5

Hair Loss Treatment History

S
ince the beginning of recorded history, men and women have
searched out cures for hair loss. Over the last 5,000 years, there
have been many cosmetic treatments that give the illusion of
more hair, a few medical treatments that use drugs to affect the hair
follicles, and some surgical treatments that remove bald areas or move
hair follicles around. And these are just the treatments that work.
Countless herbal solutions, medical-sounding cosmetics, nutri-
tional supplements, pills, oils, lotions, and shampoos have been
advanced, with little or no result. Electric shock devices, ultraviolet
light-emitting instruments, LED, laser, and vacuum-cap machines
have all been alleged to help stimulate the follicles to grow hair. Even
spiritual solutions have been advanced. In fact, prayer may indeed be
a better solution than most of the treatments that follow.
What is noteworthy about the history of hair loss treatment is
this: despite real advances in genuinely effective cosmetics, medical
treatments, and surgical procedures, bogus hair loss solutions con-
tinue to be marketed today with astonishing success. Their sales are
astonishing, that is. Despite their wild claims, most of the products
marketed as hair loss solutions don’t have a scientifically measurable
positive effect. In other words, they don’t stop hair loss or grow new
hair. But people are so concerned about hair loss, they want to believe
some “miracle cure” will work for them.

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Chapter Five

3000 BC
Wigs and hairpieces
of various sorts were pop-
ular among upper class
Assyrians, Sumerians,
Cretans, Carthaginians,
Persians, and Greeks in the
Fertile Crescent area of the
Middle East. Around this
same time period, a compen-
dium of medical knowledge
that included prescriptions
for hair loss treatment was
passed on from generation
to generation among Fertile
Crescent area healers.

1553 BC
The Ebers Papyrus, dis-
A portion of the Ebers Papyrus the first
covered in Luxor, Egypt, is
prescription for hair loss
believed to include medical
information drawn from the earlier described compendium of medi-
cal knowledge which was collected 2,000 years earlier. The Ebers
Papyrus is the oldest complete medical text ever found, and it is
devoted to treatments for various skin diseases and cosmetic condi-
tions. It includes the oldest known written prescription for treating
baldness: a mixture of iron oxide, red lead, onions, alabaster, honey
and fat from a variety of animals including snakes, crocodiles, hip-
popotamuses and lions. The mixture was to be swallowed, after first
reciting a magical invocation to the Sun God:
This is a prescription for hair restoration from the Ebers
Papyrus
“O Shining one, thou who hoverest above!
O Xare! O Disk of the Sun!
O Protector of the Divine Neb-Apt!”

36
 Hair Loss Treatment History

1500 BC
Wigs were popular among Egyptian royalty at this time as well,
and a number of elaborate and well-preserved hairpieces have been
found in tombs by archaeologists. Many Egyptian wigs were ornate
creations constructed of linen fiber as well as human hair, while
others made of metal were more helmet-like. As an example of the
importance hair played in certain cultures, certain Egyptian royalty
also used “facial hair wigs,” specifically fake beards, to signify power.
Both male and female royalty wore the fake beards.

420 BC
In ancient Greece, Hippocrates, the Father of Modern Medicine,
tried many medical solutions for his own progressive hair loss, and he
was the first to describe an effective surgical solution to hair loss. One
of his medical formulas was a mixture of opium, horseradish, pigeon
droppings, beetroot, and various spices that were applied to the head.
It didn’t work. Hippocrates eventually became so bald that two thou-
sand years later, we refer to extreme cases of hair loss as “Hippocratic
baldness.”
Hippocrates recorded the first
surgical solution to baldness. In
his collection of astute obser-
vations called the “Aphorisms
of Hippocrates,” he noted
that Persian Army eunuchs
guarding the king’s harem
never experienced hair loss.
He noticed that virile “hot
blooded” men went bald,
but since eunuchs were
castrated, they lacked
“hot blood,” and there-
fore retained their hair. In
Aphorism XXVIII he states:
“Eunuchs are not affected
by gout, nor do they become Hippocrates

37
Chapter Five

bald.” We now know that it is true that castration before or shortly

after puberty reduces testosterone and DHT levels in the blood to
such a degree that genetic hair loss is prevented.
Approximately 2,400 years later, in March 1995, researchers
at Duke University finally published the same results. The Duke
University researchers concluded: “While castration may be a cure,
it is not commercially acceptable,” (reprinted from The San Francisco
Chronicle). The search for hair loss cures went on.

