Hair Replacement

Hair loss is a major concern for men and women the world over. Unfortunately, many consumers answer ads for hair replacement products and procedures before getting the facts about hair loss. While some cases of hair loss are inherited, others are caused by disease and poor diet and may also result as the side effects of some medical treatments.

In some cases, people with hair loss conditions can re-grow hair through correct diagnosis and medical treatment while others may decide to seek alternative hair replacement options. Dermatologists specializing in treating diseases of the hair and skin may evaluate patients’ hair problems to determine what, if any, treatment may be right for that patient. Before spending hundreds of dollars on products and procedures, it is important to get a professional opinion on whether or not the problem will respond to medical treatment. 

Types of Baldness
There are numerous types of baldness (or "alopecia"); all types are divided into two categories: "scarring" and "non-scarring" baldness. "Scarring" baldness occurs after any infection, inflammation, or trauma severe enough to destroy hair follicles. Included in this category are chemically-caused baldness (e.g., baldness due to acid) and physically-caused baldness (e.g., baldness due to burns or x-rays). It is important to remember that since the hair follicles are destroyed in cases such as these, baldness considered to be permanent and incurable. 

The most common form of "non-scarring" baldness is "hereditary" or "male-pattern" baldness, which accounts for as much as 95% of all cases. Its genetic causes are not known, but there is usually a strong history of this type of baldness in the families of men who are affected by it early in life. This type of baldness is evidenced by a gradual loss of hair over a period of years. Usually, the hair loss occurs as a gradually receding hairline which becomes more severe until the front and top of the head are left bald, with hair relatively thick around the sides and back of the head. This hair loss is considered normal with age for men, although it may also occur in older women. The bald areas of the head may not be totally bald, but may contain some of the almost-visible "vellus" hairs. In this type of baldness, the follicles waste away; since the follicles cannot be regenerated, this type of baldness is permanent.

Treatments For Baldness
Currently, the only drugs approved by the Food and Drug Administration for hair loss are Minoxidil and most recently, Finasteride. Minoxidil can be found in the popular topical solution Rogaine. Although Rogaine cannot completely prevent hair loss, it does have some positive effects. According to the FDA, it is estimated that Rogaine stimulates hair growth in 10 to 14 percent of the people who try it. It generally works better on men who have been bald less than ten years and who still have fine hairs left in balding areas. 

Finasteride was originally approved in 1992 as Propecia, a medication used to treat prostate enlargement. This product has proven to stimulate hair growth in areas of male pattern baldness. Finasteride has been approved only for men since it is yet to be safely established for use by women and has shown to cause birth defects.

Product Scams
In 1989, the FDA banned all nonprescription hair loss products. The FDA has specific labeling requirements for products claiming to change the structure of hair. According to these guidelines, product labels may only claim to thicken hair, but not make it grow or prevent it from falling out. Since some products get away with “hinting” that they can regrow hair, it is important to be wary of these scams.

- “Thinning hair supplements,” oils, and special shampoos or conditioners will not increase hair growth or thicken existing hair. Instead, they temporarily make the hair appear thicker by coating it with products.

- “Vasolidators,” “hair tonics,” and other mixtures that are intended for massage into the scalp are not known to increase hair growth or prevent baldness.

- Scalp "Foods" are external preparations designed to "feed" the hair at the follicles. They cannot grow hair in cases where the follicles are damaged. The Food and Drug Administration considers the phrase "scalp food" as a typical example of a "false or misleading" cosmetic claim.

- Devices, such as "vacuum" caps or pressure helmets use infra-red radiation or positive and negative pressures to increase circulation to nourish the hair. These "treatments" cannot grow hair in cases where the follicles are damaged.

- Sprays and other products meant to cover up bald spots are usually noticeable to anyone standing near a person wearing it.

Hair Replacement Techniques
There are several methods or hair replacement and a number of variations of these methods, but they generally fall into these categories:

Wigs are available which may cover the whole heads of both men and women. Quality and price of wigs may vary depending upon the fiber used. An important disadvantage of wigs is that they are not permanently attached to the head; however, their advantages include the fact that they cover large areas of scalp. Toupees are like wigs, although toupees are meant to cover only the bald areas of the scalp. Toupees (also called Fusion, hair extension, hair bridging, hair linking, etc.) may be of different materials depending if the piece is custom- or ready-made. Toupees may be attached to the head in several ways, including tapes and clips. Various attachments may differ in ease and comfort. Toupees are not service-free, as adjustments, dyeing, etc. is often necessary for their upkeep. Of course, toupees are not permanent methods of hair replacement; the pieces can slip and are supposed to be removed periodically. Also, periodic cleaning is necessary.

Hair Weaving
Hair weaving is a non-surgical technique in which the client's own hair is woven or braided tightly, enforced by synthetic fibers. To these braids, synthetic or natural hairs are woven or "wefted", creating the illusion of natural hair. This procedure may be performed by a cosmetician or beautician. The quality of the weave may depend upon the beautician's skill and the materials used. This method is a temporary method to conceal partial baldness only. Its advantages include the fact that it is not a surgical technique. Maintenance of a hair weave is necessary; as the client's natural hair grows, the weave must be re-adjusted and tightened. Regular cleaning is needed, as may be dyeing. Some discomfort may be caused by a hair weave, although medical complication is improbable.

Hair Transplants
This method involves taking the hair of one part of the head and replacing it in another part of the same head. Transplanting is a surgical procedure and must be performed by properly certified medical personnel. The physician removes a part of the bald scalp with a "punch" of about 3 or 4mm. He/She then repeats the procedure, removing a portion of the scalp, which includes growing hair (hair, follicle, and all); this portion is called a "plug". The two portions of scalp are then switched, so that the plug with hair is "planted" in the bald area. Disadvantages of the method include its expense and its discomfort (including temporary scarring and irritation following the procedure). There is no guarantee of success, and the body may even reject the transplanted plugs. However, there are advantages to the method, including the fact that it is usually performed on an out-patient basis and that once successfully completed, the results are considered to be permanent. Both the physical condition of the client and the experience of the doctor should be taken into consideration. 

Another implantation technique involves placing one or two hairs into a needle and shooting it into a person’s scalp. This procedure can help produce a thin but visible hairline, but requires a lot of hair to create the desired effect.

Hair Implants
This procedure, too, is a surgical one and appears in two forms. In the first, "sutures" (surgical threads) are placed under the scalp in the bald areas of the head. Real hairs are then attached to the implanted sutures, creating the appearance of growing hair. In the second form, synthetic fibers are themselves planted in the scalp to "create" hair in the bald area. In both forms, the results may not be permanent, as the hair may be rejected, causing infection. 

It is important to note that the FDA has banned the use of artificial hair fibers in implantation because of their high risk of infection and other adverse reactions.

Scalp Reduction
This procedure involves a doctor cutting out the bald part of the patient’s scalp and suturing or stapling the scalp back together. While this procedure can be a permanent treatment, there is a risk of infection, scarring and thinning of the scalp’s skin.

For more information, you may contact the Food and Drug Administration in the following ways:
Department of Health and Human Services
5600 Fishers Lane
Rockville, MD 20857