American Hair Loss Council. But the number of hair transplants being performed is plunging. A survey of 2,100 members of the American Society for Aesthetic Plastic Surgery found that they did 18,120 hair-transplant surgeries last year, down from 61,023 procedures in 1997.
"The economy is certainly hurting us," says Mark DiStefano, a hair-restoration surgeon from Worchester, Mass. After all, transplants cost thousands of dollars, and, because they're cosmetic, are never covered by insurance.
The alternative to plugs, known as follicular unit transplantation, involves the removal of a thin strip of hair from an area of the scalp, usually the back, which is then dissected into thousands of individual grafts and transplanted to the balding area of the head. The result is far less tufty than plugs, which involve transferring small pieces of hair-bearing skin from the back and sides of the head to balding areas.
"Nobody notices," says Joe Demello, who has paid about $7,000 for two follicular unit transplant surgeries and other hair-loss treatments in the past two years. "It's real hair. My kids can even pull on it." Mr. Demello, a 39-year-old small-business owner in Providence, R.I., says he considered hair-transplant surgery when he began losing hair in the early 1990s but declined because the plug technique seemed "scary."
Developed in 1988 but rarely used until the late 1990s, the follicular unit transplant has now become the standard of the industry. According to an annual survey conducted in September by the International Society of Hair Restoration Surgery, 94% of the 121 members polled said they use follicular unit grafts. Only 15% reported using the traditional plug grafts.
UNPLUGGED
This alternative to much-ridiculed 'plugs,' called follicular unit transplantation, is considered more natural-looking.
Before
After
? See a list of the most popular hair-replacement techniques and products.
Follicular unit transplants typically cost $5,000 to $8,000, but can range as low as $3,000 in rural areas to $18,000 in vanity states, such as California. In many cases, the new procedure can be less expensive than older plug techniques, which can cost $8,000 to $20,000 depending on the size of the area to be covered. Plug procedures usually require between three and 10 surgeries to finish, while the follicular unit approach generally involves two operations.
Prices could go even lower. To fight off competition, Blaine Lehr, a hair-transplant surgeon in Oklahoma City, slashed his fees by 25% this year, to about $6,000 for a follicular unit transplant. Nevertheless, his business is down to just 16 surgeries a month from 1997, when 35 surgeries were the norm each month.
In addition to the new approach to transplants, some doctors are using low-level laser therapy to try to thicken hair that's already there. Advocates say the technology can combat hair loss by rehabilitating weakened hair follicles and stimulating new hair growth. The Food and Drug Administration has approved laser therapy for cosmetic use (basically for making hair look thicker) but not for helping hair grow. Nevertheless, doctors can legally use it to help stimulate hair growth if they have evidence that it can work.
Laser therapy is now offered by a growing number of hair-restoration surgeons in the U.S. Robert Leonard started using it last year and now treats more than 300 patients with the laser therapy at his four hair-loss clinics in Massachusetts and Rhode Island. He says he uses it primarily on patients seeking to stop the progression of hair loss and those who want to enhance a recent hair transplant. He says the laser helps produce faster results. "The most difficult part of a transplant is waiting for something to happen."
During the procedure, the patient's head is positioned underneath a hair dryer-like device as a laser scans the scalp for a half-hour. Patients undergo such a treatment twice a week for the first five weeks, then about once every two weeks for the several months, even up to a year. The price runs as high as $3,000 a year.
Dr. Leonard says he plans to lead a study of 300 patients next year to scientifically prove the laser therapy's effectiveness. Still, some physicians question the laser's efficacy without a broad, peer-reviewed study. "This is not any different than wrinkle cream," says Kenneth A. Buchwach, a facial plastic surgeon and hair-restoration specialist in Kansas City, Mo. "I would be highly skeptical that it does anything on a long-term basis."
