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Today's New York Times . . .

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. . . front page of Science Times:

(Since this is being posted for educatiopnal purposes, republishing here should not violate any copyright laws.)

 

Weighing the Risks of New Plumage

By DAN HURLEY

 

Published: June 15, 2004

 

Surgeons say transplant surgery for hair loss should be considered only after a doctor's evaluation and a months-long test of less drastic remedies.

 

In 95 percent of cases, thinning hair in men and women results from a hereditary condition, androgenetic alopecia. In men, the loss usually begins at the temple and the crown. Women have a gradual thinning over the entire head.

 

When hair loss occurs, a doctor should also rule out other conditions, especially if the bald spots are in patches. For instance, an autoimmune disease, alopecia areata causes distinct bald patches to form. Lichen planopilaris is an inflammatory disorder in which small flat raised areas form on hairy parts of the skin, and they are usually very itchy. Another autoimmune disorder, lupus, can also cause hair loss.

 

Among the drugs that doctors prescribe for hair loss is minoxidil, approved by the Food and Drug Administration for men in 1988, and for women in 1991. Applied to the scalp twice daily, the original formulation, with 2 percent minoxidil, was shown to cause moderate to dense regrowth in 26 percent of men from 18 to 49, with an additional 33 percent showing minimal regrowth, according to the F.D.A. Among women from 18 to 45, 20 percent can expect to see moderate to dense regrowth using minoxidil in its original formulation, and an additional 40 percent can expect minimal regrowth.

 

The stronger formula, with 5 percent minoxidil, brings significantly better results, according to Pfizer, which acquired Rogaine, the original branded version of the drug, when it bought Pharmacia Upjohn.

 

In 1997, the F.D.A. approved Propecia as the first pill for treating hair loss. Approved only for men because it can cause birth defects in women of childbearing age, the drug blocks the male hormone dihydrotestosterone, or DHT, which plays a central role in male-pattern baldness.

 

In the clinical trial that won Merck approval for the drug, Propecia resulted in maintenance or regrowth in 83 percent of patients, compared with 28 percent of those taking a placebo.

 

"Rogaine steps on the gas, Propecia takes your foot off the brake," said Dr. Ken Washenik, the medical director of Bosley Inc., a large provider of hair restoration surgery and the former director of dermatopharmacology at the New York University Medical Center.

 

Many men have been scared off Propecia, however, by reports that it can cause a loss of sexual desire, difficulty in achieving erections and a decrease in semen. Studies suggest that the sexual side effects occur in 2 percent of the men taking it and that the effects are resolved when the medication is stopped.

 

For people considering surgical transplants, the first question is cost. The going rate is at least $10 a follicle, with most procedures involving 700 to 1,200 follicles. Patients willing to be scheduled at the last minute for an opening in a surgeon's schedule can sometimes negotiate lower fees, Dr. Anthony P. DiBiase of Bosley said.

 

Practitioners agreed that it was best to find a doctor who performed the surgery frequently.

 

"It's one of those subspecialties that you must do a lot of, almost every day, if you're really going to be good at it," said Dr. Rod J. Rohrich, president of the American Society of Plastic Surgeons and chairman of plastic surgery at the University of Texas Southwestern Medical Center in Dallas.

 

Patients might also want to check whether the doctor belongs to the International Society of Hair Restoration Surgery, the largest medical group of transplant specialists, or has passed the exam of the American Board of Hair Restoration Surgery.

 

"The bottom line is, it's a safe, simple outpatient-surgery procedure, but it does require some sound judgment and a lot of aesthetic skills," said Dr. Carlos J. Puig of Houston, the president of the examination board and a member of Bosley's biggest competitor, Medical Hair Restoration.

 

Relatively mild complications like bleeding or postoperative infections occur in 0.5 to 1 percent of patients, Dr. Puig said. There have also been a few cardiac arrests reported during surgeries, "just as in dentistry," he said, adding, "You want to be sure the physician has the proper equipment in the office to manage those emergencies, but they're very, very rare."