44 BC
In ancient Rome, hair continued to be a symbol of power and
virility. This presented a problem for Julius Caesar, whose hairline
was receding even as his empire was expanding. He developed some
cosmetic solutions to his hair loss problem. First he began growing it
long in the back and combing it straight forward over his bald spot.
Sort of a “comb forward” instead of a “comb over.” This didn’t seem to
work all that well, perhaps because hair gel would not be invented for
another 2,000 years. So Caesar then took to wearing a laurel wreath
around his head to hide his hair loss. The trademark wreath soon
became a symbol of power and virility.

1624
Over 1,600 years later, King Louis
XIII of France began wearing a
full wig to camouflage his
thinning hair. Soon, other
members of the court fol-
lowed his example, regard-
less of their own hair
condition. Wigs became
symbols of power.
The height, length,
and bulk of wigs
increased with each

Nobility wearing wigs

38
 Hair Loss Treatment History

decade, and giant powdered wigs soon became the fashion in all
French courts.

1660
In England, King Charles II was restored to the throne after
his exile in Versailles where he had been exposed to the French wig
craze. The English were not to be outdone by the French. Within a
short time, more elaborate giant powdered wigs were worn in English
courts than had ever appeared in France.

1700S
Upper class American colonists picked up the wig fashion, and by
the late 18th century most wealthy people wore false hair to signify
their elevated class. However, the American War of Independence
and the subsequent French Revolution caused the look of royalty and
elevated class distinction to fall out of favor, and wigs pretty much
disappeared from the scene.

1800S
This was the heyday of the “snake oil” salesmen, and for the
next hundred years bottles of hair loss cures with names like “Mrs.
Allen’s World Hair Restorer,” “Ayers Hair Vigour,” “East India
Oil Hair Restoration,” “Skookum Root Hair Growth,” “Westphall
Auxiliator,” “Imperial Hair Regenerator” and the ever popular “Barry’s
Tricopherous” were sold to hopeful buyers seeking a cure for their
hair loss from “modern medicine.”
A hundred years later, “snake oil” cures for hair loss continue to
be marketed, except now they’re sold by beauty salons and barber
shops, by mail, cable television, over the Internet, and with great suc-
cess to listeners of talk radio programs. The names of the products
have changed to things like Helsinki Formula, Foliplexx, Revivogen,
Nioxin, Kevis, and Fabao to name just a few. The same outlandish
performance promises fool vulnerable consumers.
Amazingly enough, Barry’s Tricopherous, which was founded in
1801, was still being sold in Central America as late as the 1970s
when a bottle was discovered for sale in a Honduras pharmacy. It

39
Chapter Five

is now part of my collection of bogus hair loss remedies. The label

states: “Guarantees to Restore the Hair to Bald Heads and to Make it
Grow Thick, Long and Soft.” The bottle contains alcohol, water, and
coloring.

1850S
During the Victorian era in England, a popular hair loss treatment
was cold India tea applied to the scalp, followed by a vigorous rubbing
of the balding area with fresh lemon juice. This hair loss treatment
would probably be better to sip on a hot day than apply to the scalp.
It didn’t grow hair.

1900S
The wearing of hats by nearly all men in urban areas around this
time was blamed for causing hair loss. Anti-hat advocates urged men
to let their hair follicles “breathe” and to allow
their scalps to enjoy the benefits of “sun baths”
and “air baths.” No one seemed to notice the
countless men who wore hats who did not
lose their hair.

