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During the past several decades, superstition, old wives tales, and guess work has gradually been replaced by science.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

As the field of medical hair restoration continues advancing and evolving, hair loss sufferers look toward new, cutting edge clinics and corporations for faster, more effective, and less invasive hair loss treatments. In various but not all cases, the breakthroughs achieved through oral medications and topical solutions (seen in proven hair loss treatments like Rogaine (minoxidil) and Propecia (finasteride) are fantastic.  Thus, hair restoration entities continue striving to create the next advancement and bring the world closer to a “hair loss cure.” However, for each hair restoration treatment that’s proven safe, effective, and efficient, it seems as if a dozen others are rejected for being unproven, inefficient, or unsafe.

For this reason, it’s always advantageous to thoroughly research the newest hair loss solutions and determine whether they are safe and effective, or if they fail to live up to the high expectations set by the current gold standard treatments such as proven solutions Propecia and Rogaine.   Below, we evaluate whether Spectral.DNC, a topical solution created by Divine Skin Laboratories (DS Laboratories) can help stop hair loss and regrow hair.

Spectral.DNC is a topical treatment formulated by DS Laboratories which claims its “the world’s most effective topical hair loss treatment.” But can Spectral.DNC live up to these lofty claims and offer a more effective solution, or will it suffer the fate of many therapies before it and fail to gain the approval of the hair restoration patient community?

According to DS Laboratories, Spectral.DNC is applied (as an atomized mist or liquid) to the balding scalp twice daily, once in the morning and once at night. Along with a series of vitamins and herbal supplements (herbal extracts, copper peptides, and a vitamin complex), the active ingredients in Spectral. DNC are 5% minoxidil, Aminexil (SP94), and Retinol. Since minoxidil is also the proven, active ingredient in topical Rogaine, Divine Skin utilizes a frequently asked questions feature on its website to explain how Spectral.DNC is different and more effective than minoxidil. According to Divine Skin, it’s the two other active ingredients – Aminexil and Retinol that make Spectral.DNC more effective than Rogaine.

Aminexil (or Aminexil SP94) is a compound currently featured as an active ingredient in a line of healthy hair shampoos by L’Oreal. Aminexil is allegedly helpful in the treatment of perifollicular fibrosis – a pre-mature aging of hair shafts caused by inflammation and an overproduction of collagen proteins. It’s worth noting that while some reputable sources have researched its connection to perifollicular fibrosis, it hasn’t been conclusively linked to hair loss (especially androgenic alopecia hair loss), nor is Aminexil proven to treat perifollicular fibrosis. Furthermore, Aminexil is not recognized or approved by the United States Food and Drug Administration (FDA) as a treatment for any type of hair loss.

DS Laboratories indirectly counters these statements by sharing the results of a “worldwide” study which demonstrated an 8% increase in hair growth and a 6% increase in hair shaft diameter in hair loss sufferers using Aminexil (compared to a placebo group). This study however, is not without its limitations.  This study was conducted in 1994, only contained 130 participants, lasted for 42 days, and doesn’t appear to be published in any sort of peer reviewed publication. Because of this, it’s difficult to evaluate whether or not the addition of Aminexil as an improvement over simple 5% minoxidil. But what about the Retinol?

Retinol (and its derivatives) is a form of Vitamin A, often used in medical dermatology for maintaining healthy skin and treating specific types of acne. Allegedly, certain forms of Retinol act as hair restoration drugs (after periods of long term usage) by preventing hair loss hormones from binding to target receptors and killing healthy hair follicles. While evidence of these claims was difficult to find, many Retinol users claim that the drug is harsh on skin and utilizing it in the scalp would cause irritation and require small, likely ineffective dosages. Much like Aminexil, there’s no solid evidence to suggest that Retinol makes Spectral.DNC a more effective hair loss solution than Rogaine or other minoxidil related products. Interestingly enough, while copper peptidesare listed as in inactive ingredient, research supports that copper peptides may play a role in transforming thin vellus hairs into thicker terminal hairs, increasing follicular size, and regenerating healthy scalp skin.  However, because copper peptides aren’t listed as an official “active ingredient” by DS Laboratories nor do we know its concentration, it’s difficult to gauge its efficacy within Spectral.DNC.

