Sultan of scalp: one doctor peels back the skin to find a better cure for baldness

(Cole Wilson)

Dr. Carlos Wesley cues up some Carole King on his laptop and positions a head squarely in front of him. It’s been thawing for 24 hours, ever since arriving by UPS from a cadaver lab in Arizona that sells bodies donated to science. It’s now tender and looks frostbitten, with hair buzzed to a gray stubble.

“This was a 59-year-old woman,” says Dr. Wesley, looking down at the head. “I don’t know what the cause of death was, it should say somewhere on the box.” That box is only big enough to fit a head and packing materials: unlike most scientists and surgeons, Wesley isn’t interested in a cadaver’s internal organs or ligaments and bones. He’s only interested in the scalp.

It’s two in the afternoon, and a cloudless sky is beaming down over the Rocky Mountains south of Salt Lake City, Utah. Inside the sparse laboratory, the doctor’s blue scrubs are the only color amid the dull gleam of stainless steel tables. The air is odorless and artificially chilled. A Kevlar poster that reads “CoorsTek” — the name of the medical-device company whose lab we’re using for the day — has been hastily affixed to the wall prior to my arrival, for branding purposes.

As footloose folk-pop melodies fill the room, Wesley extends two fingers towards a small incision in the cadaver’s head and gently lifts a flap of skin. With his other hand, he picks up the piloscope, the invention he’s here to test: the device looks like a piece of AV equipment, a cross between a mic stand and a camera, with an Xbox-style controller of metal knobs and gears. He inserts its rodlike arm several inches into the cadaver’s scalp through the incision, and taps his foot on an attached floor pedal, like a sewing machine. A motor, located on the table beside him, makes a whirring sound.

After 10 minutes of intermittent whirring, Wesley lays down the device and unscrews the top of a closed Petri dish connected to the machine with a rubber tube. Pink, larval-looking hair follicles, sucked from inside the cadaver’s scalp, bob in saline solution. Wesley examines the specimens closely and looks up, triumphant. “These,” he exhorts, “are the shape we want!”

A highly regarded hair-restoration surgeon based in Manhattan, Wesley travels several times a year to Utah to spend a few days in the CoorsTek lab. There, he tests and tinkers with his piloscope, a device that’s consumed much of his attention (and financial resources) over the past five years. It’s the first-ever tool that can remove hair follicles from underneath a human scalp (pilo is Latin for hair). Wesley hopes that his creation catalyzes a new era of hair-transplant surgery, one devoid of the scarring that characterizes existing procedures.

That might seem like an incremental, unremarkable improvement, but it isn’t. Any step towards regaining a fuller head of hair without the evidence of scars, to the patients Wesley sees, is a monumental one. His calendar is filled with men coming to his office right after a breakup, their eyes bloodshot from sleepless nights scrolling through online forums like Hair Loss Help and Bald Truth Talk. They’ve become convinced that the way to restore a bruised ego and a broken heart (and maybe get a few dates) is by replacing lost hair.

"There’s no such thing as a hair emergency, but often times they make it seem like there is," says Wesley, 39, whose 6-foot frame, playful smile, and (yes) healthy crop of brown hair make him look less like a doctor than an actor playing one on TV. "Oftentimes," he says of his patients, "it’s clear a psychiatrist would be more effective."

"There’s no such thing as a hair emergency."

Wesley’s been doing hair transplants since graduating from Yale’s medical school nine years ago. After volunteering in Latin America as an undergraduate at Princeton, he’d originally wanted a job in the ER treating immigrant populations. But while working on his med-school thesis, Wesley came across research on hair follicle stem cells by a renowned New York hair surgeon named Dr. Walter Unger. After the two became friendly, Unger invited him to observe a few hair transplants. That turned into an apprenticeship, and Wesley found that he enjoyed the field’s relaxed pace and close relationships — doctors often spend all day with a single patient, and work with them over months and even years. He opened his own practice in 2007.

