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

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

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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!"

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

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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.

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Does Your Hair Really Change Every 7 Years? | HuffPost

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Does Your Hair Really Change Every 7 Years? | HuffPost

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(Photo: Delphine Achard/WWD)

If you've ever run your fingers through your hair and thought to yourself, Gosh (yes, gosh) my hair feels different than it did when I was a kid...or in high school...or even college, you are not alone. I often think back to the days of my thick, shiny golden pigtails (and later, my glorious adolescent hair flip) and sigh as I comb hair that now feels fine and wispy. And for years, I've accepted the explanation I get from stylists that about every seven years, your hair changes. But this week I finally got to the root of the matter (forgive the pun). I spoke to Carlos Wesley, a cosmetic surgeon and hair loss specialist in New York City, to find out more about the hair growth cycle.

First, a quick biology lesson. There are three phases in the hair-growth cycle: The anagen phase, when the hair is actively growing; the catagen phase, a transitional stage in between the growth and resting stages; and the telogen, or resting, phase, when the follicle is dormant for up to four months and eventually sheds its strand of hair so that a new one can enter the anagen phase.

"We are born with 100,000 hair follicles on our head that are all preprogrammed to go through a certain growth cycle," explains Wesley. "The typical cycle is about four to seven years." But this is only true for the first couple of cycles. As your hair naturally sheds, the anagen phase becomes shorter and the hairs that grow back are a little different. "They are thinner, in smaller bundles, and their growth phase is shorter," says Wesley. Bundles, you ask? Each follicle actually contains small bundles of hair strands. These bundles include anywhere from one to four individual strands of hair. "When we are born all of our hair is in bundles of one, but as you grow up they become two-, three-, and four-strand bundles," says Welsey. "Your hair bundles peak at around 12 years old." Then, sadly, as you age, bundles of four become bundles of three, bundles of three become bundles of two, and it's all downhill from there. End result: hair appears thinner and less full.

Approximately 100 hair shafts fall out every day, so hair follicles are constantly in different stages of the hair cycle, and what's more, different parts of the scalp age differently. So while it is true that your hair changes consistently over time, the seven year cycle applies to less and less of our head as you age. "As time goes on, the part of our hair that cycles every seven years is increasingly restricted to the back of our head," says Wesley.

In the end, says Wesley, the seven-year cycle is actually the best we can hope for. What can we do to extend the anagen phase? Avoid stress. "Stress can shorten and precipitate hair loss, pushing a high percentage of hair follicles into the telogen phase," he says. He also recommends a healthy diet full of protein and iron.
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Does Your Hair Really Change Every 7 Years?

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(Photo: Delphine Achard/WWD) If you've ever run your fingers through your hair and thought to yourself, Gosh (yes, gosh) my hair feels different than it did when I was a kid...or in high school...or even college, you are not alone.

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New Treatments for Thinning Hair for Women - The New York Times

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New Treatments for Thinning Hair for Women - The New York Times

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Skin Deep

After 20 years of trying every drug, supplement, diet and procedure for hair loss - including driving four hours twice a week for laser therapy - Lina Telford, a graphic artist, gave up on her "comb over" (her description) and shaved her head. From then on, she alternated between a $1,500 wig and a $4,000 wig.

"When you hear people complain about having a bad hair day, you almost can't bear it," she said. "You're like, 'Honey, you have no idea.' "

In February, though, Ms. Telford, 46, flew from her home in London, Ontario, to Sarasota, Fla., for a new $1,400 hourlong treatment known as platelet rich plasma (P.R.P.), which is said to stimulate dormant hair follicles. The procedure involves drawing blood, spinning it in a centrifuge to extract the plasma, adding various nutrients (like more protein), then injecting the resulting mixture in one-inch intervals in a grid on the top of the scalp, which has been numbed with a local anesthetic.

Like the long-suffering friend who inspired her to undergo the procedure, Ms. Telford quickly saw an improvement in her hair. New hair growth usually take at least four months, but at the two-month mark, she has already spotted some baby hairs. "Not a gazillion," she said, "but it's a start." She's planning to return for follow-up treatments every six months, and has high hopes of ditching the wigs and wearing her hair in a pixie.

