The Hair Loss Treatment Evolution


Valerie DeBenedette, Senior Medical Editor

Valerie DeBenedette is a science writer who specializes in keeping people informed about medicine and their health. She has more than 20 years of experience writing for newspapers, magazines, and websites and has written about most areas of medicine. For many years, she was a contributing writer to Cosmetic Dermatology and to Drug Topics, the leading pharmacy trade magazine. She also was a contributing editor to The Physician and Sportsmedicine for many years. She has written about most fields of medicine, including dermatology, sportsmedicine, ophthalmology, general surgery, orthopedics, and women's health; as well as public health policy and the pharmaceutical industry. In addition, she is the author of Caffeine, a book for young people. She is a member of the National Association of Science Writers.

October 11 2007

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The ancients Egyptians used a compound of fat from several animals, including a lion, a hippo, and a crocodile. Hippocrates used a mixture of cumin, pigeon droppings, horseradish, and beetroots to help prevent hair loss. No, they weren't cooking; they were trying to cure baldness.

Things could have been worse. Hippocrates also noted that eunuchs, men who were castrated before puberty, never went bald. Castration is the only proven method of preventing male-pattern baldness, but to no great surprise, it is the only hair loss prevention option men avoid.

So for the last couple of millennia, people have used enormous numbers of "hair loss products" created by humbugs, snake oil salesmen, and quacks. To get their hair to grow, they have tried potions, pills, machines that "stimulate" the scalp, and standing on their heads. Nothing worked, and a few were downright disastrous.

Of course, methods of hiding baldness were also tried. Julius Caesar may have been the inventor of the comb-over, judging from statues and busts of the man. He also wore a laurel wreath as often as possible to disguise his hair loss. Laurel wreaths have rarely been in fashion since ancient Rome, however, so few people followed his lead on that.

King Louis XIII of France started to wear a wig in the early 1600s to conceal his hair loss, and suddenly fabulously powdered wigs were the rage in Europe for the next hundred years or so. It's good to be the king. Powdered wigs stayed in fashion until 1800 in England, when the government levied a tax and taxed them out of popularity. The remnant of this fashion lives on in the ceremonial wigs worn by lawyers and judges in the British courts. That was pretty much the high point in the history of fake hair, although hair weaves and wigs today can be very realistic looking.

In the late 1970s and 1980s, some advances were made in medications for hair regrowth. Medications for hair loss are a bit like a good news-bad news joke. The bad news is that they don't work well, but the good news is that they work at all. The first drug to come along that could grow hair in both men and women was minoxidil (Rogaine), a topical hair loss treatment. You have to apply minoxidil to the scalp twice a day, and it does not work well for everyone. Minoxidil works best in the early stages of hair loss. A second drug, Propecia (finasteride), can also stop hair loss, but it is available only by prescription and can only be taken by men.

The Dawn of Surgical Hair Restoration

A surgical solution has always seemed like a better idea than medications. In the 1800s, German scientists experimented with transplanting hair from one part of the head or body to another. It worked, but few people took note of the work. A few quacks created systems that inserted animal hair or fake hair into the scalp. The results were poor and the infections were bad.

In 1939, Dr. Shoji Okuda, a Japanese dermatologist, published his successful work on transplanting pieces of skin with hair follicles (the tiny skin structures that grow hair) into scarred hairless areas on burn victims. It was groundbreaking work, but no one paid much attention to it for another 20 years.
One reason the scientific world did not pay attention (besides the fact that Okuda published his work in Japanese on the eve of World War II) is that the prevailing theory held that transplanting hair into areas affected by male pattern baldness was a waste of time. The scientists believed that the hormones that cause hair loss in men (primarily DHT, a relative of testosterone) would cause the transplanted hair to stop growing, making it all a futile exercise.

But in 1959, Norman Orentreich, MD, published a study describing how to perform hair transplantation, and showing that hairs from a donor site unaffected by male pattern baldness (usually the back of the head) would continue to grow even if they were put in areas of baldness. Hair transplantation surgery was born.

Medical Hair Replacement Today

Since 1959, hair transplants have become an accepted treatment for hair loss in both men and women. Microsurgical techniques have greatly improved the safety and effectiveness of the hair transplant process. Hair transplantation has moved beyond the era of large plugs that gave the look of "doll hair" and became the best option for permanent hair lost treatment.

Using modern surgical hair restoration techniques like follicular isolation, hair restoration surgeons now transplant a few hair follicles at a time and insert them in a pattern that mimics natural hair growth. Surgeons can recreate a full head of hair that has a natural looking hairline, greatly improving the overall look. Results are consistent and great looking.