1905
The industrial age brought new inven-
tions to the marketplace, solving a
countless number of life’s
little problems.
Allied Merke In St. Louis, the
Thermocap Evans Vacuum Cap
Company marketed
a suction device that:
“...exercises the scalp
and helps to circulate
stagnant blood, feed-
ing the shrunken hair
roots, and causing the
hair to grow...”

40
 Hair Loss Treatment History

1920S
People still suffered from hair loss, and modern science contin-
ued to work on this problem. Devices using the miracle of electric-
ity started to replace mechanical hair restoration machines. In the
United States, exotic gas-filled clear glass combs with names like
“Master Violet Ray” and “Super Marvel” glowed with purple light as
they generated an electric charge. The electrified comb was raked
across the scalp to stimulate hair growth. Amazingly, some of these
devices continued to be sold until the 1950s.

1922
In his book, Hair Culture, health advocate Bernarr MacFadden
wrote: “There is more quackery rampant in connection with hair and
scalp care—both by the medical profession and by drug and lotion
manufacturers—than there is in any other specialty ever devised
for the exploitation of ailing humans.” He then went on to say that
most hair loss is caused by lack of physical vigor
and unhygienic scalp conditions.
He prescribed scalp massage,
hair pulling, and vigorous
brushing of the scalp.

1925
The Allied Merke
Institute in New
York City began sell-
ing the Thermocap
Treatment device,
claiming to stim-
ulate circula-
tion, cleanse
clogged-up
pores, and
nourish Crosley X-ER-VAC
dormant
hair bulbs

41
Chapter Five

with heat and blue light from a special actinic quartz ray bulb. The
quartz ray treatment took only fifteen minutes a day. Along with
the Thermocap device, the complete Treatment included the Merke
Tonic, Merke Dandruff Treatment, and Merke Shampoo Cream.

1936
In Cincinnati, the Crosley Radio Corporation diversified a bit
from radios, and offered an electric scalp vacuum device claimed to
be a “Therapeutic Method for Hair Growth” and called it the X-ER-
VAC. It was available for home, local clinic, barbershop, and beauty
shop use.

1939
In Japan, dermatologist Dr. Shoji Okuda, published in the
October issue of the Japanese Journal of Dermatology his method for
using hair transplant grafts to replace hair lost from the scalp, eye-
brow, mustache, and pubic hair areas. This was the first published
account of the modern hair transplantation technique, and it worked!
Dr. Okuda removed hair follicles from the back of his patient’s heads,
and transplanted the grafts to new locations to give the look of hav-
ing more hair. His work went largely unnoticed in the West because
of World War II.

1952
Dr. Norman Orentreich, a dermatologist in New York City, was
doing a study on vitiligo, a skin pigment disorder. His study involved
transferring patches of skin from one part of a patient’s body to
another. It was noted that a skin graft taken from a hair bearing
area, when placed in a non-hair bearing area, continued to grow hair
at the new site. Soon after making this observation, Dr. Orentreich
placed ten punch grafts bearing hair on the front part of the scalp of a
patient with severe frontal hair loss. The grafts continued to grow hair
in the new location. Dr. Orentreich reported the successful results
of the first hair transplant procedure performed in the United States
in a paper submitted to the Archives of Dermatology. The reviewers of
that journal said the reported results “were not possible” and rejected
the paper.

42
 Hair Loss Treatment History

1959
Dr. Norman Orentreich was finally able to publish his “donor
dominance” theory in the New York Academy of Sciences Journal,
popularizing and refining the full size graft hair transplantation
technique. The basis of his theory was that plugs of hair follicles
taken from the back of the scalp would grow when moved to the
front or top of the scalp because those hair follicles were genetically
programmed to keep growing hair. It was the particular hair follicles
that mattered, not the location on the head. This concept became
the foundation for the entire field of hair restoration surgery. For the
next twenty years, full-size grafts were the standard technique for hair
transplants.

