After 20 years of trying every drug, supplement, diet and procedure for hair loss - including driving four hours twice a week for laser therapy - Lina Telford, a graphic artist, gave up on her "comb over" (her description) and shaved her head. From then on, she alternated between a $1,500 wig and a $4,000 wig.
"When you hear people complain about having a bad hair day, you almost can't bear it," she said. "You're like, 'Honey, you have no idea.'"
In February, though, Telford, 46, flew from her home in London, Ontario, to Sarasota, Florida, for a new $1,400 hour-long treatment known as platelet rich plasma (PRP), which is said to stimulate dormant hair follicles. The procedure involves drawing blood, spinning it in a centrifuge to extract the plasma, adding various nutrients (like more protein), then injecting the resulting mixture in one-inch intervals in a grid on the top of the scalp, which has been numbed with a local anesthetic.
Like the long-suffering friend who inspired her to undergo the procedure, Telford quickly saw an improvement in her hair. New hair growth usually takes at least four months, but at the two-month mark, she has already spotted some baby hairs.
"Not a gazillion," she said, "but it's a start." She's planning to return for follow-up treatments every six months, and has high hopes of ditching the wigs and wearing her hair in a pixie.
Joseph Greco, Telford's practitioner, who shares a patent for a process to remove growth factors from platelets, said he gets results in 80 percent of patients, more than half of whom are female. Roughly half of them fly in and out, often on the same day, he said, because the procedure doesn't require downtime and has minimal side effects. (Small clinical studies suggest further research is necessary but acknowledge the procedure's "excellent safety profile.")
PRP is one of a number of new hair-loss treatments being marketed to women, who suffer hair loss in fewer numbers but often more acutely than men because, for them, hair loss is less socially acceptable, and historically they have had fewer and less potent medical solutions.
Some 30 million women in the United States have hereditary hair loss (compared with 50 million men), according to the American Academy of Dermatology, though that figure does not include the millions more who struggle with thinning hair because of pregnancy, menopause, stress and other health conditions. Barely 5 percent of women are said to be good candidates for hair transplant surgery because women lose hair everywhere, meaning that, unlike with men, there is rarely a luxuriant spot on the back of the head from which to harvest hairs unobtrusively.
Dr. Carlos Wesley, a hair restoration surgeon in New York, said that women in his practice respond better to PRP than men do, which may have something to do with the fact that women with genetic hair loss tend to have more inflammatory cells around the follicles. From 2013 to 2014, he said, he had an 83 percent increase in female patients, in part because of PRP.
PRP, considered a nonsurgical treatment, is not covered by insurance, and clinical studies about its effectiveness (and longevity of results) are not conclusive because different doctors use different mixes. But PRP has a long (though also inconclusive) history of use elsewhere in the body. Athletes like Kobe Bryant have received the treatment in an attempt to heal injuries.
"It's extremely promising," said Spencer Kobren, founder of the independent American Hair Loss Association, "but I don't want to say it's the greatest thing since sliced bread." Because PRP varies so much, it can be hard to know what one is getting, and some doctors "ride on the vulnerability of women," he said.
Drugs for hair loss have been slow in coming because researchers are unable to grow hairs in petri dishes to use for screening. Hair drugs approved so far were serendipitous finds: side effects of compounds used to treat other conditions.
Drugs for female hair problems are even slower to develop, in part because it's easier to do measurements and hair counts on men in clinical trials.
Finasteride, better known by the brand name Propecia, is not approved by the Food and Drug Administration for women. (Because it works on hormones, it is also controversial for them.)
But in November, after 10 years of research, Rogaine introduced a new 5 percent minoxidil formulation for women. It's a mousse (instead of a liquid) that needs to be applied only once a day instead of twice, which means that it can be more easily incorporated into a woman's evening skin-care routine. Teal replaces the blue and silver palette of the men's Rogaine, and the packaging bears a lotus flower. (Also last year, Pantene introduced its Hair Regrowth Treatment for Women, which is 2 percent minoxidil.)
Angela Ledford, 34, a beauty blogger, had used the Rogaine men's formulation, after hair extensions, MAC Black Carbon eye shadow, Joan Rivers hair fill-in powder and supplements all failed to hide her thinning jet-black hair. (The men's product was not FDA-approved for women, but that didn't stop women from buying it.)
"I'm not worried I'm going to sprout a mustache anymore," Ledford said of her switch to the women's product, which doesn't drip down the face. Recently she watched a video blog of herself in which she looked down and was pleased to note baby hairs sprouting "all over my scalp," she said.
Dr. Melissa Piliang, a dermatologist at the Cleveland Clinic, said that Rogaine works better on the top and crown (for reasons not fully understood, the frontal hairline tends to be more resistant to treatment) and ideally should be started as soon as women notice thinning.
"Any regrowth you get is a minimal amount," Piliang said. "So the more density when you start, the better results you get."
Latisse, a prescription medication used since 2008 to grow longer, fuller eyelashes, is now being tested for the scalp. (Doctors report that patients have tried it on their own, but a limiting factor is that Latisse comes in a very small bottle; it doesn't go very far.)
Piliang said she expects Latisse's results to be less striking on the head than on the lashes because the drug works by shifting more hair from the resting phase to the growing phase. For lashes, only about 30 percent of the hair is in the growing phase at any given time, she said, but on the scalp, that figure is 80 or 90 percent.
Some treatments in development hold particular promise for women. Angela Christiano, a hair geneticist and Columbia University professor of dermatology, is hoping to begin clinical trials in a year or two on a procedure in which she dissects hair-follicle stem cells, grows them in the lab until she has several million, then injects them into the scalp, where, a very small study done with a human skin model has shown, they induce new hairs.
This stem cell therapy needs only a dime-size donor spot on the scalp: 50 to 100 hairs, as opposed to the bloody, painful 4- to 5-inch strip of 1,000 hairs typically required for a hair transplant.
"It's been, I would say, kind of the holy grail in the field to be able to find something that is less invasive, less surgically intensive and can capitalize on the natural properties of these hair stem cells," said Christiano, who herself suffers from alopecia areata, an autoimmune disease that causes partial or total hair loss.
Her hope is that the procedure (she has helped start a company named Rapunzel to develop it) will eventually become another lunchtime cosmetic treatment. Once a patient has had her cells harvested and cultured, they could be stored indefinitely; then, after giving her doctor a month's notice (the time it takes to grow the million needed), she could pop in for injections. Costs would likely be on par with hair transplants, roughly $10,000 and up.
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