Baldness and Hair Loss

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• QHow effective is hair transplant surgery?

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  A RealAge answered

  Advances in hair transplant surgery over the last few years have made this a promising treatment option for many people. The most common type of hair loss treated with a hair transplant is male pattern baldness. But it may also work for other types of hair loss, such as female pattern baldness, hair loss that is not on the head (for example, the eyelashes, eye brows, moustache or beard area) and hair loss due to scarring alopecia from burns, surgery or trauma. Success rates for these conditions are high, and most people can expect natural, fuller hair growth within a few months.
  
  Hair transplants are not usually effective for people with alopecia caused by an active scarring disease, such lichen planopilaris or frontal fibrosing alopecia, unless the disease has become inactive.
• QWhat is alopecia areata?

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  A Dr. Mehmet Oz, MD , Cardiology (Cardiovascular Disease), answered

  Alopecia areata, an autoimmune disorder, can cause hair loss. In autoimmune disease, the body’s immune system, which normally protects us against germs, goes haywire and starts attacking the body itself.  In this case, the hair follicles as if it were an infectious intruder. The hair can fall out in small areas, which is the most common form, or you can lose the hair on your entire head and body, including eyelashes, underarm hair, and pubic hair. There are many treatments for it, so if you are losing patches of hair, it is definitely worth asking your doctor what you can do. Ignoring it does not tend to make it go away.
• QWill we ever find a cure for baldness?

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  A Dr. Mehmet Oz, MD , Cardiology (Cardiovascular Disease), answered

  Anybody who's lost a lot of hair probably knows why the race to find a cure for baldness is a competitive one: because there are a lot of willing customers ready to try and buy. Of course, there are currently two drugs approved by the U.S. Food and Drug Administration to forestall hair loss as well as regrow hair: minoxidil (Rogaine) and finasteride (Propecia). While they help some people, many find the results they achieve a bit underwhelming - especially when it comes to regrowing hair. Going from fine peach fuzz to slightly thicker peach fuzz doesn't constitute a miracle for many modern balding men and women.

  Fortunately, many different therapies are being tested at this moment. Certain treatment approaches stand out as the most cutting edge. Gene therapy (in which genes involved in hair growth would be delivered directly to the follicle) and chemicals that increase hair's growth cycle may be on the horizon (and the "horizon" is always about ten years away, which you'll notice if you keep an eye on the research updates on hair loss treatments). One of the most interesting therapies involve cloning - a process in which scientists would clone your hair so you could donate to yourself all the hair you'd ever need or want. This breakthrough could be, oh, about ten years away. Or it might come just in time to help your great-grandchild keep his hair.

• QWhat is the cause of baldness?

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  A Dr. Mehmet Oz, MD , Cardiology (Cardiovascular Disease), answered

  Would you believe that, in the 21st century, we really still don't know exactly why hair falls out? While hair loss is genetic, we have no clue exactly why it falls out - or why it stays put in some lucky people. To be specific, doctors don't know why certain hair follicles are programmed to have a shorter growth period than others. One suspected factor for age-related male-pattern baldness is a person's level of androgens - the "male" hormones that are actually produced by both men and women. For many years, people believed that a predominance of testosterone was the root cause of baldness, but it's not quite that simple. We do know that we lose hair especially fast if it is exposed to dihydrotestosterone (DHT), which comes from the metabolism of testosterone. It's believed that the exposure of follicles to levels of testosterone that are normal for adult males causes the hair follicles to go into a resting state.
  DHT is formed in the testes, prostate, adrenals, and hair follicles themselves through an enzyme called 5 alpha reductase. The enzyme raises the levels of DHT, and that's why there's a link between higher levels of this enzyme and areas of baldness. DHT changes healthy follicles to follicles that grow thin dwarf hairs - hairs that resemble peach fuzz. Essentially, DHT shrinks hair follicles, making it impossible for healthy hair to survive. Drug companies have targeted this process by making anti-baldness medication that inhibits five alpha reductase, the enzyme that makes DHT. (Some of the side effects to these meds include impotence, decreased libido, and breast enlargement.)
  Now, age-related baldness isn't the only reason why clumps of hair start falling from the head like raindrops from the sky. Other causes, especially for women, who can also experience significant hair loss (though not as noticeably as men), include low iron levels and anemia (low blood count), recent anesthesia for surgery (it's the stress of the surgery and the pressure on one area of the head, not the anesthesia), menopause, auto-immune diseases like lupus, postpartum, thyroid disease and polycystic ovarian disease (PCOS).

• QWhy don't women go bald?

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  A Dr. Mehmet Oz, MD , Cardiology (Cardiovascular Disease), answered

  Hair is under the delicate control of sex-based hormones, including testosterone. That's why men have beards and hair on their chests and male-pattern baldness on their heads, and women don't. Women can have diffuse hair thinning, however, which can be caused by a variety of conditions.

• QAre hair transplants really effective?

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  A Dr. Michael Roizen, MD , Internal Medicine, answered

  If you lose a little grass in the yard, you just plant some new sod and let it grow. Seems like the perfect remedy, right? Well, that's why many men have turned to hair replacement surgery (such as transplants, and other procedures) as a way to deal with their male pattern baldness. In these surgeries, hair is harvested from the back of the head and inserted into the front. These procedures have declined in popularity - not because the surgeries can't be well done (they can be quite good if performed by a specialist, although many unqualified docs are doing these surgeries, too). It's because of genetics. After twenty years or so, the newly transplanted hair can thin as well - leaving very visible scarring. Isn't a smooth, shiny scalp more attractive than one that looks like a connect-the-dots workbook?