1960S
Despite scientific evidence that genetics was the cause of pattern
hair loss, other theories continued to be presented by people whose
hair loss solution happened to cure the particular theorized cause.
Scalp tightness, for example, was advanced as the reason for hair
loss, and surgical procedures to “loosen the scalp” with incisions were
performed.

LATE 1960S
The miracle of modified acrylic fiber allowed mass-produced
wigs that had the look of human hair to be constructed by machine
and sold inexpensively. Soon a whole range of wigs, hairpieces, and
other “hair supplements” were introduced, and they were even sold at
Tupperware-style “wig parties” in suburban areas.

1968
At age twenty-seven, Sy Sperling got his first hairpiece. He was
so thrilled with the success of his new look that concealed a reced-
ing hairline, he decided to make non-surgical hair replacements his
career. He created Hair Club for Men, marketing “weaves” which
were hairpieces attached to the naturally growing hairs around the
edges of the bald area. Hair Club for Men grew to become the larg-
est hair replacement company in the world, establishing a research
department to make improvements to non-surgical hair appliances.
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Chapter Five

1969
In the United States, I began my residency training with Dr.
James Burks, one of the first doctors to perform hair transplants on a
regular basis in the United States. During my residency, I performed
hair transplantation procedures every week for three years.

1970S
The “Bald is Beautiful” movement enjoys a brief moment in the
spotlight. Bald actors and celebrities such as Yul Brynner and Telly
Savalas, appear on TV and in movies with completely bald heads, a
concept almost unheard of previously.

1976
Since the 1920s, skin tumors and injured areas of the scalp were
removed surgically using a procedure called a “scalp reduction.” In
this procedure, the damaged tissue was cut out and the edges of
the surgical wound were carefully sewn back together in a manner
that left only a very small scar. In 1976, doctors Martin Unger and
Walter Unger submitted for publication to the Journal of Plastic and
Reconstructive Surgery an article titled “The Management of Alopecia
of the Scalp by a Combination of Excisions and Transplantation.” The
article described a method of removing healthy, but hairless, scalp tis-
sue from a patient to simultaneously lift up the fringe of permanent
growing hair along the sides and back of the head, while making the
bald area needing transplants smaller. The article was rejected as
“representing nothing new.” However, alopecia reductions (bald scalp
reductions) soon were regularly performed along with full-size graft
hair transplant procedures, because they allowed for increased hair
density with full-size graft procedures.

1978
In the United States, for the first time in 5,000 years, a medica-
tion has been scientifically proven to reduce the rate of thinning hair
and help grow back hairs that have been lost. Minoxidil, a medica-
tion taken in pill form for treating severe high blood pressure, was
discovered to have this beneficial “side-effect” in some patients.

44
 Hair Loss Treatment History

Clinical trials were established to prove to the U.S. Food and Drug
Administration the safety and effectiveness of this promising hair loss
treatment medication, but it will be years before the manufacturer
can advertise it as a treatment for hair loss. In the meantime, I devel-
oped a topical formula containing minoxidil that I applied to my own
scalp and prescribed for certain patients.

1979
In San Francisco, I initiated complaints to the FDA, FTC, and
California Department of Consumer Affairs against artificial hair
implant “clinics,” where synthetic fibers were surgically placed into
the scalp tissue of “patients.” The “patients” at these “clinics” were
hoping for a permanent solution to their hair loss, but instead every
customer suffered massive scalp inflammation, which often required
surgical removal of the affected area, leaving them with unsightly
scars as well as less hair. Initially, there was no response from the gov-
ernment agencies, and one bureaucrat even accused me of trying to
“stifle competition”. Frustrated with government agencies, I went to
the news media. The San Francisco Chronicle sent a reporter to the
clinic “under cover.” The resulting expose revealed that the clinic’s
“doctor” had no medical license. Criminal charges were filed and the
clinic closed. Soon after this incident, artificial hair implants became
illegal in California. Five years later, the FDA would ban artificial hair
implantation in all states.

