Introduction

Elon Musk is a renowned business magnate, engineer and industrialist who founded SpaceX and Tesla, co-founded Neuralink and OpenAI, and was ranked by Forbes as one of the most innovative leaders of 2019. In 2020, his net worth was estimated to be in excess of USD $93 billion. There is no doubt that Elon Musk is a visionary -  he has ambitious plans for all-electric cars (Tesla), high-speed travel tunnels (Hyperloop), cost-effective primary rockets (SpaceX), and brain-computer interfaces (Neuralink). Elon Musk has indeed achieved significant growth since his departure from PayPal in 2000 when he was ousted from his role as CEO because of disagreements with other company executives. However, there is another interesting difference between the Elon Musk of 2000 and the Elon Musk today. Looking at the image below, we can see that in 1998, just 2 years before his departure from PayPal, Elon Musk had extremely thin hair and a receding hairline which was characteristic of androgenetic alopecia (male-pattern baldness). On the right side of the same image, in 2018, Elon Musk is pictured with a full head of hair that is denser. 

How did Elon Musk achieve these staggering results? One could argue that Elon Musk appeared to be older in the picture taken in 1998 – a full 20 years before the picture on the right! It is indisputable that Elon Musk has reversed his hair loss. The million-dollar question is – how?

Alopecia is an extremely common cause of hair loss in both men and women; the most common type of alopecia is that of androgenetic alopecia which is an inherited disorder that affects up to 50% of all adult men and women

Did Elon Musk Have Hair Transplant?

Hair transplants are relatively safe surgeries which are associated with few complications, if any. Hair transplants are a novel and continuously evolving cosmetic surgery with an increasing popularity as people become more self-aware of their image and invest more in their physical appearance [2]. There are two ways in which a hair transplant can be conducted. The first of these is known as a follicular unit transplantation (FUT), and the second is known as a follicular unit extraction (FUE). In FUT, the aesthetic physician removes a strip of donor skin and extracts individual follicular units from it for transfer to the area of hair loss. However, in FUE, the individual follicular units are excised directly from the scalp.  Of these, FUE is the more popular choice because the surgeon can harvest more follicular grafts and there is less post-operative pain and healing time [3].

Although hair transplants in the past were characterised by a mild-moderate degree of pain, they are virtually painless today because of the widespread adoption of the FUE technique. Indeed, one 2019 study found that post-operative pain was significantly reduced in patients undergoing the FUE method as opposed to the FUT method, and that pain had disappeared by the first post-operative day [4]. Because of sophisticated anaesthetic techniques, patients hardly feel any pain during the transplant itself. Post-operatively, patients can expect some degree of swelling which progressively relieves by itself within 3 to 5 days. Some surgeons prefer to prescribe patients with oral steroids to accelerate the relief of swelling and some also prescribe patients with a headband to prevent the swelling from coming down to the face and manifesting as puffiness. Even though hair transplants are generally safe and effective, they are remarkably expensive. The cost of a hair transplant can range from anywhere between USD$8,000 to a staggering USD$40,000. Elon Musk is likely to have had his hair transplant performed by a leading hair transplant aesthetic physician in the Beverly Hills. The Beverly Hills has several high-ranking physicians who are considered to be eminent in their fields, and is also conveniently situated in Los Angeles where Elon Musk resides.

Looking at the image below which was dated in 2018, it is suggested that Elon Musk underwent a hair transplantation procedure (i.e. FUT or FUE). This is because we can see the demarcation of the donor site from which hair follicles were harvested. This area is pointed out with a red arrow.  

When deliberating whether Elon Musk underwent an FUE or FUT, it is prudent to note the differences between the two processes. The majority of men prefer an FUE as there is no linear scar left behind, as there is no stripping of skin. In Elon Musk’s case, we can see a thin linear scar (marked out by a red arrow) which is indicative of a previous FUT. FUE allows for men to wear their hair short because of the minimal scarring. 

