The Era of the big Wig

Soon after the Middle Ages wigs became popular for women. Then in the 1600’s the flamboyant and incredibly vain King Louis XIV of France lost his hair from a severe illness and took to wearing gigantic wigs thus setting the fashion for most men of his day.

These enormous creations featured such items as cages with live birds and could weigh up to 20 lbs.!

By the 1700’s England made another contribution to bad hair loss concealers. This was the age of the long, curly, and powered wigs. Even today, English judges and lawyers continue this practice. Thus the expression for those in authority – “Big Wigs.”

The“Snake oil” Years

The early 1800’s is renowned in hair loss circles as the age of the con men. There were hundreds of so-called “hair loss solutions” and many lasted well into the late 1900’s.

These treatments were marketed by fast-talking “doctors,” skilled only in bravery and possessing nerves of steel considering they were conning hardened cowboys and outlaws!

The salesmen hawked their products from the safety of their side shows and “Wild West” spectaculars. They used endless tricks to get people to buy their products, including rubbing grease into their hair to make it look thicker.

The “Modern” Era of Hair Loss Solutions

During the past several decades, superstition, old wives tales, and guess work has gradually been replaced by science.

In 1939, a Japanese dermatologist, Dr. Okuda, published a revolutionary method in a Japanese medical journal that would lay the ground work for modern hair transplantation.

This method involved using hair transplant grafts to correct lost hair from various areas, including the scalp, eyebrow, and moustache areas. However, this study didn’t make an impact in the Western Hemisphere due to the interruption of World War II.

Hair transplants are born.

In the late 50’s one physician in particular, Dr. Norman Orentriech, began to experiment with the idea of relocating or transplanting the hair on the back and sides of the head to the balding areas.

Dr. Orentriech’s experiments showed that when bald resistant hairs from the back and sides of the head were relocated, they maintained their bald resistant genetic characteristic regardless of where they were transplanted.

This principle, known as “Donor Dominance”, established that hair could be transplanted from the bald resistant donor areas to the balding areas and continues to grow for a life time. This laid the foundation for modern hair transplantation.

During the 60’s and 70’s surgical hair restoration grew in popularity. However, the standard procedure used large grafts that were removed by round punches and often contained many hairs.

Completed Result after Multiple Sessions of Large Grafts

This now outdated technique could achieve a full look if a patient completed all planned sessions. However, a patient was typically limited in the manner they could style their hair.

Patients who stopped short of completing all planned sessions were left with hair loss solutions that looked obvious and unnatural.

Such uncompleted hair restoration results are some times referred to as “barbie doll hair” or “corn rows”.

Many who have had these older techniques now refine or complete their hair transplants with today’s very refined techniques to achieve a natural look that they can style in any manner.

From big wigs to surgical hair restoration

The Era of the big Wig

Soon after the Middle Ages wigs became popular for women. Then in the 1600’s the flamboyant and incredibly vain King Louis XIV of France lost his hair from a severe illness and took to wearing gigantic wigs thus setting the fashion for most men of his day.

These enormous creations featured such items as cages with live birds and could weigh up to 20 lbs.!

By the 1700’s England made another contribution to bad hair loss concealers. This was the age of the long, curly, and powered wigs. Even today, English judges and lawyers continue this practice. Thus the expression for those in authority – “Big Wigs.”

The“Snake oil” Years

The early 1800’s is renowned in hair loss circles as the age of the con men. There were hundreds of so-called “hair loss solutions” and many lasted well into the late 1900’s.

These treatments were marketed by fast-talking “doctors,” skilled only in bravery and possessing nerves of steel considering they were conning hardened cowboys and outlaws!

The salesmen hawked their products from the safety of their side shows and “Wild West” spectaculars. They used endless tricks to get people to buy their products, including rubbing grease into their hair to make it look thicker.

The “Modern” Era of Hair Loss Solutions

During the past several decades, superstition, old wives tales, and guess work has gradually been replaced by science.

In 1939, a Japanese dermatologist, Dr. Okuda, published a revolutionary method in a Japanese medical journal that would lay the ground work for modern hair transplantation.

This method involved using hair transplant grafts to correct lost hair from various areas, including the scalp, eyebrow, and moustache areas. However, this study didn’t make an impact in the Western Hemisphere due to the interruption of World War II.

Hair transplants are born.

