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Dr. Schweiger on Good Morning America

Dr. Schweiger, our resident expert on hair loss in women, was featured in a segment about hair extensions on “Good Morning America” and ABC News online.

While many women extoll the cosmetic virtues of hair extensions — they are designed to add to the length and fullness of one’s hair — many others have realized the potential for extensions to cause hair loss.

Dr. Schweiger:

“We have patients who are in their early 20s come in after wearing hair extensions for six months or one year, and they actually have bald spots,” Dr. Eric Schweiger, a New York City dermatologist, told “Good Morning America.”

Some of the hair loss can be attributed to traction alopecia, which is localized hair loss that occurs with constant tugging on the follicles. However some of the problems occur due to underlying medical conditions, like anemia. Regardless the underlying cause, when someone is exposed to prolonged tension and weight from cosmetic enhancements, temporary or permanent areas of balding can occur. In some cases hair may grow back in those areas, but for individuals with permanent hair loss from extensions, hair transplantation may be the best treatment. In those cases, a visit to a hair restoration physician is the first step towards treating or repairing your hair loss.

This risk of damage to the hair is why it is important to use caution and care with extensions, as well as to have an understanding of potential issues the extensions might cause.

Dr. Schweiger on understanding these risks:

“It’s very important that people out there know the risks of hair extensions before they get them done,” said Dr. Schweiger. “If you’re going to do any extensions, just use them for a few hours and take them out. That’s the safest way.”

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Dr. Bernstein on CBS - Eye on NY

Dr. Bernstein was interviewed by Dana Tyler, host of the television program “Eye on New York” on CBS, for the show that aired on April 17th. The wide-ranging interview was the feature in a 9-minute segment on hair transplantation and hair loss.

Below is a partial transcript from the interview.

Hair Loss – Men vs. Women:

DT: How big a problem is it, men versus women? We heard the statistics but is it worse for one group or the other?

RB: It seems to be worse in women emotionally. Statistically it’s obviously more common in men, but the pattern is very different. When men lose their hair they lose it mostly in the front. And they can start in two different patterns. One is in the temples and in the crown or it can just go front to back. That’s called patterned hair loss and it’s pretty obvious. Women have a more diffuse pattern so it would be many years before you even notice it.

DT: What about the influence we hear, if it’s your mother’s father or your mother’s grandfather was bald then therefore, men, you will be. Is there any truth to that?

RB: Like many myths there is a little bit to it. There is a slight predominance coming from the mother’s side of the family. There is something called an androgen receptor gene, that has been found on the X chromosome, which accounts for the slight difference between inheritance from the mother’s side versus the father’s side. But most of the genetics is on the regular chromosomes, called the autosomal chromosomes, which is the same from both sides. So you can get it from either your mother or your father or your uncles or grandparents.

Early Hair Loss:

DT: Age-wise. Are there certain times – I mean, we talked about earlier in the 30s, but some young men it happens earlier.

RB: It seems that when people start to lose their hair early, it has a tendency to be much more severe. So the people who start to thin around 16, 17 usually become very bald. Time is usually on your side if you have hair into your 30s and 40s, [it’s] more likely you’ll have a full head of hair.

Hair Loss in Women:

DT: Speaking about women and the reasons behind women’s hair loss. A little different than for men.

RB: It’s genetic, as with men for the most part, but there are two different systems. Where in men it’s related to androgens directly, which causes the front-to-back pattern, in women they have another enzyme pathway which kind of evens it out and keeps their hairline longer. Also, because women have a tendency to thin all over, their genetic hair loss can be mimicked by other things, such as diseases that cause hair shedding or thinning — so anemia, thyroid disease, medications such as birth control pills — all those things can also contribute to hair loss, and it seems that those factors are much more common in women than in men.

DT: And then in trying to determine if a woman is going through that, because there are more factors is it hard to figure out why there is the hair loss?

RB: It’s a little bit more difficult [in women]. The main thing that you do is to look at the hair diameters. In genetic hair loss the hairs have different diameters. In [conditions] like anemia, or where there is shedding on medication, the hair comes out at its root. Where people think of hair loss as losing hair, most of hair loss is thinning because the hairs are actually thinner in diameter.

Preventing Hair Loss:

DT: Preventing baldness… is there anything that can be done?

RB: There are… But it’s not what you think. It’s not hats and combs.

DT: Fertilizing your head. (laughs)

RB: There are two medications, main medicines. One is Propecia, or the generic term is called finasteride, and what that does is it blocks DHT. And DHT is what causes these hair follicles to gradually miniaturize, or get smaller, and disappear. And the other is Rogaine, which actually stimulates hair follicles directly. Unfortunately, Propecia can’t be used in women because it can cause birth defects during child bearing years and it can also stimulate breast tissue, but it is very effective in men.

