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LISA CLARK: Welcome, and thanks for tuning in to our
webcast. I'm Lisa Clark. By the age of 50, approximately
50% of women will have to cope with hair loss. This is a
natural part of aging, but it's a part that most women
would prefer to skip. For many women, medications can
provide a reliable solution to hair loss. For others,
such things as clever hair styling or surgery might help
overcome the problem of thinning hair.
Here to share some helpful hair care tips and
treatment options for women who are experiencing hair
loss, we have two experts. Dr. Marty Sawaya, adjunct
professor at the University of Miami School of Medicine,
and Dr. Michael Reed, assistant professor of clinical
dermatology at the New York University School of
Medicine. He's also in private practice here in
Manhattan.
Now, it's true that although men have to endure a lot
of bad jokes if they start to thin on top, it is
socially acceptable for a man to have a little bit of
hair or no hair. Some men even shave their heads to make
a statement. But it is not socially acceptable for a
woman to start losing her hair.
MICHAEL L. REED, MD: It's true. A man can choose or
not to choose to suffer from baldness, but all women
suffer from baldness, or hair loss or thinning or
shedding, whatever it happens to be. It's because women
have to have hair. It's an absolute requirement for
them.
LISA CLARK: And she feels very stigmatized when this
starts to happen, right?
MARTY SAWAYA, MD: Exactly. It's a very big social
pressure for us to always look our best. We have to look
like the models or the front of a magazine cover. So
it's a very big pressure. And we lose about a fourth of
our hair follicles by the time we're 50 years of age, so
it's a natural aging process that we can't combat. Plus
the fact of having more hair loss on top of that, for
some people.
LISA CLARK: More good news about aging, right? When a
women is at risk for losing her hair, are there things
that she can do to slow or minimize the risk?
MARTY SAWAYA, MD: Definitely. And the sooner the
better, that they seek help and do the proper things
that they're supposed to do. Seeing their physician,
making sure there's no underlying medical things we need
to take care of. Excessive blood loss, medications,
menstrual problems. A lot of things can happen as we get
older. So making sure, health-wise, that we're really up
to where we should be, is very, very important.
And the fact that we can have changes to our scalp
with regards to age or hair loss problems, shedding
problems, use of proper medications such as minoxidil,
Rogaine for women can be very, very helpful. And
properly using them is also advisable.
LISA CLARK: What are some of the mechanical things
that women should be concerned about, in terms of taking
care of their hair? Pulling it back too tight in a
ponytail, cornrows, braids?
MICHAEL L. REED, MD: Any procedure, any product that
chronically pulls for long periods of time on the hair
shaft, will transmit that tension down into the living
root, and will tend to cut off the blood supply or cause
a low level degree of inflammation, and will actually
cause the hair to use up its natural genetic allotment
of hair growth and resting cycles, and it'll be gone
prematurely, and it won't grow back after a long time.
It will just be replaced by little fibrous tract.
Tight rollers, tight ponytail hairstyles, excessive
brushing and combing, pulling, consciously or
unconsciously, and cornrowing or braiding, those type of
hairstyles, are all not advisable.
LISA CLARK: There's a myth that washing your hair is
not a good thing. That is not true. But there is
something that you can do to be proactive about how you
wash your hair. Is that right?
MARTY SAWAYA, MD: We usually instigate shampooing on
a daily basis. I usually recommend rotating shampoos,
medicated shampoos and mild shampoos that are sensitive,
for mild sensitive scalp. It's very advisable. People in
the family usually end up liking these shampoos, and
everybody uses them in the family. The zinc containing
shampoos, depending on if you have any scale or
inflammation.
The thing I tell women is, whatever you're doing to
your scalp, if you have any itching, that's
inflammation. Inflammation and the hair follicle do not
like each other. That will start the whole process up
with regards to shedding and hair loss. So be very
careful what you do to yourself.
There is an institute for women's fine and thinning
hair that the Pharmacia company has set up so women can
call in and actually get advice with regards to styling
techniques, medical questions, and psychosocial
questions with regards to psychologists answering these
questions. So women have a source to go for information
now, which I think is just incredible.
LISA CLARK: A styling change can make a big
difference in the appearance of thinning hair. Changing
your part or cutting your hair shorter so that it's not
hanging as limply as it might tend to want to do.
Dr. Reed, more and more women are opting for a
technique that you're definitely familiar with, implants
or follicle implants, microsurgery.
MICHAEL L. REED, MD: We're now in the age of the
so-called follicular unit graft transplant. We have
discovered, we should have seen this a long time ago,
that hairs on the human scalp grow in naturally
occurring, small anatomical clusters called follicular
units, which have one, two, three, sometimes even four
or five hairs in them.
Now we take these naturally occurring clusters from
the back of the head, where they're genetically blessed
and will have a long life. Maybe the entire life of the
person. And we micro-dissect them under a dissecting
microscope, and put hundreds and thousands of them into
the thinning areas.
We have instrumentation now so we can go between the
native hairs so we don't disturb them. We now are
transplanting a large percentage of women who previously
were unaware of this treatment, and it wasn't really for
them, but now it is.
