There are lots of things I expected to diminish as I aged, like memory, stamina, hearing — and others too depressing to mention — but the one loss I never fretted over was my hair. First of all, I grew up thinking only men got bald. (Wrong!) Moreover, as a kid, I had such thick, lustrous locks that my mother took me to her beautician every few months to have them thinned with special, serrated shears.
But around the time I was enrolling in Medicare, I started to notice an unusual accumulation of hair clinging to my brush and dusting the bathroom floor. Not only was I about to be officially welcomed into the Social Security generation, but I had also joined the 80 percent of women over 60 suffering from hair loss. Would I become like my Uncle Al, who had to hide nickels behind his ear when he did magic tricks because he didn’t have enough hair to bury them on his head?
We’re all born with about 100,000 hair follicles — the tiny holes in your scalp that produce new hair — and that’s all we’ll ever have. Many of these follicles shrink as we age, getting smaller and shorter until they miniaturize into peach fuzz. Fortunately, because of my XX chromosomes, I had no reason to fear ending up with Uncle Al’s shiny pate because androgenic alopecia, the medical term for female pattern baldness (FPB) is different from the wide open spaces typical of men with M(male)PB. Women’s hair thins mainly on the top and crown, exposing the pink scalp from whence it came; rarely does female hair loss progress to total baldness or to the V-shaped hairline common in balding men. Even so, women are emotionally devastated when their crowning glory morphs into the texture of spun cotton candy.
Thinning hair starts to be noticeable around perimenopause and progresses to a greater or lesser degree depending on a combination of diverse factors: genes (from either parent), hormones, iron deficiency, eating disorders and medical conditions like lupus, hypothyroidism and anemia. There’s also a more serious category of hair loss, alopecia areata, where hair falls out in patches all over the body. This condition is linked to autoimmune disorders and can sometimes be successfully treated with steroids.
Another common type of female hair loss, telogen effluvium, is characterized by generalized hair shedding, usually of an unknown cause. It can be chronic or temporary, triggered by severe stress, drugs, chemotherapy, emotional trauma, delivering a baby, stopping birth control pills and endocrine abnormalities. When I visited the hair loss clinic of Penn dermatologist Dr. Jennifer Nguyen, I learned that the hair turning my sink into a random pattern of black and white filaments was definitely due in part to telogen effluvium. She did a little diagnostic test that you can do at home. Grab a decent pinch of hair between your thumb and forefinger and give it a yank. Do this in several spots around your head. One or two hairs from each pull would be normal. More than four or five would not. Nguyen promised me I could hold on to the hair I had if I stuck to a daily application of the drug minoxidil. “People want a quick fix for thinning hair,” she said. “There isn’t any. But if you commit to using minoxidil the rest of your life, you can preserve the density you’ve got when you start.” I’ve been dutifully rubbing Rogaine (the brand name for minoxidil) into my scalp every night for more than a year now. While I haven’t seen any new hair growth, I am gratefully maintaining my status quo.
Research and Rescue
“Female hair loss is more complicated than male hair loss, and it’s not well understood,” says renowned Penn hair researcher and dermatologist, Dr. George Cotsarelis. “But when I think about where we were 20 years ago, we’ve moved light years forward.” Research in his and other labs around the world has produced three promising approaches to hair loss, some already in clinical trials. The first is pharmacologic — either something swallowed like the pill finasteride (for men only) or rubbed into the scalp like the foam minoxidil.
As of now, these are the only FDA-approved medications for hair loss. But coming down the clinical trial highway are some newer compounds expected to grow hair and keep follicles from miniaturizing. One contains latanoprost, the active ingredient in Latisse, the miracle serum that legions of women dab on their eyelids every night to lengthen their lashes. The other is based on studies showing that stem cells in hair follicles are turned off or on depending on the presence or absence of certain receptors. Prostaglandin D2 is one of the receptors identified as a stem cell growth inhibitor. By chance, this lipid was a key component in an asthma drug that failed to pass muster in trials. Now, several pharmaceutical companies are reconfiguring the compound for a new life treating hair loss.
