Ah, the bad hair day, that equal opportunity condition that strikes at the most inconvenient time, like before a job interview or a first date.
Who hasn’t done battle with blow dryers?
Or tried to salvage a coiffure by using enough hair spray to slice a hole in the ozone?
But imagine a lifetime of bad hair days that can’t be blamed on humidity, tundralike temperatures or a coif crying for a cut.
Such was life for a Milwaukee teacher, plagued by a receding hairline.
“It started bothering me when I was about 8, because all of the other girls could pull their hair back in a ponytail, and I couldn’t,” says Kathy, 42, who asked that her real name not be printed. “Most women take for granted that they can part their hair on the right or left side. I wore my hair straight, parted down the middle. I didn’t have any options.”
Over the past year, Kathy got the bangs she once dreamed of from hair transplantation, a surgical procedure that has been dimming the shine on male bald spots since the 1960s.
But it took an innovative new method called “mini grafts”-also known as slit, line or incision grafts-to make transplants a viable alternative to wigs, weaves and other temporary treatments for some women afflicted with hair loss.
Unequal opportunity
In the United States, an estimated 21 million women suffer from “female androgenetic alopecia,” an overall, diffuse thinning of hair caused by heredity and hormones, according to the American Hair Loss Council, a non-profit group in Tyler, Texas, that represents physicians and non-medical specialists.
Of that population, the council estimates only 3 to 5 percent have undergone transplantation.
Experts cite several reasons for those figures.
Although a growing number of doctors nationwide are performing-and, in some cases, modifying-slit grafts on women, the procedure has received less media attention than other hair loss treatments, like Rogaine, the only FDA-approved topical product believed to slow down hair loss in some folks and stimulate minimal growth in others.
And while doctors have been slow in targeting women as patients, many women-turned away years ago by surgical dermatologists, cosmetic surgeons and others who insisted transplants would not deliver positive results-gave up on the idea and settled for wigs.
“I never sought women as patients because there was nothing I could do for them,” says Dr. Sheldon Kabaker, a hair transplant specialist in Oakland, who has performed slit grafts on countless men, but on only 12 women. “Applying the new technique to women is revolutionary, and I expect it to become widely used.”
The slit method, developed in 1984 by Dr. Wayne Bradshaw in Australia, involves harvesting grafts from incisions in the back of the scalp, where hair typically is dense, and then relocating those donor grafts into incisions, usually 2 to 4 millimeters in length, in the bald or thinning area.
Slit grafts create a more natural appearance than the ultraconspicuous round kind, widely known as “plugs.” That makes the new technique ideal for women who’d rather show some scalp than have hair that looked like it was manufactured by Mattel.
“The plugs caused it to grow in clumps, resulting in the tufted appearance of hair on a plastic doll’s head,” says Dr. Carlos Puig, medical director of the Puig Medical Group, with six hair transplant centers nationwide, including Chicago.
Doctors say plugs were acceptable to men, who viewed tufted hair as an improvement over no hair. But for women, whose balding patterns are more diffuse than men’s, plugs simply would attract attention to the thinning area, and therefore, weren’t an option.
Another benefit of slit grafts is that no hairs are sacrificed in the recipient site. With round grafts, doctors punched two holes in the scalp-one at the back, the other at the front.
“So if we were transplanting 10 hairs from the back, we might lose four hairs at the front of the scalp for a net gain of six,” Puig explains. “The new method is much more efficient and appears to be demonstrating improved results.”
The financial picture
But even sophisticated slit grafts aren’t the answer for all women.
In fact, only about 30 percent of balding women will qualify based on the severity of the loss and the amount of hair remaining at the back of the head, the primary donor site.
If a woman has male pattern baldness-either a receding hairline or a bald crown-she is a strong candidate for this technique because the donor area, typically, will be thick with hair, says Dr. Shelly Friedman, medical director at the Scottsdale Institute for Cosmetic Dermatology in Scottsdale, Ariz., who has performed the method on 50 women.
(Some causes of hair loss that would disqualify someone for transplants include thyroid conditions, anemia and protein deprivation.)
“A woman needs to have realistic expectations of what the surgery will do for her,” says Michael Mahoney, executive director of the American Hair Loss Council, which also distributes information to consumers on hair loss treatments. “Many men would be happy with a hairline like Peter Jennings’, but many women wouldn’t be happy with that amount of hair.”
“It’s more acceptable for a man to be bald or thinning than it is for a woman in our society,” Friedman adds. “But to a woman, any thinning is unacceptable. It’s very sad that until now, we weren’t able to help them.”
Kathy, who paid $6,000 for five hair transplantations, is ecstatic about a look she calls “normal” because her hairline “doesn’t start halfway back on my head.”
Overall treatments range in price from $5,000 to $18,000, depending on the number required to achieve the desired cosmetic effect. On average, most patients have four treatments.
“When you’re going through it, you can understand the expense because it’s so labor intensive,” Kathy says of the surgeries, which were performed on an outpatient basis under local anesthesia. “Over the past 40 years, I’ve probably wasted more money on cable television and cigarettes-and there’s no lifetime benefit to that.”
Take two aspirins
Doctors say surgery varies from 90 minutes to 2 1/2 hours and liken postoperative discomfort to a headache.
“I prescribe nothing stronger than Tylenol or Advil,” Puig says.
The following day, the patient returns for a checkup and shampoo, and bandages are removed. Within six to nine weeks, patients say they noticed hair sprouting in areas once sparse or bald, and there’s little or no scarring.
“It’s like a paper cut,” Friedman says of the technique. “Your skin is separated and then it comes back together. Same with this procedure. It heals fast because the incisions are so small.”
Although balding men often undergo hair transplants in their late 20s through 30s, women who seek treatment usually are past 40.
“The loss can become cosmetically significant by age 50,” says Puig. “It’s very traumatic for women. Not all of them want to look like Sinead O’Connor.”
Her name is `Alex’
For nearly a decade, Arlene, who also requested anonymity, contacted doctors hoping they’d be able to remedy the straggly, straight locks that barely concealed her scalp and her virtually bald forehead.
“I was ignored,” says Arlene, 43, a real estate agent and beautician in Elizabeth, N.J. “I never received any of the literature or videos I requested-and I was answering ads and calling toll-free numbers. Then I decided to start using a phony name. I’d call and say the information was for `Alex,’ my friend. Well, `Alex’ got all kinds of mail and phone calls.”
Today, she’s had three treatments and is considering a fourth. And Arlene no longer “pushes, pulls and teases” her tresses to contrive a style.
“It was subtle enough that people didn’t notice it immediately,” says Arlene, who told only a few friends about the treatment. “With females, it’s still not the kind of thing you tell everybody about.”
Despite their enthusiasm for the new technique, physicians point out that slit grafts aren’t a cure for hair loss.
“My favorite saying is, `I’m an illusionist,’ ” says Friedman. “I just rearrange hair in such a way that a woman looks like she has more hair than she did before.”
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The American Hair Loss Council offers a list of physicians nationwide who perform hair transplants. Call 1-800-274-8717 for more information.
