The modern baldness cure: follicles grown in a petri dish
Rugs, drugs, and plugs are so 20th century. Five minutes after I meet Ken Washenik, he invites me to examine his scalp. We're in the penthouse offices of Beverly Hills-based Bosley International, the nation's largest hair transplantation company, where Washenik - the head of New York University's dermatopharmacology department until 2002 - now leads Bosley's research and development. He is also, as the saying goes, a client.
He points high up on his forehead to his hairline, indicating where the transplants are. He then shows me a series of photos taken during the surgery. He's smiling broadly in the pictures as L. Lee Bosley himself, the founder of the company and Washenik's boss, removes a bloody strip of hairy scalp from the back of his head. These hairs are now implanted on top of his head.
Oddly enough, it's this 50-year-old traditional hair transplantation process that Washenik has been hired to make obsolete. Flipping through the photographs, Washenik explains that the procedure has one major shortcoming: There's never enough hair. Doctors cut out follicles from the nonbald regions and implant them on the front lines, but more often than not the bare areas can't be fully covered by the limited amount of excised hair. "It's a supply-and-demand problem," Washenik says, scratching his head unconsciously. "Only so much scalp can be harvested from the back and sides of the head."
Washenik has a solution. Rather than removing a chunk of scalp, doctors have begun to experiment with extracting single hair cells, replicating them in a petri dish, and implanting new, lab-grown cells. These cells mature into hair follicles through a process known as follicular neogenesis. If the technology can be perfected, there would be no limit to the amount of hair that could be grown. "It's the holy grail of hair technology, and we're going to be the first to get it," Washenik says. "I don't want to sound too grandiose, but we're talking about Nobel Prize-level work here."
It turns out there's a lot more to the world of hair restoration than snake oil, bad toupees, invasive transplants, and underwhelming * fixes like minoxidil and Propecia. In fact, an international race is under way to reliably culture and implant new hair cells that grow into follicles. Researchers in Canada, England, Japan, the Netherlands, and the US are on the verge of solving this puzzle, which could put an end to most forms of baldness for men and women. For the sake of his career and his hairline, Washenik desperately wants to win this contest.
Traditional hair transplants use follicles from the side of a man's head, which are genetically resistant to the hormonal changes that cause classic male-pattern baldness. Nobody knows why this pattern developed, though the leading theory suggests it evolved as a sign to the opposite sex of a man's maturity, and thus his ability to provide for a family. But try telling that to the 35 million balding American men who spend $1.5 billion a year on hair restoration products, drugs, and surgery.
Transplants, which account for more than half of that spending, are arguably the most effective treatment, but it took decades for the procedure to emerge from the shadow of hair-growth hucksterism. In 1952, New York City cosmetic surgeon Norman Orentreich pioneered transplantation in the US, proving that balding-resistant follicles could be moved to a new site on a man's head. But medical journals refused to publish the findings for seven years, and the procedure didn't become widely available until the 1960s. These early efforts were derided as hair "plugs" because they involved relocating clusters of 15 to 20 hairs, creating a bristle-brush effect. Today, surgeons are able to harvest and reimplant as few as two hairs at a time, making the transplants look more natural. Still, the supply-and-demand problem remains.
In the early 1990s, Colin Jahoda, a researcher at the University of Durham in England, took a step toward solving it. He stripped a few cells off the root of a mouse's whisker follicle and implanted them into its ear. Out grew a whisker. Next he took a section of follicle cells from his own head and implanted it between the fine, pale hair on his wife's arm. A thick, dark hair emerged, complete with male DNA. This demonstrated that the cells at the base of a follicle can and do regenerate into self-contained, preprogrammed hair factories.
In other words, hair follicles have the unusual ability to regenerate. We are all born with a fixed number of them, just as we are with one heart, two kidneys, and a liver. But Jahoda proved that it's possible to trigger the processes that create new follicles in embryos. And, more important, the cells in each follicle carry all the genetic information for a particular type of hair. A mouse whisker or a strand from a man's head could be implanted and induced to grow anywhere on the body.
The challenge, however, is not in harvesting the cells, it's in duplicating them. Simply planting one cell in a new place doesn't solve the supply problem. But once a few cells have been scraped off the follicle and cultured in a petri dish, they'll multiply. Unfortunately, during the multiplication process the cells shed the genetic code that directs them to turn into hair follicles. You end up with a lot of generic cells that won't grow a thing.
Step by step, Washenik and his team are cracking this problem. In 2001, Tom Barrows, a Bosley researcher, cultured 32 batches of hair cells and then distributed them among eight patients already undergoing traditional transplants. One of the batches produced two hairs. Encouraged, Bosley launched animal trials and began experimenting with different combinations of growth catalysts, methodically searching for the recipe that causes follicular cells to maintain their genetic code. Washenik says that 80 percent of his lab-grown cells now produce hair when implanted in mice.
But Bosley's got competition. In 1996, a University of Maryland dermatology resident named Jerry Cooley cultured and implanted hair cells from his head into his forearm. Of 15 sites he cut and seeded, one grew a hair. "You don't hear about cancer researchers injecting themselves with cells," Cooley says. "This field is like the Wild West."