FOUND! The Cure for Hair Loss

Men’s Health magazine (UK) – December 2005


Words and photography Nick Bradshaw
Hotel staff in Beverly Hills rarely bat an eyelid when people check out bearing little resemblance to those who checked in. There are no double takes, despite the double identities. The reason, of course, is that Beverly Hills is also home to some of the world’s most exclusive plastic surgeons.
Few people look old as they parade down Rodeo Drive. Instead, they look… well… altered. The norm, in the sense of God-given imperfection, is by no means “normal,” while the grotesque has become the acceptable. Facial bruising and dressings are status symbols rather than signs of an unlucky encounter with a bar stool.
There are two established Beverly Hills plastic surgeons, however, who aim not to alter but to restore. Their mission is to restore the hairline of the bald and, in doing so, restore their patient’s confidence. Together they have perfected the winningly named Fleming/Mayer Flap, the most radical treatment for male pattern baldness currently in existence and a procedure that is guaranteed to give bald men a full head of thick, lustrous, healthy hair.

“Image is important the world over, of course, but we’re in Beverly Hills where it’s integral. We’re surrounded by people who flock to this area in order to be seen and to make a name for themselves. People come here to be filmed and photographed, so it’s only natural that appearance counts.”
So says The Beverly Hills Institute’s Richard Fleming (MD FACS), one half of the double act performing this revolutionary procedure that involves a frightening combination of stretching, stapling, stitching, and scalping. The result, however, is anything but frightening.

“If you have the surgery when young but unsuitable you’ll end up with horrendous results later”

“Image is important the world over, of course, but we’re in Beverly Hills where it’s integral. We’re surrounded by people who flock to this area in order to be seen and to make a name for themselves. People come here to be filmed and photographed, so it’s only natural that appearance counts.” So says The Beverly Hills Institute’s Richard Fleming (MD FACS), one half of the double act performing this revolutionary procedure that involves a frightening combination of stretching, stapling, stitching, and scalping. The result, however, is anything but frightening.


This rating system, devised in 1975 by dermatologist Dr Norwood, plots the journey all bald men take.

Norwood Scale 1 to 2
Your testicles are producing a hormone, dihydro-testosterone (DHT) that lengthens the “resting phase” of follicles. Hence recession at temples.
Chance you’ll reach this phase 68%
Countermeasures Get a good barber.
Consolation It’s the normal male hairline.

Norwood Scale 3
DHT is causing once-thick hair to fall out and grow back as thinner, transparent hairs.
Chance you’ll reach this phase 46%
Countermeasures Rogaine and Propecia might keep you at stage 3 for ten years.
Consolation People will trust you with their daughters.

Norwood Scale 4
Your hair is like Germany in early 1945 – you’re fighting on two fronts and retreating.
Chance you’ll reach this phase 30%
Countermeasures It’s probably time for the obligatory goatee.
Consolation You’ll have heard all the “slaphead” jokes by now.

Norwood Scale 5
The hair on top of your scalp is just about vanished.
Chance you’ll reach this phase 20%
Countermeasures Keep your hair micro- short; start wearing better clothes as a distraction.
Consolation To some women you’ll appear “devilish”.

Norwood Scale 6 to 7
You’re bald, man.
Chance you’ll reach this phase 18%
Countermeasures Some form of hat and big muscles are the order of the day.
Consolation Chances are you’re older, and therefore more distinguished, and probably richer. We only said probably.

“It’s better to be bald and natural than to simply look unnatural,” says the naturally hairless Dr. Fleming. “Looking natural is the key to everything we do here, from rhinoplasty (nose jobs to you and me) to facelifts to baldness treatments. It doesn’t have to be perfect, but it has to look natural. If it doesn’t look natural then the results are devastating to the patient. Sadly, I can’t tell you the number of times over the last 30 years I’ve said ‘no’ or ‘let’s wait and see’ to people, only to have them come back and see me a while later, having done something that’s had crippling results.”

