Hair, Give Me a Head of Hair

Oh, let us count the 50 ways to lose your hair. There's androgenetic alopecia (pattern baldness), traction alopecia (evil minded hairdressers), telogen effluvium (physiological trauma like meds, chemo, stress, illness), and alopecia areata (an autoimmune disease) just to name the top ones.

Male and female pattern baldness is based on genetic background (thanks, Mom and Dad) and refers to progressive loss in predictable stages over predictable areas of the scalp. For men it can start in late puberty and peaks about age 40; for women the onset is at menopause. It accounts for about 95% of all pattern hair loss in both men and women. Mid-frontal hair loss increases with longevity; by age 80 over half of all women and 73% of men are affected. If you are wondering about the other stats, the average head of hair contains 100,000 hair follicles, while each follicle can sprout about 20 individual hairs. A healthy head of hair might lose 100 strands a day. Length comes 1.25cm a month.

There's a reason we associate bald-headed men with sexiness. In the primate world frontal balding conveys male status and maturity. A powerful sex hormone (DHT, the metabolite of testosterone) triggers the hair loss through folicular miniaturization and it takes a certain amount of confidence and bravado to just shave off what's left. Think Samuel Jackson, Patrick Stewart, Telly Savalas, Sean Connery, Steve McQueen, Yul Brynner, Vin Diesel, Ben Kingsley, Bruce Willis, Andre Agassi. Not a wimp among them.

Some clinical treatments for male pattern baldness exist, primarily finasteride (Rx Propecia) and topically applied monoxidil (OTC Rogaine). It works for most, but only if taken daily for eternity. The balding Olympic skeleton slider Zach Lund dropped his drawers and tested positive for fenasteride, netting a yearlong suspension and missing the 2006 games in Turin, Italy. In 2004 it had been added to the list of banned drugs in international sports because in tests it masks detection of cheater-drugs like the steroid nandrolone.

Hair replacement systems are widespread. Of course, there's always the wig, though we dignify it for men with a more elegant word: toupee (from the French toupet meaning hair tuft). These small wigs or hair pieces have been used since ancient times. The earliest known one was found in a tomb in Egypt circa 3200 BC. Julius Caesar wore one. True to form, only dead Hollywood men admit to wearing them: Frank Sinatra, Humphrey Bogart, George Burns, Bing Crosby, Bobby Darin, Fred MacMurray, Jimmy Stewart, John Wayne.

"I'm amazed by how often people ask me whether or not I wear a hairpiece, a wig, or a rug, as it is affectionately known."

And there are newer alternatives. Lord Xenu can't grow hair on his head, but a hairweave can approximate it for John Travolta. In 'netting' a thin, breathable net (similar to illusion tulle) is interwoven with the existing hair and supplemented with extensions. Even without the extreme closeup, his graying sideburns give it away. Other technologies include bonding, tracking, fusion, clip ons. Let's just say HairClub for Men has come a long way in the last 30 years.

Any number of female stars have experimented with these alternative methods for adding fullness and length to existing hair. Here's a whole webpage devoted to Paris Hilton's fake hair escapades! Sometimes, the look is less than successful, as displayed here on Britney Spear's head.

The permanent solutions involve cosmetic transplant of hair from one part of the scalp to another (here's a good journal article). The most up-to-date involves a surgical office procedure that harvest hair from the back or sides where it is thick and transplanting it in the thinning front regions. Using a local anesthetic, mini grafts of just a few or single follicles are used in place of the 'doll plug' punch grafts of yore. Four or more sessions, three months apart are usually required. Rob Schneider exhibited classic male pattern baldness pre-2005: hair receding from the lateral sides of his forehead and a thinning patch on the vertex (top). He's had some really nice hair transplant work. Less skillful is the work Ben Affleck has had done.

The unintended loss of one's locks is generally more disturbing for women than men. Sudden diffuse hair loss, telogen effluvium, is caused by an interruption in the normal hair growth cycle. A greater than normal number of hair folicles enter the rest stage (telogen) at all once, instead of in sequence. It takes another 3 months for the affected folicles to move into the growth state (anagen). It's at this point that the new hairs force out the old hairs and profuse shedding occurs. It has a myriad of traumatic causes: chemotherapy, childbirth, puberty, major surgery, chronic illness, severe emotional or physical stress. Usually the mechanism is a temporary disruption of hormonal balance.

Taking away a woman's hair can be a form of punishment. In ancient Greece it signified an enslaved woman. In France during WWII it marked collaboration with the Nazis. Even today it's used in US prisons. Then there are the women who chose to go bald. Sigourney Weaver may have been first with Alien 3. Demi Moore took it all off for G. I. Jane as did Natalie Portman for V for Vendetta. While praised for her unique voice and original songs, Sinead O'Connor is also noted for her expression of anger. When Britney Spears shaved her head, it triggered institutionalization in a treatment center.