The Park Avenue office where Wesley sees patients is small and utilitarian. His diplomas hang on one wall, and a framed picture of Wesley dipping his wife, Anna, at their recent Malibu wedding sits on the bookshelf behind his desk. It’s here that Wesley spends hours doing consultations, trying to convey the benefits and limitations of existing hair-restoration options. Have patients tried Toppik, colored fibers you sprinkle over your bald spot? Or Propecia, a pill that stops balding in up to 88 percent of men? Maybe Rogaine, a topical foam applied twice a day to slow hair loss? Hair transplants, he tells them, can offer robust results in some patients — but can sometimes be accompanied by significant downsides. "You have to get them to see, is the benefit better than the risk?" Wesley says.

By 35, seven out of ten men will be losing significant amounts of hair (40 percent of women experience thinning too, but fewer go bald enough to consider surgery). Despite those statistics, hair transplants remain relatively unpopular: no one tracks the procedures exhaustively, but surveys suggest they trail behind nose jobs, breast implants, and liposuction, three of the most popular cosmetic surgeries.

In part, that’s because hair transplants never recovered in reputation after decades of so-so results. During the 1970s and 1980s, doctors grafted "plugs" of hair follicles from the back of the head to bald areas. The result often resembled doll hair: round clumps with spaces of scalp in between. By the 1990s, doctors were able to transplant individual hair follicles, achieving a more natural look. But to pull that off, they had to take a long strip of scalp from the back of the head to provide "donor" follicles, leaving patients with a swooping scar from ear to ear.

Doctors today still rely on that method, but some also use a technique called Follicular Unit Extraction (FUE). FUE involves removing follicles, one by one, using a tiny punch, and then transplanting them. The procedure doesn’t create one big scar, but it does create tiny, permanent white scars that can widen, and look noticeable enough that some men fill them in with tattoos. The small punches used for FUE can also strip follicles of protective tissue, meaning some portion of the transplant might fail entirely.

Those shortcomings leave a hole that hair transplant specialists are eager to fill, and they’ve got no shortage of ideas. At last year’s annual conference of the International Society of Hair Restoration Surgery (ISHRS), surgeons buzzed about a new robotic FUE machine called ARTAS and debated the merits of transplanting beard hair onto human heads. Another surgeon, Peter Panagotacos, told me that he’d successfully grafted pubic hair onto a patient’s scalp. And various doctors, including Wesley, are experimenting with a regenerative powder derived from pig bladder.

All of these developments are tracked eagerly on online hair-loss forums, where hundreds of people share news, recount details of their own hair-hacking regimens, and chronicle the shame and anxiety that can accompany both baldness and its existing surgical solutions. "Should have been slick bald by 26…if not for thinking outside the box and experimenting," writes "Stevo" on Hair Loss Help, listing some 30 tactics and treatments he currently undergoes (among them is "Indian needling," a process whereby one rolls a needle-embedded brush over the scalp). "I had a bigger scar than I expected," admitted another user, "Varonil." He adds that he considered shaving his head, but didn’t want to expose that he’d undergone surgery for baldness, "like it was something so horrible that it merited disfiguring surgery."

Wesley’s decision to enter his profession’s world of maverick experimentation, his "aha moment," he says, came in 2009. On his way home one evening, he was distracted by a subway ad with a picture of three bald heads. It was a shame, Wesley mused, that men who undergo hair surgery can’t shave their heads because of the scars. He wondered: Why does there have to be scarring at all? Was it possible to go beneath the surface of the skin to take out the follicles, eliminating the side effect that so many men were ashamed of? His mother, an immigrant from Mexico who’d grown up in a rough LA neighborhood before becoming a successful veterinarian, had always encouraged Wesley to take big risks. So when Wesley imagined what he might be able to do for his patients — restore their hair, and do it without the downsides — he became fixated on creating a device to accomplish just that.

