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If Bald Isn't Beautiful, the Answer Is a Plug, Not a Rug, Says Transplant Pioneer Norman Orentreich

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“Castration is one remedy for baldness,” Dr. Norman Orentreich points out, explaining that dihydrotestoster-one (DHT), a male hormone, combined with a genetic predisposition, causes hair loss. But, the dermatologist admits, “It is hardly practical.” Instead, he suggests hair transplants, an operation he pioneered in 1952. Of patients done that long ago, he says, “The hair is still growing.” So is his practice. “After all, 33 percent of men are partly bald at age 30, 50 percent at 50 and 66 percent at 60,” says Orentreich, who has trained more than 700 doctors from all over the world in his technique.

“With baldness, you never totally lose the hair,” he says. “The follicles or hair canals are there, but they become minute.” Why? “It’s a game of genetic roulette,” he explains, in which baldness in the mother’s family is slightly more influential than in the father’s. Balding also affects men differently. “When some see it happening, they shave their heads and go with it. Others see it as evidence of aging.” Bald men do not have greater sexual vitality, as generally believed, the doctor says. “Some women are turned on by baldness and others by hair. It just depends.”

Born in New York City, Orentreich, now 58, graduated from New York University Medical School. During his residency there a professor asked him to lecture on hair and nails “because I had such a full head of hair,” he laughs. He continued with dermatology and surgery and in 1953 established the first “hair clinic.” (The Orentreich Medical Group in Manhattan now has three doctors and 17 nurses.) “In those days hair loss was thought to be connected with poor blood supply,” he recalls. “Doctors believed it came from tight hatbands.” The first test group for his cosmetic transplant was 50 fellow physicians; since then he has treated more than 10,000 heads (but discreetly will give no names).

A transplant requires three or four sessions over three months; each session is done in the office under local anesthetic. Using an instrument Orentreich calls “my cookie cutter,” he removes a disk or “plug,” a sixth of an inch in diameter, from the bald scalp. He replaces it with one containing six to 12 hairs (and healthy follicles) from the fringe above the neck. Filling the hole in back is not necessary “because it shrinks, and nature heals it beautifully.” Orentreich transplants 60 plugs in two hours at $15 per plug. The average bald scalp requires 240 plugs; the procedure, including follow-up, costs about $4,000. “In a week the scalp heals enough for a shampoo,” the doctor explains. “The hair in the transplanted plug falls out, and in two months new hair growth begins.”

Orentreich cautions that the procedure doesn’t work for all men, because “fringe hair sometimes isn’t capable of transplanting.” He also is leery about transplant clinics that do 200 to 300 plugs in one sitting. (“They are mostly run by nonphysicians and only have young doctors moonlighting. Their work is often ineffective, because when a large number of grafts are done, they may not take.”) Orentreich says he stresses the creation of “a natural-looking hairline to fit the age of the man” and hair plugs that “grow in the right direction.”

Hair weaving, in which side hairs are woven together with a hairpiece, “is passé and dangerous,” he says. “It pulls the other hair out.” He is also opposed to therapy involving the female hormone estrogen; doses that are large enough to impede hair loss can feminize a man. He uses another hormone, progesterone, which is present in males and females, but applies it only locally. It reduces the rate of hair loss by decreasing the male DHT hormone formation in the skin.

Baldness, of course, is not limited to men. Many women experience it, says Dr. Orentreich, but usually later in life. He often treats women with drugs to “stop them from overproducing male hormones, which will then stop hair loss.” He advises balding women not to eat certain foods with hormones in them: peanut oil, wheat germ oil, brewer’s yeast and vitamin E. “Food can be a drug and upset the delicate endocrine balance of the body,” Orentreich says.

For men with thinning hair, he recommends they shampoo frequently to remove scalp oils that contain male hormones; brush only to groom, because the 100-strokes-a-day routine breaks the hair; see a dermatologist for local anti-hormone medication; and, as a final recourse, get a transplant.

Orentreich has no objection to a good toupee, but quality is important. “It should not be designed in a way that makes a 40-year-old man have a 20-year-old hairline,” he says. “And remember, purchasing and maintaining a natural hairpiece—not Dacron—for five years is equal in cost to a full hair transplant procedure.”