 

The best way to find a doctor who performs the procedure, Dr. Rohrich said, is through a personal recommendation. Or patients can check the Web site of the International Society of Hair Restoration Surgery, www.ishrs.org. A request on a search engine for "hair restoration" quickly produced the names of group practices and hundreds of others. Patients can also ask for recommendations from university dermatology clinics.


In addition to being a patient of Dr. Hasson, I act as the legal counsel for Hasson and Wong.

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. . . front page of Science Times:

(Since this is being posted for educatiopnal purposes, republishing here should not violate any copyright laws.)

 

Weighing the Risks of New Plumage

By DAN HURLEY

 

Published: June 15, 2004

 

Surgeons say transplant surgery for hair loss should be considered only after a doctor's evaluation and a months-long test of less drastic remedies.

 

In 95 percent of cases, thinning hair in men and women results from a hereditary condition, androgenetic alopecia. In men, the loss usually begins at the temple and the crown. Women have a gradual thinning over the entire head.

 

When hair loss occurs, a doctor should also rule out other conditions, especially if the bald spots are in patches. For instance, an autoimmune disease, alopecia areata causes distinct bald patches to form. Lichen planopilaris is an inflammatory disorder in which small flat raised areas form on hairy parts of the skin, and they are usually very itchy. Another autoimmune disorder, lupus, can also cause hair loss.

 

Among the drugs that doctors prescribe for hair loss is minoxidil, approved by the Food and Drug Administration for men in 1988, and for women in 1991. Applied to the scalp twice daily, the original formulation, with 2 percent minoxidil, was shown to cause moderate to dense regrowth in 26 percent of men from 18 to 49, with an additional 33 percent showing minimal regrowth, according to the F.D.A. Among women from 18 to 45, 20 percent can expect to see moderate to dense regrowth using minoxidil in its original formulation, and an additional 40 percent can expect minimal regrowth.

 

The stronger formula, with 5 percent minoxidil, brings significantly better results, according to Pfizer, which acquired Rogaine, the original branded version of the drug, when it bought Pharmacia Upjohn.

 

In 1997, the F.D.A. approved Propecia as the first pill for treating hair loss. Approved only for men because it can cause birth defects in women of childbearing age, the drug blocks the male hormone dihydrotestosterone, or DHT, which plays a central role in male-pattern baldness.

 

In the clinical trial that won Merck approval for the drug, Propecia resulted in maintenance or regrowth in 83 percent of patients, compared with 28 percent of those taking a placebo.

 

"Rogaine steps on the gas, Propecia takes your foot off the brake," said Dr. Ken Washenik, the medical director of Bosley Inc., a large provider of hair restoration surgery and the former director of dermatopharmacology at the New York University Medical Center.

 

Many men have been scared off Propecia, however, by reports that it can cause a loss of sexual desire, difficulty in achieving erections and a decrease in semen. Studies suggest that the sexual side effects occur in 2 percent of the men taking it and that the effects are resolved when the medication is stopped.

 

For people considering surgical transplants, the first question is cost. The going rate is at least $10 a follicle, with most procedures involving 700 to 1,200 follicles. Patients willing to be scheduled at the last minute for an opening in a surgeon's schedule can sometimes negotiate lower fees, Dr. Anthony P. DiBiase of Bosley said.

 

Practitioners agreed that it was best to find a doctor who performed the surgery frequently.

 

"It's one of those subspecialties that you must do a lot of, almost every day, if you're really going to be good at it," said Dr. Rod J. Rohrich, president of the American Society of Plastic Surgeons and chairman of plastic surgery at the University of Texas Southwestern Medical Center in Dallas.

 

Patients might also want to check whether the doctor belongs to the International Society of Hair Restoration Surgery, the largest medical group of transplant specialists, or has passed the exam of the American Board of Hair Restoration Surgery.

 

"The bottom line is, it's a safe, simple outpatient-surgery procedure, but it does require some sound judgment and a lot of aesthetic skills," said Dr. Carlos J. Puig of Houston, the president of the examination board and a member of Bosley's biggest competitor, Medical Hair Restoration.