However, that is not to say that FUT has no advantages either. FUT is appropriate for men who require a larger number of follicular grafts and is overall a shorter procedure that takes between 4 and 8 hours. An FUT is also more affordable than an FUE.

Comparing Elon Musk to another tech-billionaire, it is interesting to note that Jeff Bezos – CEO of Amazon, has not had a hair transplant and remains completely bald till date. One reason for this, could be that Jeff started to go completely bald in the late 90s to early 2000s, and had no hair follicles to begin with for the harvesting. Remember – both the FUE and FUT hair transplantation procedures involve the harvesting of healthy hair follicles (usually from the back of the head) for subsequent transplant onto the target areas. Another reason could be simply that Jeff Bezos prefers to remain bald. After all, he does keep a good appearance despite being bald and has a trim physique that complements his hairless disposition. 

Will His Hair Fall off after Some Time?

Even though Elon Musk underwent an FUT, it is not a guarantee that he will continue to have thick and luscious hair forever. Indeed, the FUT transplant only replaces hair follicles that have already been lost, by harvesting them from the back of the scalp and transplanting them to areas of hair loss. However, the FUT procedure cannot entirely protect these hair follicles from future male-pattern baldness. This is because the hormonal changes which drive male-pattern baldness can certainly affect the transplanted hair follicles as well.

Did Elon Musk Use Minoxidil and Finasteride?

The most popular medications that are used for hair loss reversal are Minoxidil and Finasteride. Minoxidil was developed in the 1970s as a potential therapeutic drug for hypertension but was observed to cause abnormal hair growth as a side-effect. It was later taken advantage of for its hair-growth stimulating properties and has since been marketed as a topical solution for the reversal of male-pattern baldness. The chemical derivative of minoxidil is 2,4-diamino-6 piperidino-pyrimidine-3-oxide; this drug open potassium channels on smooth muscle cells which comprise the arteries. The influx of potassium ions into the smooth muscle cells causes the arteries to dilate, thereby increasing blood flow [5]. This explains why Minoxidil was first marketed as an anti-hypertensive drug in an endeavour to reduce mean arterial blood pressure. Most studies in the literature have assessed the efficacy of Minoxidil in the treatment of androgenetic alopecia [6]. One randomized, placebo-controlled, double-blind study conducted in 2018 demonstrated that Minoxidil was safe and effective in stimulating scalp hair growth in men with male-pattern baldness [7].

Another medication is Finasteride – a 5-alpha reductase inhibitor. Finasteride inhibits the 5-alpha reductase inhibitor which is present in sebaceous glands and hair follicles. It slows hair loss, but does not completely halt it, because it does not lead to a 100% reduction in dihydrotestosterone (DHT), the hormone responsible for driving androgenetic alopecia. Nevertheless, the evidence suggests that finasteride promotes scalp hair growth and can prevent the progression of hair loss in a significant proportion of men [8, 9]. 

Despite the relative success of these drugs however, it is unlikely that Elon Musk relied on them solely. This is because even though Minoxidil and Finasteride are extremely affordable, effective, and safe, they require months for results to be achieved. In some cases, they also require sustained application/ingestion for the results to be maintained. Elon Musk as a billionaire with a busy lifestyle would have preferred a one-time solution with more longer lasting effects. It is likely that he used Minoxidil and Finasteride as supplements to a more definitive therapeutic modality such as a hair transplantation. 

In fact, Minoxidil and Finasteride are used by aesthetic physicians as complementary treatments to hair transplant procedures. One commonly encountered complication in FUT and FUE is donor hair effluvium. This complication is also known as donor shock loss and is characterised by dramatic hair loss after the transplant. Physicians use Minoxidil, Finasteride as well as steroids immediately after the procedure to speed up recovery or to prevent the complication entirely [2]. 