Baldness is a serious matter for Fleming. He recounts the significance of work by Dr. Thomas Cash, a psychology professor at Old Dominion University in Virginia, who carried out an extensive study in 1988, comparing human reactions to both bald and hirsute men. He found conclusively that pictures of bald men were not as well received by indiscriminative viewers. They were also far more frequently picked out to be likely criminals. The bald were not seen as the beautiful, but rather the less successful, the less intelligent — the problem people.

“We all know that what makes a man boils down to a lot more than how much hair he has on his head,” says Fleming, “but the results of Dr. Cash’s test were conclusive. Appearance does count. Unfairly, baldness does make a difference.”

Dr. Fleming wears a surgical bandanna and scrubs as he prepares for his 6:15 a.m. operation, the first of many in a long day (between 12 and 40 Fleming/Mayer Flap ops alone are performed a month). Under the bandanna, there’s proof that he’s an expert baldie as well as an expert surgeon. However, his hair-loss pattern (he sports only a narrow rim of hair on the back and sides of his head) makes him unsuitable for his own procedure.

“Make no mistake, if I were suitable I’d have it done like a shot. No hesitation at all,” he insists. “You hear ‘bald is beautiful,’ but if you surveyed all bald men and gave them a choice, then you’d see that this is fantasy. If a pill were available that would give men with hair loss a full mane, you’d be hard pressed to find a man who wouldn’t take it. Given the choice, I think most people would.”

Right now, there’s no shortage of follically challenged men queuing up for Fleming’s services. The real genius behind his and partner Dr. Toby Mayer’s procedures lies in its devastating simplicity and efficacy. In basic terms — and let us ignore the finer nuances of skilled surgery for just a moment here — it involves removing a patch of bald (or balding) scalp from the top of a patient’s head and replacing it with a flap of scalp bearing healthy, long-lasting hair taken from the side of the head. This flap is flipped through 90 degrees and sewn across the head, providing a permanent, natural-looking, new hairline. Large amounts of hair, equivalent to approximately 10,000 mini/micrografts are transferred in one go.

The relative simplicity of the method does not mean that it’s undertaken without caution, however. “One has to be careful when recommending treatment — or for that matter, advising against it — because baldness is progressive,” explains Dr. Fleming. “Just because somebody looks like they’re a good candidate when they’re 20 doesn’t mean they’ll still be a good candidate when they’re 40 or 50. It’s about the supply and demand of hair follicles. If you have the surgery when you’re young but unsuitable, you’ll end up with horrendous results in years to come. You’ll be left with an oasis in the desert — a clump of hair with baldness all around it. If you don’t have adequate donor hair, you’re not a good candidate for surgery. If that’s the case, I won’t operate.”

Two weeks ago, 23-year-old James from Chicago had the area of scalp destined to be used to form his flap separated from the surrounding skin on the side of his head. Dr. Fleming marked the outline of the flap and, under local anesthetic, incisions were made along both edges. Having completed this first procedure, the incisions were immediately closed and a dressing was applied. The next morning the dressing was removed and James was able to return to his regular daily routine without arousing suspicion. A week later, further incisions were made around the tail end of the flap. Again, the edges of the incisions were sewn back together and James wore a dressing overnight.

Up until this point, not one hair had been moved and nobody in the outside world would have had the slightest notion that James had undergone surgery. That is. providing that no one had spotted the rapidly growing lump on the side of his head. This is the result of a regular insertion of sterile water into a balloon, or “expander,” inserted under the skin some weeks before in order to stretch the scalp, thereby creating a larger donor area to work with. “We’re using the expanders a lot more than we used to because I feel that gives us a better result,” explains Dr. Fleming.
As James lies on the operating table this morning, awaiting the final leg of his journey, the anesthetist administers a mild general anesthetic and the balloon is fully expanded. His hair is then tied into tiny bunches lending him the slightly disturbing appearance of Björk morphed with the Elephant Man.