In the late 50’s one physician in particular, Dr. Norman Orentriech, began to experiment with the idea of relocating or transplanting the hair on the back and sides of the head to the balding areas.

Dr. Orentriech’s experiments showed that when bald resistant hairs from the back and sides of the head were relocated, they maintained their bald resistant genetic characteristic regardless of where they were transplanted.

This principle, known as “Donor Dominance”, established that hair could be transplanted from the bald resistant donor areas to the balding areas and continues to grow for a life time. This laid the foundation for modern hair transplantation.

During the 60’s and 70’s surgical hair restoration grew in popularity. However, the standard procedure used large grafts that were removed by round punches and often contained many hairs.

Completed Result after Multiple Sessions of Large Grafts

This now outdated technique could achieve a full look if a patient completed all planned sessions. However, a patient was typically limited in the manner they could style their hair.

Patients who stopped short of completing all planned sessions were left with hair loss solutions that looked obvious and unnatural.

Such uncompleted hair restoration results are some times referred to as “barbie doll hair” or “corn rows”.

Many who have had these older techniques now refine or complete their hair transplants with today’s very refined techniques to achieve a natural look that they can style in any manner.

Hair loss Myths - What is or isn’t true?

Maybe you’ve heard that wearing a tight baseball cap too often will make you bald or that if you wash your hair too much you’ll suffer hair loss. Well, they’re both old wives’ tales.

So what really causes hair loss and what’s myth?

Brushing to Grow Hair?

The idea of brushing the hair 100 times a day to stimulate the scalp circulation is a fantasy. In fact, if you brush your hair too much, you may end up injuring and losing hair.

This myth stems from the thought that hair loss was due to poor circulation and that brushing or massaging would improve blood flow and nutrition to the follicles. The truth is, bald or not, there’s no major difference in scalp circulation.

Styling and Hair Loss?

There’s some truth and some fiction when it comes to hair styling and Hair Loss.

It is true that certain hair styles, such as corn-rows or tight ponytails, can cause hair loss. These styles put undue tension on the hairs. But as for hair sprays, perm solutions, or coloring resulting in hair loss there’s no truth to that idea. These applications may cause some damage to the hair strands. But the all-important follicles, located under the skin, stay safe.

And what about the idea that haircuts will make your hair grow back thicker and faster? That’s wishful thinking. Everyone’s hair growth and length depends on their own unique hair cycle, which is based on both nutrition and heredity. The longer your growth phase the longer your hair growth.

Blowing away your hair?

What about hair dryers? Are these follicular incinerators?

The good news is there is no evidence that hair dryers cause thinning hair. However, too hot or too much drying may lead to brittle and breakable hair. Let common sense guide you and hold the hair dryer at a normal distance from your scalp and dry to your heart’s content.

Vitamins and Steroids?

Think about this – if you were losing hair because of a lack of vitamins or minerals in your diet, why wouldn’t the back and sides of your head be affected? In actuality, vitamin deficiency results in an even distribution of hair loss all over the head. Of course, it doesn’t hurt to take vitamins on a regular basis for your overall health.

Your follicles width and amount are based on heredity. So claims of hair growing miracle drugs or natural hair loss treatments are untrue.

However, steroids use can cause hair loss. Research has proven that anabolic steroids raise the levels of baldness-inducing male hormones. For those who are genetically prone to hair loss, this can speed up the loss in as little as 3 to 6 months. While this loss may be reversed, it can be permanent.

Sexual Activity to Grow Hair?

Unfortunately, there is no truth to the idea that the more sex you have, the less hair you’ll lose! And the same goes for the rumors that the chemicals released during sex can affect hair loss. Science has yet to uncover any proof to this fantasy. But that doesn’t mean you shouldn’t keep experimenting.

The Hair Loss Family Tree

Many men believe that if their father has a full head of hair, they’ll keep a good head of hair. But hair loss or hair growth is set by a genetic combination determined by both sides of your family.Of course, if your family tree is filled with balding scalps, you do have a better chance of losing hair.

Treatments that work

While hair loss sufferers spend small fortunes on treatments based on myths, there are several proven treatments, non-surgical and surgical.

Currently there are only two non-surgical hair loss treatments that are FDA approved for Hair loss. These two are Propecia (Finasteride) and Rogaine (minoxidil).

Other treatments may or may not help stop or reverse hair loss, but they are not formally approved by the FDA

To learn about proven treatments visit our Hair Loss Solutions section.