1979
Drawing attention to the significance of hair, bald-headed
female celebrities begin to appear in the media, including and actress
Sigourney Weaver in the movie Alien (1979), and later, singer Sinead
O’Connor on her album The Lion and The Cobra (1988).

1980S
In the field of hair transplant surgery, full-size grafts (“plugs”) are
replaced first by minigrafts and then soon after by micrografts. The
new technique of micrografting allows patients to avoid the “under
construction” look, and achieves a more natural overall result than
most full-size graft procedures.

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Chapter Five

1984
The United States Food and Drug Administration (FDA) bans
synthetic fiber implants, a type of surgical hair restoration procedure
where thousands of strands of fibers were implanted in the scalp to
simulate the look of real hair. Although the fibers were similar to
surgical sutures used by doctors to stitch up wounds, within a short
period of time they would cause bumps, inflammation, infection,
scars, and even more hair loss.

1988
Minoxidil lotion is the first medication approved by the FDA for
treating hair loss. It is sold by prescription only in a two percent solu-
tion under the brand name Rogaine.

1988
Dr. Bob Limmer, a dermatologist and hair restoration surgeon
practicing in Texas, has his surgical team use stereo microscopes rath-
er than less powerful magnifying glasses while preparing micrografts.
The more powerful magnification helps his team to preserve naturally
occurring clusters of hair follicles in the donor tissue. This advance in
micrografting reduces cutting and the risk of graft failure, while pro-
ducing grafts that grow more naturally than arbitrarily cut single-hair,
two-hair, and three-hair grafts. In 1991, Dr. Limmer publishes an
article in Hair Transplant Forum International describing what would
become known as follicular unit micrografting.

1989
The FDA restricts all non-prescription hair creams, lotions, and
cosmetic products from making medical claims that they can grow
hair or prevent baldness. Manufacturers respond by altering their
advertising slightly to make medical-sounding claims without actually
stating that the products can grow hair.

1990
Another generic medication called finasteride is shown to reverse
hair loss, and it is even more effective than minoxidil in preventing

46
 Hair Loss Treatment History

baldness. The U.S. FDA originally approved finasteride as a treatment

for enlarged prostate glands. New clinical trials begin to test this
medication’s safety and effectiveness as a hair restoration treatment.

1990S
More bald-headed male celebrities are seen in the media, including
basketball superstar Michael Jordan, and Star Trek Next Generation’s
Captain Picard, portrayed by actor Patrick Stewart.

1991
Hair Club for Men introduces a unique method of eliminating
hairpiece “weaves,” by using an adhesive to attach the hair appliances
directly to the scalp. Glued-on hairpieces soon become the industry
standard.

1993
The electric shock method of “awakening” hair follicles never seems
to go away. This time a Canadian company called Current Technology
Corporation develops a machine that uses low-level electric shocks
to treat bald heads. They call the therapy ElectroTrichoGenesis. This
electroshock treatment has not been proven to work any better than
the electric comb of 1920

1994
In San Francisco, I start taking a low dose of finasteride once a
day to preserve my own hair.

1995
In an attempt to simultaneously solve the artificial hair appliance
problems of secure attachment and easy removal for hygiene, Dr.
Anthony Pignataro, a New York cosmetic surgeon, develops the snap-
on hairpiece. In the first part of this new method of hairpiece attach-
ment, surgical-quality titanium sockets are screwed through the scalp
into the skull and allowed to fuse with the bone over a period of three
months. Then, small gold-alloy snaps are screwed into the sockets.
The snaps mate securely with attachments formed into the underside
of a custom-made hairpiece. I advised my patients to avoid this pro-

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Chapter Five

cedure due to the risk of a life threatening infection. Osteomyelitis

(bone infection) of the skull and retrograde infection into the brain
are real possibilities with this procedure.