The only proven and FDA approved ingredient in Spectral.DNC is 5% minoxidil. While minoxidil is safe and efficient, it’s unclear what the additional ingredients in Spectral.DNC may actually accomplish. Furthermore, the cost of Spectral.DNC runs between $35.00 and $45.00 for a month supply, compared to around $ 25.00 for a three month supply of generic 5% minoxidil.  According to DS Laboratories, the only known side effects revolve around minoxidil (which are no different than those associated with Rogaine).  Although minoxidil is relatively safe and effective, it’s been used as a hair loss treatment for decades.

Those hair loss sufferers considering using Spectral.DNC as a treatment for thinning hair can feel confident knowing that they will, at the very least, obtain similar results to using minoxidil 5%.  Until the other active ingredients are peer reviewed, whether or not Spectral.DNC is more effective than Rogaine 5% is mostly conjecture.

Many cases of female hair lossare caused by hormonal fluctuations or changes in the body including those who have PCOS (polycystic ovarian syndrome), birth control pillside effects, a recent pregnancy,postmenopausal trauma, or menopause. Women with hair loss experience varying balding patterns These patterns can help determine the type of alopecia you have along with a thorough examination by a physician.

Because of an imbalance between estrogen and testosterone due to declining estrogen levels, thinning hair and accelerated hair loss is common in women during menopause. Hair on certain areas of the head that is more sensitive to androgen hormones like DHT(associated with male pattern baldness) may thin or fall out. Similarly, declining estrogen levels may result in unwanted facial hair growth.

In some cases, polycystic ovarian syndrome(PCOS), may accompany menopause and hair loss.

Be sure to speak with your doctor on the most effective ways to cope with menopause and minimize hair loss during this transitional time.

Alopecia areata (sometimes referred to as“spot baldness”) is a medical condition that typically results in patchy hairloss or bald spots on the scalp, beard, arms and legs. Though the exact cause of alopecia areata is unknown, it is thought to be an autoimmune disorder causing the body’s immune system to attack its own hair follicles, resulting in hair loss.

Roughly 2% of the world’s population suffers from alopecia areata and approximately 5% of these have a family history of "alopecia", the medical term for hair loss.

Diagnosing Alopecia Areata

Alopecia areata is normally diagnosed through the observation of symptoms. However, occasionally a scalp biopsy or blood tests may be performed.

Treating Alopecia Areata

There is no cure for alopecia areata and current treatments, while sometimes effective, offer limited success.  Current treatments for alopecia areata include; steroid injections, topical corticosteroids (steroid hormonesnaturally produced in the adrenal cortex of vertebrates), topical immunotherapy, Rogaine(minoxidil) and ultraviolet light therapy.

Although permanent hair loss is a possibility, the course of the disease is unpredictable and varies from patient to patient. The good news is that, even without treatment and after many years,the hair follicles do remain viable and ready to resume normal hair production if and when they receive the appropriate signal. Hair regrowth may, and often does, occur in time.

Are Alopecia Areata Patients Good Candidates for Hair Transplantation?

Patients suffering from alopecia areata are rarely considered good candidates for hair transplant surgery because donor hair grafts harvested from the “safe” zone at the rear and sides of the scalp are still vulnerable to the effects of the body’s immune system once transplanted to the recipient sites. However, if the affected area is small, has remained unchanged for an extended period of time and if there is no sign of inflammation below the scalp, hair transplantation may be an option. This would require a thorough consultation with a skilled and experienced hair restoration surgeon and the patient would need to fully understand and accept the risks of such a procedure.

Adapting to and Living with Alopecia Areata

Depending upon the severity of the condition, hair loss concealers like Toppik, Nanogen and DermMatch may help disguise bald patches. In more severe cases, a hair replacement system or full wig may be necessary.

Aswith all forms of hair loss, patients suffering from alopecia areata may experience emotional and psychological trauma. It’s important to reach out to family and friends, join an alopecia support group and/or seek the services of a mental health professional if you are experiencing intense, prolonged and overwhelming psychological effects.

