Final hair book

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HOW YOU CAN BEAT HAIR LOSS DR BARRY J. WHITE with MARCUS WHITE

MB.BS. Ph.C

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HOW YOU CAN BEAT HAIR LOSS

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Text copyright © Marcus White and Barry White, 2002.

All rights reserved. Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form or by any means (electronic, mechanical, photocopying, recording or otherwise), without the prior written permission of both the copyright owner and the above publisher of this book. Made and printed in Australia by McPherson’s Printing Group.

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THANKS TO... all those individuals and patients that made their stories and images available for this book

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CONTE

CONTENTS preface

90

introduction

120

help! i’m losing my hair!

150

the facts about hair

230

#3

why am i going bald? (and what’s not causing it)

260

#4

can i conceal my hair loss?

340

#5

will drugs make my hair grow?

390

#6

what about a hair system?

480

#7

so you’re thinking of a hair transplant

550

#8

the advent of the undetectable hair transplant

630

#1 #2

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NTENTS #9

having a transplant – gerry’s story

730

#10 seeking a solution

950

#11 female hair loss

104

#12 frequently asked questions

109

#13 the future of hair restoration

114

further reading

118

about the authors

123

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PREFACE I have specialised in the medical treatment of hair loss for more than twenty years. I spend much of my working life talking and working with men and women whose lives have been affected – sometimes severely – by this problem. For many, the psychological effects are by far the worst elements of their hair loss. For these people, losing selfconfidence is the most distressing thing about their condition. There are those who simply become resigned to losing their hair. For others, though, hair loss has serious effects on their personality and behaviour.

Hair loss is often a natural part of ageing, but for many people it brings depression or anxiety. Some of the people I see are looking for a miracle cure. Others are seeking information and advice about the realistic options for improvement.

For many people, just learning some of the basic facts about hair loss – making sense of something that seems inexplicable – helps a great deal. It is a fact that some hair loss is normal and should be expected by men and women of all ages. Hair loss can start as early as the late teenage years, or it can begin much later in life. More than 95 per cent of hair loss in men follows a common pattern, called male pattern baldness, and is a condition caused by the action of hormones.

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PREFACE

This type of information can help people understand what is going on.

For some, understanding the reasons is enough. However, resigned acceptance is not the only option.

For centuries people have tried to discover a cure for hair loss. The field of hair loss treatment has attracted more than its fair share of charlatans keen to make themselves rich by taking advantage of the misery of others. As a result, people have quite rightly become suspicious of claims about miracle cures and overnight transformations.

Many have been disappointed by the failure of treatments in the past, or have seen unsatisfactory results achieved by outdated hair transplant technology and been deterred by this. They need reliable, scientifically based information to help them decide what to do next.

My purpose in writing this book is to provide up-to-date information and advice on what can be done about hair loss. It is important to recognise that while some hair loss may be inevitable, current methods do make it treatable.

In the past the range of options was very limited. Essentially, these options were to grin and bear it, to cover up (with a hairpiece, hat or comb-over), to try an early version of hair transplantation (often with very disappointing results), or to keep applying every new over-thecounter product that promised much and invariably failed to deliver.

There have been some excellent developments over the past 10 to 15 years, and I am very pleased to be able to identify some real alternatives to the unsatisfactory approaches of the past.

For two decades I have worked on what I consider to be the most effective approach to male pattern balding: hair transplantation. My interest in this area came about through realising that hair loss was causing great distress to a large number of men, and that existing transplant techniques offered only a partial answer.

What has kept me in the hair transplant field is the fact that the

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technology has progressed so far. In the early days I went through phases of wanting to give it up because I was dissatisfied with some of the results. These days, however, we are consistently able to produce results that are truly outstanding.

I hope this book helps those who are experiencing hair loss to understand the reasons why, and to assess the many claims made by hair loss products, clinics and practitioners. My purpose is to present the facts and to answer the questions clearly and honestly. We can now be precise about the reasons why men, and sometimes women, lose their hair. We can also now honestly say that new technologies and other developments in the field mean that hair loss can be managed and treated very successfully.

I thank the many patients who have helped in the writing of this book: in particular the gentleman who agreed to make his diary available and who is quoted often in the course of the text. Thanks are also due to those individuals who agreed to the inclusion of their photographs, and to the other men who agreed to be interviewed for this book.

Hair loss affects everybody in different ways. The fact that you are taking the time and effort to read this book suggests that at the very least you are concerned about the change in appearance you are currently going through. I hope the information presented here will enable you to understand the process that is taking place and allow you to tackle the problem of hair loss, if you choose to do so, as an informed and proactive consumer.

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INTRODUCTION THE FIRST SIGNS Your reflection in the bathroom mirror tells you it’s happening. There’s other evidence too: strands of hair caught in the plughole of the shower; strands in the teeth of your comb; fallen hairs scattered across the floor of the bathroom and on your pillow when you wake. You are losing your hair. The full head of hair you might rarely have given a thought to before is noticeably thinning.

Most people, especially men who are genetically susceptible, will experience some hair loss. Despite this fact, for many people hair loss comes as a shock. You might suddenly discover that your hairline is receding, or a bald patch is developing, or both. It could be a photograph of yourself that shocks you into noticing, or it could be a flippant observation by a friend.

You might try camouflage strategies such as brushing the longer hair over the empty space that is emerging. You might try to laugh it off. You might decide to go the whole way at once and shave off all your hair, wearing a hat to ward off the cold. (If you hadn’t realised it before, you will quickly find out that hair performs an important function in helping to keep the body warm.)

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INTRODUCTION

You might start to look for solutions – ways to slow down, stop or even reverse the trend. But there is no escaping the fact that you are losing your hair.

WHY AM I LOSING MY HAIR? You’ll start to look for explanations. You’ve been under a bit of stress – maybe you need a break; you’re a bit run down at the moment – perhaps some multivitamins would do the trick.

Some hair loss is normal and inevitable, and should be expected by men of all ages. A full scalp has an average of about 100,000 hair follicles, and this number decreases with age. It is normal to shed between 50 to 100 hairs each day. It is also common for this rate of shedding to increase with age, in both men and women.

Once hair loss begins, it continues in a natural progression.

The reasons for this are explained in detail in Chapter 3.

About 40 per cent of men in western societies have significant hair loss before the age of 40.

CAN MY HAIR LOSS BE SLOWED DOWN OR STOPPED ALTOGETHER? There is no simple answer to this question; a lot depends on the individual’s response to the prescription drugs currently used to treat hair loss (see Chapter 5). However, for most people hair loss cannot be stopped: instead it may be delayed or halted for as long as the drug is taken.

Successful hair transplant therapy (see Chapters 8 and 9) can create the appearance of a fuller head of hair.

WHAT IS THE RANGE OF SOLUTIONS AVAILABLE TO ME? Many people, especially those for whom it begins later in life, simply accept hair loss as inevitable. For others acceptance is not so easy.

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INTRODUCTION

Although hair loss is a natural part of ageing, this doesn’t prevent it damaging self-confidence and sometimes triggering depression.

Regardless of the stage your hair loss has reached, there are solutions available to you. The options fall into the categories of: • cosmetics (coloured hair fibres and sprays) • drug treatments (Propecia and Rogaine) • wigs and hairpieces • surgery.

All these approaches are discussed in some detail in the course of this book, focusing on the facts that will help you answer the key question in all of this: Which solution best suits me?

SUMMARY • Cyclical hair loss is natural. We lose 50–100 hairs each day as part of the hair’s natural growth pattern.

• Progressive hair loss, where gradually the hair that falls out is not replaced, is a normal part of the ageing process for most men.

• Male pattern balding, which is caused by hormonal activity, accounts for 95 per cent of all hair loss in men.

• Hair loss often has significant negative psychological effects.

• It may not be possible to stop hair loss altogether, but it can be successfully managed or treated.

• The four main approaches are cosmetic concealers, drug treatment, wigs and hairpieces and surgical treatment.

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#1

HELP! I’M LOSING MY HAIR! Thomas is a sensitive and intelligent twenty-year-old. He’s an outstanding young musician. He first became aware that he was losing his hair at a very young age.

THOMAS ‘I was 17 when I first noticed. I remember sitting in my study – I was in Year 12, and I was very stressed. I remember rubbing my forehead, and thinking: “My hair line’s much higher than I thought.” I didn’t think a lot about it at the time. I was wearing my hair long, and no one seemed to notice much. Then, six months later, I saw a photo of myself, and I could see just how bad the hair loss was.

‘For a while, it dominated my mind. I was constantly paranoid …

It really gets in the way with women – it’s always on your mind.

I had this voice in my head, saying “You’re a bald, 18-year-old loser – what would she want with you?”. I realise that, in part, it’s to do with me, not them. It’s what’s going on in my head.

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CHAPTER ONE

‘People don’t actually say anything – they just look at your head and they’re surprised when you say you’re 20. It’s the whole paranoid thing! The fact they don’t talk about it just makes it worse – it’s obviously an issue for them …

‘For some women it’s a real issue. I tell myself that what they’re worried about is how their image would be tarnished if they were seen with a bald guy. But I know it’s an issue for me, too. If I’m honest, I’d say that losing my hair has taken away a lot of my confidence … Like, I play in a band, and I always wear a hat on stage.’

Thomas is one end of the hair loss spectrum that is a small part of the community but, in my profession, one that I see regularly. The other end of that spectrum is Dennis.

As with Thomas, the onset of hair loss for Dennis occurred in his late teens. ‘I first noticed it when I was 18. My comb would be full of hair every time I used it. Every time I looked in the mirror, I could see that it just kept getting thinner and thinner.’

Like Thomas, Dennis experienced a great deal of initial embarrassment.

At 29, though, that embarrassment has passed: indeed, he’s now quite proud of his bald pate.

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DENNIS ‘One of my mates says to me, “You’re big, bald and beautiful!”.

These days I just shave it all off. I still have a few tufts of hair, but they look shocking.’

Dennis accepts his baldness: indeed, this acceptance was part of a conscious effort on his part. ‘I remember, when I was 18, looking at older blokes who were losing their hair like I was. They were really miserable.’ And I remember thinking, “That’s not going to happen to me!”.’

Dennis works hard at not letting his lack of hair get him down. Over the ten years he’s learned ways of coping. ‘I think it’s got a lot to do with my attitude. I won’t let it worry me. I think it’s all in how you act. One thing I do worry about, though: I’m very conscious of the effects of sunburn. I have to be very careful and take precautions.’

These two men accurately reflect the two ends of the spectrum.

Some people, and particularly those young men like Thomas who lose their hair in their late teens and early twenties, are absolutely devastated by their hair loss. They are supposed to be entering those carefree years after school. Starting university or their first job, appearance and sexual partners are all-important considerations.

Essentially they are trying to find their place in the world, and just after they start getting over pimples they get hit with a far worse problem– one that won’t clear up by itself in a few years. Thomas has experienced and will continue to experience marked effects upon his self-esteem.

Dennis, on the other hand, whilst unfortunate to lose his hair at such a young age, is fortunate that his belief systems allow him to accept his hair loss. He continues through life with little or no damage to his self-esteem and none to his social life.

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CHAPTER ONE

Thomas has at some point in the not-too-distant past taken a mental snapshot of the image he projects to the world. The image he holds in his psyche of his face and body are important to him, but now as he looks in the mirror he sees that image changing and, according to the advertising images conveyed to us, Thomas’s changes are not for the better. Thomas’s problem is that he feels exactly the same as he always did. This applies just as much to someone who is 40 and suffering hair loss, although they will generally not feel as cheated as Thomas. These feelings ultimately manifest themselves in a desire to return to the former and preferable self-image before the hair loss set in.

Hair has in the past performed a number of valuable functions for men and women.

1. warmth Many thousands of years ago men and women were covered with hair from head to toe. As prehistoric man covered himself in skins and furs, the need for body hair was greatly reduced. However, anyone who has had a very short haircut and stepped out into the cold will very quickly appreciate how much warmth a head of hair can provide. Modern clothing and housing have seen this function of hair relegated to insignificance.

2. protection Again, many thousands of years ago, ancient tribesmen grew quite large Afros. These had a practical application: in battle, a large mass of hair would provide a protective barrier to what otherwise could be a life-threatening blow to the head or brain damage. Hair still has applications today for protection. When in a confined area or walking under a low tree, for example, your hair can ‘warn’ you that you are about to strike an object with your head and in many cases allow you to avoid contact. This is much the same way that a dog or cat will use its whiskers to ‘see’ in the dark. It is quite

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common for a bald man to complain that he hits his head far more often than his hirsute counterpart.

3. adornment Hair has for many years played a vital role in an individual’s expression of who they are. Hair is an important part of a person’s self-image and how they see themselves. Tribes in New Guinea and also Native Americans have worn various headdresses to signify their social standing within the group. Little has changed today, with hair being seen as an important fashion accessory for men and women.

The primary function of hair now is purely for adornment, and various studies attest to the effect hair loss can have on an individual and on society’s perception of that individual.

THE PSYCHOLOGICAL CONSEQUENCES OF HAIR LOSS Research conducted at the Old Dominion University in Norfolk, Virginia, in 1992 found that 84 per cent of balding men were preoccupied with their hair loss. The findings indicated that the emotional and psychological results of baldness are quite marked. Among the feelings these men expressed were: • extreme self-consciousness • feelings of helplessness • envy of men who have a full head of hair.

Single men in their twenties were most likely to suffer a severe loss of self-esteem.

In a study conducted in 1972, researchers showed a series of photographs to a group of 60 people who were asked to make judgments about the person depicted in each photograph. The

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CHAPTER ONE

photographs were all of the same person, but had been modified by an artist. In some photographs, the person had ‘regular’ hair, in some he was balding, and in others he was bald. The results demonstrated just how powerfully we are influenced by appearance, especially the presence or absence of hair.

The person with ‘regular’ hair was described with words like ‘handsome’, ‘strong’, ‘virile’, ‘active’. The ‘balding’ person was perceived as being ‘weak’, ‘dull’ and ‘inactive’. The ‘bald’ person was perceived to be ‘unkind’ and ‘ugly’.

The results of this research suggest that the stereotypes concerning baldness are predominantly negative.

An interesting observation I have made over the many years as a hair transplant surgeon: some patients prior to surgery appear to have lost their drive in life and have let themselves go a bit. Their hair loss, it seems, has dragged the rest of them down with it. After the results of their surgery start to grow through you can see a change in their attitude to life. They take up an exercise regime, their diet improves, and when they come back to me at the 6, 9 and 12-month marks for post-operative check-ups, many of them seem to have lost weight, their skin looks better and they just seem more alive than they did prior to the surgery. Ultimately the surgery had little or nothing to do with this, it was just the catalyst for a change in outlook.

THE YOUTHFUL PROPORTION When discussing these stereotypes, it is important to look at how hair loss affects the appearance of the person experiencing it. The loss of the hairline can change a person’s appearance substantially. As the hairline recedes, the forehead can become the focal point of the face.

Other facial features, such as the nose, eyes and chin, appear more prominent, or other features may not retain the attractive visual

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proportions they once did.

The youthful proportion is considered to be an equal spacing: • from the bottom of the chin to the base of the nose; • from the base of the nose to the top of the eyebrows; and • from the top of the eyebrows to the start of the hair line With the onset of hair loss this spacing can change so that the region from the base of the eyebrows to the start of the hairline may now account for almost half of the facial image. This change in proportion alters the whole image of the face and has a tendency to make the flaws of the face stand out, in some cases quite prominently.

¹⁄₂ ¹⁄₃

¹⁄₃

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¹⁄₄

¹⁄₃

¹⁄₄

¹⁄₃

Shown above is an example of one of my patients who illustrates this point. Prior to his procedure his forehead accounted for almost half his facial image. His forehead appears quite wide and his nose particularly out of shape. Following the procedure these features are exactly as they were 6 months prior, however, now they are hardly noticeable.

Hair loss affects everybody in different ways. The mere fact that you have purchased or are taking the time and effort to read and understand this book suggests that at the very least you are concerned about the change in appearance you are currently going through.

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CHAPTER ONE

I hope the information I present to you in the rest of this book will give you an understanding of the process taking place within your body and allow you to tackle your hair loss problem as a savvy consumer, if you choose to.

SUMMARY • Hair loss affects different people in different ways. It is only a problem when the person affected feels some adverse social or emotional stress, such as reduced self-esteem or a loss of selfconfidence.

• Hair loss changes the appearance of the face by shifting the balance of the face to the forehead, resulting in an aged appearance.

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#2 THE FACTS ABOUT HAIR Hair is composed of a protein called keratin – the same protein that forms the nails and the outer layers of the skin. Hair cells seem to begin as skin cells but, like toenails and fingernails, develop differently from normal skin cells.

The average scalp contains about 100,000 hair follicles, but this varies a great deal. Colour makes a difference: blondes have an average of 140,000 hairs; brunettes 105,000; and redheads only 85,000.