Platelet-Rich Plasma (PRP)

PRP involves concentrating and administering platelets which are found in one’s whole blood, and promotes cell growth, survival, and vascularity. Although PRP has traditionally seen merits in dermatology for its efficacy in treating aging skin, scarring and acne, researchers from the University of Toronto only recently published a systematic review on its efficacy in hair restoration. 3-monthly PRP injections in patients with androgenetic alopecia were found to be more efficacious than placebo as regards to hair density [11]. Studies have shown that just 3 treatment sessions that are 1 month apart can produce positive results which persist for up to 24 months! These results can be seen as early as 3 months after the final treatment session [12]. The most common side effect reported by patients undergoing PRP is that of temporary pain at the injection site. However, there are no major adverse effects reported [12]. Despite the novelty of PRP as a therapeutic modality for hair loss, it is unlikely that Elon Musk underwent it. This is because PRP is a recent technique which has only just begun to achieve popularity as the landmark PRP trials concluded in 2012 and 2013 [13, 14]. Furthermore, before the PRP itself, patients must have their blood harvested and processed to isolate the PRP proper. This can require multiple in-clinic visits which can be inconducive for someone with a busy professional lifestyle like Elon Musk. 

Was his hair recovered on its own?

Hair loss is frequently reported by humans during periods of excessive stress [15, 16], and studies have found that stress can shift the immune response to an extent that hampers hair growth [17]. In other words, stress and reduced mood alone can slow hair growth. Even though Elon Musk must have led an understandably stressful life, his hair loss in 1998 cannot be attributed to stress alone. This is because Elon Musk sold PayPal in 2002 and yet, continued to have persistent hair loss. One could argue that Elon Musk had even more monumental stress in his later adult life when SpaceX was hampered with multiple failures. Yet, Elon Musk continued to have a healthy head of hair despite this. 

In fact, if we analyse Elon Musk’s hair in the late 90s, it is obvious that he had a typical male hair loss type of baldness. Specifically, his hair loss was a Hamilton Norwood Scale 4. Had Elon Musk failed to intervene then, he would very likely be at a Hamilton Norwood Scale 6 by now. 

However, other systemic conditions which can result in mood changes have been shown to drive hair loss. For example, iron deficiency, hypothyroidism (low thyroid hormone levels), Vitamin B6 deficiency, copper deficiency and niacin deficiency can result in hair loss. Several Americans have a suboptimal diet and do not obtain their recommended daily requirements of protein, folate, niacin, iron, zinc, vitamins (A, D, E) and biotin. Other systemic conditions such as polycystic ovarian syndrome (in females) and chronic inflammatory diseases (e.g. Crohn’s disease, rheumatoid arthritis, and multiple sclerosis) can cause persistent hair loss even if one’s nutrition is optimised.

Nevertheless, it is unlikely that Elon Musk suffered from these nutritional deficiencies and systemic conditions. As a billionaire, it is likely that Elon Musk has access to the best medical and dietary care, and is followed up at least annually to ensure that he has a clean bill of health. Steve Jobs’ unexpected passing from silent pancreatic cancer has probably galvanized the ultra-wealthy to take their health seriously and to undergo regular screening to detect anything awry. 

Conclusion

Elon Musk is a representation of the promise of what the future holds. His genius is unparalleled, and he is driving several technological advances which span transport, neurobiology, artificial intelligence, and rocket science. However, he too was not spared from androgenetic alopecia, a condition which affects millions of American men and women. Looking at his before and after photos which are two decades apart, it is indisputable that Elon Musk was successful in reversing his hair loss. In this article, we explored several evidence-based strategies for reversing hair loss.

Medications such as Minoxidil and Finasteride are accessible and effective and remain extremely viable and safe options for the vast majority of men who are seeking remedies for their androgenetic alopecia. Even though hair transplant procedures can offer quicker results, they demand a significant upfront capital and are not without their side-effects (e.g. pain) and need to use minoxidil for some time to main the results. Elon Musk was likely to have undergone a hair transplant procedure because of the minimal down-time and the one-time effort/cost required. PRP is a novel technique which has just begun to enjoy popularity. It is unlikely that Elon Musk underwent PRP because of the need for multiple in-clinic visits and its unproven efficacy at that time. 