DT: So what does a woman do?

RB: Well, Rogaine will help a little bit. Lasers can help a little bit, perhaps not as much as the initial studies have suggested. And then, once you’ve lost your hair, surgical options are available.

Hair Transplantation:

DT: Hair transplants. I know that’s a complicated procedure. And Dr. Max [Gomez] was talking about the art of it, too, when you’re finding someone. Tell me a little bit more…

RB: The main thing in hair transplants is really to determine who is a good candidate. And the interesting thing is that because of the pattern of [hair loss] in men, men usually have a very permanent area on the back and sides of the scalp. So when you move that to the front and top, it will continue to grow. Because women’s hair loss is more diffuse, the back and sides are not always stable. So, when you’re trying to decide if a woman is a good candidate, you have to make sure that the hair, where you get it from, is going to last their lifetime. And only a small percentage of women are really good candidates for that transplant.

The Future of Hair Restoration – Medications & Cloning:

DT: What about the future? Are you optimistic about new options on the horizon?

RB: First of all, new medications are coming out. Latisse is a medication that can grow eyelashes. And we’ve just started studying it in eyebrow hair, and it seems to grow eyebrows as well. There are studies to see if you can grow hair on the scalp. And it certainly will, it’s just whether it’s practical and how well it works. It probably will be of some benefit.

DT: There always is progress, right?

RB: Right. And then [there are] hair transplants where we can take individual follicles rather than having to take a long thin strip, although that still seems to give you the best volume. And then we’re trying to multiply hair. In other words, the limitation of transplants is always that we don’t have [as much] hair as we’d like. So we’re working on cloning. We’re working on multiplying hair that can actually be plucked from the scalp. So that [the original hair] will regenerate, and you then can get the plucked hair to grow into new hair follicles.

For more interviews with Dr. Bernstein, and other media appearances, visit our Bernstein Medical “In The News” section.

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New York Times - Hair TransplantThe New York Times interviewed Dr. Bernstein for a full-length article on hair loss and hair transplant options for women interested in hair restoration. The article – titled, “Tricks and Transplants for Women’s Hair Loss” – covered modern hair transplantation techniques, hair transplant costs, camouflage techniques, and more.

Read below for some excerpts of the article:

Exploring Your Options:

Hairstylists, impressed with how realistic the “new” transplanted hair looks, recommend doctors to clients who are tired of hiding their hair loss with layers or high- and lowlights. “I’ve seen bad jobs,” said Seiji Kitazato, the creative director at Frédéric Fekkai on Fifth Avenue, who refers clients to a few surgeons. “But now you can’t even tell.”

Still, not every woman of the millions who suffer from hair loss is a candidate. Underlying conditions, including anemia and thyroid problems, that are temporary, treatable or affect the scalp rather than the hair, must be dealt with before a transplant can be considered. If a transplant is ruled out, sufferers must rely on wigs, hairpieces or styling tricks.

What’s more, “most medications can cause hair loss, some more frequently than others,” said Dr. Robert M. Bernstein, a clinical professor of dermatology at Columbia University who has a restoration center in Manhattan.

A transplant is an option only for a woman who has a thick enough area of hair from the back and sides to “donate” to a more paltry part of her scalp. But many women don’t experience this kind of localized balding; instead their entire head of hair thins out during menopause or as they age.

Buyer Beware:

So the incentive to treat any and all comers is high. “It’s a big problem,” Dr. Bernstein said. “You shouldn’t go to someone who will give a transplant to anyone who walks in the door.” If your condition is not properly assessed, you could permanently shed more hair after surgery than you gained, he warned, or if the hair transplanted wasn’t stable, “it would disappear.”

Before Hair Transplant Surgery:

If you’re suffering hair loss, see a dermatologist first, not hair transplant surgeons, said Dr. Robert M. Bernstein, a dermatologist in Manhattan who specializes in hair restoration. After determining a cause, dermatologists can offer advice about options from the medical to the surgical. Many women with hair loss try Women’s Rogaine, a solution with 2 percent minoxidil that is applied to the scalp, twice daily. Others prefer Rogaine’s foam for men, because it has 5 percent minodixil, dries quickly and feels less greasy. (But even the women’s formulation warns to discontinue use if facial-hair growth occurs.)

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Dr. Bernstein was interviewed by New York Newsday in their article, “It’s a Hairy Decision Picking a Treatment for Baldness.” The complete article is below:

HEALTH MATTERS COLUMN

Even IF they don’t talk much about it, just about all the guys he knows are taking medication for their thinning hair, said Steve, a retail manager in his early 30s from Suffolk County, NY. He would be too, but he had side effects right away. He’s had consultations for hair transplants, but that won’t work either because of the pattern of his balding.