Today it is a very refined outpatient procedure that can produce full and natural looking results, even after only one hair transplant session.

When performed correctly not even a hair stylist will detect that a person has had a hair transplant.

However, to achieve such natural results it is critical that the hair transplant procedure be "performed correctly". To do so requires a hair restoration clinic that can perform a follicular unit hair transplant at the highest levels of skill, experience, and dedication.

What it takes to create natural results.

A great hair transplant is the result of using a state of the art surgical procedure and performing it with great skill and artistry. Today the acknowledged "gold standard" in hair transplant surgery is called "Ultra Refined Follicular Unit Hair Transplantation".

This relatively new hair transplant procedure enables a patient to achieve extremely natural results because it recreates and mimics the way a person's hair grows naturally, hair for hair.

Recreating Nature Hair for Hair

To understand this procedure you must first understand how hair grows naturally.

If you look closely at naturally growing hair using magnification you will see that hair actually grows in groupings of one, two, three, and four hairs.

These naturally occurring hair groupings grow in irregular patterns on the scalp similar to trees growing in the forest. These groupings are technically referred to as "follicular units".

By relocating these carefully prepared and isolated follicular units, physicians doing "follicular unit hair transplantation" recreate a natural pattern of hair in the balding areas.

Follicular Unit Hair Transplant tough on the clinic but easy on the patient.

To do this properly is a very time consuming process. It requires a team of skilled and meticulous medical technicians working closely with the lead physician.

All our physician members perform this hair transplant procedure with excellent results. They are granted membership in the Coalition of Independent Hair Restoration Physicians strictly based on their proven high level of experience, ethics, and skill in successfully performing this patient friendly procedure.

While the follicular unit procedure is more demanding upon the medical staff, it produces dramatic and life long advantages for the patient such as undetectable naturalness, rapid healing, and optimal use of their limited donor hair.

The Standard Hair Transplant, easy on the clinic but not on the patient.

Only a minority of hair transplant surgeons are committed to doing the follicular unit procedure properly. Many physicians continue to dissect grafts without regard to the integrity of the follicular units. Follicular units are often transected and damaged as donor tissue is cut to conform to the size of the recipient holes rather than to maintain the integrity of the follicular units.

Such common standard hair transplant procedures are quicker and simpler to perform than follicular unit hair transplantation from the hair transplant surgeon's perspective. The standard hair transplant procedure is also often more profitable for the clinic since it requires less staff time, training, resources, and skill. However, the results are generally suboptimal for the patient.

Respecting the Follicular Unit

Each follicular unit is surrounded by small glands, blood vessels, nerves, and a connective tissue sac making it a tiny self contained unit.

If these follicular units are damaged during removal or dissection, the hair may grow poorly.

Therefore it is important to cut only in the loose tissue between the follicular units to keep each follicular unit intact and avoid damaging it.

Excessive DHT in the hair follicle causes specific immune responses. These responses cause the cells to release a substance known as Superoxide. This substance combats against any viruses, cells, or foreign tissues. SOD's claim to fight hair loss by reducing the presence of Superoxide.

As a result, the body is less prone to reject any offending hair follicles, which helps to ward off hair loss. SOD's actually treat hair loss in more than one way. Besides reducing Superoxide, they also stimulate growth and they have anti-inflammatory properties. SOD’s are topical, as well. They include Tricomin, Proxiphen, Proxiphen-N and Folligen.

Click to learn more about Anti Inflammatories

If you are going bald you should seriously consider hair loss medication treatments to halt or even reverse your hair loss. While there is no “Hair Loss Cure”, hair loss drugs like finasteride (Propecia) and dutasteride (Avodart) can often stop or even reverse alopecia areata in most people.

However, just like any other drug, Propecia is accompanied by a list of potential side effects, some of which have been more recently reported as potentially long term.  You can read more about this in the "What About Side Effects" section further down this page.

Studies have shown that 80% of men using Propecia stopped or even reversed their hair loss to some degree. Preliminary clinical trials for Avodart appear even more effective than Propecia.

However, neither Propecia nor Avodart has been proven to restore hair in the frontal areas. For reasons yet unknown these drugs, along with Rogaine, only generally work in regrowing thinning hair in crown area of the scalp. Only hair transplant surgery has been successful in restoring hair in the frontal hairline area once it has been lost.

