Hair-Raising Ways of Fighting Baldness

Coming to terms with hair loss can be difficult, even for men who aren’t fashion plates. Here, two experts debate the pros and cons of two established approaches: hair replacement surgery, in which flaps of hair-bearing scalp are transplanted to bald areas, and minoxidil (Rogaine), a medication that is rubbed on the scalp twice a day to promote hair growth.

Surgical remedy: Dr. Richard W. Fleming, Beverly Hills plastic and reconstructive surgeon, co-chair of the division of facial, plastic and reconstructive surgery, USC School of Medicine

“Minoxidil isn’t going to do any harm, but the percentage of people who grow hair with it is relatively small. With surgery, especially the flap technique, the results are better. And flap surgery is the only way for bald patients to achieve full, uniform coverage of hair.

“I first excise the bald area of skin. Next, large sections of hair-bearing scalp are left attached at one end and rotated from the sides and back of the scalp to (cover) the bald areas. “In most patients, this surgery eliminates or reduces baldness. It takes 2 1/2 hours and is done with general anesthesia on an outpatient basis. I take off the bandages three days after surgery and the patient has hair. The cost varies greatly, from $7,000 to $30,000.

Nonsurgical remedy: Dr. Ronald C. Savin, dermatologist, New Haven, Conn.; clinical professor of dermatology, Yale University School of Medicine

“The flap approach is like offering a car buyer a Ferrari. The surgery, like the car, is in limited production, available to just a few and is quite costly. But most (balding) men are not interested in undergoing scalp surgery. Hair transplants (sometimes called plugs) are more common but still appeal to a small percentage of balding men.

“Minoxidil is no cure-all, but it is the only medicine ever approved by the Food and Drug Administration to grow hair. Everything else is snake oil. Minoxidil is moderately expensive. It costs $55 a month plus office visits. In our office, we see patients after the first month and then every four months.

“Minoxidil grows hair to a modest extent in about 35% of men with medium amounts of baldness. If your head looks like a cue ball, forget it. In 2% to 5% of (minoxidil) patients, hair growth will be substantial. It seems to arrest or retard male pattern baldness. For that reason, it’s more useful for preventing hair loss.”