“This Book Is A One-of-a-kind Resource For The Eighty-five .

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“This book is a one-of-a-kind resource for the eighty-five millionAmerican adults facing hair loss. Its up-to-the-minute summaries ofscience and research make it an authoritative reference tool for doctors. Yet its easy style and many personal stories give comfort andhope to patients attempting to navigate their way through the manypossibilities for treatment. You only need one hair loss book—andthis is it.”—Charles Salinger, M.D.

The Complete Book ofHair Loss AnswersYour Comprehensive Guide to theLatest and Best TechniquesP E T E R P A N A G O T A C O S , M.D.www.HairDoc.com

Elite BooksSanta Rosa, CA 95403www.Elitebooks.bizLibrary of Congress Cataloging-in-Publication Data:Panagotacos, PeterThe complete book of hair loss answers : your comprehensiveguide to the latest and best techniques /Peter Panagotacos. -- 2nd ed.p. cm.ISBN 0-97200281. Cosmetic Surgery. 2. Hair Loss2005678912Copyright 2005, Peter PanagotacosAll rights reserved. No part of this publication may be reproduced, stored in a retrieval system, ortransmitted in any form or by any means, electronic, mechanical, photocopy, recording or otherwise, withoutprior written permission from Author's Publishing/Elite Books, with the exception of short excerpts used withacknowledgement of publisher and author.Cover and Interior design by Authors Publishing CooperativeIllustrations by Nan Sea LoveTypeset in Colonna and Hoefler TextPrinted in USASecond Edition10 9 8 7 6 5 4 3 2 1

CONTENTSChapter 1:Why Treat Hair Loss? .9Chapter 2:Normal Hair Growth .13Chapter 3:The Cause of Most Hair Loss.17Chapter 4:Other Hair Loss Causes . 25Chapter 5:Hair Loss Treatment History .35Chapter 6:Bogus Treatments .51Chapter 7:Cosmetic Treatments .55Chapter 8:Drugs That Can Cause Hair Loss . 63Chapter 9:Drugs that Grow Hair . 67Chapter 10: Surgical Hair Restoration Principles . 81Chapter 11: History of Surgical Hair Restoration . 93Chapter 12: Follicular Unit Micrografting . 101Chapter 13: Before, During and After Surgery . 115Chapter 14: Marco’s Story . 121Chapter 15: Ask the Expert .139Chapter 16: Which Treatment is Right for Me? .173Chapter 17: Choosing a Physician .181Chapter 18: Future Hair Loss Treatments .187Appendix 1: Sources for More Information .209Appendix 2: Drugs That Cause Hair Loss,Generic and Brand Names . 211Glossary.223Bibliography .233Index.235

FOREWORDAs a family practice physician, I see patients of all ages with concerns about their hair loss. There are young men with the first signsof a receding hairline, post-menopausal women with thinning hair,children with various hair loss conditions, and patients of all ages withhair loss caused by medications or other causes.Two things have struck me about these patients. First is the deepconcern they have about losing their hair. Some patients seem moreconcerned about losing their hair than they do about their other moreserious medical conditions. Secondly, I have observed that there is agreat deal of misinformation about hair loss and what can be doneabout it.I have found this book to be personally informative, as well asa welcome addition to the information I can provide to my patientswho are suffering from any type of hair loss condition. The book iswritten for the general public, but is medically accurate and at timesvery entertaining. My patients do not need to read the entire book,but rather can look up the information that they feel applies to theirown condition, and just read a chapter or two. But many read thewhole book, and thank me for loaning it to them!I think The Complete Book of Hair Loss Answers is the best book outthere for people who want to learn about hair loss, and what can bedone about it.Elliot Felman, M.D.Santa Monica, California

INTRODUCTIONDid you know that the oldest dermatological prescription isan Egyptian hair loss remedy that is 5,500 years old? People havesearched for answers to their hair loss concerns ever since that time.In the early years of my dermatology medical practice, I preparedwritten information on hair loss for my patients, including copiesof articles and books by various authors. More than ten years ago, Ibecame one of the first to provide accurate information about hairloss on the Internet with my web site, www.hairdoc.com. Althoughthe Internet is a wonderful resource for patient education, it hassome disadvantages. I have visited dozens of hair loss web sites thatfeature inaccurate or incomplete information and sell dubious treatment products.Based on my contact with my own patients, communicationswith other physicians, and the hundreds of emails I receive from allover the world from people who are losing their hair, it is clear to methat there is an extraordinary amount of confusion about hair loss.The general public needs a source for answers to hair loss questions,and expert advice as to which solutions really work.This book was written to address that need.I especially want to thank Dr. Jerry Litt for his generous help inproofreading this manuscript, and many thanks for his Drug EruptionReference Manual, which I refer to regularly in my office when confronted with a patient with hair loss due to medications. I wouldalso like to thank Dr. Alice Do, who was one of my brightest medicalstudents, for her illustrations. I thank Gary Grossman for editing thefirst edition of this book, and most of all I thank all of my patientsover the years, whose appreciation for my work has made my medicalpractice both rewarding and enjoyable.Peter J. Panagotacos, M.D.San Francisco, California

PREFACE TO THE SECOND EDITIONHistorically, hair transplants have been the single most commonform of elective cosmetic surgery. Only with the advent of liposuctiondid reconstructive surgery for hair loss fall to the number two mostpopular spot. The need for accurate, unbiased information aboutavailable options for those concerned about receding hairlines, maleand female pattern baldness (referred to medically as androgeneticalopecia) and thinning hair, will be addressed in this new, updatededition.Since the last edition of this book, a number of promisingadvances have been made in follicular unit grafting, cloning, stem celltransplant, and gene therapy. More is also known about the medicaltreatment of hair loss. Several of the chapters in the book have beenexpanded or changed to reflect the latest developments in this rapidlyexpanding field. New drugs are added to the list of drugs that causehair loss along with a new feature that lists the brand name.This book is meant primarily for the individual who is concernedabout losing hair now and in the future, wants to learn about thevarious causes, and explore the options for treatment. The informedconsumer can make wise decisions and take proactive steps to handlewhat is a very common, but very private concern. Response to the firstedition from physicians and patients alike cited the book a valuableresource for those who want help understanding their condition.I sincerely hope this book satisfies the need many of you have fora source of up to date information on hair loss that is as unbiased aspossible.

