Doctor's Review: Medicine on the Move

October 25, 2021
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Hair today gone tomorrow

Alas, the elite of yesteryear never believed that bald was beautiful

For women, lustrous hair has long been a sign of femininity, attractiveness and good health. For men, the stakes are perhaps even higher. Since that no-good trollop Delilah shore off the shiny locks of her suitor Samson, men -- and, indeed, many women -- have subscribed to the belief that a full head of hair is a symbol of strength and virility.


As countless contemporary dermatologists can attest, men will turn to anything to keep their hair from falling out. Though some of the fairer sex also suffer from hair loss with advancing age, certain diseases and hormonal changes, men bear the brunt of the affliction of androgenetic alopecia. Male pattern baldness, which reportedly affects more than 50 percent of the population by age 50, is perhaps the most confounding (albeit one of the few) benign conditions men are forced to deal with. As of yet, there is no proverbial little blue pill to deal with the situation, though a long tradition of trying has trickled down over the centuries.

The first mention of a "cure" for baldness can be found in the classic ancient Egyptian medical text, the Ebers Papyrus; no mention of the success rate, though. Obviously, there was not much to be done about this problem that continues to puzzle the best of today's researchers. With no cure in sight and infomercials touting spray-on hair still many centuries away, men were forced to turn to more creative cosmetic alternatives. And so, before an inkling of a surgical solution would come to light, wigs were the only options afforded to the bald and balding.

Yes, those follically challenged fops romping about Versailles during the 17th and 18th centuries had it good -- the problems of hair loss and/or lice could be cured with a simple shave and a wig. (Louis XIV popularized wigs once he wore them to hide his own retreating hairline.) Wild, white and powdered, this haughty headgear remained all the rage for centuries and even crossed the Atlantic to our fair shores as those fashion-forward Europeans began settling the Americas. George Washington and many of his rag-tag band of revolutionaries, however, broke fashion rank by refusing to wear wigs (perhaps seeing them as yet another symbol of Colonial control) and powdered their real hair instead.

Back on the continent, by the end of the 1700s, the wig craze was about to fizzle out. At the time, men and women of high birth were still in the habit of wearing elaborate, starch-powdered and lavender-scented wigs made of human hair (those made of dog or goat hair were reserved for the poor proletariat, wanna-bes and never-gonna-bes), though younger, trendier men were beginning to make like Washington and powder their own tresses. In Great Britain, when the greedy and presumably thick-haired British parliamentarians of the time decided they'd put a little extra cash in their coffers by taxing the ubiquitous wig powder virtually everyone needed to achieve the look in question, the tactic backfired. After the annual one-guinea powder tax act was enacted in 1795, instead of anteing up, people simply packed their wigs away for good.

It was probably not too much of a coincidence that at the same time, hats came back into fashion. Elaborate headpieces made of silk, velour and Canadian beaver fur were obviously a better way to announce one's social status anyway. Of course, it was also around this time, at the beginning of the 19th century, that the medical community began to search in earnest for a scientific solution to male-pattern baldness.

The first real team to make any headway into the field of mane maintenance came out of Würzburg, Germany. In 1822, a young medical student named Johann Friedrich Dieffenbach, along with his professor, Carl Unger, devised a surgical solution of sorts. After Dieffenbach practiced with skin, feathers and fur on animals, he tried it on himself, poking holes in his arm with a needle and then inserting individual hair follicles from his head. A few of them actually took hold and so the hair transplant was born. Unger boldly proclaimed it to be the end of male baldness, but somehow, the procedure failed to attract the hairless masses, mostly because of cost issues and the fact that few surgeons could repeat Dieffenbach's highly skilled work.

Later in the 19th century, several doctors attempted the first autograft, transplanting entire flaps of hairy skin in an attempt to help heal balded burn and trauma victims. In 1914, another German physician, Franz Crusius, used a special needle to transplant single hair follicles from his patients' heads to replace their missing eyelashes. Effective, yes, but a laborious process unlikely to help anyone looking to cover half a skull.

For those unable to afford (or understandably unwilling) to submit themselves to the unpracticed hands of doctors specializing in such macabre matters, there was no choice but to turn to the ubiquitous snake-oil salesmen, named for their number-one seller -- various forms of a greasy tonic originally based on an ancient Asian formulation of serpent fat, promising to add shine and thickness to men's diminishing hair and, of course, cure any ailment or complaint a prospective client could have. Snake-oil salesmen -- and their sketchy, oft-dangerous solutions to common medical complaints -- roamed the countryside throughout Europe and all over North America until well into the 20th century, bilking the hairless poor and desperate with empty promises of follicular rejuvenation. It would not be hard to argue that today's proliferation of on-line products designed to treat the same problem is nothing more than a modern version of yesterday's itinerant quackery. Sadly, there is no shortage of patients willing to pay for their false promises.

The big breakthroughs bald men had been waiting for came out of Japan in the 1930s and '40s, where three separate researchers devised the first modern hair transplants. In 1930, a surgeon named Sasagawa revisited Dieffenbach's old follicular transplantation techniques with great success. Then, in 1939, the dermatologist Okuda published a paper on the success he'd had with a method he devised to treat localized hair loss in those suffering from traumatic alopecia. Okuda's method became known as punch-grafting -- moving full-thickness plugs (instead of individual follicles) into slightly smaller, tighter holes he created at the recipient site. It was an excellent process, though one which tended to bestow a clumpy and unnatural "doll-hair" effect.

In 1943, a dermatologist by the name of Tamura began exploring the use of micrografting. By moving only a couple of hairs at a time, he managed a more natural look, though it was very labour intensive. Interestingly, Tamura's area of expertise was actually the transplantation of female pubic hairs. He probably never could have imagined that only 50 years later, women would begin paying for the privilege of Brazilian bikini waxes. Perhaps tomorrow, men with full heads of hair will be flocking to the laser-hair remover's chair with requests to duplicate the effects of androgenetic alopecia. Okay, maybe not…

After the success of this initial triad of Japanese hair movers and shakers, many refinements to these techniques were made. The causes of androgenic alopecia were also being studied, with the anatomist James B. Hamilton finally revealing a link between baldness and hormones in 1949. In 1952, dermatologist Norman Orentreich became the first to do what the Japanese hadn't: offer a bald patient the first commercially available hair transplant using the punch-grafting technique. Others soon flocked to his office and doctors around the world began to see the economic virtues of male vanity. Orentreich also came up with the concept of donor dominance, the fact that hair maintains the characteristics of the section it came from rather than the area where it was transplanted.

Today, hair transplants remain one of the most requested cosmetic procedures for men. Though several topical and ingested medical formulations currently do offer some measurable degree of success and hair plugs and transplants have come a long way since Dieffenbach's day, there is still no cure for baldness. Until the legions of thinning men around the world band together to ban comb-overs, burn their toupees or just say no to hair plugs -- or less likely still, until all women come around to the virtues of a bald, shiny pate -- the art and science of hair replacement will continue to preoccupy doctors and patients for years to come.


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