Friday, 14 November 2008

John Cleese says Hair Transplants are No Laughing Matter

Throughout his career, John Cleese has been ahead of the game - and yesterday, the star of Fawlty Towers gave hope to many follicularly-challenged males when he told Richard Madeley and Judy Finnegan that he'd not only had a hip transplant but a hair transplant.

The explanation he gave was typical Cleese: "Because I've got a very strange shaped skull, very pointy and I don't like wearing wigs."

Treatments for male pattern baldness have come a long way from Hippocrates' times - he applied a mixture of pigeon droppings, horse-radish, cumin and beetroot to his head. Cow saliva, bats milk, deer marrow, spiders' webs, horses teeth and coffee are other remedies that men throughout the ages have turned to in an increasingly desperate attempt to turn the tide of hairlessness (the term 'snake oil' originally comes from a tonic hawked in 19th century America as a baldness therapy).

However in the 21st century there have been steps forward for the man mourning his hair loss. There are medicines that have been proven in some cases to encourage new hair growth and stop the rate of hair loss (Minoxidil and Finesteride); and there are human trials currently taking place to see if hair follicle cells grown in the lab will grow in the head once replanted .

Most importantly, if you have a spare £5-8,000, hair transplantation has improved – and is continuing to improve - beyond the dreams of its early practitioners. Cleese lives in America now, but there are surgeons who are looking at this in the UK.

Greg Williams is the consultant in charge of the burns unit at London's Chelsea and Westminster hospital. He is one of a handful of surgeons in the UK who are pioneering new techniques for hair transplantation, and treats those who have lost hair, eyelashes and eyebrows due to burns, cancer treatment and male pattern baldness, though the latter is not available on the NHS.

Male pattern baldness (also known as genetic hair loss or alopecia androgenetica) is the most common form of hair loss in men. It usually develops gradually, typically involving the appearance of a bald spot on the crown of the scalp accompanied by thinning at the temples. The condition will affect half of all British men by the time they are 50 (almost a third are appreciably bald by the age of 30).

It occurs when hair follicles, the tiny sacs in the scalp from which hair grows, become sensitized to the hormone dihydrotestosterone, or DHT, which stimulates the growth of facial and body hair. The follicles shrink, so the hair becomes thinner and grows for less time than normal. The condition runs in the family, and the strongest influence is on the mother's side: if your maternal grandfather went bald, that's probably a better indicator than if your father's father lost his hair.

Put simply, hair transplantation works by taking hair from the areas that are not affected by hair loss and transplanting them to the areas that are. According to Mr Williams the results are "very good", though the take of grafts is less reliable in scar tissue than in healthy normal tissue (75–80 per cent for scar tissue compared to 95-98 per cent in normal tissue).

"Any man with male pattern baldness will have a horseshoe of hair remaining around the back and sides of his head," says Mr Williams, and it is from here that a strip of skin will be taken under local anaesthetic. The hairs from this section of skin will retain their own characteristics (ie they grow) rather than acquiring those of the place to which they are transferred (where hair does not grow). Dissecting the hairs from this strip of skin into their follicular units is painstaking work ("you have to have OCD to do this job", says Williams) and performed by a team of three or four technicians. Filling in a patient's temples alone, say, could require 500 hairs.

Old fashioned 'plugs' – the ones that gave hair transplants a bad name - would implant 12-15 hairs at one go. The modern ones use 1-3 hairs, inserted in incisions ranging from .75mm to 1.5 mm in diameter. "I normally aim to use single hair follicular units in the most important aesthetic areas, like eyebrows, eyelashes or the front hairline," says Mr Williams. "Further back I use larger groups of hairs." On average, the surgery takes around five to six hours.

It takes around 6-9 months to see the effect, but by then the hair should be growing as it did in its old home (patients who have had eyebrows or eyelashes done need to be aware of this, and the fact that they will now have to trim them every 5 -7 days). Although all patients are made aware that more work may be needed in the future , as male pattern baldness is progressive, the process can be life-changing.

"I had a patient who used to wear his hair over his eyes all the time because his eyebrow had been burnt off," says Williams. "Now he wears it off his face and that's made a big difference. There's another man who I'm about to operate on who can't go for job interviews because he feels he has to wear a hat all the time. It can be crippling."

