Episode 13: "Losing Your Hair?" with Dr. Robert Leonard
"Losing Your Hair?" with Dr. Robert Leonard
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Teri Struck: I’m Teri Struck, host of Beauty Now, where you can hear the latest in lasers, lipo, lift and rejuvenation. Today we’re going to be talking about hair restoration from Doctor Robert Leonard, a leading hair transplant specialist.
Dr. Robert Leonard: The FDA recently, about a month and a half ago, approved low-level laser therapy for the promotion of hair regrowth… And a very frightening statistic is, after 50% of one’s hair is already down the drain, is when he or she begins to notice his or her hair thinning, so it’s a very insidious process, lots of times, and they come in and say, “My God, Doctor Leonard, I became bald in the last few weeks,” when obviously that’s not the case… And you know what’s amazing sometimes: patients come in and there’s a big bald area in the back, and they didn’t notice it until they were dancing with their daughter and it’s on the wedding video or something… There was a theory that was done in the late fifties called ‘donor dominance’, and it was proven that wherever tissue is taken from and moved someplace else, it will remain intact; it will keep its genetic integrity… The oldest patient I have done surgery is 91 years old. Unbelievable; it was quite a story…
Teri Struck: Wow! I might have to introduce that person to my Nana.
Teri Struck: Welcome, Doctor Leonard.
Dr. Robert Leonard: Thank you very much for having me, Teri.
Teri Struck: Well, Dr. Leonard, are we doomed, for our hair, if we have a mom or dad who is bald or had hair loss?
Dr. Robert Leonard: Well, ‘doomed’ is a negative word, but I would say, “Yes, you probably will experience hair loss if the parent had thinning hair. Genetic hair loss is the number one cause, 98% of hair loss is due to genetics.
Teri Struck: So what would be the first step? You start to see, in the sink, some hair, and you’re concerned. What would be the first step?
Dr. Robert Leonard: Well the most common sign that people have is exactly that, hair in the drain, particularly the drain in the shower.
Teri Struck: Shower, right.
Dr. Robert Leonard: It’s normal to lose one hundred hairs per day. That’s a typical, normal shedding of the human scalp, is a hundred hairs, and people say, “My goodness, I don’t’ lose that much hair.” But when people start to notice hair that they didn’t notice before, that’s the time to be evaluated, and I’m a hair restoration surgeon. I’ve been practicing in the field for 21 years, and that would be a really good first place to start, especially for women with thinning hair, because very often women go to their primary care doctor, and they’re sometimes blown off, saying, “Oh, it’s normal to lose your hair. Don’t worry about it.”
Teri Struck: Exactly. That’s true.
Dr. Robert Leonard: And that’s the last thing that a person needs to hear from their doctor.
Teri Struck: Especially vain women like all my friends.
Dr. Robert Leonard: Well it’s not only vanity. You know hair loss… Men don’t like losing their hair one bit. The majority of my patients, by far, are men. However, it’s normal; it’s accepted in society. But for a woman to lose her hair, it’s not the case. It can be absolutely devastating.
Teri Struck: It’s devastating. Absolutely devastating, and it’s so great to hear that there are some options available.
Dr. Robert Leonard: There are lots of options. We can talk about men and women together initially, or we can break it out into either men or women.
Teri Struck: Why don’t we just talk about men right now, and then break it down to women?
Dr. Robert Leonard: Well, male pattern hair loss affects one out of every two men; it’s a very common condition. Every other guy you see will have male pattern hair loss to some extent at some point in his life, so it’s also an issue of a progressive condition. These conditions, male and female pattern hair loss, are progressive. So the most important thing to do initially is to stop it from getting worse.
Teri Struck: How do you do that?
Dr. Robert Leonard: Well there are a couple of different options. First of all, one should see a specialist, and then there are three options to treat male pattern hair loss, short of surgery. One is Propecia®. Propecia® is a pill; it works extraordinarily well for the back of the head. The back of the head is called the ‘crown’. If people have their typical balding, bald spot area, that’s the crown and that is a very, very great place for Propecia® to work. It stops progression…
Teri Struck: Now is Propecia only for men, not for women?
