Take heart, sufferers of pattern baldness: Hair replacement technology has come a long way since the toupee.
By Jason Keil
You probably remember the commercials: A fit, middle-aged man with a perfect head of hair emerges from a pool and grabs a towel from his young, bikini-clad female partner. At the bottom of the screen is an 800 number that viewers with bald spots or thinning hair can call to have a picture-perfect moment like the one onscreen, complete with a full, lustrous coif.
This hokey yet effective ad for Hair Club for Men, which also featured company founder Sy Sperling intoning the catchphrase, “I’m not just the owner, I’m also a client,” was a classic of ’80s and ’90s TV advertising. By crudely and cannily preying on modern male image insecurities, the ad – and others like it – spawned Saturday Night Live skits and leant an absurdist undercurrent to the act of male hair-replacement.
Eventually, hair-loss advertising adapted, depicting more subtle and realistic results, with celebrity testimonials from the likes of NFL star Wes Welker or Barstool Sports founder David Portnoy touting their results since undergoing treatment. But it’s that Shatner-esque, carpet-like pate that people remember.
“It’s always the bad hairpiece guy,” says Sean Dirodis, president of National Hair Centers in Uptown Phoenix. “That’s generally somebody trying to look way younger than they should.”
Advertising isn’t the only part of the industry that has improved over the years. The hair-replacement technology itself has also evolved. From hairpieces to hair replacements to pharmaceuticals, men and women suffering from baldness now have more options than ever to restore their hair – and Valley doctors have been at the forefront all along.
While hair treatments and replacement therapies have exploded in popularity over the last 40 years, wigs and hairpieces are almost as ancient as written history itself. The earliest specimen was found in a female burial site in the ancient Egyptian city of Hierakonpolis, dating to 3400 BCE. Ceremonial wigs were used widely and globally by both men and women over the subsequent centuries. Many hairpieces have used human hair, but the first toupees – which is to say, partial wigs intended to mimic natural hair or give hair an exaggerated, dramatic effect – were developed in the 18th century.
According to the Encyclopedia Brittanica, they fell out of favor after the French Revolution, when naturalism was embraced. However, in the United States in the 19th and 20th centuries, men desired to look younger, and one of the most inexpensive ways to accomplish this was with a toupee.
In the 1950s, the cosmetics company Max Factor pioneered the version of the hairpiece we know today, with real hair sown onto thin, flesh-colored lace. However, the material used for hairpieces was either synthetic or – if collected from a human donor – often imperfectly matched to the hair on the rest of the scalp. And they tended not to stay on.
“In the old days, it used to be where a guy was afraid that a woman would put her hands through their head and the hairpiece would come off,” says Dr. Shelly Friedman, a board-certified osteopathic physician and owner of the Scottsdale Institute for Cosmetic Dermatology in Scottsdale. “I remember when I was a medical student, and I was rotating in the different departments. A doctor was doing a C-section. He put his head down, and his hairpiece fell off. It was a most embarrassing thing. I can’t imagine what that poor man went through, but that was the last time he wore his hairpiece.”
Hairpieces have improved dramatically in the half-century since Friedman’s cautionary tale. For one, the scaled global market means that manufacturers have access to a wider variety of donor types, creating hairpieces with natural human hair that can usually match the recipient’s color, density and texture on the side of the head. Bonding agents and wig tapes have also improved, allowing users to keep hairpieces in place for as long as eight weeks, without the irritation and epidermal stress of older products.
Dirodis of National Hair Centers is a true evangelist of hairpieces. To paraphrase Sperling’s catchphrase, he’s not only the president, but also a client. His official “before” picture, taken when he was 22, reveals that he had scant hair on the crown of his scalp and the area just below the crown, known as the occipital region. Thus, he was a less-than-ideal candidate for hair transplants, in which hair is harvested from donor areas in the occipital region.
For Dirodis and alopecia sufferers like him, the hairpiece was the better option, particularly with the improvements in adhesives. He boasts that his hairpiece stays on even during skydiving adventures.
One drawback to wearing a hairpiece is that it – and the wearer – require monthly maintenance. For starters, the wearer needs regular barber visits to trim his or her natural hair on the sides and back, or under the hairpiece itself, so it blends properly. The hairpiece also needs to be removed regularly for cleaning and exfoliation of the scalp.
Dirodis shares a story about when he was on a date. His companion that evening didn’t even notice his hairpiece until a commercial featuring his before-and-after pictures came on the screen at the sports bar. “Every five minutes, that commercial came on,” Dirodis recalls. “Then the waitress happens to come up and goes, ‘Excuse me, is that you?’ [My date] says, ‘You got a hair transplant?’ I said, ‘No, it’s not a hair transplant. This is a hairpiece. I’m not actually a good candidate for hair transplant, but I work there, and I do the commercials for them.’”
Dirodis, now married and in his early 60s, always asked whomever he was taking out if they cared if he wore a hairpiece. If they did, he wanted to know before things got too serious. In all cases, including the woman in the above story, he says no one had an issue with it because it wasn’t noticeable.