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.

Causes and Treatments

Alopecia is the medical name for hair loss to the scalp or body.  While Androgenetic Alopecia (genetic hair loss) is the most common, there are many other forms of alopecia related hair loss worth discussing.  Each medically named alopecia comes with distinct symptoms, a unique cause and exclusive treatments. Below, we've compiled a list of and description for the most common types of alopecia related hair loss along with the available treatment options for each.

While the information on this website can be used as a guide, men and women who believe they are experiencing hair loss should always be properly diagnosed by a qualified hair restoration physician to determine its cause. To learn more about each distinctive alopecia hair loss condition, click the links below.

Traction Alopecia
Alopecia Areata
Diffuse Patterned Alopecia
Diffuse Unpatterned Alopecia (DUPA)

Cicatricial alopecia (Scarring Alopecia)

Alopecia Universalis and Alopecia Totalis

Female hair loss, otherwise known as Female Pattern Baldness (FPB), affects 1 out of every 4 women in the United States. Recent findings have found that the incidence of FPB has been reported to be as low as 8% and as high as 87%. And, it does appear to be as common for women as for men. Most often, menopause is the most frequent time for hair loss in women to become apparent.

For a woman to lose her hair can be even more troubling than for men. A woman with thinning hair is not generally accepted as part of the normal aging process. Society has come to expect a thick, luxurious head of hair as part of the attractiveness in women.

While males and females can both experience thinning hair, they typically do not lose their hair in the same order or appearance.

Women with thinning hair compared to Men

Typically men observe their hair loss earlier, whereas women will first notice it in their late 20's through their early 40's. Female Pattern Baldness (FPB) is often seen during hormonal changes. These include the use of birth control pills, following childbirth, or during or after the time of menopause.

Top view of patient, showing excellent growth of transplanted hair.

In addition, men typically have localized areas (patterns) of thinning, whilein women this usually occurs as thinning across the top, or over an even wider area. When women have very diffuse thinning over much of their scalp they are generally not good candidates for hair restoration surgery. However, women with localized hair loss, similar to the typical male pattern baldness, can successfully undergo hair restoration surgery.

Thinning hair in females is also characterized by an increase in the combination of normal thick hairs mixed in with finer, smaller hairs. This results in decreased density, and not total hair loss.

A woman's hair has also been proven to be more sensitive to the effects of stress than men's hair. Stress can result in hair loss in women and men. But this type of loss is not female pattern baldness. Rather, it is known as “telogen effluvium.” This type of hair loss is the shedding of hair in the resting phase when the body senses that it needs to divert its energies elsewhere. Therefore stress can temporarily changes the amount of hair that is shed. But the lost hair is likely to grow back.

The production of the hair loss-inducing androgens is also different among men and women. A woman produces a small quantity of androgens in the adrenal glands and the ovaries. The ovaries also produce pre-hormones, which are then converted to androgens on the outside of the ovaries or adrenal glands.

Generally speaking, a woman with hair loss will probably not experience total balding in a given area. But if there is total hair loss, this is most likely a sign of a previously hidden disease. For this reason, it’s important for females to have their hormone levels checked by a physician if they are experiencing heavy hair loss.

Finally, men and women react differently to various hair loss treatment options. In men, hair loss may be halted or even reversed by finasteride (brand named "Propecia"). However, Propecia is not safe for females or children. Minoxidil (Rogaine) can be effective for both men and women in treating hair loss.

However, for some women the causes of their hair loss are much more complex than the classic "male pattern baldness". Thus proper diagnosis of the underlying cause is vital before any hair loss treatments are attempted.

The following physicians are nationally well known experts in female hair loss. Feel free to contact them.

David Whiting in Dallas, Texas - 214 824-2087

Vera Price in San Francisco, California 415 353-4163

Maria Hordinsky in Minneapolis, Minnesota 612 625-1493

Wilma Bergfeld in Cleveland, Ohio 216 444-5722

For a web community that is dedicated to female hair loss visit HerAlopecia.com