Dr. Robert Leonard: It really is FDA-approved for men only. There can be the potential of birth defect if a woman of childbearing age takes Propecia, so it’s been my rule in my practice not to prescribe it to women who are not menopausal. I do use it off-label for menopausal women, but really it’s a treatment that’s really best for men, and it stops further progression in 83% of guys, and re-grows hair back there in 66% of men. So that one option; it’s a pill, and it had to be taken long-term. The second option is Rogaine®, a minoxidil solution. Rogaine has been around since the 1980’s, and there’s a brand-new formula of Rogaine called ‘Rogaine Foam’…
Teri Struck: Right, I’ve heard of that.
Dr. Robert Leonard: It’s excellent actually. It’s much less messy, much more easy to use, and it stabilizes progression in the front of the head, in the middle, and in the crown, although all the literature you read states it only works in the crown, Rogaine Foam works all over the head, very well. Twice a day application to the scalp.
Teri Struck: So when you’re applying the foam to your head, and you get it all over your fingers, you don’t have to worry about growing hair on your hands? How does the foam work actually?
Dr. Robert Leonard: The foam is actually the vehicle into which the minoxidil is dissolved. So the minoxidil actually stimulates hair follicles where there are follicles. There are no follicles on the palms of the hands. But I always have people wash their hands after any application of medication, so that would be the only issue that I would really be concerned about in that regard. So certainly that would be a second option for people. And the third option is the newest option we’ve had over the last five years, called ‘laser therapy’. Low-level laser, or low-level light therapy, and that typically is an in-office treatment where people would come to the office, and this modality will actually stabilize for the hair loss again in the front, the middle, and the back, in approximately 90% of patients, and regrowth of hair 50% of the time, and that’s…
Teri Struck: What about those ‘laser combs’ I see sometimes advertised in newspapers?
Dr. Robert Leonard: I’m sorry?
Teri Struck: You know those ‘laser combs’? Have you seen those?
Dr. Robert Leonard: Yes, the ‘laser combs’ or the ‘laser brush’; there are two that are available of late. : The FDA recently, about a month and a half ago, approved low-level laser therapy for the promotion of hair regrowth. And these also are hand-held units that can be used at home. The wattage is a little less. It’s quite much less in fact than the in-office treatments, but certainly they’ve been proven to be helpful.
Teri Struck: So tell me about the in-office treatment. How many times per week do you need to do that for it to be effective?
Dr. Robert Leonard: In my practice I have patients come a half hour, two times a week, over a two-month period of time, and then after that they come one time a week for a couple of months, and then it spreads out to every other week, and finally just once a month for the second half of the year. I think it’s very important for people to do a full year-long protocol, because any type of treatment to do with the hair cycle takes a minimum of three or four months to become effective, because that is the normal physiologic cycle of time that the hair cycle goes from a newly-growing hair to a falling-out phase and then to the regrowth of another hair. So that’s… It’s not a ‘magical’ time, but three or four months is the time that most things begin to work. So once they get the first three or four or five months under their belt, then they can start to see the benefits of the laser therapy.
Teri Struck: So then they just start to see new little hairs? Now are they supposed to try to use the Rogaine Foam in conjunction with the laser therapy?
Dr. Robert Leonard: And the Propecia, if they’re willing to do it, but I try to throw everything at these people, as far as stabilization, if they’re willing to do these things, because each of these modalities work separately and distinctly from the others, so it’s very important that they know that if they do two it’s better than one; if they do three, obviously it’s better than two, because each one works on a separate population of hair follicles.
Teri Struck: I’ve heard that Propecia… Some people have said that it causes impotence; is that true?
Dr. Robert Leonard: What happens with Propecia in 0.3% of men, there is the side-effect of decreased hardness of an erection, and decreased sex drive; 0.3% it almost never occurs. And if a man were to be among the unlucky 0.3% to experience the side effect, if he stayed taking the pill for another two weeks, 60% of those people will revert back to normal, because the body adjusts to the medicine, and 100% will go back to normal if they stop it. So it’s something that happens extraordinarily rarely, and if a person were to get a side effect, it typically takes care of itself in the majority of people.
Teri Struck: Well that’s good to know, because that’s what I’ve been hearing.
Dr. Robert Leonard: It is. I’ve been taking Propecia myself for about nine and a half years. It works very well for the back of the head.
Teri Struck: Okay, good. So then if these treatments don’t work, then is that when you recommend surgery? Or do you recommend surgery because it’s easier than going in twice a week for laser?