Propecia and Avodart are also less effective in growing hair in older men. These hair loss drugs work best for men who have been balding for less than five years.

Women must NOT USE Propecia

Both Propecia and Avodart are not recommended for use by women or children.

It’s been found that these drugs can cause birth defects. More specifically, these birth defects may occur when large amounts of the drug are absorbed into the body during the period of foetal development.

Physicians advise pregnant women to not handle Propecia tablets, as this may harm male foetuses. But as of yet, there has not been a single reported case of birth defects caused by handling these tablets.

Furthermore, there’s also no evidence that pregnant women exposed to the semen of Propecia or Avodart patients will risk any birth defects.

Propecia and Avodart are also not advisable for men with liver disease or prostate cancer.

Get a Prescription for Propecia or Avodart.

Often our member physicians will prescribe Propecia or Avodart to halt a patient’s hair loss and then restore the hair already lost with hair transplant surgery. These treatments in combination can work synergistically. The drugs work to halt the hair loss, while hair restoration surgery restores what was lost.

To get a prescription for Propecia or Avodart schedule a free no obligation consultation with any of our quality hair restoration physicians. Find a physician in your area.

Propecia and Avodart should be taken once a day. It has been found that after two years of treatment, Propecia effectively grows hair in about 66% of patients. Also, about 83% of the subjects receiving this treatment continue to maintain their existing hair after two years.

Propecia (Finasteride) was originally a drug called Proscar, which was used to treat and reduce men's prostate conditions such as benign prostatic hyperplasia (BPH).

Its parent company, Merck & Co., soon realized that the drug had a unique side effect - it grew hair on bald men's heads.

In December 22, 1997 the FDA approved Propecia as a hair loss pill. Merck & Co. then marketed the drug as a hair loss treatment under the trade name of Propecia.

More recently Dutasteride, sold as Avodart, has generated interest as a promising new hair loss medication. Like finasteride (Propecia) it inhibits the creation of DHT and was originally developed as a treatment for men’s prostate condition.

However, unlike Propecia, Avodart inhibits the creation of both type one and type two 5 alpha reductase enzymes. Dutasteride has been shown to decrease levels of DHT by 90% after only two weeks, making it a more powerful and faster acting weapon against hair loss than Propecia (Finasteride).

Dutasteride is not yet FDA approved for the treatment of hair loss. However, some hair restoration physicians also prescribe it for the treatment of hair loss. Like Propecia, Avodart is not safe for women and children.

Sticking with the program to see results

Losing your hair took time. So too will regrowing your hair using Propecia or Avodart. These drugs require patients to take the drug daily for at least three months before any obvious changes will be noticeable. Most physicians advise taking these drugs for a year before evaluating their effectiveness.

At this time, Propecia and Avodart are only available by prescription. Our member physicians are available to discuss these hair loss drugs with you and prescribe them if appropriate. To find a quality hair restoration physician in your area.

Other DHT Blockers

Aside from Propecia and Dutasteride, there are other treatment options (all topical) that may or may not work to block the effects of DHT on vulnerable hair follicles. These include Revivogen, Crinagen, Progesterone Creams, and Xandrox (a type of minoxidil). Other DHT Blockers

To learn more about these treatments, as well as all other topical options, visit our Topical Hair Loss Products and Treatments section.

How hair loss drugs inhibit DHT and Alopecia Areata

Baldness is largely the result of dihydrotestosterone (DHT) interacting with those hair follicles that are genetically vulnerable to their effects.

DHT is essentially the active ingredient or catalyst for the hair loss process. DHT binds with the receptor sites of genetically vulnerable follicles and gradually degrades the follicles ability to produce healthy hair. This eventually results in baldness in the affected areas.

Hair loss drugs like Propecia or Avodart work by inhibiting the conversion of testosterone into dihydrotestosterone (DHT). By reducing the amount of DHT present in the scalp the hair loss process is slowed and in some cases even reversed.

What about side effects?

Up until a couple of years ago, side effects when taking Propecia or Avodart were only considered temporary. However, over the last several years, many me have reported ongoing side effects from Propecia even after stopping treatment.  This more permanent condition has become known as "Post Finasteride Syndrome" or (PFS). Side effects included but aren't limited to reduced semen production, a reduced libido and softer erections.