THE STRUCTURE OF HAIR Hair has three sections. The outer protective layer, called the cuticle, is thin and colourless. The second layer, called the cortex, is the most substantial part. It gives the hair strength, colour and thickness, and determines whether it will be straight or curly. The third layer is the outer root sheath

sebaceous gland

medulla, and it is typically made up of a row of cells which are two to

inner root sheath cortex medulla matrix

arrector p muscle inaba’s knob bulge dermal papilla

four columns wide. Its exact function in the hair is unknown.

The final element is the follicle, a sac within the scalp where the hair

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CHAPTER TWO

is generated. Strands of hair are rooted in these hair follicles in the skin, and glands called sebaceous glands surround the follicles.

HAIR GROWTH Hair growth is controlled by hormones called androgens. Blood is carried to the hair follicles via tiny blood vessels, and this supplies the nutrients that make hair growth possible. The sebaceous glands produce an oily substance called sebum that helps waterproof the growing hair and makes it shine.

Like skin cells, hair grows and is shed regularly. Healthy hair grows at the rate of approximately a centimetre per month on average, and it grows more quickly in summer than in winter. Hair grows best between the ages of 15 and 30. Growth typically starts to slow down between the ages of 40 and 50, and both men and women begin to lose hair after the age of 50.

Blood provides the raw materials for hair growth, but it is the androgens – a group of male hormones – that control the rate of hair growth. the follicle produces the hair, but only at the rate the androgens allow.

PHASES OF HAIR GROWTH 1. The active growth, or anagen, phase. This lasts between two and six years. During this phase in the growth process the follicles produce hair at the rate of roughly a centimetre a month. The duration of the anagen phase determines the maximum length an individual’s hair can grow. For example, someone with a 48-month anagen phase may only be able to grow his or her hair 48 centimetres long.

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THE FACTS ABOUT HAIR

2. The transition, or catagen, phase. This lasts between two and three weeks. The hair is no longer supplied with nutrients and is now at its maximum length.

3. The resting, or telogen, phase. This lasts between two and six months.

Once the follicle has rested and the old hair has been pushed out, the new growth phase begins.

All the hair follicles do not, of course, go through the growth cycle in unison. At any one time there are follicles in all three phases. On average we lose 50–100 hairs from our heads each day through this normal growth process. Problems only arise when more hair is being lost than is being replaced, or when the replacement hair is weaker, finer and less pigmented than the shed hair.

late anagen

catagen

telogen

anagen

SUMMARY • Hair is produced in follicles, which are tiny sacs that sit within the scalp skin.

• Nutrients carried by the blood are the raw materials of hair growth.

• Hormones called androgens control the growth cycle.

• Hair growth occurs in three phases: a growth phase, a brief transition phase and a resting phase.

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#3 WHY AM I GOING BALD? (AND WHAT’S NOT CAUSING IT) For those people who have just begun to lose their hair, the signs are obvious and the question invariably the same: ‘Why am I going bald?’.

You begin to notice more hairs on your pillow in the morning. As you lean over your desk and run your hands through your hair, you see more hairs than normal drop onto the pages in front of you. Or maybe it’s the white vanity basin at home, which seems to collect an inordinate number of hairs per day. Invariably you notice a slightly higher hairline or a thinner crown in a photo from the last family get-together. And again you probably ask yourself, ‘Why am I going bald?’.

It was Hippocrates who first made the connection between hair loss and male hormones. He noted that eunuchs did not go through the balding process but, instead, maintained a head of hair essentially as good as the day they lost their manhood. He theorised that due to the loss of the testicles there was a lack of ‘hot blood’ in the body. It was this ‘hot blood’ that burnt the hair follicles on top of the scalp. The term ‘hot blood’ probably referred to sex drive. It took us almost 2,400 years to realise how correct Hippocrates was.

In the 1950s, a psychiatrist by the name of Dr Hamilton was working in a mental institution and was astounded to see a severely bald

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WHY AM I GOING BALD? (AND WHAT’S NOT CAUSING IT)

identical twin visit his institutionalised brother, who had a complete head of hair. What Dr Hamilton observed was contrary to accepted medical beliefs: being identical twins, their hair loss pattern should have been exactly the same. It struck Dr Hamilton that there must be some outside factor attributable to the incarcerated twin retaining a full head of hair. He discovered that the critical difference was that the institutionalised twin had been castrated some years before, as was a common practice for inmates of such institutions. Castration was performed as some sort of misguided treatment, and it did seem to reduce the frustration of inmates who had no release for their sexual urges.

To confirm his theory that the male hormone testosterone was responsible for hair loss, Dr Hamilton administered testosterone injections to the castrated twin. Within a matter of months he was as bald as his brother. In an attempt to reverse the hair loss Dr Hamilton ceased treatment, but the hair did not grow back. Once the follicles had been killed off by the male hormone, they were not able to be resurrected.

It is important to note that had this individual not had a history of hair loss in his family, i.e. his twin brother had not been bald, normal doses of testosterone injections would not have induced hair loss.

ANDROGENETIC ALOPECIA What I have described above is the most common form of hair loss in both males and females. It has the scientific name androgenetic alopecia: andro

for the male hormone

genetic

for the inherited balding gene

alo

loss of

pecia

hair

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CHAPTER THREE

‘Androgenetic alopecia’ therefore means the loss of hair induced by the genes and the male hormone.

We now know that hair loss is caused by two factors working in conjunction: • genetics: To experience hair loss an individual must inherit, from at least one parent, the balding gene. It can come from either parent, and it can come from the father’s side whilst he himself does not suffer from hair loss. When we receive our genetic makeup from our parents at the time of conception, those of us that receive the balding gene grow hairs on the front, top and crown of the scalp with a useby-date attached to them. At a certain age they are programmed to wither and die.

• testosterone: The male body is constantly producing testosterone.

An enzyme in the body known as 5 alpha reductase reduces this hormone down to a more potent form called dihydrotestosterone (DHT). It is DHT that acts upon those hair follicles genetically programmed to die and essentially acts as the messenger of death.

T the formation of dht

DHT

dht the effect of dht on hair follicle

As you go through the male pattern baldness process, the hair on top of your head changes.

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WHY AM I GOING BALD? (AND WHAT’S NOT CAUSING IT)

1. shorter anagen or growing phase: A shorter growing phase means that the hair can only grow to a certain length before shedding and a new and generally weaker and finer hair grows.

2. hair lies flat to the scalp: As hair becomes progressively weaker, it loses its ability to stand up and add volume.

3. hair is less pigmented: The weaker, finer hair is unable to carry as many pigment cells as the thicker and stronger hair, and adds little to your overall appearance.

4. hair shaft is significantly finer than hair shafts on the side of your head: As part of the shorter growing phase, the hair that is produced is significantly finer than the previous one. midscalp crown

front

hairline, midscalp and crown Hair that grows in these areas

sides back

is affected by DHT sides and back of the head Hair that grows in these areas is NOT affected by DHT

The hairs that grow at the front, top and crown are the ones programmed at conception for some people to be susceptible to the affects of DHT at a certain age. The hairs that are produced at the back and sides of the head are resistant to the effects of the DHT and will continue to grow for a lifetime. This, in effect, explains one of the basic principles of hair transplantation. The hairs that grow at the back and sides of the head are the ones that are used in hair transplantation.

Because they will not be affected by the male hormone, they can be

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CHAPTER THREE

transferred to anywhere in the body and will continue to grow regardless of the DHT levels.

HAIR LOSS AND DIET It appears evident that diet has very little effect on androgenetic alopecia. While proteins, vitamins and minerals are essential for normal hair growth, a lack of these will not induce androgenetic alopecia, but may in some cases cause a diffuse thinning as the body directs its vital resources away from hair growth to survival. The crash dieter can at times experience this form of diffuse thinning. Normal hair growth will resume within a few months of returning to a normal diet.

It has also been suggested that red meat may increase the levels of testosterone in the body, subsequently resulting in an increase in androgenetic alopecia. Researchers have noted that since World War II there has been an increase in baldness among Japanese men. They suggest that this could be traced back to changes in diet – to a more westernised diet, with higher consumption of animal fat – in the years since 1945. This hypothesis is based on a link between this kind of diet and the higher sebum production. However, the change in androgen level as a result of red meat consumption is so small as to be relatively insignificant.

Diet will not induce androgenetic alopecia. Treatments purporting to supply nutrients to the hair shaft and aid the growing process should be looked upon with some scepticism.

HAIR LOSS AND SMOKING The results of research into this question seems to suggest the following findings.

As has already been pointed out, a major factor in male pattern baldness seems to be the conversion of testosterone into DHT. DHT is the chemical that attacks the hair follicles, shrinking them and

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ultimately destroying their capacity to produce healthy scalp hair.

In one study, involving over 1200 middle-aged men, DHT levels were between 9 and 18 per cent higher among smokers than non-smokers.

The study did not look specifically at hair loss, but given the role that DHT is known to play, the results suggest that it is highly likely that smoking may result in hair loss.

In summary, it seems fair to conclude the following: • If you DO NOT have a genetic predisposition to hair loss, smoking will not make your hair fall out.

• If you DO have a genetic predisposition to hair loss, stopping smoking won’t stop your hair falling out but may well slow the process.

HAIR LOSS AND BLOOD SUPPLY All sorts of myths are associated with hair loss and blood supply. Don’t wear a cap or you will cut off the blood supply to your scalp! Stand on your head for five minutes a day and improve the circulation to your scalp! Massage your scalp to improve your circulation! All interesting theories, and all baseless.

The hair has withered and died under the influence of DHT. Wearing a cap or massaging the scalp will not affect the amount of DHT that arrives at the follicles. Thirty-five years of hair transplant surgery has shown this to be true, with grafts performed in the 1960s to the top of the scalp growing just as well to this day as the hair at the back and sides.

HAIR LOSS AND HYGIENE Sebum is secreted by the sebaceous gland, which is located near the hair follicle. This surface sebum can be high in testosterone and, more importantly, DHT, which, it has been theorised, may re-enter the follicle and induce or exacerbate androgenetic alopecia. Daily shampooing is

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likely to be beneficial in reducing surface levels of DHT. Many treatments are based on this theory, but any shampoo from a supermarket will fulfil the role of removing surface sebum.

HAIR LOSS AND CLOGGED PORES This is another of those plausible theories suggested to people just before they are asked to pay for some special lotion to flush out those clogged pores and induce marvellous, luscious hair. We have all had ingrowing hairs. This phenomenon occurs where a hair literally punches its way through skin where there’s no opening for it, quite often causing a pimple. It is, hard, then to believe that a clogged pore could stop the hair growing.

HAIR LOSS AND ETHNIC BACKGROUND It has become apparent to me over the years that there are certain ethnic hair loss traits. Particularly Greeks, but southern European males and females in general, appear to suffer from hair loss more than people from other geographical areas.

NORWOOD CLASSIFICATION OF MALE PATTERN BALDNESS The following chart is used to classify hair loss and was developed by Dr O’Tar Norwood. Most men suffering androgenetic alopecia will find that they fall into one of the eight categories or their adjuncts. The chart also allows people to see the patterns of hair loss that are most common, and where they may progress to in future years.

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i

ii

iii

iii vertex

iv

v

vi

vii

SUMMARY • Hair loss is caused by a combination of two factors: family history or inherited genes, and the male hormone.

• Only hair at the front, top and crown is affected by male pattern baldness, with a ring of DHT-resistant hairs found at the back and sides of the scalp.

• A number of myths, and some widely held community beliefs regarding hair loss and its causes (and solutions), have no basis in fact.

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#4 CAN I CONCEAL MY HAIR LOSS? There are a number of products on the market that can very effectively reduce the appearance of thinning hair. Initially my thoughts on these were a little negative, but I have since seen results that have amazed me. For men and women with thinning hair, the current range of coverup products provides an excellent short-term alternative that can look very natural.

The basic principle behind all these products is to remove the contrast between hair and skin, to stop the scalp showing through.

Users must have some hair in the area to be thickened as the products cannot create the appearance of hair where there is no hair. Obviously they are not intended for bald people. declaration of financial interest Marcus White (co-author) acts as the Australian agent for the Toppik and Couvre range of products.

TOPPIK As I mentioned before, there is a product that has amazed me – Toppik, which comes in a salt-shaker type container. It is basically thousands of tiny hair fibres charged with static electricity, which you apply by

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shaking the container over the thinning areas. The fibres electrostatically attach to the hairs in the application area and in less than a minute it is possible to camouflage mild-to-moderate hair loss with a result that looks totally natural.

The fibres are made almost entirely of an organic keratin protein, with the balance being colouring agents and glidants (these aid in the ‘flow’ of the product) to allow it to blend seamlessly with the hair.

Toppik is not damaging to the hair or scalp and can be used daily.

It is supposed not to come out in the wind or the rain or while you are sweating. I have heard stories from clients about their experiences with Toppik that confirm these claims.

One of my patients had undergone a hair transplant procedure one week prior and had a thin coverage of about 25 per cent all over the top.

The post-operative scabs were clearly visible and he was to attend a wedding that weekend. One application of Toppik restored what looked like a full head of hair for this man. The reception was held in a marquee on a sweltering summer afternoon. He reported to me that he danced most of the afternoon and evening and sweated profusely throughout that time. At no stage did the Toppik run down his forehead or embarrass him in any way.

Toppik can be used in conjunction with pharmaceutical treatments such as Propecia or Rogaine. It is a dry, colourfast fibre and will not stain clothes or pillowcases. If you get any on your clothes it is simply a case of brushing it out. The only way to remove Toppik from your head is by shampooing the hair. It is not waterproof and as such does not maintain its appearance after swimming.

Toppik is available in various colours, as listed. Sometimes the best results can be achieved by combining two colours, such as medium brown and light brown for somebody with variable light brown hair. Hair is rarely all one colour – it is usually a combination of shades. Toppik

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works best with Toppik Fibrehold Spray, which also adds some shine to the fibres. The manufacturer claims that, unlike ordinary sprays, this one is made from alpha-grade resins, which increase the bond between the hair and the fibres. This may or may not be the case. I have seen this product produce, however, a healthy shine to the fibres. Naturallygrowing hair has a coating of sebum on the cuticle that gives the hair a natural sheen. Toppik fibres do not have this sebum and, as such, can look matte in the darker colours or when the ratio of fibres to naturallygrowing hairs is a little low. Toppik Fibrehold Spray used after the application of the fibres will give them a natural sheen and help them blend in with your own growing hair.

Toppik is available in the following colours: • Black (blue-black, very dark and generally only suitable for people of Asian and Indian descent) • Dark brown (very dark, almost a Caucasian black – most people who think their hair colour is dark brown actually have medium brown hair) • Medium brown • Light brown • Blonde • Auburn • White • Grey

COUVRE The product Couvre is marketed as an alopecia-masking lotion. It is a liquid, oil-based scalp colourant and is applied with a sponge applicator included with the product. It works primarily by reducing the contrast between the remaining hair and the scalp that is showing through. It is applied directly to those areas that are thinning and does add some volume to the hair at the base of the scalp.

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Couvre is not really beneficial in the frontal hair line but can be applied to thinning areas, no matter how large they are. As long as there is a moderate amount of hair remaining, it is possible to provide a very natural and much-improved appearance. Being an oil-based product, Couvre will not be affected by the rain or sweat, and you can even swim with it. It is easily removed by shampooing out.

Couvre is made of natural vegetable oils and colourings and is similar to a foundation for the skin. It can be used in conjunction with Propecia or Rogaine. Simply apply the Rogaine and wait for it to dry and then apply the Couvre over the top.

Couvre will stain clothes and sheets if it comes into contact with them.

Couvre is available in the following colours: black, dark brown, medium brown, light brown, blonde, auburn, grey and white.

DERMATCH Dermatch is similar in principle to Couvre. It is sold as a solid, compressed powder in a form similar to a woman’s compact, and is supplied with a small sponge applicator. The suggested application method is to wet the applicator and then rub it onto the Dermatch.

Dermatch is available in a number of colours: black, dark brown, medium brown, light brown, grey and red. It is waterproof and washes out with shampoo, but I am led to believe it will stain pillowcases if not washed out prior to sleeping.

SPRAYS Various sprays have been on the market for many years and I have seen some people use them effectively. They generally come in an aerosol container and are sprayed onto the thinning areas from a distance of about 30 cm. The result can look very matte or powdery and I am told it can run if you get caught in the rain. Again, this product will stain bed sheets and clothes on contact.

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You should confirm all claims of ‘waterproof’ and ‘sweatproof’ for yourself if you intend to use any of the products described above. Apply them at home when exercising, or wear them in the backyard in the rain, to see if the claims made in relation to their effectiveness in such situations are accurate. This will give you peace of mind if you are caught in one of these situations.

SUMMARY • Cosmetic concealers can make thinning areas virtually ‘disappear’ in some cases. I have found these products to be very good in the following circumstances: 1. To thicken up localised areas of thinning to delay surgical treatment, or in conjunction with medical treatments such as Propecia.

2. For use after surgery to conceal the visible signs of the procedure.

3. For women with diffuse thinning whose only alterative may be a wig.

• No concealing product can create the appearance of hair where there is no hair, so these products are NOT for bald people.