Dr. Robert Leonard: Well, no. They’re really different things. I liken it to having fluoride in toothpaste. You know if one has a cavity, you go in and you have a filling, and that’s equivalent to the transplant. If you have baldness, the transplant is going to grow hair where the baldness is. However, the transplant will not stop progression of existing hair. In many people, when they first come to the office, they’re not candidates for transplantation. They just need to begin to do something to stabilize further progression. And a very frightening statistic is, after 50% of one’s hair is already down the drain, is when he or she begins to notice his or her hair thinning, so it’s a very insidious process, lots of times, and they come in and they say, “My God, Doctor Leonard, I became bald in the last few weeks,” when obviously that’s not the case. It’s a very slow, slow process, and they may have gotten their first sunburn, for example, and they said, “My goodness, where’d my hair go.” Or you know, a comment may have been made at the gym, or they’re driving in their car and they see through their hairline in the rearview mirror, so…
Teri Struck: Or their wives tell them. Or their children; their children, “Daddy, you have a bald spot back here.”
Dr. Robert Leonard: That’s a very common thing as well. And you know what’s amazing sometimes. Patients come in and they have a big bald area in the back and they didn’t notice it until they were dancing with their daughter and they saw it in the wedding video or something.
Teri Struck: That’s true.
Dr. Robert Leonard: They’re bald, and haven’t seen it until now.
Teri Struck: Well we nee to take a quick break her to thank our sponsors. I’m so interested to find out more, why is our hair thinning. We’re going to be right back with Doctor Leonard.
Teri Struck: Hi, we’re back with Doctor Leonard, and we’re talking about thinning hair, baldness, male and female. Welcome back, Dr. Leonard.
Dr. Robert Leonard: Thank you, Teri, very much. As far as the transplant goes, we were talking about transplantation as really the permanent solution to baldness, because when we transplant hair, that hair will grow. And many people don’t realize this; it grows on their head for the rest of their lives. And the technique has changed dramatically over the last twenty years, from the old technique that was known as the ‘plug’. That was a technique that didn’t offer, in most cases, the most natural look, but it certainly provided hair on one’s head.
Teri Struck: What’s the difference between plugs and a hair transplant?
Dr. Robert Leonard: Well today it’s different. The transplant of today is virtually undetectable by the untrained eye. What I do today is I lift the hair up in a row in the back. The area along the sides and back of the head, that horseshoe-shaped area, is called the ‘donor area’. And that is… The hairs in that area grow lifelong, so if I surgically move skin and hair follicles from the back of the head, and transplant it to the top, those hairs will grow for the rest of the person’s life, as if they were still on the back of the head. O what I do today is I lift the hair up in a row in the back with a hair clip, shave about a half-inch band of hair, numb it with local anesthetic, and then we remove the strip of skin that has all these shaved follicles in it, which is then placed in saline solution. Ands that small incision then is sutured, stitched up, and the hair clips are removed, and the hair then will shingle right over the stitched area on the back of the head and it’s unseen. So it can be completely hidden. And then, under magnification, my staff will dissect that strip into grafts today that have only one hair, two hairs, and three hairs, so they’re very, very small grafts that we create from the strip in the back. Then they are placed in saline solution. And then the area that
S bald, whether it’s the front, the top, the back, the entire head, eyebrows, sideburns, wherever we’re transplanting hair to that day, is made numb by local anesthetic, and then I make tiny little incisions, little tiny splits in the skin, into which then these tiny grafts are planted. And once they’re in place, we shampoo the patient’s hair, and they put on a baseball cap or whatever they wish, and they go home without any bandages at all. And that’s the transplant process. That all happens in one single session, one setting.
Teri Struck: how painful is it?
Dr. Robert Leonard: It’s all… It’s actually pain-less, because the transplanted area is all numb. To do the anesthetic there’s a little pinch and a burn initially, but that really is just for a second or two and then it becomes numb, and then after the procedure most people complain about the stitches on the back being sore. Most people by far use Extra-Strength Tylenol® as their main post-operative medication, but I also prescribe a stronger medicine if they wish.
Teri Struck: Painkiller. If they want it. I don’t really understand why, in the back of your head, so you’ll use that as the donor area, and you’ll put it on the top of the head. But how come that hair doesn’t fall out?