Joseph Greco, Ms. Telford's practitioner, who shares a patent for a process to remove growth factors from platelets, said he gets results in 80 percent of patients, more than half of whom are female. Roughly half of them fly in and out, often on the same day, he said, because the procedure doesn't require downtime and has minimal side effects. (Small clinical studies suggest further research is necessary but acknowledge the procedure's "excellent safety profile.")

P.R.P. is one of a number of new hair-loss treatments being marketed to women, who suffer hair loss in fewer numbers but often more acutely than men because, for them, hair loss is less socially acceptable, and historically they have had fewer and less potent medical solutions.

Some 30 million women in the United States have hereditary hair loss (compared with 50 million men), according to the American Academy of Dermatology, though that figure does not include the millions more who struggle with thinning hair because of pregnancy, menopause, stress and other health conditions. Barely 5 percent of women are said to be good candidates for hair transplant surgery because women lose hair everywhere, meaning that, unlike with men, there is rarely a luxuriant spot on the back of the head from which to harvest hairs unobtrusively.

Dr. Carlos Wesley, a hair restoration surgeon in Manhattan, said that women in his practice respond better to P.R.P. than men do, which may have something to do with the fact that women with genetic hair loss tend to have more inflammatory cells around the follicles. From 2013 to 2014, he said, he had an 83 percent increase in female patients, in part because of P.R.P.

P.R.P., considered a nonsurgical treatment, is not covered by insurance, and clinical studies about its effectiveness (and longevity of results) are not conclusive because different doctors use different mixes. But P.R.P. has a long (though also inconclusive) history of use elsewhere in the body. Athletes like Kobe Bryant have received the treatment in an attempt to heal injuries.

"It's extremely promising," said Spencer Kobren, founder of the independent American Hair Loss Association, "but I don't want to say it's the greatest thing since sliced bread." Because P.R.P. varies so much, it can be hard to know what one is getting, and some doctors "ride on the vulnerability of women," he said.

Drugs for hair loss have been slow in coming because researchers are unable to grow hairs in petri dishes to use for screening. Hair drugs approved so far were serendipitous finds: side effects of compounds used to treat other conditions.

Drugs for female hair problems are even slower to develop, in part because it's easier to do measurements and hair counts on men in clinical trials.

Finasteride, better known by the brand name Propecia, is not approved by the Food and Drug Administration for women. (Because it works on hormones, it is also controversial for them.)

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From left: Latisse, Rogaine's new 5 percent minoxidil formulation for women, and Pantene Hair Regrowth Treatment for Women.

But in November, after 10 years of research, Rogaine introduced a new 5 percent minoxidil formulation for women. It's a mousse (instead of a liquid) that needs to be applied only once a day instead of twice, which means that it can be more easily incorporated into a woman's evening skin-care routine. Teal replaces the blue and silver palette of the men's Rogaine, and the packaging bears a lotus flower. (Also last year, Pantene introduced its Hair Regrowth Treatment for Women, which is 2 percent minoxidil.)

Angela Ledford, 34, a beauty blogger, had used the Rogaine men's formulation, after hair extensions, M.A.C. Black Carbon eye shadow, Joan Rivers hair fill-in powder and supplements all failed to hide her thinning jet-black hair. (The men's product was not F.D.A.-approved for women, but that didn't stop women from buying it.)

"I'm not worried I'm going to sprout a mustache anymore," Ms. Ledford said of her switch to the women's product, which doesn't drip down the face. Recently she watched a video blog of herself in which she looked down and was pleased to note baby hairs sprouting "all over my scalp," she said.

Dr. Melissa Piliang, a dermatologist at the Cleveland Clinic, said that Rogaine works better on the top and crown (for reasons not fully understood, the frontal hairline tends to be more resistant to treatment) and ideally should be started as soon as women notice thinning. "Any regrowth you get is a minimal amount," Dr. Piliang said. "So the more density when you start, the better results you get."

Latisse, a prescription medication used since 2008 to grow longer, fuller eyelashes, is now being tested for the scalp. (Doctors report that patients have tried it on their own, but a limiting factor is that Latisse comes in a very small bottle; it doesn't go very far.)