• The website www.hairtransplantnetwork.com has in its discussion area a section called Shampoos, Sprays and Concealers. In this area you can find users’ comments about all sort of products posted to a bulletin board. If you think any of the products I have described may be worth trying, this is an excellent place to read about other users’ experiences – good and bad.

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#5 WILL DRUGS MAKE MY HAIR GROW? Drug therapy for the treatment of hair loss is a relatively new development that a doctor and his or her patients may add to their arsenal against hair loss. There are currently two products on the market that have been proven in clinical trials to be beneficial. These are Rogaine (minoxodil) and Propecia (finasteride).

The best candidates for treatment are people at the very early stages of hair loss. Prolonged androgenetic alopecia can kill off hair follicles and no amount of treatment thereafter is going to revive them. However, treatment for people with partial hair loss can prevent further loss.

ROGAINE (MINOXODIL) development Rogaine has been around for some years as a solution applied to the scalp to arrest or, in some cases, reverse hair loss. It is a trademark of Upjohn Pharmacia Pty Ltd. The active ingredient of Rogaine is minoxodil, which was originally prescribed in tablet form for the treatment of high blood pressure. As well as reducing blood pressure, it was found to grow hair on the scalp. Unfortunately it also induced

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hypertrichosis, or hair growth on the face, shoulders, arms and legs of women and on the entire body of men. While growth of hair on the scalp was seen as an encouraging side-effect, the collateral growth everywhere else was unacceptable. This resulted in the delivery system being changed to a solution applied topically to the localised area where hair growth was desirable. This solution is what is now currently available in Australia over the counter at chemists, as a 2 per cent or 5 per cent Rogaine solution. how does rogaine work?

We know Rogaine works, but we are unsure of the exact reasons why it works. We know that Rogaine is a powerful vasodilator, effectively increasing the blood flow to the scalp; however, the positive growth aspects occur irrespective of this. There are many credible theories.

It is known that the use of Rogaine holds the hair in the anagen or growing phase longer, warding off the catagen or destruction of the follicle phase. how well does rogaine work?

The best results with Rogaine have been achieved by patients in their twenties with a recent onset of hair loss, and a small area of loss.

A cosmetically significant improvement in regrowth occurs in less than 10 per cent of patients. However, a larger percentage have found that with continued use it is possible to stop further loss in the short term.

However, in the long term, hair loss generally continues. how do you use rogaine?

Rogaine is administered in a liquid form of varying strengths from 2 per cent to 5 per cent. The recommended dosage is twice-daily applications of 1 ml to the areas affected by hair loss. It is available without

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prescription from pharmacists. Some pharmacists have a generic form available with added tretinoin. The tretinoin acts as a surface irritant, helping the absorption of the Rogaine into the skin. who can use rogaine?

Rogaine can be use by both men and women. what hair loss is best suited to the use of rogaine?

The crown area of the scalp appears to respond best to Rogaine.

It appears to have little effect on the front hairline or the temple region. side-effects Rogaine has been shown to cause the following side-effects in some people: • hypertrichosis Strong hair growth has been seen in the forehead and eyebrow region and in some cases new hair growth on the tip of the nose has been noted.

• scalp irritation Itching, inflammation and redness of the scalp, which can be exacerbated by the inclusion of tretinoin in the solution.

• irregular heartbeat Due to Rogaine’s vasodilating effects, people with heart problems or on blood-pressure medication should consult their doctor before using it.

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PROPECIA (FINASTERIDE) I and many other hair transplant doctors were initially very sceptical about the use of Propecia in treating male pattern baldness. Propecia is a trademark of Merck Sharp and Dohme Pty Ltd. With talk before its release of side-effects including deformed male babies, loss of sex drive and ineffectual results, I also asked myself ‘How will it affect my patients?’. However, after reading the clinical trial information, I realised that Propecia appeared to be a very effective treatment, with minimal side-effects and an excellent safety profile, and ultimately it would be in the best interests of some of my patients to treat them with it. Since those early days, hair transplant surgeons around Australia, including myself, have embraced this medication for use on its own and in conjunction with a hair transplant. development Propecia is the first treatment of its kind that deals with the actual cause of the problem in those individuals with a genetic disposition to hair loss. The drug was originally developed by Merck Sharp & Dohme to treat benign prostatic hyperplasia, a non-cancerous swelling of the prostate gland that affects middle-aged men and can make it difficult to urinate. As such, Propecia has been on the market for many years and has a proven safety profile for the treatment of enlarged prostates.

Over time, patients on the medication began to notice that thinning areas of their scalp now had hair that was thicker and stronger than before. Merck Sharp & Dohme were understandably quite excited at the prospect of a drug that could retard hair loss and, in some cases, regrow hair–particularly as the drug had already undergone trials and had an established safety record.

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how does propecia work?

As discussed previously, androgenetic alopecia occurs because of two factors: family history and DHT. It is impossible to change the genetic makeup you inherited from your parents. To recap, the male body produces testosterone, which is reduced by an enzyme (5 alpha reductase) to form dihydrotestosterone (DHT). This DHT attacks those hair follicles that are genetically predetermined to wither and die under its effects. So far, however, Propecia is a powerful suppressant of the 5 alpha reductase enzyme, which results in a lower amount of testosterone being converted into DHT. Lower DHT levels in the body allow the DHT-sensitive hairs to defy their natural destiny and continue to grow and renew themselves after falling out.

DHT

the formation of dht

T propecia blocks formation of dht

dht the effect dht has on the hair follicle

DHT

propecia™

T

the effect propecia has on the hair follicle

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how well does propecia work?

The results from the trials of Propecia have been quite impressive.

In one-year clinical trials: • 48 per cent of men taking Propecia had improved hair growth • 38 per cent maintained their present status • 14 per cent noticed some deterioration of hair quality.

Compare this with those who did nothing: • 7 per cent of men who took no action had improved hair growth • 35 per cent maintained their present status • 58 per cent noticed some deterioration of hair quality. how do you use propecia?

Propecia is administered in a tablet form and is generally prescribed as one tablet per day. You need to take it continuously for six months to a year to determine how beneficial it will be for you. who can use propecia?

Propecia is intended for use by men only. It is only beneficial in treating androgenetic alopecia. Theoretically it can cause birth defects in male babies of women who take it. It is not considered dangerous for a woman to conceive while her partner is undergoing treatment, however, a number of my male patients have elected to cease treatment while their partner is trying to conceive. side-effects Propecia has a couple of side-effects relating to sex, which may not please men considering this medication.

• reduced sex drive What good is a full head of hair if you can’t realise the supposed benefits of the new, more attractive you? In

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reality, this unwanted effect was an issue for less than 1 per cent of people on the clinical trial.

• erectile dysfunction This is related to the above side-effect and was found to be an issue for less than 1 per cent of people on the trial.

• decreased semen volume Less than 1 per cent suffered this side-effect and none of my patients have mentioned this problem.

The vast majority of my patients have encountered no adverse effects from the medication. A small number have commented that they feel a slight reduction in their sex drive. I believe that the sexually adverse side-effects are more common among smokers.

Of all the hundreds of my patients who have commenced using Propecia, only a few have come back and told me the side-effects were so bad they would have to discontinue therapy.

If an individual does suffer any of the listed side-effects, they will quickly go away after the treatment is stopped. Some people on the trial suffered the side-effects only temporarily and reverted to a pre-treatment sexual state while continuing with the therapy. long-term side-effects Finasteride (the active ingredient in Propecia) has been used very effectively by the middle-aged and older with prostate problems for many years, and no long-term side-effects have come to light at this stage. However, Propecia is very often used on an ongoing basis by people as young as their late teens to early twenties, albeit in a weaker dosage. cautions Propecia is metabolised and disposed of by the liver and subsequently requires healthy liver function for it to be taken effectively. Hepatitis,

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sclerosis of the liver, and indeed any condition that interferes with the proper function of the liver should be discussed with your prescribing doctor.

Propecia lowers the amount of prostate-specific antigen (PSA) in the body. Levels of PSA in the body are used as indicators for prostate cancer screening tests. Effectively, Propecia can mask one of the earlywarning indicators of prostate cancer. If your doctor is performing any PSA tests, you must advise them that you are taking Propecia so they can accurately determine the results.

SAW PALMETTO Saw palmetto is a naturally occurring plant extract that has been offered as a more natural alternative treatment to Propecia. Saw palmetto has been beneficial in the treatment of benign prostatic hyperplasia, a condition that is also treated by finasteride. For this reason, people have also believed that saw palmetto could be beneficial for treating hair loss. However, it has no effect on PSA or prostate volume and therefore no effect as a 5 alpha reductase inhibitor. As such, there is little evidence to support the claims of saw palmetto’s efficacy in the treatment of androgenetic alopecia.

NIZORAL Nizoral has been available in Australia as an over-the-counter antidandruff medication for some years. The active ingredient in Nizoral is ketoconazole and it is available as either 1 per cent or 2 per cent.

Ketoconazole is beneficial for more than just dandruff, as it is also a powerful anti-androgen. This means that for those affected by male or female pattern baldness, shampooing with Nizoral may be beneficial.

The results of a recent study were presented at the American Academy of Dermatology. Investigators found that Nizoral 1 per cent used 2–3 times weekly over a six-month period yielded the following gains:

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• Hair diameter increased by an average 8.5 per cent • Hair shed over a 24-hour period was reduced by 16.5 per cent • Hairs remaining in the anagen growing phase increased by 6.4 per cent.

For those currently using topical Rogaine, Nizoral can also be beneficial to reduce itchiness or dryness resulting from the Rogaine.

So, for any hair loss sufferer the research suggests that regular use of Nizoral will, in many cases, have a positive effect on hair growth.

SUMMARY • Medical treatment is best for those in the early stages of hair loss, those whose focus is to stop further loss, or in combination with a hair transplant.

• In my opinion, people with extensive hair loss will, in most cases, get no benefit from medical treatment other than to delay further loss.

• Rogaine (Minoxodil) is a topical solution applied to the scalp, for use by both men and women. Possible side-effects include unwanted facial hair growth, scalp irritation and irregular heartbeat.

• Propecia (Finasteride), is a drug taken in tablet form, suitable only for men. Possible side-effects include reduced sex drive, erectile dysfunction and decreased semen volume.

• Saw palmetto is a naturally occurring plant extract believed to be a herbal form of Propecia. It has not been proven beneficial in clinical trials.

• Nizoral is an over-the-counter anti-dandruff medication whose active ingredient is an anti-androgen that can be beneficial for treating hair loss.

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#6 WHAT ABOUT A HAIR SYSTEM? Wigs, toupees and hairpieces – now the hair loss industry likes to call them hair systems. Call them whatever you will, but the principle is always the same: synthetic or human hair fibres attached to a base, the base then attached in some manner to the bald scalp.

There are some very good examples of hair systems. Bruce Willis, Nicolas Cage and Sean Connery have all worn totally undetectable hair systems in movies. In Hollywood, hair systems are made from superfine bases, the hair is expertly matched to the thickness and density of the actor’s surrounding hair, the edges are integrated by trained makeup artists before every shoot, and at the end of each day they throw it away and start again with a new one the next day.

In the real world things are a bit different. The best quality hair systems used to be handmade one at a time, similar to a tailored suit.

They were made from the highest-quality European hair and painstakingly crafted by an expert wigmaker. The hair was expertly matched to the client’s existing hair and then knotted into the base, either singly or in a small group of hairs. The end result was generally very credible appearance but the costs were high: a single hairpiece could cost $5000–$6000 and the wearer generally required at least

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two, so one could be cleaned and maintained while the other was worn.

The hairpiece became mass-produced in Australia between the late 1970s and early 1980s and is now marketed by all manner of sporting identities. It is by far the most common form of hair replacement in Australia today, for a number of reasons. The initial cost is reasonably affordable at around $1500–$3000, the change in appearance is virtually immediate, and there is no surgery, which is a big plus for many people.

The mass-production of hairpieces drove the cottage-industry manufacturers producing a low-volume, high-quality product out of business. Today most hairpieces are manufactured in Asian countries using oriental hair that is sourced from countries such as China and India. The hair is bleached and stripped of its cuticle and then recoloured in various shades to approximate western hair colouring.

It is then knotted into the base, generally taking one person a couple of days to perform the entire knotting process.

The problem with this hair is that it is thick and coarse and very rarely blends with the texture and consistency of the wearer’s own hair.

Due to the extensive processing the hair becomes brittle and breaks after continuous wear of only a few months. For this reason, hair systems are generally made with far more hair in them than is natural to account for the future loss, resulting in the wearer looking like he or she has an unnaturally thick head of hair.

Some of the disadvantages of the hairpiece that have been relayed to me by my clients are: 1. unsatisfactory front hairline As with any form of hair restoration, including hair transplants, the front hairline is the most difficult area on which to achieve a totally natural appearance. In the past, manufacturers created hairlines that were so full of hair for

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longevity reasons that the result couldn’t possibly pass for natural.

Recently the industry has been experimenting with replaceable fine lace hairlines for hairpieces, where you detach the front and attach a new one to the existing hairpiece. They have had varying success.

2. permanent attachment Without doubt, nearly all companies massmarketing hairpieces will try to permanently attach the hairpiece to the wearer’s scalp, generally using glue. There are a number of reasons for this: if it is permanently attached it is not necessarily a ‘wig’ in the client’s eyes, the client must come back to the place of purchase to have it removed and cleaned, and it will wear out much faster.

3. hair breakage Due to the type of hair used and the process it goes through, the hair tends to be very brittle and breaks at the base within a few months. It will generally require extensive repairs by the six-month mark.

4. hair fade This would have to be one of the biggest problems facing any hair-system wearer–trying to maintain a natural colour that is the same as the surrounding hair. Because the hair is so heavily processed, it can be coloured and look quite natural on the day of the maintenance visit but after six months of continuous wear and colouring, the hairpiece, in many cases, can no longer hold its colour for more than a couple of weeks. As the hairpiece begins to fade, there will be an appreciable colour difference between the wearer’s own naturally growing hair and the colour in the hair system. This is generally the problem you see when you notice a hairpiece that is light red-brown on top and the person’s growing hair around the back and sides is dark brown.

5. lifestyle restrictions While the adverts show people water-skiing, swimming at the beach and so on, most hair-system wearers wouldn’t dare do such things with the hairpiece they have just paid

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over $1500 for. And yes, you can do all these things in a hairpiece, but the colour fade and breakage would see it destroyed within a couple of months. These restrictions stop wearers swimming with their kids and other social activities they would like to do. The other problem clients have noted is that as they perspire, their own growing hair becomes wet with perspiration but the hair system on top remains completely dry, as the perspiration does not permeate the base. This effectively stops many clients going to the gym or means they have to wear a cap.

6. fear of detection Without doubt, the biggest fear associated with wearing a hair system is that your friends or work colleagues will realise you are wearing a ‘wig’, as they call it. As one client so succinctly put it, ‘It only takes one bad-hair day for everybody at work to figure out that you are wearing a wig.’

7. ongoing cost While surgery is an expensive alternative, the hair system has a lower entry cost. However, the costs continue on year after year–maintenance once a month can often cost in excess of $100 and two new units every two years will add a further $3000–$6000.

THE ATTACHMENT PROCESS A number of ways have been devised for attaching hairpieces: • double-sided tape is used to adhere the hair system to the bald, or in some instances shaved, areas of skin. This method allows the user to remove the system at his leisure, for example, so he may sleep without it and not shower with it every day, which can lead to premature wear.

• clips attached to the perimeter of the hair system allow the wearer to attach and remove the system at his leisure. Problems arise because the pulling on the hair by the clips can cause traction alopecia, a

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permanent form of hair loss.

• bonding or fusion basically involves gluing the hair system to the scalp. The wearer is unable to remove the system for himself and is reliant on the seller to perform maintenance, commonly termed ‘refusion’. This involves removing and reattaching the hair system every four to six weeks as it becomes loose on the scalp. Proper hygiene is vital when using this method. Wearers must thoroughly rinse underneath the unit daily to avoid infection and a build-up of sebum and shampoo residue, which can result in a strong odour under the hair system.

The points I listed above are not intended to discourage you from wearing a hair system, but they are intended to inform you of some of the considerations you must weigh into your decision to proceed with a hair system. Over the years I have seen some excellent examples worn by everyday people. They are the best solution for people who: • have an inadequate supply of donor hair • are too young to accurately gauge future hair loss • do not wish to go through surgery • do not wish to pay the higher entry cost involved to restore naturally growing hair.

ARTIFICIAL HAIR IMPLANTS While not strictly related to the hairpiece family, artificial implants deserve a mention because they fall into the ‘be very careful’ category.

The basic principle involves inserting a polymer fibre with a loop on the end into the upper dermis of the skin. To fill in a bald head, 5000–8000 ‘hairs’ may be required.

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~

4mm

9mm

normal growing hair

artificial hair implants showing ‘loop’ in skin and skin surface open to infection

Problems arise for the following reasons: • chronic infection

The skin can never properly heal while an

artificial fibre is protruding through it. As a result, the patient must endure constant infection in the recipient area, with pus being secreted from the base of many of the fibres.