• QWhat causes baldness?

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  A Dr. Mehmet Oz, MD , Cardiology (Cardiovascular Disease), answered

  There’s an old myth that guys inherit baldness from their mother’s father--if
  he’s bald, you’re doomed (domed?). But the truth is that baldness comes from both parents. While it’s typically something that happens as you get older, sometimes hair can start thinning as early as high school.
  
  Male-pattern baldness occurs when testosterone is converted to another chemical, dihydrotestosterone (DHT), which causes hair follicles to stop producing hair. But hair can also start thinning because of poor nutrition or eating disorders, so you’ll want to try straightening out your diet first.

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• QWhat can I do about my patchy hair loss?

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  A Discovery Health answered

  There is no cure for the patchy hair loss called alopecia areata, but it does respond to medical treatment to varying degrees. The treatments are less effectively in cases of alopecia totalis (complete scalp hair loss) and alopecia universalis (complete body hair loss). Unfortunately, hair transplants do not work on alopecia areata. It's what doctors call "recipient dominant." That means the bald patch, which would receive transplanted hair, has no potential for hair growth.

  Patients whose conditions do not respond to medical treatment might want to explore wearing wigs. Some insurance companies pay for these - the American Hair Loss Council can give you more information about the companies that do. If you have patchy hair loss, you might also try hair coverings such as turbans or scarves. Experts suggest you avoid covering just the patchy balding area with a small hair addition. Instead, use something to cover the entire head. Because of the unpredictability of the condition, a small hair piece might be useless within a few weeks due to advancement of the alopecia. Dermatologists can best tell you when your condition has stabilized. When it has, more options might be available to you.

  Experts also suggest that parents support their child's choice in purchasing a wig or prosthesis. Putting pressure on the child to wear a wig has the potential to send the wrong message and make the child feel even more self-conscious about the way he or she looks. Support groups across the country offer help for people of all ages. To find a group in your area, you can contact the National Alopecia Areata Foundation.

• QAre there hair restoration products besides Rogaine and Propecia?

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  A Discovery Health answered

  Less familiar hair growth medications include Retin-A alone or in combination with minoxidil (also called Rogaine or HealthGuard) to treat male pattern baldness. Retin-A increases the absorption of the minoxidil thus increasing the amount of minoxidil that reaches the hair follicle cells. Retin-A should only be used at night because it is degraded by strong light. If you're using a combination formula, you should wear a hat or stay in the shade.

  Xandrox solutions, which are alternatives to Rogaine, come in various formulas with different amounts of minoxidil, Retin-A and azelaic acids. Ask a doctor or pharmacist to help you choose a formula that's right for you.

  Grocery stores sell a variety of products, such as shampoo bottles marked "for thicker hair." If these grab your attention, you might want to think again before you toss one into your cart. The FDA says none of the shampoos or hair products claiming to give you thicker, fuller hair can actually deliver on the promise. Instead, these products create the appearance of greater hair fullness by plumping up hair follicles.

  Another interesting product on the market is make-up that colors your scalp to match your hair color. It's cheap, it's fast and it's safe. According to the manufacturers, it won't run when wet but will easily wash off with normal shampooing. You ca not create a frontal hair line with these products, but if you can't afford surgery or a good wig, why not check it out?

• QWhat are my options for artificial hair, other than a wig?

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  A Discovery Health answered

  Non-surgical hair additions can be added to existing hair or to the scalp to give the appearance of a full head of hair. Hair additions include hair weaves, hair extensions, hairpieces, toupees and partial hair prostheses. Devices can consist of human hair, synthetic fiber or both.

  Partial hair additions, which are more popular than full wigs, can be attached in several ways. All techniques use either the existing hair or the skin to anchor the new hair. Weaving, fusion, bonding and cabling are all techniques used to attach the new hair to a person's existing hair. They are all dependent on the growing existing hair therefore they have to be reattached or tightened as the existing hair grows. This can cause a problem. Techniques that stress your existing hair, including weaves, can cause permanent damage if done incorrectly or if put on an inappropriate candidate.

  Techniques using the skin as an anchor site include adhesives (like two-sided tape) and water-proof liquids. Most adhesives are safe. Still, it's always a good idea to have a dermatologist perform a patch test to check for skin allergies.

  On the down side, these hair systems can be very high maintenance and, in the long run, can be more expensive than options such as surgery or medicinal hair growth solutions. Depending on materials and design, hair additions can cost from $750 to $2,500 or more for a quality custom-made piece. Although insurance generally doesn't cover the cost of hair replacement products for male or female pattern hair loss, it can sometimes cover the cost of a hair addition when the hair loss is the result of a disease or other abnormality.

  The expense for hair additions is not limited to initial cost. You will always need two hairpieces - one that is worn and one that is being re-styled. And in about a year to 18 months, you need to replace both. The hair piece is constantly being dyed, brushed and permed so it will match your natural hair. After a while, just like natural hair, each strand will break or become over-processed.

  You also have to visit the hair center at least once every four to six weeks so your hair can be trimmed and the piece can be reattached and blended.