I remember what a blow to my confidence it was to see my then longish locks spiral down the plughole, never to be replaced

The relative youth of Fleming’s patient this morning should not be a surprise. “The psychological response to hair loss can vary depending on a person’s age,” says Dr. Fleming as he injects the scalp of is young patient with a local anesthetic to reduce bleeding. “Nobody likes losing their hair, but younger people tend to be more devastated when it happens. The older man is generally more established, both personally and professionally, and as a result he can deal with it better. The young man who’s establishing his career, and my or may not be married or involved in a serious relationship but is looking to do that in the future, obviously wants to put his best foot forward.”

It’s probably only fair of me at this juncture to offer up a small confession. I am a bald man in my thirties and my reasons for witnessing this operation so closely and listening to Dr. Fleming so intently are not solely professional. I have a personal interest in what’s happening in Beverly Hills. I first noticed that my hair was thinning around the time I left university (and around the same time my then girlfriend decided that she preferred men with ponytails.) At 21, my boyish good looks meant I couldn’t always get served in bars. By my late twenties, I needed ID to take part in poolside activities on a Club 18-30 holiday.

One day, when I was 25, I finally decided to do something about my hair loss and spent more than £3,000 on a hair weave. I only wore it once under a baseball cap. It was good, really good in fact, but I knew it was there and was convinced that everyone else did too. I went back the day after having it attached to have it removed. I’ve worn my hair short ever since.

I can’t imagine the hassle of having hair now. Not having hair has become part of who I am. Fortunately, I tend to get my head rubbed gently more often than it gets patted. Even so, I remember what a blow to my confidence it was to see my face get longer and longer as my forehead got higher and higher; to watch my then longish locks spiral down the plughole, never to be replaced.

As I mull over these thoughts in my closely tonsured head, Dr. Fleming is operating with impressively measured speed and precision. “If hair is destined to fall out in future years, then it will fall out regardless of its location, “he explains, while taking a scalpel to a pre-marked line along the front of James’ head. “In the same way, if it’s destined never to fall out, then it will never fall out, even if you move it to a new site on the head. It’s never a question of how much hair will be left in the area affected by loss,” he says, working deftly and quickly as he uses the blunt end of the scalpel to detach the pre-weakened outline of the flap. “It’s a question of how big the area will be and whether there is a big enough donor area of permanent healthy hair available elsewhere to cover the part of the head that’s bald.”

The flap is flipped and Dr. Fleming works his way carefully down what will become the front hairline, shaving off bits of scalp to create a deliberately imperfect (and therefore natural) result. Because the flap is flipped rather than removed and replaced, the blood supply to the flap is never lost — vital if the procedure is to work. After much checking, the flap is twisted around and carefully hand-sewn into place using the tiniest of stitches.

“We either do a straight hairline or one that’s a little receding,” Dr. Fleming says. “God can make a good rounded hairline, but if we try that it tends to look more ape-like. We always get a little bump that we call a dog ear, where the frontal and temporal hairlines meet but that will decrease significantly in the first week.”

After more stapling, sewing and the disregarding of a patch of scalp, James’s operation is complete and is head is bandaged. Unlike some other patients who undergo additional micrografting, he will need no further surgery. “These bandages will come off in three to four days and reveal a full head of hair,” declares Dr. Fleming proudly, as his groggy patient is woken by the anesthetist and wheeled into the recovery room, all just over an hour after his operation began. This revealing moment can elicit a variety of responses, from patients who look in the mirror then thank their doctor and leave with a smile on their faces to those who are just stunned into shocked silence. “Sometimes it’s a real jolt to their senses to see a full head of hair. It’s one thing to see before and after pictures of someone else, but when it’s you gazing into the mirror, the response can be unpredictable.”

As soon as the bandages are taken out, James will be able to have his new hair shampooed, cut and styled as he wishes. After six days, the hairline stitches will be removed, then four days later, the stitches at the back of the flap and on the side of the head will follow. Job done. From that point on, James will have a full head of hair that will stay with him until he pops his clogs.

Treatment of this kind costs $12,250 (£7,000), or $15,800 (£9,000) if an expander is needed. Despite the high expense and the glamorous location of his operating theatre, Dr. Fleming insists that his procedures are not the sole preserve of the very rich or the famous. “Hair by hair, it actually works out cheaper to have a flap than to get micrografts,” he claims.