• breakage Because the fibres are a manmade product and not regenerating, any friction, such as sleeping, will cause them to wear.

Twenty to 25 per cent breakage at the base of the scalp is not uncommon, leaving the loop and a small amount of fibre protruding from the scalp, continuing the infection problem.

• permanent hair loss Infection and ensuing inflammation can cause permanent hair loss in areas close to the recipient site.

• appearance The artificial fibres do not simulate the appearance of real growing hair, generally being far too shiny and coarse to the touch.

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• maintenance Approximately every month the patient must return to the clinic to cut the original growing hair and remove plugs of dirt and sebum from the base of the implants.

One doctor in Australia is currently performing artificial hair implants, only available after careful assessment and a small trial to ascertain if the client is a suitable candidate.

If you are offered this option, you should be aware of the potential problems.

SUMMARY Hairpieces are a viable alternative for those affected by significant hair loss (generally Norwood 5 or greater). However, for a continuing natural appearance you must be prepared to: •

endure the costly and time-consuming monthly maintenance required

•

purchase two new hairpieces every 12–18 months

•

accept some restriction in lifestyle, such as not being able to go swimming

•

accept the stigma that exists when wearing a wig.

Artificial hair should be considered very carefully in light of the infection concerns and ongoing maintenance.

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#7 SO YOU’RE THINKING OF A HAIR TRANSPLANT Of all the procedures or treatments a person could consider to correct or compensate for their loss of hair, the surgical alternative carries with it the most risk. In my opinion, hair restoration is one of the most demanding of all the cosmetic procedures available today. The specialist skill and artistry are learnt over many years of trial and error, and can not, I believe, be practised part time. Some years ago I made the decision to practise hair transplant surgery full time and it is a decision I have never regretted. I do not believe the results I am achieving today would be possible if I had been juggling my time between hair transplantation and other cosmetic procedures.

There are two important factors in a technically successful hair transplant procedure: • technical competence The doctor performing the procedure must have an intimate knowledge of the best procedures for natural-looking hair with, at the very least, a very high growth rate. He or she will also require the latest equipment and staff, with up-to-date training.

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• artistic considerations A surgeon must have a good aesthetic eye in order to design a procedure that suits the individual’s current and future age, current and future hair loss, facial structure, hair colour and type, and so on.

With these two factors taken into consideration, a doctor can produce a technically successful procedure. But ultimately the doctor is not the judge of the success or failure of a procedure. The doctor didn’t pay for it, nor did they endure an operation for it, nor do they have to wear it for the rest of their life. The patient is the final judge of the success of the procedure. a successful procedure always begins at the consultation stage.

I could be the best hair transplant surgeon in the world and consistently produce the best results in the world. Yet every procedure I perform could be a failure in the eyes of my patients if I gave them unreasonable expectations of what is achievable.

The consultation is an opportunity for the patient to find out about the doctor and the procedure, but just as importantly it is an opportunity for the doctor to assess the patient’s expectations and decide whether those expectations are realistic. There is quite clearly a right and a wrong time to adjust a client’s expectations to what is realistic and achievable. The right time is prior to the client committing himself to the procedure. Quite clearly then, the wrong time is any time after this commitment has been made, particularly after the procedure has been performed.

If during your consultation you are not asked enough questions to accurately gauge your expectations, you will most likely be dissatisfied with the results. How can any doctor fulfil your expectations if he or she does not first find out what they are?

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My advice to you is the same as it is to those people that come to my clinic for a consultation. As a potential client, you should look around and review the various options available to you. If you decide a hair transplant is the method best suited to your lifestyle and expected outcomes, you should see a number of doctors who offer this service.

Listen to their methods and weigh up the pros and cons of the surgical plans and advice offered to you. When it comes time to make your decision, you will do so armed with all the facts, and you will have given yourself the very best chance of achieving the aims you set out to achieve.

The answer to who should perform your procedure will be found when you can confidently answer the following question: which doctor or clinic understands what i am trying to achieve, and has a method or procedure that can achieve it?

THE HISTORY OF THE HAIR TRANSPLANT Dr Okuda, a Japanese dermatologist, performed the first recorded attempts of hair transplantation on humans. In 1939 he reported in Japanese dermatological journals his results from treating various burns victims by transplanting plugs of hair from the permanent hair zone into burnt scar tissue on the scalp, eyebrow and moustache regions. Dr Okuda never mentioned treating male or female pattern hair loss and it is unlikely that he realised the potential of his work. His reports never made it outside Japan and he was killed during World War II. Dr Norman Orentreich of New York, completely unaware of Dr Okuda’s previous work, described a similar procedure he had performed in 1959. Dr Orentreich is considered to be the father of modern hair transplantation because he realised the application of the procedure in the treatment of baldness, and also because he recognised the importance of donor dominance.

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DONOR DOMINANCE The success of any hair transplant procedure is dependant upon the incidence of donor dominance. Simply stated, this is the phenomenon whereby hair-bearing skin taken from the permanent zone at the back and sides of the scalp and transferred to the balding areas at the front, top and crown will retain its original programming (or resistance to the effects of the male hormone) and will grow hair and continue to grow hair for as long as it would have in its original position.

Since those early days in New York, the science and art of hair transplantation has evolved to become the most commonly performed procedure on men in Australia today. To fully explain the advancements that have been made, it is necessary to look back at how the procedures were performed.

DIFFERENT GRAFT SIZES Previously, grafts were classified as plug grafts, mini grafts and micro grafts. Each graft was an improvement on its predecessor, but none could actually mimic nature and regrettably all three are still used by some doctors today.

• plug grafts are those large plugs of hair that produce objectionable results–many potential patients refer to them as the ‘doll’s hair’ look.

The grafts themselves are approximately 3–4 mm in diameter and contain 15–20 hairs. Due to the relatively large size of the grafts, a hole needs to be cored out of the recipient area to place the graft into. These recipient holes remove valuable blood supply to the scalp. Due to these blood flow considerations, a maximum of 100 grafts could be performed in one sitting more importantly, the plugs had to be placed 3–4 mm apart, compounding the unnaturalness of the appearance, particularly in the front hairline.

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• mini grafts were the next progression, containing from four to eight hairs. They have a diameter of between 1.5 and 2.5 mm. They also require a recipient hole to be inserted and result in similar problems to the punch graft, albeit to a lesser degree.

• micro grafts were a significant step forward, containing one to four hairs and ranged in size from 1 to 1.5mm in diameter. Whilst they have a size that allows for a natural-looking appearance, they also have a very low growth rate. The inherent flaw in micro grafts is that the natural grouping of follicles is ignored and split up, damaging vital anatomic structures. This results in a growth rate of around 50 per cent or less of the hair that was originally taken from the donor area. This invariably results in a sparse final result and a waste of the precious resources from the donor area. recipient area

micrografts

donor area plugs

mini graft

micro graft

In the following chapter I will explain how we have overcome the above problems and achieved the high growth rate of punch grafts, combined with the natural results achievable from micro grafts. This method is called follicular unit grafting.

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SCALP REDUCTIONS Scalp reductions were developed in the late 1970s as an adjunct to hair transplantation. They involve removing the section of scalp suffering from hair loss and utilising the available stretch in the skin to pull the thicker hair from the sides up to the top of the scalp.

The original scalp reductions involved removing a section of skin with an elliptical shape similar to that of an Aussie Rules football. This would result in a central scar running from the forehead to the crown.

Various other shapes have been devised in the hope of producing a less noticeable scar. Problems with this procedure are as follows: • unnatural hair direction This procedure can result in the patient having a central scar through the top of the head and the hair growing out of it on either side at right angles.

• accelerated hair loss Trauma to the scalp can result in postoperative hair loss in the joining site.

• stretchback Due to the tension on the scalp, it is not uncommon for the central scar to widen, in some cases by 2–3 cm.

• difficulty correcting Subsequent thinning of the donor area may make such procedures difficult to correct with the latest follicular unit grafting. The donor area will have a lower yield because of the reduced elasticity of the skin.

The author of The Bald Truth, Spencer David Kobren, sums up the opinion of most patients who have had a scalp reduction: Scalp reductions are barbaric and disfiguring … the bald part of the scalp or crown is literally cut away and the edges are sewn together, bringing the hair-bearing scalp from either side to meet in the middle. In some cases, a hideous scar results that makes the top of your head look like your buttocks. The scalp reduction scar is sitting in the middle of an area in which scalp is still often seen, resembling the “crack” between the two cheeks you sit on.’

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scalp reduction

removed section

before operation

balding area removed in 1 or more procedures

immediately after–unsightly central scar

some years later–central scar more evident

FLAPS This procedure is about shifting large slabs of hair-bearing skin in one piece. It involves removing a section of bald scalp, generally in the front hairline region. A section of hair-bearing scalp, generally from the side just above the ear, is then cut away on three sides in a corresponding shape. The remaining side of the flap is left attached to nourish it. The flap is then rotated into position on the front hairline of the scalp. The donor site is then sutured together, with the attached section forming a lumpy ‘knot’. Small grafts can then be placed into the scar tissue in the front hairline in an attempt to make it look natural.

This procedure has a number of potential problems: • necrosis of the flap Because the flap is relying to a large extent on the relatively small connected corner of tissue for ongoing nourishment in the early stages of healing. If this fails to adequately supply the flap with nutrients, it will die in whole or in part, leaving the patient horribly disfigured.

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• a ‘heavy’ brow An excess of skin can result in the patient having neanderthal eyebrows protruding from the face.

• unnatural hair direction Generally a flap will result in the patient having hair growing back at an angle of 45 degrees.

• scarring A linear scar running the full length of the front of the hairline. However, this can generally be disguised by using smaller grafts placed in front of the flap. rotation flaps

SUMMARY • Hair transplantation provides a lasting solution to hair loss because of the incidence of ‘donor dominance’.

• The consultation is a critical time for the patient and the doctor to assess the client’s expectations of the procedure and to determine the likelihood of achieving these expectations. To reiterate, ‘a successful procedure always begins at the consultation stage’.

• Over the last thirty years progressively smaller-sized grafts have been used in hair transplantation, each with their own inherent problems.

• Scalp reductions and flaps are outmoded technology and have no place in the 21st century. The natural results achievable with follicular unit grafting have further highlighted the limitations of these ‘olderstyle’ procedures.

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#8 THE ADVENT OF THE UNDETECTABLE HAIR TRANSPLANT It’s easy to define a bad hair transplant: if it’s obvious it’s a hair transplant, then it’s quite obviously a bad hair transplant.

We have all seen the tell-tale signs: the plugs of hair interspersed with big gaps of naked skin, hairlines so straight and uniform they look like a pleat on a military general’s pair of pants–not examples that anyone concerned about their appearance would be rushing out to emulate.

THE BREAKTHROUGH For years I looked for a hair transplant procedure that would provide me with results I could be absolutely proud of.

Patients seemed generally pleased with the results of the past. They knew the limitations of the larger plugs. They knew the hairlines had their limitations. They knew that at times their result would appear like a hair transplant. While to them the results were better than being bald, I wanted something better to offer them.

The breakthrough I had been looking for was presented to me at the annual International Society of Hair Restoration Surgery meeting in

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October 1994. An American hair transplant surgeon, Dr Bill Rassman, presented three patients who had undergone follicular unit grafting. He invited every doctor in the auditorium up onto the stage to view firsthand the results achievable with this new method he had devised.

I was amazed. The results were unbelievable, the best I had ever seen–hairlines that naturally recreated a gradual transition from forehead to hair-bearing skin. A midscalp without the large gaps between the plugs. The wind could blow it all over the place and you would never know. You could climb straight out of the pool and be confident it looked natural.

This was what I had been looking for ever since I started performing hair transplants. Following the conference I was fortunate enough to be approached by two technicians who worked with Dr Rassman. They offered to come to my rooms and show me the technique that had been developed.

In December 1994 I switched over totally to follicular unit grafts. At that stage they were being cut without the aid of magnification. The danger with this method was that if the grafts were trimmed down too much, the vital sebaceous glands and other tissues that are an integral part of the graft could be removed, effectively destroying the graft and resulting in low growth rates.

I have a good relationship with Dr David Seager in Toronto and knew that he was interested in this particular technique. He persuaded me to go to Canada and learn how to cut the grafts with the aid of a microscope. The benefit of the microscope is, of course, that you can see all the appendages of the follicular unit group and leave them intact. Ultimately, for the prospective patient this means they can be assured of very high growth rate–in excess of 95 per cent in nearly all cases.

In 1998 I went back to Dr Seager and he performed a procedure on

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me in which 1,900 grafts were placed in my frontal area. Over the next few months this produced very good growth. It looks totally natural and requires no special maintenance other than washing, combing and cutting. Anyone who has a transplant will only need to have it cut by their normal hairdresser and can use any shampoo and conditioner.

This was what I had been searching for: • natural-looking and growing hair that requires no special maintenance • the transfer of a large amount of hair in one procedure • consistently high growth rates, in excess of 95 per cent.

The methods of hair transplantation that you will read about in the next few pages have not been developed by me, but are the culmination of many years of work by a number of surgeons who have dedicated their practices to the field of hair transplantation.

FOLLICULAR UNIT GRAFTING (FUG) the best hair transplant is the one you never see.

A normal head of hair is composed of a mass of hairs growing in follicular units, naturally occurring in groups of one, two, three and occasionally four hairs. These units are randomly but closely spaced and ultimately form what we know to be a natural-looking head of hair.

The best hair transplant, then, the one that you never see, would mimic ‘nature’s way’.

This is the principle behind follicular unit grafting. Clusters of one, two, three and four-haired grafts occur naturally all over the scalp. After male pattern baldness sets in they are still growing this way from the donor area at the back of the scalp. With the benefit of hindsight it is

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now easy to see that, if that is the way they were growing and they obviously looked natural prior to any hair loss, the most natural appearance would be achieved by putting them back that way.

In the past, surgeons unaware of their existence or relevance ignored these follicular unit groups. Micro grafts quite often contained the same number of hairs as the follicular unit graft, but they were dissected with the naked eye. This dissection resulted in transection of the follicular unit, which damaged vital structures crucial to graft survival. As a result, growth rates of around 50 per cent for micro grafts or follicular units cut without the aid of magnifications were not uncommon.

The introduction of the binocular stereoscopic dissecting microscope has made it possible for surgeons to see these follicular units and dissect them intact by sculpting around the glands and muscles and removing the excess skin. There are three distinct advantages from using the microscope: • we can see all the follicles The microscope allows us to see and sculpt around the hair follicles instead of cutting straight through them. Using the older, unmagnified methods, a large percentage of hairs were transected and as a result were generally discarded. This fact alone allows us to yield approximately 20 per cent more grafts from the same-sized donor area.

• we can cut them better Every growing hair on our heads is supported by sebaceous glands and dermal tissue. These appendages are a vital part of the hair factory, and if they are cut during the dissecting process their chances of survival can in some cases be halved. The microscope allows us to identify these structures and sculpt around them, leaving them intact. They are impossible to see accurately without the microscope. In addition, not only do we get more grafts, we also dramatically improve the growth

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rate of the grafts we have cut–by a further 20 per cent.

• we can preserve hair follicles invisible to the naked eye As discussed in Chapter 2, at any point in time approximately 10–15 per cent of follicles are dormant in the telogen phase, or their hair has failed to reach the surface of the skin. However, they are still viable and should not be discarded, but implanted as part of the transplant process. These follicles are invisible to the naked eye but with the microscope we can identify a good portion of thm and potentially increase the yield by a further 5 per cent.

The net effect of all these benefits can be shown in a comparison between micro grafts and follicular unit grafts. If an average micro-graft procedure

were

ultimately

to

yield

2,000

growing

hairs,

an equivalent follicular unit graft would yield almost 3,200 growing hairs. standard micrograft procedure

2000

plus hairs in telogen phase

( + 5%)

200

2200

plus improved growth rate hairs

( + 20%)

440

2640

plus all available follicle hairs

( + 20%)

528

3168

As can be seen from the comparison, the cumulative effect of FUG using microscopic dissection over a standard micro-graft procedure is a very big difference. You must also take into account those extra 1,168 hairs removed from the donor hair, which would have been lost as wastage in the older-style procedure.

SINGLE HAIR GRAFTING Occasionally I am asked by prospective patients whether I offer allsingle hair grafting. It is pertinent to discuss this while we are on the subject of graft cutting.

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The hair on your head doesn’t generally grow singly anywhere except on the front hairline. As such, there is no requirement to replace it singly anywhere except on the front hairline. When performing a FUG procedure, we will generally yield about 20–25 per cent single hair grafts that occur naturally. These grafts are strategically placed in the reconstruction of the hairline, along with some of the two-haired grafts.

The balance of two, three and four-haired grafts are used behind the hairline for a thicker appearance. This is all that is required for a natural result. To go through and break up follicular units into single hair grafts for placement anywhere other than the hairline would be tantamount to vandalism. The destruction of active, growing hair follicles would generally result in growth rates lower than 50 per cent An all-single hair-grafting procedure is more labour intensive, more expensive, has lower growth rates, has lower density and does not mimic the way nature naturally grows hair.

