Remember the musical "Hair," and its title song that had actors singing, "Give me a head with hair, long beautiful hair/Shining, gleaming, streaming, flaxen, waxen/ Give me down to there hair, shoulder length or longer … "
Well, those happy words may have rung true for most of us, too, once upon a time. (Not the length, perhaps, but surely the coverage.) But now, heredity and a diminished gene pool may be to blame for a fully in-retreat hairline, even to the point of dreaded male - and yes, even female - pattern baldness, which can strike seemingly at any age, but is much more prevalent as people get older.
And there may be other reasons, too, that men and women either have lost, are losing or will lose their hair, including certain medical conditions and treatments.
For most, it's a sad goodbye, though some seem to have adapted fairly well to a barer pate, even clean-shaven ones - more acceptable today, but clearly cases in which a mix of surrender, confidence and bravado seem to rule.
At any rate, cover-ups and cures range from the standard fix of toupees, wigs and hairpieces to weaves, implants and transplants to a whole boatload of the pseudo and seriously scientific, including ointments, creams and oils, as well as the use of lasers to stimulate at-rest and reluctant follicles. Cutting-edge scientific research, notably the use of stem cells to correct the problem, is also under way, largely at the university level.
"People lose their hair for a number of reasons, such as genetics and medically related causes, and they have it replaced for reasons that include improving their self-esteem and increasing their confidence, as well as to look and feel younger," states Theodore Katz, M.D., FACS, a board-certified plastic surgeon, and also board-certified by the American Board of Hair Restoration Surgery.
Katz, who owns and operates AMS Hair Restoration Center in Washington Crossing, adds that "in this day and age, there may be subtle discrimination against bald and balding people in the work place, so it's important to people to have their hair replaced for that reason, too.
"It is estimated there are from 30 million to 40 million men, and between 20 million and 30 million women, in the United States who've suffered significant hair loss," he acknowledges.
One increasingly popular option is hair transplantation, which has been available actually since the 1960s, he says, and which, as recently as five years ago, was characterized by "visible plugs that were reminiscent of dolls' hair and corn rows," but is much more sophisticated and aesthetically appealing today, offering a very natural look.
As he explains, "Hair grows in one-, two- and three-hair groups called follicular units. Depending on the amount of hair on a person's head, these can be transplanted to bald and balding areas of the scalp.
"While not everyone is a candidate for this - it's a matter of anyone's own supply of hair and demand (the amount of hair loss) for its transplantation - it's a surgical procedure that works very well for many men and women," adds Katz, inventor of micro-video dissection, a process that uses TV basically in place of microscopes and magnifying glasses. Once completed, he says, it takes nine months to a year for the hair to mature in growth.
In the overall scheme of things, hair transplantation is quite effective, as are treatments with Rogaine and Propecia, to some degree, although it doesn't work on the front of the scalp, just the sides and back. Herbal treatments, such as Kevis and Avacor, do not work, he says, and electronic gadgets, notably the laser comb, also are worthless.
"These are a waste of time and money, in a word 'bull,' " he confides.
Barry H. Hendler, DDS, M.D., director of OMS/Cosmetic Surgery Associates in Plymouth Meeting and part of the University of Pennsylvania Health System, says some type of hair loss is common in most men when they are 30 to 35 years old, with 70 percent of men showing some hair loss by the time they're 50, and 90 percent of all men having some hair loss at some point in their lives.
"There are seven basic types of hair loss, ranging from type 1, in which there is some hairline recession, to type 7, which shows that someone is completely bald, with just a rim of hair around the bottom of the scalp," he says.
"Hair-loss patterns differ in women - only 20 percent to 30 percent of whom have hair loss, and who don't usually begin to show hair loss until around age 50. Women can lose their hair diffusely over their entire scalp. Primary reasons for both men and women are hormonal and hereditary," explains Hendler.
Some people may feel comfortable with a hairpiece, which has to be taken off at night, or a weave, he says, which literally connects what is commonly called a "piece" to existing hair. Hair Club for Men (and Women), which imports much of the hair it uses from India, he notes, has turned this into an art form.
"But there is extraordinarily high maintenance with hairpieces in the form of trimming still growing hair and, in some cases, tightening replacement hair, and it can be expensive, too - up to $3,000 per hairpiece - while new ones have to be bought occasionally," he remarks.
Certain psychological issues may attend hair loss for many people because they look and feel so different, he says, but some people are able to deal with the issues better than others; there are style choices involved: "Entertainers and sports figures, some of whom have little or no hair, can be very influential in how someone thinks about hair loss, and what or what not to do about it."
As for myths about hair loss, yes, it's true: High levels of testosterone in men can contribute to less hair, just as the strongest genetic link is the mother's father, attests Hendler.