The Bald Truth
Americans turn to weaves, rugs, plugs, and drugs to alleviate hair loss, creating a $1.5 billion industry
Minisurgery. But it is not just marketing pressure that is persuading more balding men to let physicians take scalpels to their heads. Within the past several years, doctors have developed and refined a new transplant technique that more accurately replicates the way that hairs grow on their own. Since most hairs actually sprout from the scalp in one- to three-hair clusters, surgeons now transplant hairs in these same patterns, typically called micrografts and minigrafts. Behind the hairline, surgeons will transplant grafts of as many as eight hairs. Today, the micrograft and minigraft method is used by just about all physicians who perform transplant surgery.
This new technique is derived from a procedure that was developed by Norman Orentreich in 1954. A dermatologist at New York University, he began punching out small circles of follicles and scalp about the diameter of a pencil from the back of the scalp and dropping them into holes above the forehead. The transplanted hairs fell out soon after the operation, but new ones began to sprout within several months and eventually became long enough to provide some coverage to the scalp. This same routine of the hairs dying out and then regrowing, doctors have since learned, is a natural part of any transplant procedure.
Even with the more recent advances of micrografts and minigrafts, hair-transplant surgery today is neither quick nor pretty. Recently, in an operating room at the Los Angeles office of the New Hair Institute, which performs over 1,000 transplants a year nationwide, a patient sat back in a chair smiling--a disposition attributable to the painkilling drugs in his system. In the corner of the room, a medical assistant busily sliced micrografts from a hairy piece of scalp that only hours earlier had been attached to the back of the patient's head. Hovering over the patient's fairly large bald spot were a pair of technicians using sharp forceps to jam strands of hair into tiny holes drilled into the patient's head. Each plunge of the technicians' needles put another of the 1,800 one- to four-hair grafts being transplanted that day into place--and brought a slight oozing of blood. The patient paid about $9,000 for the roughly eight-hour procedure.
One problem for patients is that doctors themselves do not agree on any single best approach to transplant surgery. Dr. William Rassman, founder of NHI, has made a career by performing what he calls "megasessions." Instead of the 1,500 or so grafts that most physicians limit themselves to in any one surgery, Rassman continually pushes the envelope to reposition as many follicles as possible during a single operation. His current ceiling stands at around 4,000 grafts, though that is a record he expects to top soon. This strategy is controversial among many in the transplant community, who say that moving that many follicles unnecessarily increases the procedure's failure rate. But the megasessions are a crucial element of NHI's strategy. The outfit has positioned itself as the low-cost, high-volume competitor in the market, charging as little as $5 a graft.
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