DENSE PACKING Dense packing is usually performed in conjunction with the megasession (a single procedure resulting in the transfer of 1500 - 3500+ follicular unite grafts) and is used to plant grafts in extremely close proximity to one another. This is possible because the FUG method does not require the extraction of skin when making the recipient hole.

Because of the very small nature of follicular unit grafts, grafts can be inserted into holes made with only a hypodermic needle, allowing us to leave intact the delicate blood supply to the scalp.

The dense packing method has required a slight change in procedure. When procedures were performed in the past, generally the doctor would go through and make up to 1000 incisions for the grafts to then be placed by the technicians. The problem was that by the time the technicians got around to the job some hours later, the holes had all but

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healed up. This then required the use of a larger needle so that the hole was still sufficiently open to accept the graft when the technician got around to placing it. This was obviously more invasive to the scalp.

The ‘stick and plant’ technique involves the technician making the hole under the direction of the doctor and then inserting the graft immediately. Then a second hole is created and the graft is inserted into that, and so on. This allows for the use of a far smaller hypodermic needle, because the skin is not allowed to partially heal prior to the insertion of the graft. A smaller needle allows the grafts to be placed closer together and is far less invasive to the scalp.

This minor change allows us to implant nearly twice the number of grafts per square centimetre, ultimately creating a high density in a small area when required.

THE FRONT HAIRLINE Without doubt the most critical aspect of any hair restoration surgery is the construction of a natural-looking front hairline. In the past, front hairlines with a symmetrical bell shape and plugs stretching across with an absolutely perfect and uniform spacing throughout were quite a common sight. When people talk about ‘doll’s hair’ and ‘rows of corn’ this image is invariably the one they are talking about.

As a general rule, when people build things they look for symmetry or order in the design. Hairlines created using this same philosophy resulted in the problems mentioned above. Nature, when it creates a hairline, is erratic and random, lacking symmetry close up but when seen from a distance appearing to have perfect symmetry. The challenge was how to create this irregular zone that appears so natural.

The most natural hairlines a have a soft transition from the forehead through sparse fine hairs to the thicker, denser hairs approximately 1–1.5 cm behind the front hairline:.

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With the development of the follicular unit graft we have also developed ways to implant the grafts in a shape, pattern, angulation, direction and density that is indicative of a completely natural hairline.

• shape refers to the overall curvature of the hairline, taking current and future hair loss and ageing into consideration.

• pattern refers to the distribution or final position of 1, 2 and 3 hair grafts.

• density refers to the number of grafts placed per square centimetre required to achieve a natural outcome. For example, a lower density is generally required in the temple region than is required right at the front of the hairline.

• angulation refers to the angle of implantation of the grafts in relation to the scalp. Commonly at the front hairline the angle of implantation is around 25–30 per cent from the scalp, generally rising to 60 per cent as we move towards the crown.

• direction refers to the direction of the implanted hair graft and whether it will point to the left or the right. Such a decision is based upon the way the individual has styled his hair in the past and how he intends to style it in the future.

zone one Single hair grafts placed sporadically for a low to very low density

zone two 1 & 2 hair grafts placed for medium to low density

zone three 2, 3 & 4 hair grafts placed for maximum density

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The illustration shows the type of hairline design that can be used in many cases where a total reconstruction of the hairline is required. The first 1.5–2 cm of the hairline is constructed out of three distinct zones of varying densities and graft sizes. The use of these distinct zones allows us to produce natural results that defy detection as a transplanted hairline.

The hairline shown here is of a general nature and will apply in some cases but not all. Your consulting doctor will, with your input, design a hairline for you that takes into account variables such as age, current and future hair loss, facial features, skin colour and hair type and colour.

Some doctors will design the hairline for you at the consultation stage, while others will do it prior to the procedure at the meeting before surgery commences. Either way is okay. Just ensure that you are happy with it prior to surgery commencing.

SUMMARY The basic facts about hair transplants: • A hair transplant involves taking hair-bearing skin from the back and sides of the scalp where it is plentiful and resistant to the effects of the male hormone. This hair-bearing skin is then implanted into areas at the front top and crown.

• What has been moved is the follicle that grows the hair, so afterwards you will have a growing, regenerating result.

• It is only possible to move around what you have left–it is not possible to transplant hair from other individuals.

• Generally a section is removed from the back of the scalp in one piece and is then dissected into individual groups containing a number of hairs. These transferable groups are called grafts.

• Transplanted hair will continue to grow in its new area for as long as it would have in the area it was taken from. If it was correctly taken from the rim of ‘lifetime’ hair at the back and sides of the scalp, it will last a lifetime.

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• Remaining original hair around the transplanted area will generally continue to recede and further procedures may be required at a later date. This is especially true for younger patients.

• Variations in the result achieved occur because of: 1. the size of the area to fill Obviously a larger area will require more grafts to achieve the same density as a smaller area.

2. the density of the donor area A large number of hairs per square centimetre will yield a larger number of grafts for a given area.

3. scalp flexibility If the patient has quite loose, flexible skin it is possible to remove a larger piece of skin, while leaving an acceptable amount of tension on the scalp.

4. hair type Thick, strong hair with a large-diameter shaft can make the final result appear considerably thicker than weak, fine hair.

5. hair and skin colour contrast The best visual results are attained by individuals with either dark hair and dark skin, or fair hair and light skin. Dark hair with fair skin can be very challenging.

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#9 HAVING A TRANSPLANT– GERRY’S STORY It all started in 1990. I was twenty-one. I had just broken up with my girlfriend. All of a sudden I started to lose a lot of hair. My pillow was covered in hair every morning when I woke up. The drain was clogged with hair when I got out of the shower, and every time I brushed my hair, I would have to brush the hair off the back of my shirt.

I made an appointment at a leading hair loss clinic immediately.

I was told I had poor circulation of the scalp, embedded dandruff and oil blocking the follicles, which was causing my hair to fall out. They wanted me to sign up on a $1700 program that was guaranteed to stop the hair loss immediately.

As desperate as I was to do something quickly to stop my hair falling out, I wanted to get other opinions, so I told them I would think about it. They said, ‘What is there to think about? If you don’t do anything right now, all your hair will be gone in two years.’

It was a typical high-pressure sales pitch, which put me off. I read the fine print on the guarantee and it was dependent on using the clinic’s own brand of products, which would make me a customer for life.

I became suspicious so I contacted the Australian Consumers Association (Choice magazine). They sent me a story they had done on

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the hair loss industry entitled ‘The Bald Facts’.

It covered everything: cause and effect, cures and camouflages and, most importantly, what to do if you think you are losing your hair. The very first page told me male pattern baldness is not caused by poor circulation of the scalp, embedded dandruff or oil blocking the follicles.

It is a result of two factors: an inherited genetic predisposition combined with a certain level of male hormones.

Choice recommended seeing either a dermatologist or a trichologist (trichologists are not doctors, but they specialise in hair and scalp problems). I contacted the Australian branch of the International Association of Trichologists (IAT). They provided me with the names and locations of its members, who are certified trichologists.

SEEING A TRICHOLOGIST I saw a leading trichologist, who told me what my options were (which weren’t many, back then). The only thing proven to work on male pattern baldness in clinical trials was minoxodil 2 per cent.

I got a prescription and applied minoxodil 2 per cent to my scalp twice a day. After six months it wasn’t working for me. My hair was still falling out, so I stopped using it.

I was devastated! There was nothing I could do to save my hair. I could only hope the hair loss slowed down. I kept in touch with my trichologist every few months, seeing if anything new was on the market to help prevent male pattern baldness.

The hair loss did slow down, but five years later, in the middle of 1995, I was unable to style my hair the way I used to and get away with it. People began to notice my hair was thinning–some made comments, others made jokes.

Every time I looked in the mirror or saw myself in a photo, I got depressed. If someone made a comment or, worse, a joke, I was

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shattered for days.

Losing your hair affects different people in different ways. Some people say they couldn’t care less, while for others (including me), losing your hair can be devastating, especially when it happens at a young age. I felt it made me look older than I actually was. I felt less attractive to the opposite sex and I was less confident in social situations. I stopped doing a lot of things I enjoyed, so as to avoid the people who made comments and jokes. I avoided mirrors and wouldn’t let people take pictures of me.

It was beginning to affect me psychologically, so I started reading books on positive thinking, trying to convince myself it didn’t really matter. But deep down, it really did matter. I had to look at my options again. I couldn’t stop thinking about it. I wanted my life back!

My only options now were surgery or a hairpiece. I first looked into hair fusion, although I never seriously considered it as an option. This option is high maintenance and I am a low-maintenance kind of guy. The fusion technique involves a hairpiece, or ‘unit’, that is meant to be tailor-made to fit your hair and pattern of balding. Your own hair is pulled through the mesh base of the unit to hold it in place, along with clips or glue or double-sided tape. Because the unit is attached to your hair, it starts to lift off as the hair grows and so needs to be refused every four to six weeks.

One subscriber to Choice discovered that ‘units’ have a limited lifetime. His lasted only nine months before the hair started falling out.

In that time it had also changed colour, having been bleached or faded by the sun. Others complained the unit was very uncomfortable, did not look natural, and they always had to be on the lookout to protect it from the sun and rain.

Considering the replacement cost, plus the cost every month for a ‘refusion’ and that the guarantee offered is dependent on using the

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clinic’s own brand of shampoos, reconditioners and revitalisers, hair fusion can be a very high maintenance and expensive option.

I also looked into wigs and hairpieces, the oldest method of disguising baldness. They are particularly good for people who have lost a lot of hair as a result of chemotherapy or an accident. For people with male pattern balding, the only advantage a hairpiece has over hair fusion is that it can be taken off, making washing it and your own scalp easier.

I decided hairpieces and hair fusion were not an option. I spoke to my trichologist and saw a hair transplant doctor he recommended. At the time, scalp reductions, flaps and plugs were the most common forms of hair transplantation. Mini grafts and micro grafts were just starting to be introduced as the latest technology in hair transplantation.

I saw guys who’d had scalp reductions, flaps and plugs, and was not impressed. Scalp reductions create a scar that sits in the middle of an area of the scalp, which is still often seen. Also, the direction of the hair growth is altered, which results in an unnatural appearance. Flaps leave scars both above and below the flap. They also result in a hairline that grows backwards at an angle of 45 degrees to the scalp, which results in an unnatural appearance. A plug contained 15 or 16 hairs, which meant the new hair looked a bit like rows of corn and not very natural at all. These methods were not an option as far as I was concerned.

Mini grafts and micro grafts were the most natural-looking option at the time, but were only being done in small numbers, which meant several sessions were required to cover a large area of baldness. Due to the size and spacing required, you would have a ‘tufty’ or ‘pluggy’ appearance after the first couple of sessions that could only be filled in with multiple sessions in the gaps between grafts. This could represent a period of two to three years to achieve the final result, with the

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potential for some embarrassing moments during that time.

I wasn’t prepared to have several operations and look like a freak for two or three years. Again my hopes were shattered. Here I was, twentysix years old, going bald, and there was nothing acceptable I could do about it. All I could do was try to accept it. I went out and bought a hair clipper and put a number one through what was left of my hair.

WAITING FOR A BREAKTHROUGH In 1996 a breakthrough came. It was discovered that the drug finasteride, which was being used for treating people with enlarged prostate glands, had a fascinating side-effect: some patients’ hair started growing back.

This led to the discovery that male pattern baldness is caused when the male hormone testosterone is converted to a derivative, dihydrotestosterone (DHT). High levels of DHT cause hair follicles to age prematurely and shrivel.

Finasteride works by blocking an enzyme, 5 alpha reductase, which converts testosterone to DHT. The drug can cause DHT levels to drop by up to 70 per cent in eight hours. When DHT levels are low, follicles can strengthen and produce hair for longer. The only downfall is a possible loss of libido and difficulty in achieving an erection in less than 1 per cent of patients.

It was simple: reduce DHT, reduce hair loss, and maybe grow some hair back. Now I had some hope. The only problem was the drug had to be tested in clinical trials before it could be sold to prevent male pattern baldness in Australia.

My trichologist said it would be at least a year before finasteride was released in Australia. He also told me about a herb, saw palmetto, that could do the same thing (and could cause similar side-effects).

I immediately went to a health shop and purchased some saw palmetto

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(Proseren) capsules. I took two a day at a cost of $20 a month and took my chances. I had no side-effects, but no noticeable improvement in hair growth either. It did, however, slow down the hair loss. I saw less on my pillow in the morning.

I did this for about a year until finasteride, marketed as Propecia, was available in Australia. I decided to change to Propecia, since it had been tested and proven to work on male pattern baldness, where saw palmetto had not.

I have taken Propecia ever since, with similar results to saw palmetto, at a cost of about $70 a month (my health fund allows me to claim $500 a year of the total cost). Propecia is definitely helping keep the hair I have left. I know this because the rate of fallout is virtually nil.

It took a while before this happened.

I decided to stay on Propecia for at least 12 to 18 months before I could confidently say whether it was working or not. By mid-1999, I still had not had any regrowth, but I was holding what I had left. So I started looking into hair transplants again. I found they had improved dramatically over the previous four years. Follicular units had been discovered. It had been found that the hair at the back of the scalp does not grow individually, but in naturally occurring groups of one to four hairs. The discovery of the follicular unit had allowed doctors to mimic nature by transplanting hairs in the same way nature grows them.

It sounded good. The doctor would remove a strip of scalp 1 cm wide and up to 20 cm long from the back and side of the head. The donor site would be closed with stitches, staples or sutures until the wound healed. The strip of scalp would be divided up and given to several technicians. Using microscopes to see these follicular units, the technicians would dissect them precisely and then replant them densely into the bald scalp in large numbers. This procedure is often referred to as a mega-session.

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For the first time in a while, I was excited. I learnt that a megasession consists of 1500–3500 follicular unit grafts placed in one sitting. Each of these grafts contains from one to four hairs. One follicular unit mega-session equals three to five sessions using the commonly performed conventional methods with mini and micro grafts.

The smaller follicular units can be placed much closer together than traditional mini and micro grafts, effectively negating the ‘tufty’ appearance.

Since there are fewer sessions, there’s less time off work, less discomfort and less anxiety regarding the procedure. There is not much difference in the price (since fewer sessions are required) and the end result is much more natural.

It all sounded good, but I wasn’t getting my hopes up. After what I had seen before I was sceptical, so I decided to look further into follicular unit hair transplants.

MY RESEARCH The Internet is an excellent source of information. This is where my search started. A list of sites I regularly visited can be found on pages 120–1. I spent most of my time on the non-commercial sites to find out the positive and negative aspects of follicular unit hair transplantation, as the commercial sites focus only on the positive aspects. I also wanted to talk to as many people as I could who’d had follicular unit hair transplants and ask them about their experiences and results.

FINDING A DOCTOR After studying the web sites and speaking to people who had had a follicular unit hair transplant, I was convinced this was the breakthrough I had been waiting for. I now had to find a doctor in Australia who was using the same procedures and getting the same results.

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I spoke to my trichologist and others registered with the IAT to get an independent view on the hair transplant surgeons in this country. I had consultations with four of the doctors they recommended, all of whom were members of the Australian Society of Hair Transplant Surgery.

Most of them gave me names and phone numbers of former patients.

After meeting some of these former patients, I found they were all getting excellent results.

I have listed my reasons for choosing Dr Barry White at the end of this story.

BEFORE MY PROCEDURE I booked the operation and requested two weeks’ annual leave. This would allow me time to completely recover from the operation. I didn’t tell anyone at work I was having a hair transplant, as I wanted to go back to work unnoticed.

After I booked the operation I felt relieved. I had finally done something about my hair loss, which had been bothering me for a long time. I also felt very nervous. Even though it is minor surgery, it is still an operation and I was worried about complications. Hair restoration procedures differ from general surgery, however, in that they involve only the outer layers of the body. In Dr White’s experience, postoperative complications have been infrequent and never serious, the most common being minor swelling and occasional bruising around the forehead and eyelids on the third day. This may last for up to a week. I was told that part of my scalp might remain numb for some time due to temporary interference with the nerves in that area.

I was also worried about how I would look after the operation. Some people look better than others do after a hair transplant due to certain factors. After having many consultations and doing so much research, I knew the following factors about my hair and skin:

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• My hair is straight and dark brown in colour on fair to olive skin.

• My hair texture is medium and I have good donor density and scalp flexibility.

Dr White described various aspects of restoring my hair and how these factors would contribute to the outcome of my transplant.

MY EXPECTATIONS Hair transplantation does not create new hair. It simply relocates it from your donor area (the sides and back of your head) to your area of male pattern baldness. Transplanted hair may look wonderful and full, but it will never be as thick as it once was. Some people are satisfied with just re-establishing a thinning look in an area where they were once bald, while others are not satisfied until they’ve achieved a look of having a full head of hair.

