Hair Restoration Improves

With New Science, Hair Restoration Improves
By DAN HURLEY

Published: June 15, 2004 - NYT

"How you doing, Tom?" asked Dr. Anthony DiBiase, a Manhattan surgeon, in the midst of jabbing a lancet 1,130 times into the balding head of Tom Raybek. "You O.K.?"

"Yep," said Mr. Raybek, as mellow and relaxed on a mild tranquilizer and topical anesthetic as if he were getting a haircut, which was pretty much the opposite of what he was getting.

At the age of 58, Mr. Raybek, a ski lodge owner from Killington, Vt., had agreed to undergo hair transplantation at no charge in exchange for allowing his image to be used by Dr. DiBiase's employer, Bosley Inc., in "before" and "after" photographs.

This, however, was "during," and it was not pretty. Tiny beads of blood welled up as Dr. DiBiase's hand jabbed up and down as rhythmically as a sewing machine, making three or four minuscule punctures every second.

Two medical assistants standing nearby counted off every puncture, so that they would add up precisely to the number of follicles that had already been "harvested" from the back of Mr. Raybek's head earlier in the morning. In the afternoon, the medical assistants would spend nearly three hours using tweezers to plant the individual follicles into the holes.

"Pretty amazing, isn't it?" Dr. DiBiase said, standing back to admire his handiwork, like a farmer gazing out on a newly planted field of wheat.

With little fanfare, the science of hair restoration has in the last few years undergone vast changes. Hair plugs, infamous for their artificial appearance, are becoming a thing of the past, as scientists refine techniques of transplanting individual hair follicles rather than circular scoops of skin, giving the hair a more natural look. At least one new hair-growth drug is in the pipeline.

The cloning of individual hair cells is only a decade away, experts say - an advance that, by providing an unlimited source of replacement hair, could give even the baldest head a luxuriant thatch, while at the same time making hair transplantation surgery safer.

The market for such developments is sizeable. The Food and Drug Administration estimates that some 40 million men and 20 million women experience hair loss. Sales of Propecia, one of the most popular hair-growth potions, totaled $111 million in the United States in 2003 alone, up 13 percent from 2002.

Close to 32,000 hair transplants, 88 percent of them in men, were performed in this country last year, according to the American Society of Plastic Surgeons, up from 29,000 in 2002. With the typical transplant running upward of $10 per follicle, and the average procedure involving about 1,000 follicles, that translates into nearly a third of a billion dollars.

The field's advances have not done away with bad hair jokes: A running gag in the recent film "Hellboy" revolved around the doll's hair look of a character's hair plugs.

"The big problem we've had to overcome is 30 years of plugs," conceded Dr. Bobby Limmer, a dermatologist in San Antonio and the developer of individual follicle transplants. "You mention hair transplantation to the guy on the street, and the first image that's going to come to him is the plug."

But the evolving medical science has come a long way since 1981, when a Boston lawyer named John Kerry, not yet a political figure, represented 16 men whose heads had been surgically implanted with carpet fibers.

"They were badly, badly infected, and in most cases large parts of their scalps had to be excised," recalled Roanne Sragow, then Mr. Kerry's law partner and now the first justice of the Cambridge District Court. "It was pretty gruesome."

Hair transplantation has been possible since 1952, when Norman Orentreich, a dermatologist at New York University, figured out how to transplant circular scoops of follicle-rich skin stolen from the back of the head.

The result was tiny tufts rising up like so many islands of hair amidst a barren sea of baldness. This effect was especially unfortunate at the hairline, where the hair plugs were plainly visible.

Even five years ago, experts say, plugs remained the hair replacement technique of choice; they are still used by some, particularly on the crown, where the doll's hair effect is not as visible."