LISA CLARK: I want to ask you some specifics. If a
woman comes to you to have this surgery done, is it a
process? Are there several steps that you go through in
doing sections, or do you do it all at once? How does
that work?
MICHAEL L. REED, MD: It's done in many different
ways, but most women, I find, like to get it over with
as quickly as possible. Especially older women tend to
have a sensitive scalp, and it's sore in the back
afterwards, because it has to be sutured. Although when
it heals, you don't miss the hair on the back. There's a
pencil-line scar that usually disappears. And the top,
there's a period of time where a person may have a
little bit less hair, because it's a shock to the scalp,
and even some of the native hairs will come out and grow
back with the transplanted hairs. That takes two or
three months to really get going. But it works in
everybody. Everyone gets a good result nowadays with the
techniques.
LISA CLARK: When do you recommend this option to a
patient?
MICHAEL L. REED, MD: It can happen any time that they
get to the point where their hair is noticeably thin, so
that in normal circumstances, you can see through the
hair and you can see scalp. You don't have to have a
bald spot, you just have to have a thin spot. We can
fill it up.
LISA CLARK: Dr. Sawaya, let's talk about some of the
alternative therapies, and whether any of them actually
work. People may see things advertised such as saw
palmetto.
MARTY SAWAYA, MD: Correct. Saw palmetto is an herbal
agent you can buy in the health food stores. Especially
for men, because of prostate problems. They'll have
advertisements that will also link it to hair growth.
It's very disconcerting, because there have not been
clinical studies showing that this actually helps men
with hair loss, much less women.
But people can find it, it's readily available. They
think it's a cheaper alternative than trying our two FDA-approved
products, so they will opt because it's the easier
choice, it's faster for them. I think there's a false
hope. "I'm hoping that the unknown will work better than
our known products." This is very difficult to try and
convince patients, unless they've gone through years of
searching with these products, and then realized it
didn't do anything for me thousands of dollars later.
That's a product that men use for prostate
hypertrophy, urinary retention, and it has made some
medical claims on helping DHT, which is a problem with
miniaturizing the hair follicle. But, again, there have
been no proven efficacy or clinical studies to show that
saw palmetto works with even men for male pattern hair
loss, much less women.
LISA CLARK: Same story with B-vitamins? Now, those
are much more common.
MARTY SAWAYA, MD: Right. All of the things, as we
say, alternative treatments that you might find on the
cable channels, internet, magazines, if they haven't had
the FDA approval, be very careful in using them because,
again, they have no proven clinical efficacy. And we
have clinical studies down to a science today, where we
really can show if they do grow hair. If the companies
don't back these in clinical studies, we have to use
them with some sense of caution in advising our
patients.
LISA CLARK: Here's the championship Scrabble word:
Electrotrichogenesis.
MARTY SAWAYA, MD: This is electrical waves that you
can have in helmets or in devices set up in doctors'
offices. It's supposed to have electrical stimulation
that stimulates the hair follicles. And there have been
some clinical studies in literature, but most of the
outcomes of these studies have not shown any proven
efficacy, and certainly do not outdo our two medical
products that are approved by the FDA. So, again,
skepticism with even the devices that are out there.
LISA CLARK: Dr. Reed, let's talk about some of the
things that are being studied for possible future use,
for men as well as women. Genetic technologies, and
follicle cloning. What can you tell us about those?
MICHAEL L. REED, MD: Those are two science fiction
fantasies at the present time. But usually today's
science fiction becomes tomorrow's scientific fact, and
I think both of them will come to pass, although
probably two generations for gene therapy, and maybe a
generation for cloning.
Cloning is basically a modification of the surgery we
do now, where instead of taking a hair follicle from the
back and moving it to the top, a one-to-one gain, would
take a follicle and will take a portion of it, and will
grow out the little stem cells, and inject maybe several
hundred of them, and make several hundred new hairs in
the new location.
The trouble is that, right now, we haven't really
isolated the exact cells, and when they do get in tissue
culture, they don't really behave properly, because it's
not the right environment for them.
Gene therapy is very intriguing because it may be
possible to attach, once we find out what gene to do,
which we don't have, it may be very difficult. But once
we get the right gene, we might be able to inject some
type of a carrier or put it into a topical preparation
that penetrates into the hair root cells, and it will
add the genetic material that's missing in these doomed
hair follicles that are destined to be lost prematurely,
and make them into the genetically blessed hair
follicles that live forever.
LISA CLARK: Those are far down the road, as you say,
but we should remind women who are having hair loss
issues, there are treatments available now, and you need
to see your dermatologist.
MARTY SAWAYA, MD: Correct.
MICHAEL L. REED, MD: They work.
LISA CLARK: They work, all right. Thank you both for
joining us. We really appreciate it. And thank you for
joining us for our webcast. Let me say thanks to Dr.
Marty Sawaya, and Dr. Michael Reed.
MARTY SAWAYA, MD: Thank you.
LISA CLARK: I'm Lisa Clark |
SUMMARY