I was prepared for a natural, thinning look, but hoping for a look of a full head of hair. I believe it is better to look thin than to look bald. My expectations: • I wanted a natural look, with an even coverage of medium density.

• I wanted it to blend in with my existing hair and not be detectable.

I went over these expectations several times with Dr White. Although it was impossible to predict what the final outcome would be, he guaranteed I would look better after the procedure.

THE PROCEDURE – DAY OF CHANGE 8:15 am Arrive at Melbourne airport and am greeted by the National Hair Institute’s chauffeur.

9:00 am Arrive at the National Hair Institute feeling very nervous. I settle my account, then change into a medical gown and take a seat in

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a chair that is very similar to a dentist’s chair. I am given a menu and order lunch. Dr White hands me a mirror and draws a line on my forehead that will represent my hairline. He rubs it off two or three times until we both agree it looks right. Dr White will focus on using the estimated 2500 grafts on the front half of my bald scalp, going back about 10 cm from the front hairline. This will establish my hairline and give me the most dramatic initial improvement.

9:15 am I am given an injection (to help calm my nerves and relieve the pain of the local anaesthetic injections) and some tablets (to help healing and prevent infection). I am hooked up to a machine that monitors blood pressure and heart rate. It beeps like crazy until the injection kicks in, because I am so nervous.

9:30 am The hair in the back is taped up and a strip 1 cm wide by about 20 cm long is shaved. Dr White gives me several injections of local anaesthetic in the back of my scalp from where my donor hair is to be taken. This is the most discomforting part of the whole operation.

9:45 am The back of my head is now numb. Dr White removes half the donor strip and gives it to the technicians. The other half will be removed later, when the technicians finish dissecting the first strip. This way the donor hair is out of the body for the shortest possible time.

While the technicians prepare the donor strip, Dr White staples the donor area closed (he uses sutures on some people and staples on others). During this process I can’t feel any sensation at all.

10:00 am The first strip of donor hair is divided up between the six technicians and, using microscopes, they begin to dissect it into follicular units. One-hair follicle grafts, two-hair follicle grafts, threehair follicle grafts and four-hair follicle grafts are placed in separate trays and put in a refrigerator until needed.

11:15 am Dr. White gives me several shots of local anaesthetic in the front top of my scalp. This is the area where he will be transplanting my

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hair follicles. Once the local anaesthetic takes effect, the top of my head is completely numb. Dr White now removes the second half of the donor strip and gives it to the technicians. While the technicians prepare the donor strip, Dr White staples the donor area closed. The tape holding the hair in the back is removed and the hair drops down and covers the staples.

11:30 am Two technicians begin placing the grafts (one on each side), while the other four continue to dissect the second strip of donor hair.

An incision is made with a hypodermic needle and the follicular unit graft is placed into the incision. I can’t feel it at all. The one-hair follicle graft is placed in the frontal area of my scalp and the two-hair follicle grafts, three-hair follicle grafts and four-hair follicle grafts are placed behind the one hair follicle graft. To create hair that grows with a natural appearance, the incision angle is made mimicking the original growing hair. The fineness of the incisions allows the technicians to make the incisions closer together while still minimising any trauma to my scalp tissue.

12:30 pm Time for lunch. I get up and immediately look in the mirror (I cannot contain myself ) and am amazed to see all the short hairs sticking out of my previously bald scalp (the donor hairs are shaved down to less than 6 mm to make them easier to handle). I eat my lunch and read the paper as I normally do. I am not in any pain at all. The back of my head doesn’t even feel tight after they take out the donor hair.

1:00 pm I return to the chair and watch TV while the technicians place the grafts.

5:00 pm All my grafts (2811, but I have only paid for 2500) have been successfully transplanted to the top of my head. A light bandage is placed around the donor area to help stop any bleeding.

5:15 pm I am given some post-op instructions, both verbally and in writing, and a number to contact Dr White in case of an emergency. I am

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given paracetamol to take if I need it, antibiotics to prevent any kind of infection, anti-swelling tablets and healing aid tablets to take for the first four days. It appears the main concern in the first 72 hours, besides infection, is the grafts popping out. No exercise, lifting, leaning forward or sex for three days (not that it matters!). Any pressure on the head or elevation of blood pressure can cause the grafts to pop out.

6:00 pm I spend the next half-hour staring in the mirror. I am surprised at how close the grafts have been placed together and how different I look.

7:00 pm After dinner I watch TV for a while. I am still in no pain at all. I can honestly say hair transplants are not painful, but the injections at the beginning of the procedure were a bit uncomfortable.

10:30 pm I go to bed. I have to sleep at a 45– degree angle for the first three nights after the procedure to reduce the instance of swelling. I have bought a neck pillow in preparation for this. It takes me a while to get comfortable, but eventually I fall asleep.

AFTER THE PROCEDURE the day after I wake up, still not in any pain (which surprises me). I have breakfast and then make my way to the clinic. One of the technicians removes the bandage, washes my hair and inspects the transplant. She says it looks excellent and I don’t have any bleeding from last night. She shows me how to wash my hair for the next few days. I have to use a cup with warm water and a little shampoo in it and I dip a gauze pad into the water and then use a dabbing motion on the grafted area. I then rinse the grafted area with the cup of warm water. This is a daily process as I am unable to put my head under the shower or submerge it for at least five days I take it easy for the rest of the day. I am reading a book I had started

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some months earlier and hadn’t had the chance to finish. Ironically the chapter I am reading is called ‘Day of Change’.

That night I start to notice some swelling around my forehead area, so I apply an ice pack to my forehead every hour or so for 10 minutes. two days after I still haven’t experienced any pain. A friend calls in to see me. He is aware that I have had a hair transplant. When he sees me, the first thing he says is ‘Wow! He really packed them in there. That is going to look excellent.’ He knows a guy who had the older micro grafts and wasn’t expecting me to have so many grafts so densely packed together.

The swelling is getting worse, so I keep applying the ice pack to my forehead every hour for 10 minutes. three days after I am still sleeping upright and am in no pain, but I have experienced a lot of swelling around my eyes and face. I have a bit of a shock when I wake up because I think both my eyes are going to go black and close.

I use the ice pack every hour for 10 minutes. I speak to Dr White and he reassures me this is normal and not to worry. He says the swelling will start to go down very quickly. four days after Just like Dr White said, the swelling starts going down very quickly and I can sleep lying down for the first time since the operation. It takes a while to get comfortable due to the staples in the back of my head. five to ten days after The swelling is completely gone after day five. It is getting more and more comfortable to sleep, as I am used to the staples by now. At about day six to seven I begin to shower again. I can now gently rub the grafts in a

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circular motion and a lot of the scabs and crusts, which have formed around the grafts, come off. I speak to Dr White about the redness of my scalp, and again he assures me not to worry because it will go away very quickly. eleven to thirteen days after All the scabs and crusts have come off completely and the redness is gone, just like Dr White said. I make an appointment with him and he removes the staples. He is very pleased with the progress of the transplant and says I look fantastic. The transplanted hairs look natural, much to my relief.

Another of my friends sees the transplant and is amazed. He expected to see a head full of scars and dents. He says it just looks like I have shaved the front part of my head. This is really the only problem: It looks like I started to put a number one through my hair and then stopped because I changed your mind. If it wasn’t for the incision at the back, I would have put a number one through the rest of my hair myself.

I visit my hairdresser and tell her what I have had done. I ask her to cut the rest of my hair as short as possible without revealing the scar at the back. She is impressed and says, ‘You wouldn’t even know you’ve had had it done.’

It looks a lot better now, because my hair is much more even. two weeks after I return to work with the intention of telling my workmates I had a hair transplant only if they ask. I have grown a beard in the two weeks I have had off, and they are all making comments about how different I look. A few guys look at my head but no one says anything. I think they can’t figure out that I went on holidays and came back much hairier. I have developed the habit of looking into the other person’s eyes when I am

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talking to them to see if they are looking at my hair. I am back to my usual routine of going to the gym three times a week. three weeks after My transplanted hairs begin to shed. This is normal (although I hoped it wouldn’t happen). After they shed they will stay dormant for three to seven months and then begin to grow. I will have to be patient now. four weeks after The shedding starts to slow down. The hairs that remain are growing and I can’t ever remember looking in the mirror this much. I have an appointment with Dr White and he tells me I have healed remarkably well. The donor scar, even after four weeks, is barely visible. five weeks after The shedding starts again. Some days are worse than others. I still have about 30 per cent of the transplanted hairs. Some of the hairs that broke off are starting to grow again. My scalp remains slightly pink. I think I am noticing this more because most of the hair has now shed and the scalp is more visible. I went to the hairdresser this week and had another trim. She remarked how I had lost most of the transplanted hairs and asked if this was normal. I assured her it was but could tell she was sceptical that the hairs would grow back. six weeks after The secret is out. At work this week I was talking to a guy and saw him looking at my head. He said, ‘You’ve done something to your hair–you have pimples. Have you had a hair transplant?’ I said, ‘Yes, I have, and you are the first to notice.’ He was very negative and started telling me all these hair transplant horror stories he had witnessed. It really got

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me down and was the first time I have had second thoughts.

The transplanted area is still a bit pink and this week I have had a few pimples develop. This is what made him notice (and because he knew a few people who had had other work done). The ‘pimples’ are completely normal and are a definite sign of new growth. They are actually in-grown hairs just trying to find their way to the surface.

The shedding has stopped. I guess I have about 25 per cent of the transplanted hairs left and they are growing. seven weeks after The pimples have not been as bad this week. The pinkness is still there but it is getting better. No one else at work has noticed, or at least nobody said anything. I am starting to see some new growth. A lot of hairs have poked through to the surface of my scalp, which explains why the pimples aren’t as bad. I am not shedding at all and can’t stop looking in the mirror. two months after Not much has changed this week. The pimples and the pinkness are getting better every day. You can just see all the new hairs popping up.

It’s really exciting, actually. The back of my head is still a bit numb. I only really notice it when I put my head back on the headrest in the car. three months after The pinkness and pimples have completely disappeared. I’d say about 50 per cent of the new hairs have started growing, and the hairs that never fell out are over 25 mm long. The new hairs always start growing fine and colourless. After they grow out about 6 mm, they have more thickness and colour. Again, the only problem is that it looks like you started to put a number one through your head and then stopped due to the difference in length of the new hairs and the existing hairs.

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four months after It’s amazing the difference four weeks makes. I have had a few comments this month from people who know I have had a transplant.

My hairdresser told me she didn’t think the hairs would grow back because of the trauma of the transplant, but is really surprised at how they are growing. This gave me enough courage to shave off the beard.

I have noticed that from the side it looks like I have a hairline again. five months after I hadn’t seen one of my friends for about a month and as soon as he saw me he looked at my hair and said, ‘Oh yeah, it’s kicking in now, it’s really starting to fill in.’ He also said it has taken about ten years off my appearance.

The transplanted hairs look natural and the scar at the back looks like a thin white line about 3 mm wide across the back of my head, which is undetectable unless you look for it with a comb. The back of my head is now completely back to normal. At this point it is like I never had the operation. six months after – halfway If I get the same amount of growth in another six months, I am going to look fantastic.

A few people at work who I don’t see regularly have told me I look different. One guy said, ‘Have you had a haircut or something?’ I also saw the only guy who noticed I had the transplant. He said to me, ‘Your hair looks good. I am surprised, actually.’ He told me I am the only guy he knows who has had some success with hair replacement. He has friends who have detectable hairpieces and bad transplants. He even knew a guy who had artificial fibres implanted into his head and got a terrible infection. He said, ‘It makes you look younger and really suits

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you.’ I told him I am only at the halfway mark and it takes 12 months to get the final result. He seemed shocked it would get better and said, ‘What? It’s going to get better than that? Even if it doesn’t get better, you really got your money’s worth.’

I don’t have any second thoughts now. With every positive remark, my confidence slowly grows. It is higher now than it has been for a long time. nine months after I saw myself in the family Christmas photos. For once I thought I looked good. I don’t mind having my photo taken now. I have to try to convince my parents to hide all the bald family photos of me. One of my friends said to me recently, ‘It is amazing what Dr White has done for you.’ One of my neighbours, whom I haven’t seen for a while, said, ‘Are you growing your hair?’ (I was cutting what was left really short.) ‘You look younger.’

I went for a haircut recently. My hairdresser said, ‘It must feel like you are getting a real haircut now.’ No more clippers to keep the back and sides as short as possible. She now cuts all my hair with scissors.

It used to be embarrassing sitting waiting to get a haircut. A few times I had the comment ‘You have nothing to cut’. I only used to get charged half-price, too. For the first time I can remember I was charged full price and I had my fringe cut. My hairdresser said, ‘It’s really taking off now.’

I have started to experiment with hairstyles. I haven’t decided which one suits me the best. The density looks better though when I keep it long and comb it to the side. twelve months after – final result I went to a club recently and had to produce ID. The bouncer looked at me, then looked at the picture on my licence, three times before he let me through. It is unbelievable how different hair can make you look. I

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still haven’t decided which hairstyle suits me best, but to be honest I like keeping it short and brushed down because it is the least maintenance and I don’t have to worry about the wind messing it up.

I am still getting comments from people I don’t see regularly. They all tell me I look different, and I do. Because the process is so gradual, people don’t notice. It’s not like getting a rug and in one day you go from bald to having a full head of hair.

I was telling a friend it’s been 12 months since I had the transplant and he gave me the ultimate compliment. He said, ‘You know what, I had forgotten you had it done.’

REASONS WHY I CHOSE DR WHITE 1. Dr White has been through this procedure himself. He had the confidence to have it done on himself. He knows what losing your hair is like and I found him to be a genuine and caring person.

2. Dr White specialises in follicular unit hair transplants. He doesn’t do any other type of cosmetic surgery.

3. Dr White uses the latest state-of-the-art techniques. He has received intensive training overseas and has brought technicians over from the United States to assist him and his staff with the latest methods, and has been applying them for the last five years with excellent results.

4. Dr White was the first doctor mentioned by my trichologist and others registered with the International Association of Trichologists.

5. I met with several of Dr White’s former patients, and even spoke to a patient while he was having the procedure.

6. I met Dr White three times (twice on a Saturday, so I didn’t have to take any time off work) and was not charged for any consultation. I called him several times to ask questions. I was always put through to him and not a consultant. He always confidently answered my

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questions and when he wasn’t available he always called back the same day.

7. Dr White holds open-house seminars where you can meet and ask questions of former patients.

8. Dr White’s was the only hair loss clinic where I felt comfortable. The staff at the National Hair Institute were all very friendly and extremely professional. The day after I made the appointment, I had a video delivered to my door. It introduced Dr White and explained why hair loss occurs and what can be done about it. It also contained a detailed explanation of what follicular unit hair transplantation is, what the procedure is like and, most importantly, some pictures of former patients, before and after the procedure.

9. Dr White would perform the most grafts in one session (up to 3,500).

Most other doctors wanted to do between 800 and 2000 grafts in one session. I wanted to achieve the best possible results in the least possible time, with the least number of operations.

10. There were never any phone calls, letters or high-pressure sales pitches from Dr White or anyone else asking me if I had decided to go ahead with the procedure. I first saw him in November 1999 and made my decision in May 2000.

11. Dr David Seager taught the techniques currently in use at the National Hair Institute to Dr White. I regard Dr Seager as the best hair transplant surgeon in the world, because other hair transplant surgeons from Canada, Brazil, Mexico, the United States, Europe and Australia (including Dr White) have chosen Dr Seager to perform the surgery on them.

12. You have to consider the technicians the doctor uses. I felt Dr White’s technicians were the most experienced and intensively trained in the country. They are also a very tight-knit group, who socialise and even go on holidays together.

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13. With Dr White there would be fewer sessions, which meant less time off work, less discomfort and less anxiety regarding the procedure.

I didn’t want to wait two to three years to achieve the final result.

CONCLUSION: AM I HAPPY? Yes, definitely. It’s not the hair I had when I was 18, and I knew not to expect that, but it has exceeded my expectations. I guess the hardest thing was waiting to know what the final outcome would be. But as you can see in the photos above, it was worth the wait.

How has it changed my life? I am now a lot more outgoing. Before I used to avoid social outings with friends. Cameras and mirrors don’t bother me any more, either. I no longer spend hours on the Internet looking at hair loss web sites.

One of the best things – no more bald jokes. I remember being best man at a wedding and getting up to make a speech, and someone yelled out ‘Baldy!’ and everyone laughed. I had never been so humiliated in all my life.

Would I do it again? Actually I am going back to have another procedure. Dr White told me before the first operation that at my stage of baldness, if I really wanted to look good, I would need at least 5,000 grafts. I have already had 2,811 in the front. The next procedure will add a few more in the front and put the rest in the areas we couldn’t cover last time. I think I look great now but, being the perfectionist I am, I want to look as good as possible. I will be continuing this story, so stay tuned.

What do other people think about it? Friends and family say it looks great. I went to a couple of Dr White’s open-house seminars so other people could see my results up close and to get an independent view from people who don’t know me and would be totally honest. The bottom line: a lot of the guys I met were impressed enough

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to have it done on themselves.