Indeed. A recent survey of five European countries found that British men are unhappier about being bald than most of their European counterparts, but are too embarrassed to do anything about it. More than half said going bald made them feel old and less attractive.

Two years ago, LibDem MP Mark Oaten blamed his midlife crisis and ensuing sex scandal on losing his hair. It's unfortunate then that skilled hair transplantation is still so rare - the British Association of Hair Restoration Surgeons of which Williams is a member numbers only 11 members, and he is only one of two surgeons in the country who transplants eyelashes.

But he remains upbeat. "The reason it's not so popular in the UK is that the training is almost non-existent and people have memories of the bad transplants in the past," he says. "Cosmetic surgery in the UK lags behind America by about 10 years but as we are seeing more and more men having plastic surgery and botox I'm sure there are more who will be interested in hair transplantation."

And with Cleese speaking out with enthusiasm for such operations, Williams is likely to be right.

Julianne Moore Changes Mind About Cosmetic Surgery

The star of new movie 'Blindness', 47-year old Julianne Moore, has always been outspoken about her negative feelings concerning cosmetic surgery. But recently, it seems the Oscar-nominated actress has had a change of heart.

The actress has been quoted as saying a few years ago, “I would never ever have plastic surgery. We’re all just going way too far. I know it’s a product of the whole celebrity industry, but it’s something I absolutely detest. I want my daughter to see what is real, not what is unachievable and fake.’ The 46 year old actress believes in aging gracefully and that the aging process is a “fact of life.” Moore adds, “I’m a 43-year-old woman, and 43-year-old women have lines. I think imperfections are important, just as mistakes are important. You only get to be good by making mistakes and you only get to be real by being imperfect.”

She also more recently spoke out against Botox, a dermal injectable used to combat wrinkles, saying, “”I don’t know why women do Botox. It doesn’t make them look younger, it just makes them look like they had work done. You are not going to look the same as you did at 25. What are you going to do about it?”

But now, the red-headed vixen is changing her tune in regards to going under the knife, reportedly saying, “I never say never.”

But the newfound open-mindedness came with a caveat, as she is quoted as saying, “The only thing that worries me, the analogy I use is ancient Chinese feet-binding.

At what point did they decide that small feet were more beautiful? People started making them smaller and smaller until they were stumps and not beautiful at all.

I feel we have decided that being expressionless and young looking is the most beautiful thing and, in pursuit of that, it becomes more and more exaggerated and totally obliterates what we look like.”

On his blog, Dr. Anthony Youn writes, “I think the Chinese foot binding analogy goes a bit far. Much of plastic surgery is meant to restore the body to a previous state or remove excess skin that can become both a cosmetic and functional problem, such as tummy tucks and thigh lifts. The aim of good plastic surgery is a natural rejuvenation, not abnormal deformation like in Chinese foot binding.”

Dark Side of Cosmetic Surgery Addiction

The Telegraph reported recently on a Korean woman addicted to plastic surgery has been left unrecognisable after her obsession led her to inject cooking oil into her face.

Hang Mioku, now 48, had her first plastic surgery procedure when she was 28; hooked from the beginning she moved to Japan where she had further operations - mostly to her face.

Following operation after operation, her face was eventually left enlarged and disfigured, but she would still look at herself in the mirror and think she was beautiful.

Eventually the surgeons she visited refused to carry out any more work on her and one suggested that her obsession could be a sign of a psychological disorder.

When she returned home to Korea the surgery meant Hang's features had changed so much that her own parents didn't recognise her.

After realising that the girl with the grossly swollen face was indeed their daughter her horrified parents took her to a doctor. Once again the possibility that Hang had a mental disorder was raised and she started treatment.

However, this treatment was too expensive for her to keep up and she soon fell back into old ways.

Amazingly, she found a doctor who was willing to give her silicone injects and, what's more, he then gave her a syringe and silicone of her own so she could self-inject.

When her supply of silicone ran out Hang resorted to injecting cooking oil into her face.

Her face became so grotesquely large that she was called "standing fan" by children in her neighbourhood - due to her large face and small body.

As Hang's notoriety spread she was featured on Korean TV. Viewers seeing the report took mercy on her and sent in enough donations to enable her to have surgery to reduce the size of her face.