Most Americans see a healthy bald woman and assume she’s a lesbian, radical feminist, political extremist or understudy for an alien role ala Star Trek. The sight of a woman’s bare scalp still makes society’s hair stand on end.

Beauty and sexuality remain tied to a woman’s hair. Natalie Portman said post V haircut: "It was kind of wonderful to throw vanity away for a bit."


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Hear Anne live on the Kevyn Burger show 10:00 to 11:00am Thursdays featuring Knifestyles of the Rich & Famous.

Bride of Botox

Botox has overtaken Hollywood in a big way. The shine reflecting off those smooth, wrinkle-free foreheads is blinding. We need a new term for these shadowless faces. Suggestions anyone?

Approved for cosmetic use by the FDA in 2002, Botox (Botulinum Toxin Type A) has numerous established therapeutic applications. It is a neurotoxin protein produced by a bactierium, one of the most poisonous naturally occuring substances in the world. It acts by blocking neuromuscular transmission, the body's signal for movement. Used in minute doses, it treats conditions caused by muscle spasms, from blepharospasms and dystonias to hyperhidrosis. (That's tics, spazzes, and flop sweat for the lay person.)

It also happens to work quite well on those wrinkles that come with facial muscle movement. In fact, physicians refer to them specifically as "lines of expression," which is also the secret to verifying it's Hollywood use: can the actor in question emote using a full range of natural facial expressions?

Who admits to it? Teri Hatcher confession is perhaps the most common: "In the past I've had Botox and collagen." The picture at right gives the lie to that. It's the same claim made by the author of Beauty Junkies: Inside Our $15 Billion Obsession with Cosmetic Surgery. Alex Kuczynski (39) says botox was her "gateway drug" before she swore off everything. One look at her television promotion for the book tells you she isn't clean just yet.

But a few are open fans. Vanessa Williams (43) endorses it: "I think it's fine...It's a reality that so many people are incorporating into their lives...bring it on!" Virginia Madsen (45) is actually the spokesperson for Allergan, manufacturer of Botox and Juvederm. There's probably not a virgin face in Hollywood over the age of 12 right now. Even the youngest of actors is indulging in 'preventative injecting.' Early intervention immobilizes the movement that causes eventual wrinkling.

Botox is the gold standard for treating crow's feet, brow furrow, and forehead lines. It works by partially paralyzing the muscles creating those wrinkles. Done well, it provides a 'chemical browlift' and rejuvenates the upper third of the face. But a heavy-hand with the needle yields an immobile forehead like Nicole Kidman (40), Marcia Cross (45)...Nicollette Sheridan (43) won't comment. All exhibit shiny foreheads so frozen, it's almost frostbite.

What are the giveaways? Sometimes a still picture is more than enough. A grinning 40-year-old Caucasian woman has wrinkles. Inept technique can yield 'Spock' eyebrows, arched too far laterally or sprung apart medially. In motion, the face no longer emotes within anthropological norms because the eyes and brows don't move. Women in particular express a great deal with the upper third of their face (ask any man). Bad Botox really flattens an actress's range of emotion.

This mixed message has implications elsewhere, as well. Outside of Hollywood, Katie Couric fell victim to incautious use of Botox. John Kerry's presidential bid was almost derailed by a venture into Botox (or the appearance of it). Too much Botox garbles the visual cues for the observer, the face doesn't 'read.' When that happens, the viewer is liable to think all sorts of things.

What's exciting are the new, emerging uses of Botox for pain disorders in dentistry like TMJ (temporal mandibular joint disorder), bruxism, and temporal masseteric fasciitis pain syndrome. How you might ask? Botox works on smooth muscle fibers and, as it turns out, some pain fiber nerve termini– a source of many pain syndromes. Blocking the nerve transmission in pain fibers yields relief for all sorts of neuralgias such as migraines. Major medical research centers are actively exploring new treatment avenues using Botox for many intractable medical problems involving hyperfunctioning of muscle fibers. Emerging uses at Mayo Clinic (search on the word 'botox') include treatment of BPH (benign prostate hypertrophy) and irritable bladder syndrome. There really is a lot to be said for Botox, but don't expect to hear it out of the mouths of Hollywood stars.

Jane Fonda (69) famously blurted out: "No, I have not had Botox. I will see a woman in Hollywood walking towards me and I'll think that I know her but I don't know who she is. It's terrifying. Everyone looks the same....What I like about England is that people look like they're supposed to look."

Now Jane Fonda has had plenty of work done, but she still looks natural and age-appropriate. In moderation, Botox can look natural. Her objection has legitimacy, however. Many of these younger women who seek to emulate a creaseless existence have ended up erasing their individuality, who they are. In some cases they take it to an extreme and change species (think Joan Rivers).

As Cate Blanchett (37) shouted "...just live your life, death is not going to be any easier just because your face can't move!"



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Hear Anne live on the Kevyn Burger show 10:00 to 11:00am Thursdays featuring Knifestyles of the Rich & Famous.