Dr. Robert Leonard: Well, we don’t now. We don’t know. The donor area is genetically programmed to grow life-long. So wherever it’s moved to, the ‘soil’ is not poisoned, so any transplant that’s planted into a bald area will not become bald. There was a theory that was done in the late 50’s, called ‘donor dominance’. It was proven that wherever tissue is taken from, and moved someplace else, it will remain intact, will keep its genetic integrity. So the first experiments they took a graft of hair from the back and put it in the bald spot, and took out a bald area and put it in the area in the back, and they watched, and they showed that the graft that had hair grew forever, and the bald graft that was moved from the bald area to the area where there was hair remained bald forever. SO that’s how they proved the theory of ‘donor dominance’, and that’s how that’s the basis of transplantation.
Teri Struck: That’s how life’s not fair sometimes. [laughter] Not fair but at least now we have this option. So could you tell us what’s available for women?
Dr. Robert Leonard: Transplantation likewise is available for women. I would say close to 15% of my surgery patients now are women. Many years ago transplantation wasn’t all that great of an option because of the technique we did in those days. But today most women have a generally thinning pattern, and what I do now, instead of removing any tissue where it’s thin, I’ll actually plant grafts among the thin area and therefore get a thicker result. It doesn’t happen instantaneously though. It takes time for the hairs to grow…
Teri Struck: How long does it take? About the normal wait?
Dr. Robert Leonard: Pardon?
Teri Struck: The normal growth pattern that you have, that’s how long it takes to grow back?
Dr. Robert Leonard: It does. What happens is the transplant takes place today and then over the next three weeks the little hairs in the graft will grow, and then the hairs fall out after about three or four weeks after the transplant. The graft hair is in place, but the hair grows and falls out. And then it takes that magic three or four months for them to begin to re-grow, so it takes about three months for the new hairs in the graft to reach the surface of the skin, and patients will start to feel these little hairs growing, little nubs on the top of their heads. And that hair grows at the normal rate, about one quarter inch per month thereafter. I tell people after month five is when they really can start to see a change as far as an effect, a beneficial effect from the transplant. And at the one-year mark, I tell them this is when you can see what I did for them, at the one-year mark, because at a year post-op, the hairs have grown long enough, and by then people are cutting and curling and coloring the hair.
Teri Struck: What’s the oldest patient that you have?
Dr. Robert Leonard: The oldest patient I have done surgery is 91 years old.
Teri Struck: Wow!
Dr. Robert Leonard: Unbelievable. It was quite a story.
Teri Struck: You might have to introduce that person to my Nana. [laughter] Well that’s great. I mean that’s so good to know, that at 91 you can still get a hair transplant.
Dr. Robert Leonard: At what age do you think is the average age of my first-time patient, the first time a person sits in my chair for surgery?
Teri Struck: Uhm, shoot, I would just be guessing. I would say…30’s?
Dr. Robert Leonard: Fifty years old. [indistinct]
Teri Struck: Fifty years old. And is that waiting too long?
Dr. Robert Leonard: It’s not waiting too long, but that’s the… You know a lot of young people say, “Well geez, when I’m 50 I won’t care about my baldness,” and that’s just not the case. Men especially are bothered, and women alike, they’re bother4ed by their hair loss all through their lives, and often people… You know that’s average, so I have people coming in, in their 20’s and people in their 70’s and 80’s and this one guy in his 90’s as well. But hair loss bothers people their whole lives, and if there’s something that can be done that looks natural, is permanently growing, people are taking transplantation very seriously.
Teri Struck: And if you can do something about it, why wouldn’t you?
Dr. Robert Leonard: That’s right.
Teri Struck: So is there any special hair product, shampoos, anything that you could recommend?
Dr. Robert Leonard: Well the only shampoo product that I personally use in my practice has copper peptide in it. Copper peptide has been shown to be healthful for the follicle. And I have that through my office. The other beneficial thing is shampooing. It’s important. People, especially young guys, they come into the office for their first examination, and their hair is filthy, and I know the whole routine is that when they wash their hair, they see hair falling out, and therefore they say, “Well the shampooing is causing my hair to fall out.” And then they don’t shampoo. And that’s counter-productive. In fact that can cause increased hair shedding. So it’s important for people to shampoo every day. Once a day is proper scalp hygiene.
Teri Struck: Exactly, so… So, you can buy this shampoo through your office.
Dr. Robert Leonard: Yeah.