1Why Treat Hair Loss?At a point in our lives while growing up, we each form a mental image of ourselves.We develop a picture of our face and body, an image ofhow we think others see us. When we look in a mirror, we identifywith what we see and inwardly say, “That’s me.” Even without a mirror, we have an idea of the image of ourselves that we project to theworld.But as a man or woman begins to lose hair, the image in the mirror no longer matches the internal self-image developed over manyyears. This can be disturbing, since we pretty much feel the same asbefore. Hair loss does not affect our physical health, but it does makeus look older. When we see our reflection in the mirror, a differentimage confronts us. We protest, “That isn’t me.”Our hair is one of the most defining aspects of our appearance. Ahealthy head of hair makes us look attractive, youthful, and desirable.Our appearance directly affects our own self-image, and most of uswant to maintain a self-image that is youthful and healthy looking.Our appearance also affects how we interact with other people,both in how others respond to how we look, and how our appearance affects our own self-confidence. Having a full head of hair canimprove the quality of our life, our success in business relationships,and our success in romance.9

Chapter OneBut despite the fact that losing hair, and even going bald, is partof the normal process of aging, we often don’t accept it. At age forty,most people feel pretty much the same as they did at age thirty, oreven age twenty. Confronted with hair loss, people may begin to feelforeign to themselves and somewhat disoriented. This discomfortresults in a desire to return to the former, more youthful appearance.Today there are many cosmetic, medical, and surgical options forpeople who really want to do something about hair loss.Take one of my patients; I’ll call him “Larry.” I first met Larry in1980, when he was thirty-five-years-old. He already had considerablefrontal hair loss, but the hair on his crown and back of his head wasquite dense. He was a physical fitness buff, and could not come toterms with his receding hairline. He worked out, felt pretty good, andlooked great, except for his hair loss.After considering all the options, Larry decided to have hairtransplant surgery. At that time, surgical procedures for hair lossresulted in an “under construction” look for a period of time followingsurgery. Larry was a foreman of a crew of men who installed acoustical ceilings. It was possible for him to wear a hard hat or a baseballcap to cover his new grafts until they healed. Initially, keeping his hairtransplants secret was a big concern to him. Then, after about threeweeks, he began to tell his friends and co-workers about his surgeryfor hair loss.There was a positive response from everyone, except for oneco-worker. Larry explained to me that his co-worker, who we’ll call“John,” began harassing him about his hair transplants during his firstmonth following surgery. The second month, John wanted to knowif the surgery was painful, and then he wanted to know how muchit cost. Soon after, I met with John, and he scheduled his own hairtransplantation procedure.People want to look the way they feel. A man or woman at ageforty doesn’t really expect to look twenty again, but increasingly moreand more people want to keep a youthful appearance. Hair helpsframe the face, and it directs attention very powerfully. Everyonehas seen men with a few wispy strands of hair combed over the topof their heads in an attempt to frame their face with hair. Of course10

Why Treat Hair Loss?their “comb-over” just directs more attention to their hair loss, whichis not the desired effect.Although our society tends to be youth-oriented, most peoplewith hair loss are not preoccupied with achieving a perpetually youthful appearance. In fact, many people accept their hair loss as just a factof life. Humans have an enormous ability to adjust to imperfect situations and go on with their lives. But if you’re reading this book, youprobably have an interest in doing something about your hair loss.Wanting to do something about hair loss is not just a matter ofvanity. The desire to look better and have a more pleasing appearanceis also a normal human attitude. Undeniably, hair loss adds years toa person’s appearance. Hair loss represents to men what wrinkles doto women. And hair loss for women is even worse than wrinkles! AndFemale hair loss11

Chapter Onewhile men with hair loss often state that they don’t care about losingtheir hair, if there were some form of magic that could instantly andpermanently give them a full head of hair just by wishing it, the vastmajority would do just that.In 1995, Sean Connery stated in an interview, “I don’t understandmen who want hair transplants.” That same month, he was photographed going to a social event wearing a hairpiece. Five years later,he seemed to have accepted his baldness in his personal life. He does,however, continue to wear a hairpiece for movie roles that call for aman with a full head of hair.The media, especially television and movies, continue to placeenormous emphasis on models, actors, and actresses with hair. Womenportrayed in the media, and in advertisements for almost any product,generally have full heads of hair. Entire industries are dedicated towomen’s hair care products and hair care styling services, all with thegoal of helping women make the most of the hair they have.The significance of hair to women in our society is so great, thatwomen suffering chemotherapy for cancer treatment are often moreemotionally devastated by their chemotherapy-induced hair loss thanfrom their cancer.Men’s magazines rarely display a man with thinning hair, andalmost never one

of articles and books by various authors. More than ten years ago, I became one of the first to provide accurate information about hair loss on the Internet with my web site, www.hairdoc.com. Although the Internet is a wonderful resource for patient education, it has some disadvantages. I have visited dozens of hair loss web sites that feature inaccurate or incomplete information and sell .