A costly turf war


Vin Diesel has embraced his baldness. And it’s doubtful Michael Stipe spends much time browsing for toupees. But not all of the 40 million American men with follicularly challenged scalps are going quietly into that bald night. They’re raging -- with Rogaine, among other things.

Men who want to hang on to their hair have many options, including medications and surgical transplants, says Dr. Marc Avram, hair transplant surgeon and clinical professor of dermatology at Weill-Cornell Medical College in New York City. The near future may even bring treatments that can end baldness forever -- at least for people willing to pay the price.

The war against baldness is already expensive. Just one hair transplant operation can cost more than $10,000, or about $5 per transplanted hair. The International Society of Hair Restoration reports that surgeons performed more than 95,000 hair transplants in 2010. Do the math -- hairlines are a gold mine. In fact, the ISHR estimates that men and women spend more than $1.8 billion each year on hair loss treatments of all sorts.


Rogaine and Propecia -- medications that are applied directly to the scalp -- are still the most popular choices for men who want to slow or reverse hair loss. They have both been around for well over a decade, but no other hair-loss drugs have come along to take their place. According to Avram, they work best on men who have just started to notice thinning hair. They won’t restore hair to a bald head, he says, but they can keep hair from falling out and can make remaining hair look fuller and thicker. In his practice, he often recommends Rogaine foam (5% minoxidil) once daily. He says the foam -- available over the counter -- helps about 80% of all users, if they’re patient enough to stick with the product for the six to eight months it takes to notice results.

Men who want to cover up bald spots have two options: A toupee or a hair transplant. (And hats, but those don’t fool anyone.) Moving hair from one part of the head to another is no simple procedure. “It’s a full-blown surgery,” says Dr. Rashid Rashid, a dermatologist and hair transplant surgeon with the University of Texas in Houston and the MD Anderson Cancer Center.

In the most common approach, called the strip method, a surgeon removes a long, thin section of the scalp at the back of the head and then strategically plants each follicle in places that need more coverage. The skin is then sutured together, leaving a long scar that is eventually covered by new hair growth.

Hairs from the back of the head don’t have the genetic instruction to fall out with age, so they should stay put for life. The biggest complaint, Avram says, is that the end result isn’t as thick as patients would like. For best results, he recommends daily doses of Rogaine after the transplant.

Of course, hair transplants still have a stigma. The term conjures images of a 1970s club-goer with large chains, an insufficiently buttoned shirt and scattered hair plugs reminiscent of a freshly seeded lawn. “People are afraid that it will look pluggy, but it’s not like that at all anymore,” Avram says. “By definition, nobody notices all of the good-looking hair transplants out there.”

Some surgeons around the country offer newer, less invasive alternatives to the strip method that may be a better option for some patients. In a process called follicular unit extraction, a surgeon removes and replaces follicles one at a time, leaving a bunch of small, easily hidden scars instead of one long one. The procedure can be time-consuming, although a new robotic device called the Artas system can streamline some of the work.


For now, hair transplants are limited by the number of hairs a person has available to donate. But that may change. In five years or so, Avram predicts, surgeons will be able to clone an unlimited supply of donor hair for any head.

And as scientists learn more about hair and hair loss, there’s always the chance that a new drug will come along to really banish baldness. In one tantalizing step forward, UCLA researchers reported last February that a compound designed to block stress hormones actually regrew hair on balding mice.