Some physicians also claim results for the HairMax LaserComb, made by Lexington International LLC, a hand-held device that incorporates the same low-level laser therapy but can be used at home. A study of 35 patients, published this year in the International Journal of Cosmetic Surgery and Aesthetic Dermatology, claimed the LaserComb increased the hair count by 93%. The study didn't use any placebo treatment.
More than 15,000 LaserCombs were sold via mail and at clinics last year for $645, its manufacturer says. The FDA has approved the LaserComb for cosmetic benefits, such as making hair shinier and fuller, and Lexington is seeking FDA approval to market it as a hair-growth product. Canada has already approved the LaserComb for the additional claims.
If none of these options sounds appealing, there's always a hairpiece. According to the American Hair Loss Council, more than 360,000 people wear them. Hair specialists say more people are asking for bonding techniques that use medical adhesive to attach thin hairpieces to the scalp, instead of the traditional tape, glue or hair clips. The wig is made of human hair and usually is readjusted each month. The cost is as much as $500 a month, but clients can change hairstyles easily.
"It's like leasing hair," says Peggy Thornhill, a hair-replacement specialist in Hattiesburg, Miss.
Getting It Back
Here's a rundown of some of the most popular hair-replacement techniques and products:
TECHNIQUE: Follicular unit transplantation
PROCESS: Hairs are divided and then transplanted into the thinning areas for results that come near replicating the patient's natural hair-growth patterns.
COST: $5,000- $8,000
PRO: Patient can usually achieve desired density in one or two surgeries. Hair looks more natural. People leave without bandages.
CON: Only a limited amount of hair a patient can donate from other areas before they run out of hairs to transplant.
COMMENT: Has become the standard in hair transplant surgery within the past five years.
* * *
TECHNIQUE: Plugs
PROCESS: Eraser-sized pieces of hairbearing skin are moved from the back and sides of the head to balding areas.
COST: $8,000-$20,000
PRO: Easier to perform.
CON: Is less natural looking because of the space between the transplanted hair. Can have poor growth after surgery. Requires between three and ten surgeries.
COMMENT: Far fewer doctors now perform the technique. Was the standard hair transplant procedure for more than 30 years, beginning around 1960.
* * *
TECHNIQUE: Low level laser therapy
PROCESS: Laser/light wavelength emitted is supposed to repair tissues and increase the blood flow and oxygen to the scalp.
COST: $1,750-$3,500 a year
PRO: Doctors say laser therapy can reduce hair loss and spur hair growth in some cases.
CON: Scarce and questionable scientific data.
COMMENT: Used by people in early stages of losing their hair and those who want to maintain the status quo.
* * *
TECHNIQUE: Rogaine
PROCESS: Clear liquid rubbed in the scalp twice a day to revitalize hair follicles.
COST: $25-$35 a month
PRO: FDA-approved to regrow hair in men and women. Has been known to stop the progression of hair loss.
CON: Side effects include itching, scalp irritation and dryness.
COMMENT: Has been sold over the counter since 1996.
* * *
TECHNIQUE: Propecia
PROCESS: Once-a-day pill.
COST: $45-$60 a month
PRO: FDA-approved to stop hair loss. Hair growth also happens in majority of its users. Known to make hair shafts look thicker.
CON: Though rare, has been linked to decreased sexual desire, partial impotence and other reductions in sexual performance.
COMMENT: Derived from Finasteride, a prostate drug sold as a prescription under the name Proscar. Both drugs are manufactured by Merck & Co.
* * *
TECHNIQUE: Microfiber hair solutions
PROCESS: "Hair-building" fibers are sprinkled from a container onto the scalp to create the appearance of hair over thinning areas. They bond to existing hairs through static energy.
COST: About $20 for a month's supply
PRO: Creates the look of hair in the balding area. Can also make hair appear thicker. Will not run, melt or stain.
CON: The more hair a person has the better the product works. Looks more noticeable on balder people and doesn't work as well. More obvious up close.
COMMENT: A popular product with many entertainers.
Write to Christopher Windham at christopher.windham@wsj.com
Updated November 11, 2003 3:51 a.m.