So he’s using a protein product that makes his hair look fuller, changed his diet to include leafy green vegetables, gone to two psychics for help. And, he said, he’s biding his time, waiting for new hair restoration medications or for hair cloning to hit the marketplace.

“In the ’90s, everything’s about looks,” said Steve, who asked that his last name be kept confidential. “No one wants to give up their youth.” All the effort to find a hair restoration solution is worth it, he said, “because losing my hair bothers me a lot.”

Sure, hair loss isn’t crippling or life-threatening. But to hear people’s tales, it’s traumatic, depressing and embarrassing.

Yet, you’re more likely to get a snicker than a hug for your pains, said Spencer Kobren, 34, a Manhattan consumer activist and author of “The Bald Truth,” (Pocket Books, 1998, $6.99.) There may be few open arms to comfort you, he said, but there are plenty of extended hands to take your trust and your money.

Kobren should know. He has spent several years testing out hair loss products and talking to the experts about his own hair loss, which began at 22. Now he serves as a sounding board and clearinghouse for the good news and the bad about hair loss and its treatments on a syndicated radio show, aired locally on WEVD /1050 AM on Sunday nights.

“You feel like you’re losing a part of yourself. You see your appearance deteriorate, often rapidly and drastically,” he said. You become vulnerable to promises and pitches, but don’t be swayed by them, said Kobren, who now has a full head of hair. Instead, do a lot of research. The wrong hair restoration products or treatments may not only fail to grow hair, they can make matters a lot worse. For example, he said he gets thousands of letters and e-mails about botched hair transplants that leave men scarred, poorer and balder.

According to Kobren, about $7 billion is spent by consumers annually on finding solutions to hair loss. There are about 50 million men who are balding, with at least 20 percent starting in their 20s. Most have male-pattern baldness, genetically linked and triggered by the action of a hormone called dihydrotestosterone (DHT).

Hair loss is not just a guy thing, though. Plenty of women — about 20 million — have varying degrees of it too. Hair loss is finally getting recognition as a women’s health problem, said Maggie Greenwood- Robinson, whose book, “Hair Savers for Women” (Three Rivers), is due next spring. Kobren’s “The Truth About Women’s Hair Loss,” (Contemporary) will be out in January. “There are more options than ever before for women with hair loss,” said Greenwood-Robinson, and they shouldn’t give up.

But they do have to be cautious. The diagnosis and treatment for men and women is very different, said Dr. Robert M. Bernstein, assistant professor of dermatology at Columbia College of Physicians arid Surgeons and medical director of the New Hair Institute in Manhattan and Fort Lee, N.J.

“Women usually have a diffuse type of hair loss with thinning all over,” he said, “while men generally lose hair on the front and top and keep a permanent zone on the back and sides.” Female baldness can also be due to DHT, but many women lose hair because of anemia, gynecological issues, thyroid disorders or stress, among other reasons. You don’t want to waste your efforts on hair restoration products when what you need is more iron or different birth control pills. “A medical evaluation is extremely important to rule out underlying medical conditions,” said Bernstein.

The treatment of hair loss is an increasingly complicated decision for both men arid women, but at least there is more information than ever to help you ask the right questions. Web sites include www. thebaldtruth.org and www.regrowth.com. Bernstein’s practice has a Web site at www. newhair.com and a detailed book called “The Patient’s Guide to Hair Restoration.”

Your hair restoration options include:

Medication: Finasteride (brand name Propecia), taken orally by prescription. Available for under two years, Propecia is for men only and causes side effects in about 2 percent of them. It has been shown to stop hair loss in about 87 percent of users and new growth in about half. It’s not for women, because it can cause birth defects if a woman is pregnant, and if she’s past child-bearing age, it doesn’t seem to work.

Minoxidil: (brand name Rogaine), used topically. It can be used by both men and women and appears to slow down the rate of hair loss, but not to prevent balding in the long haul. Any effect from either of these hair restoration medications stops when you no longer use them.

Hair transplant surgery: for men and women. Bernstein has pioneered a state-of-the-art technique called follicular unit transplantation, a precise method using hair-follicle groupings that result in a more natural growth of hair and doesn’t leave scars.

Removing grafts of skin from your head and placing them in balding spots is clearly an art as well as a science. Besides being a good candidate for surgical hair restoration, you need to find a dermatologist with a lot of experience performing hair transplant surgery. Expect to ask many questions, learn the risks, see pictures of other patients and meet them in person.

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