Interested in knowing more about Elon Musk's hair transplant? Be sure to read Matt Dominance's "Elon Musk Hair Transplant Analysis". It gives in depth analysis on the hair transplant that brought Elon Musk's hair to where it is now. 

References

1.            Mysore, V., et al., Expert consensus on the management of Androgenetic Alopecia in India. International journal of trichology, 2019. 11(3): p. 101-106.

2.            Kerure, A.S. and N. Patwardhan, Complications in Hair Transplantation. Journal of cutaneous and aesthetic surgery, 2018. 11(4): p. 182-189.

3.            Khanna, M., Hair transplantation surgery. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 2008. 41(Suppl): p. S56-S63.

4.            Kim, Y.S., Y.C. Na, and J.H. Park, Comparison of postoperative pain according to the harvesting method used in hair restorative surgery. Archives of plastic surgery, 2019. 46(3): p. 241-247.

5.            Haddy, F.J., P.M. Vanhoutte, and M. Feletou, Role of potassium in regulating blood flow and blood pressure. Am J Physiol Regul Integr Comp Physiol, 2006. 290(3): p. R546-52.

6.            Varothai, S. and W.F. Bergfeld, Androgenetic alopecia: an evidence-based treatment update. Am J Clin Dermatol, 2014. 15(3): p. 217-30.

7.            Blume-Peytavi, U., et al., Efficacy and safety of a new 5% minoxidil formulation in male androgenetic alopecia: A randomized, placebo-controlled, double-blind, noninferiority study. J Cosmet Dermatol, 2019. 18(1): p. 215-220.

8.            McClellan, K.J. and A. Markham, Finasteride: a review of its use in male pattern hair loss. Drugs, 1999. 57(1): p. 111-26.

9.            Inadomi, T., Efficacy of Finasteride for Treating Patients with Androgenetic Alopecia who are Pileous in other Areas: A Pilot Study in Japan. Indian journal of dermatology, 2014. 59(2): p. 163-165.

10.          Nusbaum, B.P., Techniques to reduce pain associated with hair transplantation: optimizing anesthesia and analgesia. Am J Clin Dermatol, 2004. 5(1): p. 9-15.

11.          Gupta, A.K., et al., The Efficacy of Platelet-Rich Plasma in the Field of Hair Restoration and Facial Aesthetics-A Systematic Review and Meta-analysis. J Cutan Med Surg, 2019. 23(2): p. 185-203.

12.          Stevens, J. and S. Khetarpal, Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol. International journal of women's dermatology, 2018. 5(1): p. 46-51.

13.          Trink, A., et al., A randomized, double-blind, placebo- and active-controlled, half-head study to evaluate the effects of platelet-rich plasma on alopecia areata. Br J Dermatol, 2013. 169(3): p. 690-4.

14.          Li, Z.J., et al., Autologous platelet-rich plasma: a potential therapeutic tool for promoting hair growth. Dermatol Surg, 2012. 38(7 Pt 1): p. 1040-6.

15.          Plikus, M.V., et al., The circadian clock in skin: implications for adult stem cells, tissue regeneration, cancer, aging, and immunity. J Biol Rhythms, 2015. 30(3): p. 163-82.

16.          Hadshiew, I.M., et al., Burden of hair loss: stress and the underestimated psychosocial impact of telogen effluvium and androgenetic alopecia. J Invest Dermatol, 2004. 123(3): p. 455-7.

17.          Peters, E.M.J., et al., Hair and stress: A pilot study of hair and cytokine balance alteration in healthy young women under major exam stress. PloS one, 2017. 12(4): p. e0175904-e0175904.