 

Relatively mild complications like bleeding or postoperative infections occur in 0.5 to 1 percent of patients, Dr. Puig said. There have also been a few cardiac arrests reported during surgeries, "just as in dentistry," he said, adding, "You want to be sure the physician has the proper equipment in the office to manage those emergencies, but they're very, very rare."

 

The best way to find a doctor who performs the procedure, Dr. Rohrich said, is through a personal recommendation. Or patients can check the Web site of the International Society of Hair Restoration Surgery, www.ishrs.org. A request on a search engine for "hair restoration" quickly produced the names of group practices and hundreds of others. Patients can also ask for recommendations from university dermatology clinics.


In addition to being a patient of Dr. Hasson, I act as the legal counsel for Hasson and Wong.

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OK, that was one of two articles. Here's the other:

 

With New Science, Hair Restoration Improves

By DAN HURLEY

 

Published: June 15, 2004

 

"How you doing, Tom?" asked Dr. Anthony DiBiase, a Manhattan surgeon, in the midst of jabbing a lancet 1,130 times into the balding head of Tom Raybek. "You O.K.?"

 

"Yep," said Mr. Raybek, as mellow and relaxed on a mild tranquilizer and topical anesthetic as if he were getting a haircut, which was pretty much the opposite of what he was getting.

 

At the age of 58, Mr. Raybek, a ski lodge owner from Killington, Vt., had agreed to undergo hair transplantation at no charge in exchange for allowing his image to be used by Dr. DiBiase's employer, Bosley Inc., in "before" and "after" photographs.

 

This, however, was "during," and it was not pretty. Tiny beads of blood welled up as Dr. DiBiase's hand jabbed up and down as rhythmically as a sewing machine, making three or four minuscule punctures every second. Two medical assistants standing nearby counted off every puncture, so that they would add up precisely to the number of follicles that had already been "harvested" from the back of Mr. Raybek's head earlier in the morning. In the afternoon, the medical assistants would spend nearly three hours using tweezers to plant the individual follicles into the holes.

 

"Pretty amazing, isn't it?" Dr. DiBiase said, standing back to admire his handiwork, like a farmer gazing out on a newly planted field of wheat.

 

With little fanfare, the science of hair restoration has in the last few years undergone vast changes. Hair plugs, infamous for their artificial appearance, are becoming a thing of the past, as scientists refine techniques of transplanting individual hair follicles rather than circular scoops of skin, giving the hair a more natural look. At least one new hair-growth drug is in the pipeline. The cloning of individual hair cells is only a decade away, experts say - an advance that, by providing an unlimited source of replacement hair, could give even the baldest head a luxuriant thatch, while at the same time making hair transplantation surgery safer.

 

The market for such developments is sizeable. The Food and Drug Administration estimates that some 40 million men and 20 million women experience hair loss. Sales of Propecia, one of the most popular hair-growth potions, totaled $111 million in the United States in 2003 alone, up 13 percent from 2002. Close to 32,000 hair transplants, 88 percent of them in men, were performed in this country last year, according to the American Society of Plastic Surgeons, up from 29,000 in 2002. With the typical transplant running upward of $10 per follicle, and the average procedure involving about 1,000 follicles, that translates into nearly a third of a billion dollars.

 

The field's advances have not done away with bad hair jokes: A running gag in the recent film "Hellboy" revolved around the doll's hair look of a character's hair plugs.

 

"The big problem we've had to overcome is 30 years of plugs," conceded Dr. Bobby Limmer, a dermatologist in San Antonio and the developer of individual follicle transplants. "You mention hair transplantation to the guy on the street, and the first image that's going to come to him is the plug."

 

But the evolving medical science has come a long way since 1981, when a Boston lawyer named John Kerry, not yet a political figure, represented 16 men whose heads had been surgically implanted with carpet fibers.

 

"They were badly, badly infected, and in most cases large parts of their scalps had to be excised," recalled Roanne Sragow, then Mr. Kerry's law partner and now the first justice of the Cambridge District Court. "It was pretty gruesome."

 

Hair transplantation has been possible since 1952, when Norman Orentreich, a dermatologist at New York University, figured out how to transplant circular scoops of follicle-rich skin stolen from the back of the head. The result was tiny tufts rising up like so many islands of hair amidst a barren sea of baldness. This effect was especially unfortunate at the hairline, where the hair plugs were plainly visible.