Dr. Piliang said she expects Latisse's results to be less striking on the head than on the lashes because the drug works by shifting more hair from the resting phase to the growing phase. For lashes, only about 30 percent of the hair is in the growing phase at any given time, she said, but on the scalp, that figure is 80 or 90 percent.

Some treatments in development hold particular promise for women. Angela Christiano, a hair geneticist and Columbia University professor of dermatology, is hoping to begin clinical trials in a year or two on a procedure in which she dissects hair-follicle stem cells, grows them in the lab until she has several million, then injects them into the scalp, where, a very small study done with a human skin model has shown, they induce new hairs.

This stem cell therapy needs only a dime-size donor spot on the scalp: 50 to 100 hairs, as opposed to the bloody, painful four-to-five-inch strip of 1,000 hairs typically required for a hair transplant.

"It's been, I would say, kind of the holy grail in the field to be able to find something that is less invasive, less surgically intensive and can capitalize on the natural properties of these hair stem cells," said Professor Christiano, who herself suffers from alopecia areata, an autoimmune disease that causes partial or total hair loss.

Her hope is that the procedure (she has helped start a company named Rapunzel to develop it) will eventually become another lunchtime cosmetic treatment. Once a patient has had her cells harvested and cultured, they could be stored indefinitely; then, after giving her doctor a month's notice (the time it takes to grow the million needed), she could pop in for injections. Costs would likely be on par with hair transplants, roughly $10,000 and up.

Laser treatment companies, which claim their devices can reverse shrinking of the follicles, stimulate hair growth and more, are also targeting women with caps and combs. For example, the $895 Theradome, a cap that looks like the top of a bike helmet, has been cleared by the F.D.A. for women. Users wear it for 20 minutes twice a week.

If that sounds a little too much like a late-night infomercial, consider that Dr. Shani Francis, a dermatologist in Skokie, Ill., often recommends laser treatments in conjunction with minoxidil in her practice, which is 90 percent female.

Skeptics (among them, Dr. Wesley) are starting to come around after a 2014 randomized double-blind study published in the American Journal of Clinical Dermatology found a "statistically significant" difference in hair density for women who used a laser comb compared with those who used a sham device. ("Comb" is something of a misnomer. The device looks like a hairbrush crossed with a cordless phone; it is glided back and forth across the scalp, roughly a half-inch at a time, usually about 15 minutes three times a week.)

Some of Dr. Piliang's patients took part in the study, but in her practice as a whole she hasn't seen similar results from the combs, perhaps because of a lack of compliance.

"It's some effort to use these things," she said. "I tell patients it definitely won't work if it sits in your drawer."

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New Treatments for Thinning Hair for Women

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Skin Deep After 20 years of trying every drug, supplement, diet and procedure for hair loss - including driving four hours twice a week for laser therapy - Lina Telford, a graphic artist, gave up on her "comb over" (her description) and shaved her head.

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6 Reasons You Actually Do Need to Wash Your Damn Hair | Allure

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6 Reasons You Actually Do Need to Wash Your Damn Hair | Allure

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Three days, five days, a week... The number of days one goes without washing their hair and just getting by with dry shampoo has become a point of pride these days. We even hear colleagues brag about how many workouts their most recent blowout has lasted through. (Congrats?) But even though over-washing is indeed harsh on strands and can strip their natural moisture, experts tell us that, depending on your hair texture, there actually can be such as thing as going too long between suds. Without regular shampooing hair can become lackluster, smelly, and worse. So, today, in honor of National Shampoo Day (which falls on either the twentieth, twenty-first, or twenty-second day of October-the true date of the made-up holiday is a point of contention in the beauty industry), we asked hairstylists, colorists, dermatologists, and hair experts for the quick and dirty on coming clean.
1. Shampoo Is, You Know, Basic Hygiene
How do you like the sound of "microfauna" in your hair? Us, neither.

"Sebum, which is nature's hair conditioner, is constantly secreted out of the scalp and onto the hair, and it will build-up without washing. This can leave the hair looking and feeling oily, but worse still, this sebum can act as a food source for microfauna whose action can lead to dandruff and, in extreme cases, can cause hair loss. In addition, product build-up residue from conditioning and styling ingredients will also occur without washing, which collectively can dull the hair and weigh it down. A good cleaning with a good shampoo will prevent all of these issues. In short, this new 'no poo' movement really is a crock of .... well, poo."- Trefor Evans, cosmetic chemist and technical consultant to the hair-care industry
2. It Acts Like Skin Care
You know what happens when you don't wash your face-and the same goes for your scalp.