Another encouraging area of research is hair cloning (or hair multiplication), where a hair sample is taken from a balding donor’s scalp and cultured in a lab to produce an unlimited supply of new hair for transplantation. This would be a godsend for men who don’t have enough of their own hair to harvest for a transplant procedure. Finally, Cotsarelis is exploring the curious result of experiments on bald mice. His lab got the mice to grow hair from skin stem cells that had been removed, scraped and wounded, causing them to revert to embryonic cells before they were sewn back onto the mice, where they sprouted hair. Now they are looking at what compounds could trick skin stem cells into behaving like hair follicle cells.
You may be thinking, “Science, schmience. What I want to know is, how can I camouflage my see-through hair?” While our mothers might have tolerated hair loss as something to kvetch about at the mah jongg table, that won’t wash with today’s aging boomers who want a full head of hair framing the youthful face they’ve bought at the cosmetic surgeon’s office. If you’re injecting fillers to plump up your aging face, you don’t want the look ruined by old lady hair. For a temporary remedy, there are two products to disguise thinning areas and cover bald spots between washings. One is a spray called Fullmore; the other, a fiber-building powder called Toppik. Both come in an assortment of dark and light shades. With a spritz of the former or a shake of the latter, your shiny scalp disappears, leaving the illusion of thicker hair.
When it comes to permanent solutions for hair problems, the best — and only — option right now is a hair transplant, a procedure that shifts assets from the rich growth in the back of the head to the impoverished areas of the crown. Transplant technology has come a long way from the time when hair plugs were the size of pencil erasers and many men looked worse after the procedure than they did before. Today, all transplants involve small micrografts of one to five hairs. The grafts are harvested three different ways. There’s the traditional method, which surgically removes a narrow strip of donor hair from the back of the head in an arc stretching from ear to ear. The harvest site is stitched closed and once the hair grows back (which happens fairly quickly), the scar is invisible. That strip yields hundreds of individual follicles for replanting into the places where the recipient needs new hair.
The newer method is something called FUE — follicular unit extraction. Instead of cutting out a strip of scalp, the donor area is shaved and the follicles are removed by vacuum extraction with an instrument called a neograft, a dentist-like drill with a head smaller than a pin to minimize trauma. As with strip extraction, the donor hairs are separated, washed and individually placed back in the scalp to create what will grow into a natural-looking head of hair. Dr. Kathy Rumor, an Ardmore cosmetic surgeon who is also a trained engineer, says her team can remove as many as 3,000 follicles in a sitting — enough to create an impressive mane that doesn’t come cheap. Prepare to spend anywhere from $6,000 to $12,000, depending on how much coverage you need. The procedure’s done in one long day and most people are back to work the next morning. Rumor also does neograft eyebrow transplants.
Given that so many surgeries these days are done with the aid of robots, it’s not surprising that one was developed for hair transplants. Dr. Thomas Griffin, a dermatologist working in the offices of the Cross Medical Group, has been doing hair transplants for 25 years and is currently the only doctor in Philadelphia offering the Artas robotic option. He thinks this is a superior method of FUE because the robotic sensors can accurately identify usable follicles and determine just the right angle for the tiny hole punch to extract them. “The robot never gets tired,” he says, “and in a labor-intensive procedure like FUE, that cuts down the potential for human error.”
The robot is used only in the extraction phase, which is followed by the doctor manually inserting the units of hair where needed. This is where experience and an artistic eye really matter, so choose your transplant surgeon carefully. The robot is not yet approved for women but Griffin expects to be using it in the near future, and he will work with hair stylists to minimize the effect of needing to shave the donor area. Meanwhile, he offers the strip method for the 50 percent of women in his practice who are struggling with FPB.
Everybody is hoping for some magical way to grow new hair, but nothing currently available comes with that guarantee. Some people report moderate success with a laser comb (it didn’t do a thing for me) or from sitting under a more intensive laser hair restoration machine 25 minutes twice a week at a cost of $2,500 for a year of treatments.
Rumor is a big advocate of platelet-rich plasma (PRP) to regenerate hair. “I have seen significant hair growth in over 100 patients with thinning hair, both male and female,” she says. PRP is a treatment first developed in the 1990s to promote healing in dental surgery, fractures and skin grafts. The physician draws a small amount of blood from the patient, spins it in a special centrifuge to isolate platelets and other growth proteins and then injects them directly into the areas that need stimulation.