I have written this in the hope that the people who read it don’t fall into the trap I almost did, and to let you know there is now something you can do about hair loss that is successful. People losing their hair, especially in the early stages, are desperate, and will do just about anything to try to stop their hair falling out. Some hair loss clinics take advantage of this, and the only reason a lot of them are still in business today is because after their customers get ripped off they are too embarrassed to do anything about it.

Making the correct decision about treating your hair loss can make the difference between happiness and hell. Some people will agonise over their hair loss their whole lives and never do anything about it.

Others have tried and failed, been ripped off or, even worse, scarred and disfigured in the process. I consider myself to be one of the lucky ones. I found an excellent trichologist who referred me to a person I consider to be the best hair transplant surgeon in the country.

Hair transplants, in the right hands, really work. Before you do anything, please read everything you can get your hands on, talk to and meet as many people as you can, and make a wise choice. good luck!

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#10 SEEKING A SOLUTION WHEN YOU SEEK HELP When you seek the help of a doctor or other health professional, it is important to have clear expectations. You should always expect that your physician will look thoroughly into the reasons for your hair loss.

The overwhelming majority – in excess of 95 per cent – of cases of hair loss in men fall into the category of male pattern baldness. It is also clear that most hair loss in women is in the category of female pattern baldness. The likelihood of hair loss being caused by something else is therefore very slight. Nevertheless, it is important that health professionals are open to alternative diagnoses.

Once the cause of the hair loss has been established, a decision can be made on the best method of treatment. When searching for the best method we would suggest that you consider the issues discussed in this chapter.

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THE POSITIVES AND NEGATIVES OF TREATMENT ALTERNATIVES COSMETIC CONCEALERS positives Instant results Relatively inexpensive Easily applied Negatives Can be messy Need to be applied daily Temporary solution

PHARMACEUTICAL TREATMENT positives Can stop hair loss and in some cases promote limited hair growth Can be used in conjunction with surgery to limit further hair loss negatives Possible side-effects Long-term drug treatment is required to maintain the benefits Topical products can be inconvenient

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HAIR SYSTEMS positives Thick, full appearance is achievable Instant coverage Easily reversible negatives Can look like a wig and wearer may feel self-conscious about their appearance Lifestyle restrictions Costly to purchase and maintain

SURGERY positives Results last a lifetime Your own growing hair No special maintenance required Undetectable results are achievable Can be most cost-effective over the long term negatives Surgical procedure Time off work is required to undergo and recover from the procedure Results will never be as thick as the hair you once had Can have a high initial entry cost

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SUITABLE TREATMENT ALTERNATIVES FOR HAIR LOSS STAGES

i

MEDICAL E.G. ROGAINE, PROPECIA

ii

COSMETIC CONCEALERS E.G. TOPPIK iii

iv SURGERY E.G. SINGLE-HAIR FOLLICLE TRANSPLANTATION v

vi HAIR SYSTEM

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HAVING A STRATEGY It is important that you take responsibility for your own treatment and undertake your own research into the range of alternatives that are available. Before you make a decision about the kind of treatment you will undergo, you should take the following steps: • Read widely, but critically • Attend information sessions • Familiarise yourself with the range of approaches and treatments available • Develop a clear understanding of the causes of hair loss–with this information in mind, you will be better equipped to assess how believable the claims made about various treatments are • Check the credentials of the practitioner and the organisation offering the treatment • Read testimonials, but also meet people face-to-face who have undergone the treatment you are considering, and ask them to tell you about their experience • Develop a clear set of criteria on which to base your decision.

Here are some useful criteria to consider: prospects What can you reasonably expect from the treatment or procedure? logic behind the treatment Is the rationale and method that underpins this approach sound? costs involved Are there initial consultation fees?

How expensive is the initial treatment?

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Is follow-up treatment likely to be required?

Are there any hidden costs?

What will be the long-term cost, over ten years or a lifetime? level of inconvenience involved With some treatments, such as lotions and ointments, there will be no pain; with others, some degree of discomfort may be expected. side-effects and after-effects Are there any side-effects? (This question will apply in particular with pharmaceutical treatments.)

Are there any known long-term after-effects? limitations Are there any limitations on the success of the approach? For example, are there medical conditions that make the drug or process being offered inappropriate? time frame Over what period of time will the treatment take place?

Will follow-up treatment be necessary? appearance (during and after treatment) Will the treatment enable you to look the way you want to look? (For most men, this can be translated into, ‘Will I have hair that looks natural, or will I be constantly self-conscious?’) aftercare Will I have to follow any special procedures or maintenance–special cleaning, on-going drug treatment, further consultations?

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approval Does the method have the necessary health and safety approval? (Drug treatments, for example, must pass a formal testing and accreditation process before they become legally available.) permanence How long will the results of the treatment last? evidence What evidence is there to support the use of the approach? Try to double-check any research results and testimonials you read.

Here is a list of situations to be cautious of: • The clinic does not thoroughly assess the nature, extent and causes of your hair loss.

• The clinic tries to persuade you in the direction of a single treatment or procedure without discussing the range of options.

• The clinic relies solely on anonymous testimonials and is unable to put you in direct touch with other clients who have benefited from the procedure.

• You can find no scientific evidence that supports the claims about the clinic’s treatment. For example, with regard to the various drug treatments, research methods and results are written up in the literature on the subject. The same is true of hair transplant techniques: practitioners should be able to produce written evidence that their approach has been shown to be effective in scientific studies.

• Claims are made about miracle cures or procedures. Some clinics use technological fads to attract unsuspecting customers. One example of such a situation is the advertising of laser treatment for hair loss. This

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is pure gimmickry. At this stage in its development, laser technology has no known application in treating hair loss.

• There is no discussion of the potential side-effects or negative aspects of the treatment.

• The clinic uses pseudo-scientific jargon to sell its treatment.

Advertisers have long understood the power of technical-sounding language to influence uninformed buyers.

• The product is sold as a ‘tried-and-tested’ solution. Claims like this should be treated with scepticism. If it’s a tried-and-tested remedy, why doesn’t everyone know about it already? Anything that purports to rely on the patient’s efforts offers a convenient loophole to avoid blame when the treatment turns out not to work.

A useful consumer web site to investigate is www.thebaldtruth.org, which deals firmly with irresponsible and over-hyped claims of various hair loss treatments and cures.

What if you think your hair loss is caused by something other than genetic factors? Generally speaking, if there is any reason to believe your hair loss is caused by factors other than male or female pattern baldness, you should inform your doctor about your concerns.

MEDICAL HISTORY When examining your medical history, the doctor should ask a range of questions that might help to document the details of your hair loss.

Attention should be paid to things like: • the location and pattern of the hair loss • whether you have had a recent illness • high fever

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• your hair-care habits • your emotional state • whether you have been under unusual stress recently • whether you have nervous habits such as hair pulling and scalp rubbing • your history of accidents and emergencies–whether you have ever been involved in an accident that affected your scalp or hair • whether other symptoms are also present • what medication you have been taking.

PHYSICAL EXAMINATION A thorough examination of the hair and scalp is usually enough to diagnose the nature of the problem. Diagnostic tests are not usually necessary, but possible tests include: • Microscopic examination of a plucked hair • Skin biopsy (if skin changes are present).

SUMMARY It is important to take a proactive approach when seeking an appropriate hair loss treatment. Before committing yourself to any treatment it is important to: • read widely • attend information sessions • find out about the range of approaches and treatments • develop a clear understanding of the causes of hair loss • check the credentials of the practitioner and the organisation offering the treatment • develop a clear set of criteria on which to base a decision • examine the evidence.

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#11 FEMALE HAIR LOSS FEMALE PATTERN HAIR LOSS Male hair loss is seen as inevitable for a large proportion of men in the community and therefore acceptable. Female hair loss, however, has a certain stigma attached to it because women were just never meant to be bald.

A lot of women who come to see me with hair loss are very confused by what is happening to them. They may have been to see their GP about the problem, but the GP may not see hair loss as a health problem and, in some instances, may have recommended that the woman see a psychiatrist to help her ‘get over it’.

As has already been stated, both men and women lose hair density as they age. The typical pattern of male baldness is associated with the presence of the male hormone testosterone and its conversion to dihydrotestosterone (DHT). Women also develop a characteristic pattern of hair loss, termed female pattern hair loss or alopecia.

This involves a gradual loss of hair. Whereas in men the hair loss tends to take the form of a receding hairline and a thinning patch at the crown, with women the pattern is more diffuse. Hair is lost throughout the region at the top, making the scalp more and more evident.

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Women have a significantly lower level of testosterone in their system than men. This testosterone is converted into DHT in the same way it is in the male body. Even significantly lower levels can result in DHT-induced hair loss. The DHT will then attack those follicles with a predisposition to hair loss. Anything that alters the delicate balance between male and female hormones can result in hair loss.

Individual hairs last for between two and six years, the average being around four to five years. Hair grows at the rate of roughly 1cm a month. Genetic baldness – or female pattern hair loss – occurs when the body can no longer produce new hairs to replace the lost ones or, more commonly, the replacing hairs are weaker and finer than the previous ones.

Listed below are some of the external and internal factors that can have an effect on a woman’s hair. However, we must also recognise the possibility that hair loss may not be due to some factor we can pinpoint, but simply that the individual is sensitive to the normal levels of hormones in her body.

PREGNANCY For roughly 50 per cent of women, pregnancy has an effect on hair growth. Here’s the good news: during pregnancy, many women find that their hair becomes thicker. It may also trigger the fingernails becoming stronger. The exact explanation is not clear, but it does seem to be related to changes in the levels of hormones in the woman’s system.

Now for the bad news: many women experience hair loss in the first three months after their baby’s birth. Again, it is believed that changing hormone levels are responsible.

One theory is that during pregnancy more hair follicles continue in their growth phase – that is, the follicles are more active in producing hair fibre. Following the birth, with the reduction in the hormone levels, many more hairs go into the resting phase – hence the increased hair loss.

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It is important that women understand what is happening. Sometimes the loss of hair can be distressing. However, unless there is an underlying problem of disease, things will return to normal over a period of six months or so, as the growth and resting cycle is reestablished.

THE PILL Contraceptive pills that are high in male hormone/androgens can induce hair loss in those females who have a predisposition to it. Some women will obviously only find out that they have a predisposition to hair loss once it has commenced. Regrettably, most doctors are unaware or unconcerned about the potential problems, concerning themselves only with what happens to the target organs (e.g. the ovaries).

All drugs that may have an effect on hormones should be investigated thoroughly. Check the listed side-effects of the drugs you are taking and ask your doctor about side-effects. Some contraceptive medications that are high in female hormones are used in the treatment of hair loss.

MENOPAUSE As a woman ages, her body begins to produce less of the female hormone oestrogen. This ultimately culminates in menopause, when the production of oestrogen all but shuts down. In some individuals this can shift the delicate balance between male and female hormones and result in hair loss. Treatment is generally more complicated than hormone replacement therapy.

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PHARMACEUTICAL TREATMENT OF FEMALE HAIR LOSS rogaine This drug has been discussed extensively in Chapter 5. However, it is relevant to mention that Rogaine is suitable for use by women and in some cases women can achieve slightly better results than men. propecia This drug has also been extensively discussed in Chapter 5. It is not recommended for use by women because of the potential to cause birth defects in male babies. There is a possibility that it may be beneficial for women suffering androgenetic alopecia, but only doctors specialising in female hair loss would prescribe it to women, and then probably only if she has come to the end of her reproductive life. spironolactone Spironolactone is also sold under the name Aldactone. It is generally used as a diuretic and to control high blood pressure.

It is also used to treat hair loss, as it works as an anti-androgen by decreasing production of testosterone by the adrenal glands. It also prevents DHT from binding to its androgenic receptor.

It is not suitable for use by men, as it can lead to impotence, breast enlargement and decreased sex drive. The side-effects for women can include breast tenderness, irregular menstrual cycles, cramps, diarrhoea and drowsiness. oestrogen/progesterone Generally prescribed during menopause, when hormone levels drop.

The delicate balance is adjusted and it is at this time that the chances of the male hormone testosterone being converted to DHT increases, and hair thinning may therefore increase.

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the contraceptive pill Some contraceptive pills contain progesterone, which can increase hair loss in some women. You should discuss this further with your doctor, as there are other pills available containing feminine progestagens.

Due to the limited scope of this book, it is difficult for me to do much more than touch on some of the issues affecting women and hair loss.

The following may be of further interest: The Truth About Women’s Hair Loss by Spencer David Kobren, Contemporary Books, 2000. This is an excellent book for any woman concerned about hair loss. www.thebaldtruth.org This is the official website of the author of The Truth About Women’s Hair Loss, and features a section for women’s comments. www.regrowth.com/hairlossforums This web site contains a forum area for women. www.hairsite.com This web site has an area dedicated to women and hair loss. www.hairlosstalk.com/discussions This web site is for discussions about hair loss. It includes sections for women.

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#12 FREQUENTLY ASKED QUESTIONS why is it that people only lose hair from the front, top and crown?

When referring to hair loss, it is commonly called male or female pattern baldness because there is a distinct and predictable pattern to it. The follicles that grow hair at the front, top and crown are genetically programmed to be affected and eventually wither and die under the influence of DHT. The follicles at the back of the scalp are generally resistant to the effects of DHT and continue to grow hair well into advanced old age. lots of people i see down at the beach who are hairy all over their backs, chests and upper arms also suffer hair loss. is there a correlation?

Yes. While DHT shrinks the hair follicles on the head, it is believed to have the opposite effect on the body, actually stimulating hair growth on the chest, back and upper arms.

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do some races suffer hair loss more than others?

In my practice I have noticed that young men of southern European descent, particularly Greeks and Italians, are more prone to hair loss than others. Interestingly, women from the same region also appear more susceptible to hair loss, often having more facial and body hair than is considered normal, as well. can i transplant hair from other parts of the body?

No. The hair that grows in other areas of the body is of a different colour, length and texture and would not provide the natural appearance that we strive for. can i transplant hair from other people?

It was long believed that the recipient’s immune system would kill off the donated skin. This has since been proven incorrect in laboratory trials; however, you would find it difficult to find a donor and also to find a doctor to perform the procedure, because the results of the trials were inconclusive. how important to the final result is the quality and density of my donor area at the back?

The type and strength of the donor hair at the back of the scalp will ultimately determine how good a result you will achieve in the recipient area. If a person has weak, fine hair the result they will achieve will be weak and fine. Conversely, an individual with thick, strong, dense hair will achieve a much thicker final result. how much pain is involved during the procedure?

There is a degree of discomfort when having a procedure. From pain management surveys I have conducted with past patients, it is clear

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that almost 100 per cent anticipated the procedure to be far more painful than it actually was. When I had my own procedure performed I found it no worse than having dental surgery. can i be put to sleep during the procedure?

This is possible; however, with the minimal pain involved in a hair transplant procedure, it is hard to justify the extra expense and inconvenience that the use of a hospital and a specialist anaesthetist would require. General anaesthesia also carries with it increased risk. will i have a bald patch at the back of my head?

No. The donor area at the back of the scalp is simply pulled back together and held in place with stitches. Most scars are approximately 2 mm wide and easily concealed by the patient’s lifetime hair at the back and sides. Individual scars may vary. how thick a result can i achieve?

This will depend on many factors, such as the number of grafts available, the size of the area to fill, the individual hair shaft density, the contrast between hair and skin colour, and hair curl. Other variables also need to be taken into account and it is really only possible to determine a likely outcome at a consultation. Those considering going ahead are also advised to meet previous patients and view achievable densities first hand. can i achieve a full growing result in one procedure?

This depends upon the amount of hair loss you have suffered. If we are attempting to fill from the front hairline all the way through the midscalp and the crown, I consider about 5,000 grafts to be the minimum. This would be conducted as two procedures. Smaller areas

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may be able to get away with one procedure only. As mentioned previously, the type of donor hair you have will also be a factor. are all hair transplants successful?

Doctors attempt to assess how successful their work has been all the time. Ultimately, though, only the patient can answer that question.

Have I fulfilled my expectations? If, 12 months after the procedure, you can answer yes, then the transplant has been a success. To ensure that your hair transplant is a success, you should investigate all your options and make sure what you are being offered is achievable and your expectations are realistic. Talk to past patients and see their results. will there be any scarring?

Yes. Any hair transplant procedure requires that the skin be cut, resulting in scar tissue. However, follicular unit grafting uses very small incisions and any scarring in the recipient area is generally invisible to the naked eye. There will also, of course, be a scar from the donor area at the back of the scalp, but the existing hair will hide this.

If prospective patients are concerned about scarring, they are advised to see examples of individual surgeons’ work before commencing any treatment. how soon can i return to work?

Many people who have a procedure take around 7–10 days off. can i wear a hairpiece while the hair transplant grows through?

Yes. It is possible for wearers of existing hairpieces to continue wearing the hairpiece on a temporary basis after the procedure.

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how soon will i see the results of the procedure?

For some people the grafts grow immediately; however, these people are the exception. In most cases the hair in the grafts will go into a resting phase and shed, with new growth appearing three to four months after and a final result expected within 9–12 months. is there any special maintenance required of my new hair?