When discussing the topic of hair-loss remedies, it’s worthwhile to distinguish between hairpieces and hair “restoration.” While the former has been around for millennia, the latter – which entails the revival or transplant of productive hair follicles – dates back to 1822 in Germany, first performed by surgeon Johann Dieffenbach. Known as “the father of plastic surgery,” Dieffenbach conducted experimental procedures in which whole sections of healthy, hair-producing flesh were grafted onto a recipient scalp.
The technology leaped forward in 1952 when Dr. Norman Orentreich, a New York University School of Medicine graduate, pioneered the “punch graft” method, which took hairs from a patient’s donor areas and inserted them into a 4-millimeter area of the scalp. While effective, the hair was inserted too straight, causing patients to look like they had dolls’ hair – thus the stigma long associated with the treatment.
Friedman has personally manned the front lines of hair replacement over the last few decades, serving as the founding president of the American Board of Hair Restoration Surgery, the certifying board for hair transplant surgeons. He has shared his medical knowledge on the Today show and was one of the first doctors to perform hair transplants in the Valley four decades ago.
“When I started in the early and mid-’80s, it was like no one wanted to ever mention they had a hair transplant because it was embarrassing for a man,” Friedman says. “Hair has always been for men and women their crowning glory.”
Other methods came and went in the years following Orentreich’s system. Candidates for a hair transplant can now choose between follicular unit transplantation (FUT), which came to prominence in 1995, and follicular unit extraction (FUE), a variation of the punch method from the 1950s.
During a FUT procedure, a surgeon harvests tissue from the donor area and dissects it stereomicroscopically into naturally occurring one-, two-, three- and four-hair follicular unit groupings. Thanks to the development of handheld devices and robotic technology, surgeons can increase the number of grafts transplanted per surgery from hundreds to thousands.
“We would take out a strip from one ear to the other and suture that closed,” Friedman explains. “Then, we actually looked at the graft under the microscope and measured its width and height. We dialed in exactly what we wanted to fit the graft. Every person is different. Some people have very fine, medium, slightly coarse and coarse hair. It could take five fine hairs to make one coarse hair, so why were we using the same blade for everybody?”
FUE uses a pen-like tool to extract and implant each follicle. Instead of a 4-millimeter punch graft, the punches are around a millimeter wide. Friedman, the first doctor in the state to offer patients robotic-assisted FUE, says the disadvantage of this method is that the number of grafts that can be harvested is about 30 percent less than with FUT.
“One reason a patient chooses FUE is because they want to keep their hair short,” Friedman says. “They’re afraid that the linear scar they would get with [FUT] will be visible. [FUE] is great for somebody who doesn’t need a lot of grafts or whose pattern [of loss] is well-established. The problem today is we’re getting young guys who are 25 years old or younger wanting to have FUE. We can see where their hair loss is, and we know that they’re going to need a lot more grafts than we’re going to be able to harvest.”
Patients should remember that when they decide to transform their hairline, they also need to manage their expectations. Dirodis, who started at National Hair Centers in 1998 as a patient consultant before taking the helm, says he always steers potential clients toward “age-appropriate” solutions because he knows that if someone comes in sporting a look straight out of a comedy film, it’s not a good look for the client – or National Hair Centers.
Like most Valley hair clinics, Dirodis and his team offer a full suite of replacement services – from transplant to hairpiece – and he often finds himself dispensing the same advice to patients that he got back in the day: When their hair is too thin or the balding too extensive in the donor area, the hairpiece is a better bet.
Though his clinic can prescribe minoxidil-based products like Rogaine and other pharmaceuticals, Dirodis says they will not restore lost hair. According to Dr. Kathie Huang, co-director of the Hair Loss Clinic at Harvard-affiliated Brigham and Women’s Hospital, such products can thicken hair follicles and promote hair-lengthening, which can often be mistaken for growth, but will not usually offer profound alterations of appearance. It can also take months to
see improvement.
However, if transplant patients choose FUT or FUE, they must maintain their existing hair post-procedure, lest their hairline retreat further, marooning the new implants as unnatural-looking islands of hair in a sea of baldness. So, Rogaine and other products are often prescribed.
Some Valley doctors are exploring platelet-rich plasma, or PRP, as a hair-loss therapy. It works like this: A doctor extracts blood and spins it in a centrifuge to separate the red blood cells from the platelet-rich plasma. The plasma, which can stimulate hair follicles, is injected into the scalp to help make hair denser.
One maintenance method that Friedman offers is low-level laser therapy. In this process, a patient wears a cap with hundreds of lasers lined inside that stimulate scalp cells, causing hair follicles to become thicker and more robust. Getting one is expensive, costing roughly between $1,000 and $3,000, depending on the model. Then again, getting another hair-replacement procedure can also be costly, with each one running between $4,000 and $15,000, according to WebMD.
To be sure, that’s a lot of money to pay for something that does not make you healthier or wiser. But it’s an acceptable bargain for many who believe their self-confidence and attractiveness are at stake.
“Coming to a place like this, in and of itself, takes courage,” Dirodis says. “You’re finally admitting you care about this, and it’s hard to do that.”