Various doctors are experimenting with a regenerative powder derived from pig bladder

With Dr. Unger’s encouragement, Wesley got a job working nights at his friend’s wine shop, swapped frequent restaurant meals for a diet of homemade spaghetti, and put every extra penny towards bootstrapping the piloscope. He rented hysteroscopes, devices typically used to inspect uteri, because they were the "most affordable" existing tool with some similarities to his initial concept. From there, Wesley prodded around on cadavers (a practice that’s actually routine when testing new medical devices) and determined that you could insert a device into a layer of tissue below hair follicles but above nerves and blood vessels. When he scraped together enough money, he hired freelance engineers to help craft early prototypes. Two years and $200,000 later, he’d fashioned a crude device and was eager to try it on live scalps. By luring them with the promise of free FUE grafts, Wesley recruited five of his former patients and his brother-in-law to serve as guinea pigs in an experimental piloscopy session. That study showed that follicles extracted with Wesley’s device grew 45 percent better than those transplanted using FUE. From there, Wesley secured $2 million in seed funding and partnered with CoorsTek to refine the device.

At the ISHRS conference in October, Wesley introduced the piloscope to fellow hair surgeons. Within days, online hair-loss forums lit up with people seeking more information. "I heard from credible sources that Dr. Wesley’s technique is ‘amazing’ BUT there are still some barriers," wrote a user named "didi." "I think if this was something really interesting, we would have heard something by now," replied "Arashi." "Be patient guys," advised "Javert." "Maybe something will leak soon!"

Shortly after his presentation, Wesley was a guest on a popular podcast, The Bald Truth, where host Spencer Kobren mused that piloscopy — what Wesley calls the technique — may become the "new gold standard" in hair-transplant surgery. Over 1,000 people subsequently contacted Wesley to volunteer for his next clinical trial, which starts this month. Wesley plans to share the piloscope with a few of the industry’s top surgeons by 2015, make adjustments based on their observations, then release it more widely. He hopes the piloscope will be freely available to hair doctors by early 2016.

Despite the buzz, some doctors in the field still aren’t convinced that Wesley’s device will succeed. "Those of us who’ve been in scalps for a long time have lots of questions," says Dr. Carlos Puig, a Houston, Texas-based hair surgeon and former president of the ISHRS. He worries about surgical complications like hematoma (bruising) or other swelling that could lead to infection. And Dr. Jim Harris, a prominent hair transplant doctor near Denver, Colorado, is skeptical that surgeons will be able to access enough scalp from a single small incision, "which means more than one incision will be required," he said in an email. "This runs contrary to what the piloscope is all about."

But it’s actually Wesley’s mentor, Dr. Unger, who points out the piloscope’s biggest drawback: it still isn’t a perfect solution for patients who need a lot of hair transplanted. Much like FUE, piloscopy can only remove a limited number of follicles before it starts to create noticeable gaps in existing hair. "Dr. Wesley’s device," he says, "will at least eliminate the production of scars."

For many men, that might be enough. "I absolutely would have considered it," says one of Dr. Wesley’s patients, a man who requested anonymity in part because he didn’t want to draw attention to his thick, red scalp scar from an earlier procedure from a former doctor. "That peace of mind is irreplaceable."

"Clearly, this matters to a lot of people."

Back in the lab, Wesley grabs a fresh head to give me a side-by-side comparison of piloscopy and the standard FUE technique. He inserts the piloscope’s arm through an incision in the scalp, and carefully clicks and maneuvers for 15 minutes before switching to the other side of the scalp to core out follicles using a FUE punch.

Watching him concentrate, I wonder whether Wesley’s work in this little corner of science is worth it. After all, he estimates that piloscopy may cost a patient upwards of $20,000 out of pocket, and it isn’t exactly a life-saving procedure. Over dinner the night before, Wesley admitted he once pondered that question too — or at least worried that others were. When he first started in the field, his hands would shake and his face would turn red whenever people asked what he did. "When you go to these fancy schools," he said, "people expect you to go down a more traditional path." But over several years and hundreds of cases, Wesley found value in helping patients "just get on with their lives," even if he wasn’t saving them. "Clearly," he told me, "this matters to a lot of people."

After more drilling on the cadaver’s scalp, Wesley shows off the results for comparison. The side on which he’s performed FUE looks like the surface of a Parmesan cheese grater. Even though circulation had long since stopped, blood has risen to the surface of the holes — glistening pinpricks that would, in a living body, gradually harden into scars. The side where the hair follicles have been removed by the piloscope looks entirely untouched — exactly as Wesley had intended. "And that," he says, pulling off his goggles with a smile, "was my equivalent of a fireworks show!"

Photography by Cole Wilson.