Off topic -- 6/15/04 NYT article on baldness / hair restoration.
June 15, 2004
With New Science, Hair Restoration Improves
By DAN HURLEY
"How you doing, Tom?" asked Dr. Anthony DiBiase, a
Manhattan surgeon, in the midst of jabbing a lancet 1,130
times into the balding head of Tom Raybek. "You O.K.?"
"Yep," said Mr. Raybek, as mellow and relaxed on a mild
tranquilizer and topical anesthetic as if he were getting a
haircut, which was pretty much the opposite of what he was
getting.
At the age of 58, Mr. Raybek, a ski lodge owner from
Killington, Vt., had agreed to undergo hair transplantation
at no charge in exchange for allowing his image to be used
by Dr. DiBiase's employer, Bosley Inc., in "before" and
"after" photographs.
This, however, was "during," and it was not pretty. Tiny
beads of blood welled up as Dr. DiBiase's hand jabbed up
and down as rhythmically as a sewing machine, making three
or four minuscule punctures every second. Two medical
assistants standing nearby counted off every puncture, so
that they would add up precisely to the number of follicles
that had already been "harvested" from the back of Mr.
Raybek's head earlier in the morning. In the afternoon, the
medical assistants would spend nearly three hours using
tweezers to plant the individual follicles into the holes.
"Pretty amazing, isn't it?" Dr. DiBiase said, standing
back to admire his handiwork, like a farmer gazing out on a
newly planted field of wheat.
With little fanfare, the science of hair restoration has in
the last few years undergone vast changes. Hair plugs,
infamous for their artificial appearance, are becoming a
thing of the past, as scientists refine techniques of
transplanting individual hair follicles rather than
circular scoops of skin, giving the hair a more natural
look. At least one new hair-growth drug is in the pipeline.
The cloning of individual hair cells is only a decade away,
experts say - an advance that, by providing an unlimited
source of replacement hair, could give even the baldest
head a luxuriant thatch, while at the same time making hair
transplantation surgery safer.
The market for such developments is sizeable. The Food and
Drug Administration estimates that some 40 million men and
20 million women experience hair loss. Sales of Propecia,
one of the most popular hair-growth potions, totaled $111
million in the United States in 2003 alone, up 13 percent
from 2002. Close to 32,000 hair transplants, 88 percent of
them in men, were performed in this country last year,
according to the American Society of Plastic Surgeons, up
from 29,000 in 2002. With the typical transplant running
upward of $10 per follicle, and the average procedure
involving about 1,000 follicles, that translates into
nearly a third of a billion dollars.
The field's advances have not done away with bad hair
jokes: A running gag in the recent film "Hellboy" revolved
around the doll's hair look of a character's hair plugs.
"The big problem we've had to overcome is 30 years of
plugs," conceded Dr. Bobby Limmer, a dermatologist in San
Antonio and the developer of individual follicle
transplants. "You mention hair transplantation to the guy
on the street, and the first image that's going to come to
him is the plug."
But the evolving medical science has come a long way since
1981, when a Boston lawyer named John Kerry, not yet a
political figure, represented 16 men whose heads had been
surgically implanted with carpet fibers.
"They were badly, badly infected, and in most cases large
parts of their scalps had to be excised," recalled Roanne
Sragow, then Mr. Kerry's law partner and now the first
justice of the Cambridge District Court. "It was pretty
gruesome."
Hair transplantation has been possible since 1952, when
Norman Orentreich, a dermatologist at New York University,
figured out how to transplant circular scoops of
follicle-rich skin stolen from the back of the head. The
result was tiny tufts rising up like so many islands of
hair amidst a barren sea of baldness. This effect was
especially unfortunate at the hairline, where the hair
plugs were plainly visible.
Even five years ago, experts say, plugs remained the hair
replacement technique of choice; they are still used by
some, particularly on the crown, where the doll's hair
effect is not as visible.