As a result, in April of 2012, the FDA mandated labeling changes to finasteride related products.  Labeling changes to Propecia include "libido disorders, ejaculation disorders, and orgasm disorders that continued after discontinuation of the drug".  Labeling changes to Proscar include "decreased libido that continued after discontinuation of the drug".  Labeling changes to both Propecia and Proscar include "reports of male infertility and/or poor semen quality that normalized or improved after drug discontinuation".

While most men don't experience any side effects at all, it should be known that a small percentage of men may experience persistent side effects even after stopping treatment.  Most men who experience side effects however, only experience them temporarily and stopping treatment makes them go away.

For a list of potential side effects and more information on Post Finasteride Syndrome", visit http://www.pfsfoundation.org/.

Over the past several years surgeons have used various techniques to perform follicular unit hair transplantation. One such technique is the Lateral Slit Technique, also known as Coronal or Perpendicular Grafting. This technique’s name is derived from the angle and direction in which the graft incisions are made.

While there are other techniques for performing densely packed and highly refined follicular unit transplantation, the lateral slit technique offers a high degree of control over the angle and direction in which the transplanted hairs will ultimately grow.

The lateral slit technique has been used both intuitively and systematically for years by hair restoration physicians. However, it has recently gained popularity as a systematic and precise way of performing follicular unit hair transplantation.

How our member physicians use the Lateral Slit Technique.

Many of our physician members use the Lateral Slit Technique exclusively or in combination with other techniques for creating graft incisions. The lateral slit technique enables a surgeon to create graft incisions at varying angles (ranging from 10 to 90 degrees to the scalp), including very acute angles that will make the transplanted hair grow out lying flatter to the scalp. The ability to create incisions at very acute angles is particularly useful in areas such as the front temples and sides where the hair normally grows out lying flat on the scalp.

The graft incision determines the direction of the hair growth

The lateral slit technique also helps enable a surgeon to determine the direction of the graft incisions. This then determines the ultimate direction of the transplanted hairs growth. Thus a surgeon can use this technique to control and vary both the direction and angle at which the transplanted hair will grow in order to mimic the subtle changes in hair direction that occur naturally.

Each graft incision is created by analyzing the neighboring hair so the surgeon can reproduce the correct hair pattern. As a result, as each transplanted hair emerges from the scalp it will grow and lay in a similar direction as its neighboring non-transplanted hairs.

Lateral slits can enable denser packing of grafts

Lateral slit incisions also tend to be more parallel to the scalp and thus more superficial and less invasive to the scalp’s underlying vascular structure. This parallel alignment also enables a physician to place more grafts per square centimeter with out the grafts compressing or popping up since the pressure exerted on the grafts does not push them upward from the scalp.

Using blades cut to the size of the grafts

Some of our members use custom blade cutters to create tiny blades to make incisions that match the size and depth of each follicular unit graft being transplanted. This enables a surgeon to safely dense pack more grafts into a given area during a surgical session. Healing time is also more rapid, with minimal scarring.

Typically most clinic’s blades range from 1.5mm to 2mm in size. However, by using the custom blade cutter our physicians can create blades as small as .7mm for a single hair graft and .9mm for a multi hair graft.

In addition, the blades created by the custom cutter are squared off to match the shape of the bulb end of a hair follicle. Non custom cut blades are typically spear pointed which requires them to be inserted deeper thus causing more trauma to the scalps vascular structure.

The ability to control the depth of the incision each blade makes is also critical. Each blade is placed in a blade holder that is set to not allow the blade to go any deeper than required for the graft to being placed in the incision. This minimizes unnecessary trauma to the deep vasculature of the scalp, thus enabling close tight incisions, minimal tissue swelling, and quick healing that leaves no visible scaring, pitting, or cobble stoning of the scalp.

Placing grafts to maximize their aesthetic result and coverage

The plane and direction in which each follicular unit graft is placed on the scalp can also impact the ultimate appearance of density that can be produced with a given number of grafts. This is because hairs within a follicular unit are typically next to each other inline.

Therefore by arranging each multiple hair graft on the scalp in a linear fashion to the line of sight, each follicular unit will provide the maximum appearance of fullness and scalp coverage. This also mimics how hair is normally aligned on the scalp.

Special thanks to Dr. DeYarman, Dr. Sharon Keene, Dr. Jerry Cooley, Dr. Alexander, and Dr. Glenn Charles for contributing their expertise and photos for this section.