During the first procedure surgeons removed 60g of foreign substance from Hang's face and 200g from her neck.

After several other sessions her face was left greatly reduced but still scarred and disfigured.

And it would seem that even Hang can now see the damage she has done; she now says that she would simply like her original face back.

Vegas Doctor Refuses Surgery to Smokers

A Summerlin-area surgeon is making sure his patients not only know, but see, the negative consequences of smoking on certain cosmetic procedures.

For a face lift, a tummy-tuck or a breast lift, Dr. Samir Pancholi, a board-certified cosmetic surgeon who practices at 8068 W. Sahara Ave., requires that his patients stop smoking four weeks before the procedure and refrain from smoking for four weeks after the surgery.

If they are having a hard time grasping the concept of the dangers of smoking, he shows them graphic pictures of people who falsely said they quit smoking prior to their surgeries.

Patients see dead, black skin and fat around the operated area. They see raised, red scars and deep bruising. They see skin tissue that needs to be removed, sometimes requiring a skin graph to repair. In some cases they see photos of patients who had to be hospitalized and receive antibiotics.

"People are shocked," Pancholi said. "I really do gauge how receptive people are to me showing them the pictures. I show them the pictures if I feel they're not really getting it, or if they feel I'm blowing smoke at them about the seriousness of the situation."

Some 12 million cosmetic surgery procedures were performed at a cost of $12 billion in 2007, with the number of procedures up 7 percent from 2006, the American Society of Plastic Surgeons reported. The number of procedures had doubled since 2000, the society said.

Because of the growing number of procedures, more studies are being done and more is coming to light about the effects smoking can have on certain cosmetic surgeries.

Nicotine from cigarettes restricts blood flow and oxygen to the healing skin, potentially causing the tissue operated on to die.

For procedures like Botox or breast augmentation, Pancholi recommends that patients quit smoking, but doesn't require it because survival of the tissue is not as dependent on blood supply. In procedures like a tummy tuck, where skin at the bottom of the stomach depends on blood flow supply from around the rib cage, the bloody supply is coming from a long distance, requiring no restriction to blood flow, Pancholi said.

Pancholi is not the only surgeon requiring patients to kick the habit. Dr. William Zamboni, professor of plastic surgery the University of Nevada School of Medicine and spokesman for the American Society of Plastic Surgeons, mandates that his patients completely abstain for three weeks before and three weeks after for a face lift, breast reduction or a tummy tuck.

"More than ever are plastic surgeons aware of the dangers of smoking on certain plastic surgeries," Zamboni said. "I don't know exactly the percentage of how many doctors require abstinence of smoking for a time, but I hope that 100 percent of board-certified plastic surgeons make it mandatory. If the patients having those procedures don't quit smoking before and after, they're just asking for trouble."

Even one cigarette puff or walk through a smoky casino could damage the tissue, Zamboni said.

"And if they have family members who smoke, they must go outside," he said.

To be sure his patients have quit, Pancholi requires that a week before the surgery, every patient take a urine test to check nicotine levels.

"You do see people who just can't quit," Pancholi said. "I don't feel comfortable doing the surgery. There are other alternatives that are less risky. They may not provide ideal results, but when it comes to health versus cosmetic, I choose health."

If patients are serious about quitting, but can't seem to do it, even with graphic pictures, Pancholi prescribes medicine like Chantix to help patients quit. Nicotine gum, however, cannot be used because it has nicotine.

The good news about requiring people quit for a period of time is that some who have been trying to quit for years find a motive to help them quit permanently.

"If they can quit smoking for six weeks, they're pretty well off to quit," Zamboni said.

About one in five of Zamboni's patients who are required to quit smoking will quit for good, he said.

"In life, they've never abstained for six weeks, so once they've done that, they realize they can quit," he said.

In general, Las Vegas is a very popular city for cosmetic surgery because of the entertainment industry. Both Zamboni and Pancholi said the most popular cosmetic surgery is breast augmentation.

Television shows focusing on cosmetic surgery and lower costs are a couple reasons cosmetic surgery is growing, but TV doesn't always depict the risks of the procedures, Pancholi said.

"The perils of cosmetic surgery are not presented on television," he said. "Hopefully I can reiterate some of the risks to patients in my office so they understand before surgery and after."