“We have people coming through our doors from all walks of life, not just the rich and famous, and from all over the world, including a lot of patients from the UK. Many people who come here for the flap look at it as an investment that will last their whole life. You can spend three times the amount on a car that will last you two years. They are investing in themselves, knowing that, over the long haul, the expense is not so high. That said, price comparison should have nothing to do with your decision on how to cure your baldness, I just say ‘treat it or don’t — it all depends on how it’s going to make you feel.’”

Minoxidil and laser treatment
Minoxidil is a scalp lotion applied twice daily, often found in chemists and dispensaries under the trade name of Regaine (Rogaine in the US), retailing at just under £30 per bottle.
“First one has to evaluate how well Minoxidil works,” warns Dr Fleming. “As far as we know, if someone has a positive result with Minoxidil – either slowing down the progression of hair loss, stopping the progression completely, or growing new hair (which is not very common) – then it they continue to use it, the result will continue. But the moment they stop, your hair will revert to its genetically determined loss pattern.”
Sometimes Minoxidil is used with laser treatment, where the heat of the lasers is used to stimulate the blood supply in the scalp to feed hair follicles that would otherwise die off. Minoxidil doesn’t claim to be a cure for baldness but goes some way to helping some sufferers achieve a slow down in baldness.Mane

A colored hairspray that coats thinning hair, thus making it appear thicker. It also colours the scalp under the hair, disguising bald patches. The downside of this is that if your hair is very thin and you spray this on, your scalp will appear to be black. Available in a range of shades, it costs £13.95 per bottle.

These vary from toupees held in place with double-sided tape to weaves which stay attached for weeks and even appear to grow as the wearer’s own hair is pulled through gaps in the hairpiece. A cheap synthetic wig can be yours for a few quid. A decent weave, professionally attached and using real hair, can cost thousands of pounds.
“There are people who wear hairpieces that even I wouldn’t be able to pick out in a crowd,” Dr Fleming admits. “I have two well-known actor friends who wear hairpieces but the public don’t know. Hairpieces can be good, but buyers beware: there are plenty of hairpieces out there that don’t kid anyone.”
Mini- and micrografts
About a quarter of Dr Fleming’s work involves grafting – where a strip of healthy hair follicles is removed and transplanted to a barren spot. Either a few hairs are transplanted together, or they are placed in their new home individually. “Grafted hair never grows back thickly and you may need several procedures to achieve an overall effect,” concludes Dr Fleming. “You also have to accept that when the hair is wet, it might not look so good. But there’s nothing wrong with the micrograft process. The question you have to ask yourself is, ‘What do I want to achieve?’ These days micrograft procedures can result in a very natural appearance. As men get older, into their fifties, sixties and seventies, they just don’t want to look completely bald. These kinds of people tend to be very happy to accept the end results of micrografting.”

Doctor Fleming and Doctor Mayer have attracted attention from other eminent plastic surgeons, although as yet, their procedure is not being performed in the UK. “It looks gruesome, but it’s really not,” says Dr. Jan Adams, plastic surgeon and co-presenter of the Fiver series All New Cosmetic Surgery Live. Some patients undergo a second flap operation if their hair loss extends to cover the crown are of the head. “There’s not a limit to the number of procedures a patient can go through in order to solve the problem, without any danger whatsoever,” Dr. Adams continues.

On a personal note, I went into Dr. Fleming’s operating theatre pretty much convinced that I would never try to hide my baldness again. I still accept that my head is genetically disposed to feature a large area of slap, but if I had £9,000 to spare, I’d consider going under the knife. There are risks with any surgery that involves general anesthetic, but to date the success rate of this surgery has been 100%. Since the flap keeps its normal blood supply at all times the risk of the flap being rejected is nil. There is a risk of infection, but with the Fleming/Mayer Flap procedure, the risk is low. Much higher is the chance of someone thinking I’m Patrick Stewart, Michael Stipe, or worse, Lenin. It’s a fate that will never await someone destined to live their whole life with a full head of hair. Someone like James.

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