No. Transplanted hair is just your own growing hair moved to a different position on your head. You can go to your hairdresser for a haircut and use any commercially available shampoo. In short, just treat it as you did your old hair. how do i know my new hair won’t fall out like my old hair did?

We know that the hair from the back of the scalp does not wither and die under the affects of DHT. It will therefore grow and continue to grow in its new position and will not bald as the old hair did. The results from procedures done up to 40 years ago attest to this fact. how do i know i won’t end up looking like those older-style procedures?

Hair transplant procedures have made incredible advances over the last twenty years and in particular in the last five years. The results from the latest follicular unit grafting allow us to recreate an incredibly natural hairline. This area was always the Achilles heel of the older-style procedures–the area they found the most difficult to mirror nature in.

Performed correctly, it is now possible to recreate a very natural hairline and relatively strong, full hair behind this area.

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#13 THE FUTURE OF HAIR RESTORATION The last twenty years have seen a number of improvements for people suffering the onset of hair loss: • The advent of cosmetic aids that actually look natural • Medications that can stop hair loss in many cases • Hairpieces that are much lighter and more natural-looking than those of past years • Hair transplantation that looks extremely natural.

It is obviously fair to assume that the next twenty years will be equally exciting. There are a number of options now being investigated that may be on the market at some stage in the future. dutasteride Dutasteride is a drug developed by Glaxo Smith Kline currently undergoing clinical trials to evaluate its effectiveness and safety profiles.

Dutasteride is similar in action to Propecia, acting as a 5 alpha reductase inhibitor. However, Dutasteride inhibits both Type I and Type II (Propecia only acts on Type II) and is expected to be considerably more effective than current treatments. However, Dutasteride’s extra strength

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over Propecia may come at a cost, and its effects on the male libido and erectile dysfunction are yet to be determined. The incidence of gynecomastia, or enlarging of the breasts, is also a possibility.

If the drug trials successfully it may be submitted for a new drug application to the Food and Drug Administration (FDA) in America, and then ultimately made available to the general public. release date:

subject to approval by the FDA, possibly by 2006

cost:

Due to increased effectiveness we would expect it to be more expensive than Propecia.

cloning Cloning involves taking a very small donor piece from the back of the scalp and then reproducing that hair-bearing skin to produce as much donor hair as required to fill any-sized bald area.

Currently the supply of donor hair and the donor scar at the back of the scalp is the limiting factor in hair transplant procedures. Cloning will address these problems.

• Today’s hair transplant procedures involve removing and redistributing a section of hair-bearing skin. Cloning will allow us to create completely new hairs to place into those balding areas.

• Cloning will negate the need to take a large section of hair-bearing skin from the back of the scalp, so it will bear no significant scarring.

• Today’s procedures generally allow us to perform around 3000 grafts in one session. Cloning will allow us to produce as many grafts as are required to complete the procedure in one session–potentially, around 10,000 grafts per operation.

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The prospect of cloning is exciting, but it is likely to be some time before it is commercially available, and it will still require transplanting techniques to insert the grafts. release date:

Unlikely to be available before 2010

cost:

Extremely expensive in the early stages and then possibly becoming more affordable as the technology becomes more mainstream.

gene therapy Hair loss is caused by a combination of hormones (testosterone) and ‘balding genes’ that you have inherited from either side of your family (see Chapter 3). If it were possible to remove or modify those balding genes, then theoretically you could ‘turn off’ hair loss.

Research into gene therapy is still in the embryonic stages and researchers must isolate the gene and then find a way to switch it off without causing a detrimental effect on other bodily functions. It is possible that turning the gene off may permanently reduce a person’s sex drive or not allow them to reproduce. Obviously years of development lie ahead for researchers. release date:

Unlikely to be available before 2020.

cost:

Extremely expensive in the early stages and then possibly becoming more affordable as the technology becomes more mainstream.

RU58841 RU58841 is the name given to an experimental compound devised and patented by French pharmaceutical company Rhone Poulenc. The known method of production uses dangerous gases that are

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environmentally unacceptable. Alternative methods of production are possible, but to my knowledge nobody is currently undertaking this research.

RU58841 is a non-steroidal anti-androgen that blocks the action of DHT on the hair follicle. It is applied as a lotion topically to the affected area. Daily application is believed to stop hair loss in many cases, and in some cases to produce regrowth. release date:

No research is being undertaken at this time so possibly never.

cost:

Unknown

SUMMARY • As research continues over the coming years, treatments for hair loss will obviously improve. However, that is no reason to delay taking action against your hair loss now.

• If your hair loss is just starting, you could commence with Propecia to stop your hair loss and then, as treatments improve, switch over to Dutasteride if/when it becomes available.

• If you feel that a hair transplant is your best alternative, you could have a procedure using the current technology and then update that procedure using the cloning method when it becomes available.

• If your hair loss is concerning you now, you can take action. There is no need to hold off doing something, waiting for a better alternative.

Take action now and aim to incorporate future technology as it becomes available.

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FURTHER READING Thank you for reading How You Can Beat Hair Loss. This book is intended to provide general information about hair loss causes and treatment alternatives. It does not intend to cover every possible treatment, and new treatments do become available. Those who wish to investigate their options further may find other books and the Internet an excellent source of information.

BOOKS The Bald Truth by Mr. Spencer Kobren, Pocket Books.

The Truth About Women’s Hair Loss by Mr. Spencer David Kobren, Contemporary Books.

These books are difficult to find in Australia but may be ordered from www.amazon.com, where you may find other books on hair loss as well.

Simply search under the keywords ‘hair loss’.

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INTERNET SITES www.newhair.com.au The web site of the National Hair Institute and of the author of this book, Dr Barry White. It explains how hair transplantation works and shows the latest results achievable with follicular unit grafting. You can arrange a consultation over the Internet or book to attend one of their information sessions showing the results of past patients. www.toppik.com.au The Australian web site of the Toppik and Couvre range of products.

Products may be purchased over the Internet and sent throughout Australia, New Zealand and South-East Asia. They may also be purchased by phoning 1800 424 737. www.hairtransplantnetwork.com An online community established by a patient of Dr Ron Shapiro in the USA. It features a number of discussion groups, which at times host quite heated debates. It also lists a number of doctors that are recommended by the site. www.ashrs.org.au The site of the Australasian Society of Hair Restoration Surgeons. Lists all its members, with links to their respective web sites and email addresses. www.ishrs.org The site of the International Society of Hair Restoration Surgeons. Lists all its members, with links to their respective web sites and email addresses.

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following are the internet site recommendations made by the patient and author of ‘having a transplant–gerry’s story’ www.hairlosshelp.com The best hair loss site on the Internet. You can ask questions of experts in the hair loss field, including Dr Robert M. Bernstein and Spencer Kobren. Dr Bernstein is the medical director of the New Hair Institute and is regarded as one of the masters of follicular unit hair transplantation. www.thebaldtruth.com Spencer Kobren is the author of a bestselling book, The Bald Truth: The First Complete Guide to Preventing and Treating Hair Loss. He also has his own web site and hosts a radio program called ‘The Bald Truth Radio Hour’ (a talkback radio show devoted to the topic of hair loss). You can listen to this program via the web site. www.regrowhair.com This man has had three follicular unit hair transplants done by Dr Ron Shapiro and looks fantastic. He takes you through a hair transplant procedure with photos of the progress of his hair transplant. There is also a lot of other good information about hair loss on this site. You can email him and ask questions. www.regrowth.com An excellent site that covers everything to do with hair loss, including transplants, interviews with leading transplant doctors, treatment suggestions, product reviews, cover-up products and links to other hair loss web sites. There is a chat room where you can chat with other hair loss sufferers. The webmaster also takes you through his own personal treatment program.

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www.hairlosstalk.com On this site people write in and discuss their experiences. It also has a lot of other good information about hair loss. There is a chat room where you can chat with other hair loss sufferers.

DOCTOR-SPECIFIC SITES www.hair-doctor.com Dr David Seager is the doctor other hair transplant doctors go to when they need a hair transplant. Dr Seager has, over the years, distinguished himself as an innovator in the field of hair transplantation. He was so confident in his method and his team that he had them do a hair transplant on himself. His before and after photos are on the web site, along with the stories of patients he has performed transplants on. www.800newhair.com Dr Robert M. Bernstein and Dr William R. Rassman set up this medical group of board-certified physicians devoted solely to hair restoration.

They are very confident in their work, having regular open-house seminars where you can meet former patients. This web site has dozens of before and after photos of patients, sorted in hair loss pattern types. www.hair-transplants.org Dr Ron Shapiro's work is so highly recommended that at one stage he could not take on any new patients. His pioneering contributions to follicular unit hair transplants have earned him the respect of his peers.

This web site has lots of before and after photos of patients Dr Shapiro has performed transplants on.

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www.micro-transplants.com Dr Bobby L. Limmer introduced the use of the microscope into hair transplant procedures and has been at the leading edge of transplantation surgery innovations, giving more than 30 presentations at prestigious medical conferences and publishing more than a dozen articles in leading medical journals. He is recognised as one of the premier hair transplant surgeons worldwide.

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ABOUT THE AUTHORS dr barry white Barry White was born in Melbourne in 1936 and attended Caulfield Grammar until his matriculation in 1952. In 1953 he went to the College of Pharmacy in Melbourne and graduated with a Diploma in Pharmacy in 1957. He spent the next three years as a relieving pharmacist at a number of establishments, but failed to find a position that was stimulating enough. As a result in 1961 he returned to university to study medicine at Monash University.

Dr White graduated with an MB. BS. in 1966 and commenced his first year of residency at Geelong Hospital. The next ten years were spent at various hospitals, acting as an anatomical registrar dealing with post-mortems and surgical specimens.

In 1976 Dr White entered general practice, specialising in the area of weight loss. Seeking new challenges, he began training with Dr Frank Torok in 1978, learning various surgical hair procedures. In 1980 he wound down his general practice and began working as a hair transplant surgeon for the Hair Transplant Clinic of Melbourne, and then for the Harley Medical Centre, performing hair transplants and

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other cosmetic procedures. In 1982, the Australasian Society of Hair Restoration Surgery was formed and Dr White became a founding member.

In 1985 he founded the National Hair Institute, which specialises in hair transplantation. He also opened Le Visage Medical Centre to perform chemical face peeling, liposuction, rhinoplasty and other cosmetic procedures.

The next ten years were spent studying with various doctors to refine the procedures in use at the National Hair Institute. However, the procedures at this time had their limitations and Dr White was constantly seeking any change in method that would give improved results. He was particularly interested in methods that provided improved growth rates, more natural hairline shapes and natural graft angulation techniques.

In 1994, Dr Bill Rassman (now considered to be a pioneer and expert in the field of follicular unit grafting) presented a breakthrough technique to Dr White and other members of the International Society of Hair Restoration Surgery. This procedure was known as follicular unit grafting (FUG) and, patients could expect very high growth rates with extremely natural results. This appeared to be the breakthrough Dr White had been seeking for many years, and later that year he met with Dr Rassman to learn more about the new procedure.

Late in 1994 Dr White was approached by two of Dr Rassman’s former technicians. They later came to Australia and assisted in training National Hair Institute theatre technicians in the techniques of FUG. In 1995 Dr White was elected as secretary of the Australasian Society of Hair Restoration Surgery. In 1996 he travelled to Canada to observe and learn the role of the stereoscopic binocular dissecting microscope in FUG from Dr David Seager, considered to be one of the world’s best surgeons performing FUG. After visiting Dr Seager Dr White realised the

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potential of these new procedures. Unfortunately the level of commitment required to excel in them meant that, upon his return to Australia, Dr White would have to relinquish his involvement in Le Visage Medical Centre so he could specialise solely in the field of hair restoration.

In 1998 Dr White returned to the offices of Dr Seager to learn the new ‘dense packing’ technique. While in the United States he underwent the procedure to recreate his front hairline.

Due to increasing demand for Dr White’s services, the National Hair Institute acquired and refitted a former Commonwealth Bank branch and residence in Middle Park, Victoria.

Dr White was elected President of the Australasian Society of Hair Restoration Surgery in 1999.

marcus white Marcus White is Dr White’s son and was born in Melbourne in 1970. He completed his HSC at Brighton Grammar in 1988, and following his final year he commenced a cadetship with Australian National Line and studied for a Bachelor of Applied Science in Nautical Studies.

In 1994, seeking a new direction, Marcus joined Dr White and the family group of companies. He has attended a number of business management courses and international conferences focused on hair loss prevention and treatment. In 1995 he attended the American Hair Loss Council meeting in San Francisco. He also attended the 1996 American Hair Loss Council meeting in Fort Lauderdale.

Marcus became a founding member and was elected the Victorian representative of the Australasian Hair Restoration Society in 1997. In 1998 he became Clinic Director at the National Hair Institute and is now involved in the administration and marketing of the institute and also acts as a patient adviser.

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In his time working with Dr White, Marcus has gained valuable insight into the hair loss industry, both in Australia and around the world. His involvement in the creation of this book has been helping to make it more readable to the layperson.

Marcus acts as the Australian agent for the Toppik and Couvre range of products.

australian society of hair transplant surgeons Dr Keith Harper first proposed an association of hair transplant surgeons in 1972, but due to the infancy of the procedure and the limited number of doctors performing it in Australia at the time, nothing came of it.

By 1982 there were still very few doctors performing hair transplants, but Dr Mario Marzola of Adelaide also proposed the need for a society in Australia. As a result, the Australian Society of Hair Restoration Surgeons was formed in Melbourne in 1982. The society consisted of only 13 members at the time. Dr Richard Shiell was the driving force behind its inception and was elected president. Dr Marzola was elected Secretary.

The Society started with the following aims in mind: • To elevate the standard of hair transplantation in Australia • To open the lines of communication between competitors and encourage the sharing of ideas • To have an annual meeting to assist with the above aims.

To become a member of the society, the prospective physician must perform a minimum of 50 procedures per year.

Of the original members, Dr Shiell, Dr Marzola and Dr White are the only ones still practising hair transplantation on a full-time basis.

They have however been joined by some excellent new surgeons over the years.

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In 2001, the ASHRS was affiliated with the Australian College of Cosmetic Surgery.

members of ashrs Following is a list of current financial members (at the time of printing) of the Australian Society of Hair Restoration Surgeons. dr barry white

National Hair Institute (Head Office) 104 Canterbury Road MIDDLE PARK VIC 3206 Email: admin@newhair.com.au Phone: (03) 9699 7733 Toll free: 1800 815 043 NSW Consulting Office 159 New South Head Road EDGECLIFF NSW 2027 Phone: (02) 9327 4422 Qld Consulting Office Phoenician Resort 24–26 Queensland Avenue BROADBEACH QLD 4218 Phone: (07) 5561 0803

dr gerard brady

56 Wylie Street GRACE VILLE QLD 4075 Email: erolands@powerup.com.au

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dr david cooke

72 Oxford Street EPPING NSW 2121 Email: davidco@tig.com.au

dr bruce fox

Suite 11, 517 St Kilda Road MELBOURNE VIC 3004 Email: drfox@smart.net.au

dr kim harwood

1/197 Wickham Terrace SPRING HILL QLD 4000 Email: rherns@ecn.net.au

dr george kerry

641 Greenhill Road BURNSIDE SA 5066

dr russell knudsen

Level 3, 4–10 Bay Street DOUBLE BAY NSW 2028 Email: russell@hair-surgeon.com

dr jennifer martinick

1/21 Stirling Highway NEDLANDS WA 6009 Email: info@image21.com.au

dr mario marzola

60 Hutt Street ADELAIDE SA 5000 Email: mario@marzola.net

dr simon rosenbaum

5 Avoca Street SOUTH YARRA VIC 3141 Email: imagemelb@aol.com

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dr richard shiell

Suite 203, 34 Queens Road MELBOURNE VIC 3004 Email: hairman@mira.net

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references: 1. Spencer David Kobren, The Bald Truth: The First Complete Guide to Preventing and Treating Hair Loss (Pocket Books,1998).

2. Spencer David Kobren, The Truth About Women’s Hair Loss: What Really Works for Treating and Preventing Thinning Hair (Contemporary Books, 2000).

3. A.H. Powers, Hair Structure and Chemistry Simplified (Milady Publishing Corporation,1977).

4. Francisco Camacho & William Montagna, Trichology: Diseases of the Pilosebaceous Follicle (Libros Princeps,1997).

5. Walter P. Unger (ed.), Hair Transplantation (3rd edition, Revised Marcel Dekker, 1995).

6. Toby Mayer & Richard Fleming, Aesthetic and Reconstructive Surgery of the Scalp (Mosby–Year Book,1992).

7. Dow Stough & Robert Haber (eds), Hair Replacement: Surgical and Medical (Mosby–Year Book,1996).

8. Richard Shiell, Russel Knudsen & Dow Stough (eds), Hair Transplant Forum International: The Next Five Years (1996–2000) (International Society of Hair Restoration Surgery, 2001).

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