But on Oct. 21, 1988, Dr. Limmer made hair restoration
history by transplanting follicular units, naturally
occurring groups of one to five follicles that are sown
over the bald area in an evenly irregular pattern that is
indistinguishable from naturally growing hair.
Derived from the Latin word follis, for bag, the hair
follicle is the complex pouch-like structure from which
grows hair, ground out like so much sausage and composed
primarily of the same dead keratin that makes up nails.
Normally each follicle goes through a five-year cycle of
growth and rest, with about 90 percent growing hair at any
one time, averaging about six inches per year.
Baldness begins when, in the presence of
dihydrotestosterone, or DHT, a byproduct of the male
hormone testosterone, the growth cycle of genetically
susceptible follicles on the crown and temples gradually
speeds up to as little as 60 days. Newly growing hair never
gets a chance to mature, and eventually the worn-out
follicles die. Hair on the back of the head remains in
place, however, because it is not genetically susceptible
to the ravages of DHT.
When surgeons first realized they could transplant hair
from the back to the front, they thought the follicles
could only survive when transplanted in swaths, like strips
of sod on a new lawn. But slowly they succeeded in
transplanting smaller and smaller sections, until Dr.
Limmer, who said he has given lectures sponsored by Merck
but does not receive research financing from the industry,
proved that an individual follicle, like a single miniature
tulip bulb, could be transplanted and grow normal hair.
Like any surgery, hair transplantation is not without
risks: Serious complications are rare, doctors say, but
minor ones occur in one-half to one percent of cases. But
the results have made the procedure far more appealing, and
surgeons say it now attracts the Hollywood elite, although
not, one may surmise, Bruce Willis or Ron Howard.
"How many movie stars have I transplanted?" said Dr. Jon
Gaffney, a plastic surgeon in Beverly Hills who recently
became a partner in Hair Club. "Over a dozen."
But, Dr. Gaffney said, he cannot name names.
"Men in
general are pretty close-mouthed about any cosmetic
surgery," he said. "Women will share their surgeons with
their friends. The ladies are all waiting back home to see
how it went. But some men, they don't tell they wives,
their mothers, their best friends, their brothers."
The only men who seem eager to talk about their transplants
to anyone who asks - or even to those who don't - are the
ones in the transplant business. Twice in the first minute
on the telephone, Mike Smith, vice president of marketing
for Hair Club, the nationwide network of hair replacement
clinics, told a reporter that he was "also a client."
The man who coined that catch phrase of the 1970's ("I'm
not only the president, I'm also a client") is the founder
of Hair Club, Sy Sperling. Although he sold the company a
few years ago, he is glad, he says, that the company has
recently begun offering transplants in addition to its
stock in trade, hairpieces.
"I never wanted to do transplants, because they always had
that doll's hair look," said Mr. Sperling, 62, reached at
his oceanside home near Boca Raton, Fla. "But today there's
so much new technology, it looks absolutely fantastic."
He added: "I would do one myself at this point, but I
can't. I don't have enough density to work with. If you try
to cover a whole football field with a little bit of sod,
it's not going to work."
But Mr. Sperling said he would be the first to sign up if a
technique for cloning hair cells was available.
"That I would do in a second," he said.
Scientists are,
in fact, studying how to isolate follicular stem cells,
nudge them into proliferating in a test tube, and then
implant them back into the head of the man or woman from
whom they were originally taken. Those stem cells, in turn,
create follicles and hairs. In March, researchers, led by
George Cotsarelis, director of the University of
Pennsylvania's hair and scalp clinic, reported in the
journal Nature Biotechnology that the process had been
successful in mice.
"It was pretty amazing, because not only did they make hair
follicles, they also made epidermis and sebaceous glands -
the oil glands that cause acne," Dr. Cotsarelis said.
He said at least three biotechnology companies are trying
to develop the technique in humans and he estimated that it
could become commercially available within a decade.