"Dry shampoo will bind and pull the oil away from the scalp, but doesn't remove it and can leave hair dry. That, along with dead skin on the scalp, and hair products, like oils and volumizers, need to be removed intermittently, otherwise they can block follicles and lead to inflammation. Some newer shampoos are even designed to strengthen the hair. My favorite is Julien Farel Hydrate Restore, which includes resveratrol and antioxidants, and sits on the scalp for a few minutes before rinsing."- Doris Day, a New York City dermatologist
3. It's the First Step in Style
Every good blowout starts in the same place: the shampoo bowl.

"Using the right shampoo for your hair type resets hair and gives you a good foundation for any style. If you have thin hair, a volumizing shampoo cleanses hair of volume-deflating build up, while a shampoo for thick coarse hair is designed to hydrate and coat the cuticle to weigh down flyaways. And if you were to skip shampoo altogether, your hair wouldn't be prepared to hold the style you're looking to achieve. Lastly, it's plain-old good hygiene. No one wants to talk to someone whose B.O. enters the room before they do, and no amount of fragranced dry shampoo is truly going to mask it."- Greg Ruggeri, stylist, colorist, and owner of Salon Ruggeri in New York City
4. Healthy Hair Starts at the Roots
The health of your scalp directly translates to the health of your hair.

"Since skin turns over approximately every 28 days, the build up of [dead skin] scales can grow more pronounced if you don't wash your scalp. Washing hair has been shown to significantly reduce the level of the stress hormone, cortisol, in hair follicles and this hormone has been associated with increased hair thinning in women. Female patients often admit they're afraid to wash their scalp because they see hair in the shower drain afterwards. But we normally have about 100 hairs fall out every day and about 100 hairs grow back, so the more days we wait, the larger the number of dislodged hairs grows. Regular cleaning with well-formulated shampoo will not damage hair. In fact, some studies show that it may help fragile hair by decreasing grooming force."- Carlos K. Wesley, a New York City-based cosmetic surgeon specializing in men's and women's hair loss
Celebrity hairstylist Christophe Robin lists the most common mistakes women are making with their hair color. 5. It Makes Hair Color More Vibrant
When you drop bank on your color appointments, you want to make it last.

"As a colorist, I have a love-hate relationship with shampoo. The wrong one can destroy your color, but with the right one you can gain a lot of benefits. If you highlight your hair, washing the oil out makes your color seem brighter; I always get the most color compliments when my hair is clean. I like Christophe Robin Color Fixator Wheat Germ Shampoo. For dark hair, a tinted shampoo like Davines Alchemic Shampoo Chocolate for brunettes and Davines Alchemic Shampoo Copper for redheads can help keep your color looking fresher longer. For those with an oily scalp keep those pores clean! I recommend

which is, of course, color safe."- Sarah Spratt, a colorist at Takamichi Hair in New York City
6. It's Not Out to Damage Your Hair
Rather than blaming shampoo for breakage, tweak your conditioning, heat styling, and brushing routines.

"If you're a daily washer, the key is choosing the right shampoo and conditioner to get your hair and scalp clean without over-stripping. The deciding factor should be how your scalp produces oil and sweat, and if it's prone to irritation. Using a great conditioner and minimizing heat treatments like blow drying, curling, and flatironing also prevents breakage and damage. I'm a big fan of Davines, which is natural and produced sustainably. Another point people don't pay enough attention to is how they brush after washing. By not tugging on wet hair while brushing it, you minimize breakage and stretching of the hair shaft, which ultimately makes it weaker. I've been converted to using

after years of trying to detangle my wavy hair. It's a serious game changer. "- Erin Gilbert, a dermatologist in New York City
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6 Reasons Why You Actually do Need to Wash Your Damn Hair

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Three days, five days, a week... The number of days one goes without washing their hair and just getting by with dry shampoo has become a point of pride these days. We even hear colleagues brag about how many workouts their most recent blowout has lasted through. (Congrats?)