For hair growth, Rumor uses a microneedle to wake up the skin of the scalp; she then injects concentrated PRP into the dermal layer of the thinning area and applies it topically as well. She claims that it appears (the operative word) that PRP increases blood supply and activates stem cells in the hair follicle. The initial treatment costs $2,000; the second, $1,500. “We’ve had women who’ve tried everything to grow hair,” Rumor says. “They come for PRP — and it works.”
The Replacement Fillers
The art of hair replacement is way ahead of the science, which is why women with hair loss problems are increasingly turning to beauty salons rather than doctor’s offices for semipermanent hairpieces that look so real, nobody can tell you are wearing one.
Joan, a Center City resident, was one of them. She’d always had thin, curly hair that became increasingly unmanageable. “I was doing my best to adjust to the problem,” she says, “until I experienced a handful of incidents where strangers stopped me and kindly asked how my chemotherapy was going. I never had cancer, but my hair was so thin it looked like it was growing back from chemo. That’s when it started to percolate for me that I needed to do something.” A friend directed her to Kat Spence, a hair stylist at Chroma in Old City who is a certified specialist in the Evolve volumizer system. This is a featherweight, 12-inch-long human hairpiece that comes in a variety of textures and color choices. The hair is attached to a silicone mesh stretch base that lays flat on the head. Using a tool like a crochet hook, the stylist pulls the client’s hair through the mesh and clamps it onto the base at 38 fixing points. Once the piece is firmly set, it’s cut and styled and you walk out with a new head of thick hair that you can wash, blow dry, swim and exercise with. “The initial cost is $1,500 and every piece is customized,” Kat explains, “so nobody looks the same. And it will not come off!”
Joan visits Kat every four or five weeks to have her piece professionally washed and reinstalled at a cost of $150. “It’s so easy to take care of,” she says, “and if you ask me, having this hairpiece is more transformative than cosmetic surgery.”
At Images Hair Studio in Jenkintown, a salon that looks like a cozy art gallery filled with the owner’s paintings, stylist Gloria Harrelson has been solving hair loss problems for 40 years. In addition to ordering custom pieces, she has drawers full of stock items in a myriad of colors, straight or wavy textures, some on bases as small as two-inch clip-ins, others large enough to cover the crown. “My typical client is a woman who’s reached a point where her hair is so see-through she won’t sit under a light in a restaurant. I look at women like this on the street and I want to go up to them and say, ‘I could help you!’ ’’ Most of her pieces are attached through a microlink system that pulls the client’s hair through the mesh and locks it on with a special bead. The pieces need adjusting every month or so because they loosen a bit as your hair grows in. Her prices range from $400 to $1,000, including the cut and styling. “Hairpieces have gotten phenomenal,” Gloria explains. “They used to be heavy and look phony. Now the hair is soft and weightless, and they are definitely not wigs!”
On Your Own
Finally, for the DIY crowd, Alan Bernhardt at Image Hair Salon on Chestnut Street off Rittenhouse Square can promise you’ll never have another bad hair day. I heard about Alan from my friend Anita. I had been watching Anita’s hair get thinner and thinner, limper and limper, to the point where no matter how impeccably she dressed, she always looked old and dowdy. Then one day I bumped into her and she looked wonderful. I couldn’t put my finger on why until I realized her hair looked terrific. “It’s a hairpiece,” she beamed.
Alan customizes each hairpiece by creating a low-tech template of your crown out of plastic wrap and tape. It looks not unlike a yarmulke. He sends that to a lab in Florida along with a detailed instruction sheet outlining particulars on the density, the degree of wave or curl, a color sample of your own hair, the length, etc. Six to eight weeks later, your “hair supplement” arrives in the mail. Alan will trim and style it for you or you can take it to your own hairdresser. After that, you’re on your own. Using the little snaps around the base, you clip the piece around your crown in the morning and take it off before bed. It blends in with your own hair and adds the volume and fullness you’ve been missing. The pieces last about a year and cost $775.
Carol Saline is the chief medical affairs correspondent for Inside. This article originally appeared in Inside Magazine, a Jewish Exponent publication.