The ability to clone hair cells would turn hair
transplantation into a less risky procedure, because the
patient would no longer need to have strips of scalp
removed to provide donor hair. At the same time, cloning
would provide an unlimited supply of donor hair, allowing
far greater hair density than is currently possible. "It's
not like curing cancer," Dr. Cotsarelis said. "It's
definitely doable."
Also on the horizon is a promising drug called dutasteride,
being tested by Merck for its hair-growing ability. Like
Propecia, dutasteride was originally approved to treat
benign prostatic hyperplasia, an enlargement of the
prostate gland, by blocking DHT. But because Propecia
blocks only one of the two types of DHT and dutasteride
blocks both, doctors expect it will work even better, and
some are already cautiously giving it to their hair-loss
patients when other medical therapies have failed. A
spokesman for Merck said the company has not yet decided
how far it will go in studying dutaseride as a hair-loss
remedy, but the company is preparing the results of a study
for publication in a medical journal.
In the meanwhile, Propecia and Rogaine, the two medications
already approved for treatment of hair loss remain the
foundation of any treatment plan for both men and women,
even those who opt for surgery. "In the old days, we had to
plan for extended hair loss," Dr. Gaffney said. "Surgery
was like rearranging the deck chairs on the Titanic. Now we
can hold the line with agents that, together, will have a
90 percent response rate."
Mr. Raybek had been using one such product, minoxidil, for
years by the time he arrived at the Bosley offices on Park
Avenue wearing a golf hat at 7:30 a.m. on a Friday in
mid-May. As a team of five registered nurses, medical
assistants and clinical assistants scurried about, he
watched the news on television while Dr. DiBiase drew lines
on the top of his head with a Maybelline eye shadow pencil,
to show where the follicles would be placed. Petri dishes
sat on the counter nearby labeled, "Raybek, Tom, Rm. 5."
At 9:10, the cutting began. Dr. DiBiase used a two-bladed
scalpel to cut a half-inch-wide strip of close-shaved hair
and skin from the back of Mr. Raybek's head. Extending just
over a foot long and immediately placed on ice, it
resembled a strip of bacon or sushi, with a stubble.
As Dr. DiBiase stitched together the gap left by the
excised tissue on Mr. Raybek's head, the assistants began
cutting up the strip into smaller and smaller pieces.
First, two of them, hunched over microscopes, sliced them
into sardine-sized pieces. Then four other assistants began
the tedious process of teasing apart every follicle into an
individual piece.
Using magnifying glasses to see and surgical knives to
manipulate the tissue, they identified each follicle by a
tiny black dot, barely visible to the naked eye and smaller
than the period at the end of this sentence. From the dots
trailed even tinier shafts resembling the tails of minnows
or sperm. For the next two hours, as they separated the
follicles into mushy little piles, the assistants labored
like factory workers.
Although they had hoped to come up with 1,200 follicles,
they were 70 short when they finished at 11:10 a.m., a
deficit Dr. DiBiase judged to be cosmetically
insignificant. He made the tiny incisions into Mr. Raybek's
head, and by noon the team was inserting the follicles into
the holes. Near the hairline they used single or double
follicles, to recreate the gradual, feathered-in look of a
natural hairline. Farther back they used three- and
four-follicular units. By 2:30 p.m. they were done.
Reached three days later by cellphone as he drove home to
Vermont, Mr. Raybek said the only difficulty he had
encountered so far was a bit of itchiness. Aside from some
redness, nothing on his head looked different to the casual
observer, he said, with even the scar hidden by hair. Now
all that remained was to wait a couple months for the
follicles to begin producing thin baby hair that would look
increasingly thick and dark within six months. Maybe then
he could ditch the golf hat.
Correction: June 16, 2004, Wednesday
An article in
Science Times yesterday about advances in transplanting
hair misidentified the manufacturer of dutasteride, a drug
being tested for its hair-growing ability. It is
GlaxoSmithKline, not Merck.
Copyright 2004 The New York Times Company. |