Teri Struck: And we’ll link your website to ours, www.PersonalLifeMedia.com and then listeners can find that shampoo through your office?
Dr. Robert Leonard: Yes, they can. They can just actually call a toll-free number and we’ll be happy to send it to them.
Teri Struck: That’d be great. Okay. And so, you can dye, color, and perm your hair after a procedure?
Dr. Robert Leonard: That’s right. It’s their own hair. They can cut, curl, comb, color. They can do anything they want because it’s their own growing hair.
Teri Struck: And you can exercise and sweat?
Dr. Robert Leonard: I like people to wait about, anywhere from, typically three days for them to do typical non-weight-bearing, as far as non-weight-lifting exercise, but after the sutures come out at one week, then they can go back to their typical routine at the gym.
Teri Struck: So how big are these little stitches, these little sutures that you do?
Dr. Robert Leonard: How what?
Teri Struck: How big are they? How long are they?
Dr. Robert Leonard: Well they’re very short, because what I do… You don’t feel all these little pricks like you would on a small incision. I do a stitch that’s a looping stitch, so it’s a continuous stitch, so when you feel the back of the head, you feel pretty much smoothness. You don’t feel all these little individual stitches…
Teri Struck: But it doesn’t look like one big long scar? It’s just little scars?
Dr. Robert Leonard: The typical scar on the back of the head is about… If you drew a line with a pencil, the width of the pencil line is a typical scar length remaining under people’s hair. So that’s not seen unless one shaves one’s head.
Teri Struck: And do you use general anesthesia for hair transplants, or is it just only local?
Dr. Robert Leonard: Typically local. I mean it’s very rare, maybe a couple of times a year I’ll have to bring a patient into the hospital because they may have some other medical condition that they’re not able to tolerate the local anesthetic, but it’s extremely rare. Most people by far have all local anesthetic. They’re wide-awake watching movies during their transplant. And it takes, like I said, three to five hours.
Teri Struck: And going to sleep, so it’s only if you have a medical condition?
Dr. Robert Leonard: Or if someone’s very nervous, if they’re very anxious, I’ll sometimes prescribe a benzodiazepine, like a Valium® or a [indistinct] if they’re nervous, and if they are then they’re much more comfortable in their own skin and they go through with flying colors.
Teri Struck: How much does this cost?
Dr. Robert Leonard: Transplantation ranges anywhere from $5500 to $8500 and my fees are based on the size of the area that I transplant. I think that’s the most fair way for fees to be charged to patients. I don’t charge per piece, in other words.
Teri Struck: There are financing companies available, right?
Dr. Robert Leonard: Oh, most definitely, yes. We take all credit cards and their financing…
Teri Struck: Credit cards, all that kind of stuff, so there’s ways to get it, and finance it yourself.
Dr. Robert Leonard: Absolutely, yes.
Teri Struck: Well that’s so great. Well thank you so much, Dr. Leonard, for talking to us. Is there anything you want to add before we go?
Dr. Robert Leonard: I’d just encourage people, if they’re starting to lose their hair, that’s when they should contact a doctor who is familiar and has a specialization in hair restoration, because the earlier we treat, the sooner we can get something stabilized and therefore it won’t get worse.
Teri Struck: Even young people in their twenties. I mean that’s what was shocking to me.
Dr. Robert Leonard: Most definitely, people in their late teens and twenties, that’s when typically male and female pattern baldness begin to be noticeable, and that’s when they should come in to have their first consultation. And in my office it’s a free consultation, so they have nothing to lose but their time, and they gain a tremendous amount of [indistinct].
Teri Struck: What do you do for people so young? Do you recommend the laser treatments and the foam to start?
Dr. Robert Leonard: And the Propecia if it’s a male, yes, all three of those things.
Teri Struck: Well, that’s so great. So you can find local doctors through your website, and get recommendations for people in your area, and if you are a hair transplant surgeon or doctor, you want to be linked up to www.PersonalLifeMedia.com, and get referred here. Thank you so much for your time today. I’ve learned so much about hair transplants, and we’ve really enjoyed talking to you.
Dr. Robert Leonard: Thank you, Teri.
Teri Struck: This concludes our show with Doctor Leonard, a hair transplant specialist. I’m Teri Struck, host of Beauty Now. If you’d like this transcript or any others, please go to www.PersonalLifeMedia.com.
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