 

Even five years ago, experts say, plugs remained the hair replacement technique of choice; they are still used by some, particularly on the crown, where the doll's hair effect is not as visible.


In addition to being a patient of Dr. Hasson, I act as the legal counsel for Hasson and Wong.

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Don't know whether to laugh or cry. Some poor schmuck is going to read the Times and figure that this information must be legitimate ... and then he's going to go to Bosley or MHR and get his head butchered, and he's going to go in with the expectations that (a) $10 per follicle is typical and (b) 1,000 follicles is what he should hope for.

 

These articles are garbage and this reporter Dan Hurley has shown gross professional irresponsibility.

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It's amazing that the Nation's most respected newspaper would publish such poorly researched material.


In addition to being a patient of Dr. Hasson, I act as the legal counsel for Hasson and Wong.

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I looked this story up and there are additional pages to this horror story. the whole story is found at.. http://www.nytimes.com/2004/06/15/health/15hair.html?pagewanted=1&8br

 

Page three has this...

 

Mr. Raybek had been using one such product, minoxidil, for years by the time he arrived at the Bosley offices on Park Avenue wearing a golf hat at 7:30 a.m. on a Friday in mid-May. As a team of five registered nurses, medical assistants and clinical assistants scurried about, he watched the news on television while Dr. DiBiase drew lines on the top of his head with a Maybelline eye shadow pencil, to show where the follicles would be placed. Petri dishes sat on the counter nearby labeled, "Raybek, Tom, Rm. 5."

 

At 9:10, the cutting began. Dr. DiBiase used a two-bladed scalpel to cut a half-inch-wide strip of close-shaved hair and skin from the back of Mr. Raybek's head. Extending just over a foot long and immediately placed on ice, it resembled a strip of bacon or sushi, with a stubble.

 

As Dr. DiBiase stitched together the gap left by the excised tissue on Mr. Raybek's head, the assistants began cutting up the strip into smaller and smaller pieces. First, two of them, hunched over microscopes, sliced them into sardine-sized pieces. Then four other assistants began the tedious process of teasing apart every follicle into an individual piece.

 

Using magnifying glasses to see and surgical knives to manipulate the tissue, they identified each follicle by a tiny black dot, barely visible to the naked eye and smaller than the period at the end of this sentence. From the dots trailed even tinier shafts resembling the tails of minnows or sperm. For the next two hours, as they separated the follicles into mushy little piles, the assistants labored like factory workers.

 

Although they had hoped to come up with 1,200 follicles, they were 70 short when they finished at 11:10 a.m., a deficit Dr. DiBiase judged to be cosmetically insignificant. He made the tiny incisions into Mr. Raybek's head, and by noon the team was inserting the follicles into the holes. Near the hairline they used single or double follicles, to recreate the gradual, feathered-in look of a natural hairline. Farther back they used three- and four-follicular units. By 2:30 p.m. they were done.

 

Reached three days later by cellphone as he drove home to Vermont, Mr. Raybek said the only difficulty he had encountered so far was a bit of itchiness. Aside from some redness, nothing on his head looked different to the casual observer, he said, with even the scar hidden by hair. Now all that remained was to wait a couple months for the follicles to begin producing thin baby hair that would look increasingly thick and dark within six months. Maybe then he could ditch the golf hat.

 

 

Correction: June 16, 2004, Wednesday

 

An article in Science Times yesterday about advances in transplanting hair misidentified the manufacturer of dutasteride, a drug being tested for its hair-growing ability. It is GlaxoSmithKline, not Merck.

 

Correction: June 17, 2004, Thursday

 

Because of an editing error, an article in Science Times on Tuesday about advances in hair restoration characterized the hair-loss drug Propecia incorrectly and omitted a side effect. Because the drug can cause birth defects, it is not the foundation of any treatment plan for women. (Some doctors prescribe Propecia for women who are infertile or postmenopausal.)

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This is horrifying. It's like when you were a kid and you were given a test to find all the things wrong with this picture.

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