1995
The FDA approves two percent Rogaine lotion as an over-the-
counter drug, meaning it can now be sold without a prescription.
Generic versions of minoxidil lotion become available in concentra-
tions up to five percent, and are sold in supermarkets and drugstores.

1995
In the United States, micrografting evolves into Follicular Unit
Micrografting and becomes the new state-of-the-art method of hair
transplantation. The key to this technique is to identify and pre-
serve the natural clusters of hair follicles from strips of donor tissue,
minimizing cutting and risk of damage to the limited supply of donor
follicles. In addition, the grafts are kept chilled and moist during
all stages of the procedure to further reduce graft failure. I develop
several improvements to instrumentation used in Follicular Unit
Micrografting, including using cool fluorescent transillumination and
a disposable clear vinyl cutting surface with stereomicroscopes during
graft preparation.

1995
I am astonished to see artificial fiber implant procedures again
advertised as the ultimate solution to hair loss by Ivari International
in national magazines such as Harper’s Bazaar. Their innovation—
called the Intra Dermic Micropoint—is a supposed improvement
over the knotted fibers used in the past. The innovation appears to
be some sort of bead that is surgically implanted into the scalp to
anchor each implanted hair. The procedure is illegal in the United
States because of severe immune response reactions, so patients who
visit the Beverly Hills or New York City clinics of Ivari International
are flown to Paris for treatment. The cost of the procedure starts at
$60,000.
I immediately contacted the Attorney General’s office and filed
another complaint. Included in the complaint was a copy of the

48
 Hair Loss Treatment History

February 3, 1979 San Francisco Chronicle article in which I was

quoted as follows: “Whether they use real hair, synthetic fibers, and
stick it straight in or knot it, it just can’t work. There is no known
substance that can go through the skin and remain there that won’t
allow bacteria to migrate down and cause an infection.”

1998
Finasteride becomes the second prescription medication approved
by the FDA as a hair loss treatment. It is sold in pill form under the
brand name Propecia. This medication now makes it possible for men
in the early stages of hair loss to keep the hair they have, and even
gain back some hair that was recently lost. Eighty-five percent of men
stop losing their hair while taking Propecia.

1998
In Canada, a company markets a laser-light treatment that prom-
ises to stop hair loss and stimulate hair. With just two thirty-minute
sessions twice-weekly, along with regular use of their own branded
shower head filter, shampoo, conditioner, and nutritional supple-
ments, they claim that seventeen of eighteen patients in their study
showed absolutely no further signs of hair loss, and fifteen of eighteen
people showed signs of new hair growth.

2002
A Portland, Oregon firm offers balding men and women the ser-
vice of storing samples of their hair in a basement room for an annual
fee, in the hopes that in the future a cure for baldness will require a
hair sample. A staff writer for the San Francisco Chronicle interviewed
Dr. Alexa Bower Kimball, a dermatologist at the Stanford University
Medical Center, and asked if she could think of any reason why some-
one should bank a sample of his or her hair. Her answer: “Not off the
top of my head.”

2000-2005
Hair cloning (culturing stem cells from the patient’s hair follicle,
stem cell transplants, hair multiplication and scalp impregnation
therapy are all terms for harvesting hair stem cells for the purpose

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Chapter Five

of transplanting an endless supply of new hairs. All these techniques

have been improved upon in the past five years and some doctors
have offered potential patients the opportunity of being on a “waiting
list” for the procedure when it is approved. Gene therapy to correct
androgenetic alopecia has been found to be possible, but it will take
years of experience before it will be safe to use on the public. More
on this in Chapter 18: Future Hair Loss Treatments.

TODAY
Currently, the most effective cosmetic treatments for hair loss
are wigs and hairpieces, which work regardless of the cause of the
hair loss. The most effective medicines for androgenetic alopecia
(hereditary pattern hair loss) are Propecia for men, and a combina-
tion of spironolactone and hormone therapy for women. The most
effective surgical procedure for pattern baldness is follicular unit
micrografting.

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