Category: Tidbits

What is the story on Donald Trump’s hair? He looks like he is trying to hide something?

As I understand it, Donald Trump was a victim of the old hair transplant process starting in the 1980s. The quality of the work most probably resulted in the pluggy look, and he possibly had scalp reductions (which were popular in those days). Between the two, he might have little donor hair left. There may be significant scarring as well if he had many procedures in the ‘old days’. He apparently found the solution to cover up his hair loss problem, with a creative hair styling that he is now well known for. He knows that his hair is the subject of much focus and with people who just love to talk or make their living hosting entertainment shows. That is the price of today’s celebrity.

What he has done is to exploit a ‘comb-forward’ style, maximizing what hair he has to cover what he wants to hide. Like the comb-over, it layers hair from one part of the scalp to another (comb-forward means that the hair is kept long and combed to the front). I call this the ‘Trump style comb-forward’ in my private office practice, because of his celebrity status. This style uses what many people with frontal balding exploit (see the Norwood Class 3 or 4 pattern balding). The less hair that is lost and the more hair that remains, the more effective is the result of styling to hide thinning or balding in the frontal area. When taken to extreme, whether it is the comb-over or the comb-forward, the appearance does not look good.

When any reasonable amount of hair is transplanted in the Class 3 or 4 balding pattern (those with natural Norwood Class frontal balding patterns), a comb-forward can work even better so restoring all of the missing density is not needed. Nobody ever knew that CBS News sports reporter Steve Hartman was balding and he perfected the combing to the front and side enough to hide his thinning hairline. This canopy comb-forward was very effective for him (a common combing style for many men), but he was slowly losing the battle to preserve his look. Many men tell me that they spend more and more time dealing with their hair, not only in the mornings, but throughout the day as well. One man who comes to mind told me that his comb was like his Mont-blanc pen, always needed wherever he went and he carried hair spray with him to touch up the styling in bathroom breaks that he had to take quite often. Steve’s hair, on the other hand, was very cooperative with a strong character that easily laid down the way he wanted it to. Rather than waiting too long and risking an unnatural appearance, Steve decided to take the bull by the horns and had one transplant procedure (see pictures). Steve went for natural fullness as he did not want to maintain any illusion at all, so we put as much hair as we could safely move in just one transplant session. The point between where Steve came from and a really bad comb-over (the kind that everyone sees on TV or at the airport), is a slow, insidious process — so slow in fact, that the person who is doing it never notices the advancing balding nor the progressive failure of the grooming style. I always wonder why family members do not comment on the failure of this styling process, but maybe they are just not saying anything early enough and now are embarrassed to say anything at all so late in the process.

Some men with bad comb-overs deny their evolving look, putting a mental block on the unnatural appearance they evolved, and others just stop going out into the public arena. Hats and wigs solve the problem for some, a type of cover-up that does not work for everyone and I have seen a few take it to extreme levels, creating a bouffant style with hair that is one or two feet long and combed into a circlular pattern, layered hair by hair to mimic what the person thinks is normal.

I have been asked many times why the rich and famous who can afford the best doctors don’t just get the best surgical hair restoration money can buy. Ignorance is part of the answer. I believe that many men with the old deforming hair transplants find themselves in a difficult situation. They may not know that they were going down that road when the process initially started. When they found out, they may have come to the conclusion that it was too late to do something about it. With luck, men in this predicament may find some solution that they learn to live with when it works (comb overs, hats, wigs, scalp coloring agents, and the like) or they may find their way to a good hair transplant surgeon who can fix the problem.

With today’s modern Follicular Unit Transplant and Follicular Unit Extraction (FUE) techniques, some amazing work can be done. With FUE in particular, it is virtually for all practical purposes scar-less and the procedure is minimally invasive. Not everyone can be brought back to “normal” if too much of the hair has been squandered, or if scarring has gone too far. If Mr. Trump had old type plugs, he can have that hair redistributed so that the big bad plugs are no longer present. Any hair that is moved can be put to better esthetic use in other scalp locations under the guidance of an artistic hair restoration surgeon (see Dean’s Story for an example of this).

Had Mr. Trump been a patient of ours, I could never have written anything about him because patient privacy is central to the way doctors operate their business today. I hope that by writing this piece in answer to your question, I have not offended him in any way.

I saw Bruce Willis on the David Letterman show the other day and he told everyone that he was bald and happy. That could put you out of business so don’t buy your new Mercedes yet doc. What do you think of the balding trend? Is bald beautiful?

I have followed Bruce Willis’ hair loss over the years from his thinning during the TV series Moonlighting, to the present day shaved head look he sports. A while back, I did notice what I thought were hair transplants placed in the front of his head, showing a less than artistic straight line of hair (suggesting a poor hair transplant), but if my initial guess was correct, there would be some signs of it on the front (recipient area) and in the back of the head (donor area). Judging by photos I’ve seen, I can not stand by my original assumption. I do not think Bruce Willis ever had transplant work done. It is interesting that my daughter met him at a party in the mid-90s and engaged him on the balding issue and my transplant services. He commented that he would remember the connection when the time came, so with that knowledge, I have followed his balding over the years waiting for him to come to my office and join others in that line of work that have come my way.

It must be clear to anyone considering hair transplants, that the option to shave the head as Bruce Willis does may be lost if you have the procedure, as some scarring may be present at the donor site (even with the FUE technique). I have seen many patients that had a small-session transplant, which was inadequate to cover the bald area, because less hair is moved to produce the fullness that a reasonable person might expect. Small, delicate follicular units will mimic the normal hair and to get that, the doctors performing the surgery must be adhering to the standards of Follicular Unit Transplantation. Anyone with even a good hair transplant that uses strip harvesting would have a noticable scar if the head was shaved, even if it were 1mm in size. For the unfortunate person who had unsightly or poorly planned hair transplants, they may have no choice other than to live under a hat or a hair piece most of the time.

Some men shave their head as a way to accommodate their balding. This is a style that has more recently been accepted by the ‘hip’ young men today. We see many ways these men deal with their balding/thinning at our monthly Open House events, where a significant number of men who have to deal with balding come to learn more about the hair restoration process. Many men shave or clip their hair short, or are wearing baseball hats or hair systems. Unlike the average guy, Bruce Willis could get away with wearing a baseball hat to the Oscars because of who he is, but I would not recommend interviewing for a high powered job with a baseball hat on your head. With a poorly done or incomplete hair transplant, an interviewer might spend too much time looking at the hairline rather than in the eyes of the interviewee.

Society has stereotypes and a bald head is stereotypically a ‘hard’ look, the man’s man look. In the past, Hollywood actors have gone clearly bald (Yul Brynner, Telly Savalas), and they were tough character actors. Bruce Willis now joins that pack, but if he had transplants, unlike those bald men who could elect to let their hair grow in and not shave their head, Bruce Willis may not have that choice. His options may be limited if he wanted both hair and the opportunity to keep shaving his head.

Now to comment on your last inference, I am not buying a new Mercedes and I fully expect to keep driving my Toyota minivan, which seems to get me from here to there just fine. If it is short hair you want, don’t worry about my car payments as I have accounted for those choices already.