HAIR TRANSPLANTATION IN WOMEN
Hair loss occurs in women as well as in men, and increasing numbers of women seek medical or surgical treatment for thinning hair. The time is long past when women were unwilling to recognize their hair loss, or accept it as an inevitable consequence of aging.
Hair transplantation is a hair-loss treatment option chosen by many women whose loss of hair has a hereditary basis-the type known as female pattern hair loss. Like male pattern hair loss, female pattern hair loss is genetic in origin and “runs in the family”. It is the most common form of permanent hair loss in women. See female hair loss to read more about reasons for hair loss in women).
Be Certain About the Cause of Hair Loss
No treatment for a woman’s hair loss should be undertaken until the cause and permanence of her hair loss is diagnosed with certainty. While hereditary female pattern hair loss is the most common cause of permanent loss of hair in women, there are other causes of both permanent and temporary hair loss that should be ruled out before hair transplantation is undertaken.
Hair transplantation is not an option for treatment of temporary hair loss. Temporary hair loss should never be treated by hair transplantation or other surgical intervention.
Hair transplantation may be a treatment option for some non-pattern causes of permanent hair loss such as physical trauma to the scalp, but female pattern hair loss is the most frequent indication for hair transplantation in women. No treatment should be undertaken until the patient thoroughly understands the rationale for treatment.
What Causes Hair Loss in Women?
Androgenetic alopecia-inherited pattern hair loss-is the most common cause of permanent hair loss in women as it is in men. Female pattern androgenetic alopecia usually occurs as diffuse thinning of hair rather than the frank baldness often seen in men. However, patterns in hair loss vary greatly in women and every case of hair loss in women should be considered for individual diagnosis. Correctly diagnosed hair loss can usually be treated medically or surgically.
Other common causes of hair loss in women include:
- Alopecia areata-patchy loss of hair from the scalp and sometimes eyebrows or other hair-bearing areas of the body; thought to be due to an autoimmune disorder. Hair loss can be episodic and recurrent.
- Traction alopecia-hair loss associated with consistent traction pressure on hair follicles, as may occur with tight braiding or corn-rowing of hair.
- Trichotillomania-compulsive hair plucking, believed sometimes associated with emotional stress or a psychological disorder.
- Telogen effluvium-unusually accelerated hair loss that may have hormonal, nutritional, drug-associated or stress-associated causes.
- Loose-anagen syndrome-a condition in which scalp hair is easily pulled out by normal combing or brushing; more common in fair-haired individuals.
- Triangular alopecia-due to unknown cause, hair is lost from areas around the temples.
- Scarring alopecia-caused when physical trauma or burns damage scalp hair follicles. Traction alopecia can lead to scarring alopecia.
Remember that most female hair loss can be treated medically or surgically, but successful treatment requires correct diagnosis by a physician hair restoration specialist.
For more detailed information on causes of female hair loss, see female hair loss.
As noted in the discussion in female hair loss, hair loss in women can sometimes have an underlying hormonal or dermatologic cause, or be associated with severe emotional or physical stress. When such an underlying cause is suspected, a physician hair restoration specialist will refer the woman to an appropriate medical specialist for further examination and diagnosis. Hair loss can be a first sign or symptom of an underlying medical condition.
Appropriate treatment of an underlying medical condition may resolve the problem of hair loss, and no treatment for hair loss will be indicated. Some causes of temporary hair loss-such as hormonal changes during pregnancy-will resolve spontaneously. When a prolonged period of temporary hair loss seems likely-for example, while a woman undergoes prolonged treatment for a medical condition such as cancer-the patient may consult a physician hair restoration specialist regarding a full or partial temporary hair prosthesis.
When is a Woman with Female Pattern Hair Loss a Good Candidate for Hair Transplantation?
After it is determined that a woman’s thinning hair is due to female pattern hair loss and no other cause, hair transplantation can be considered as a treatment.
When is a woman a good candidate for hair transplantation? The criteria for candidacy are largely the same for both women and men, with some specific considerations that apply more often to women than to men. The best approach to the question is open and honest discussion between the woman and the physician hair restoration specialist.
A woman should not be “sold” hair transplantation as a hair-loss treatment; she should choose it as a treatment only if she fully understands the reasons for the physician’s recommendation. Neither should a woman “push” for hair transplantation that the physician is unwilling to recommend. The decision to undergo hair transplantation should be made on the basis of the physician’s professional judgment after complete examination of the patient, and full and honest discussion between patient and physician regarding cost, time, details of the procedure, potential side effects and complications, and anticipated result.
Hereditary hair loss patterns differ in women as compared to patterns in men. Hereditary hair loss in women tends to be more diffuse than in men, presenting as areas of patchy thinning rather than the areas of total hair loss more common in men.
The extent and rapidity of patchy hair loss are considerations in determining whether a woman is a good candidate for hair transplantation.
The physician hair restoration specialist will use scalp examination as well as the patient’s personal and family history to determine (1) whether there will be enough donor hair currently and in the future to make transplantation a viable treatment option, and (2) if hair transplantation is undertaken, will the result meet the patient’s expectations for cosmetic improvement? Inadequate donor hair could rule out hair transplantation as a viable option for female hair loss treatment. In some women, for example, the diffuse pattern of hair loss is widespread and rapidly advancing, and this may make it difficult for the physician hair restoration specialist to find scalp hair that is dense enough to provide adequate donor hair (the hair that is taken from one site on the scalp and transplanted to a balding recipient site).
Other scalp and hair characteristics that the physician may consider include hair color, hair texture, degree of hair curl, and skin-to-scalp hair color contrast-all characteristics that the physician hair restoration specialist may be able to use to achieve maximum cosmetic improvement. For example, the physician hair restoration specialist may creatively use color, texture and curl of transplanted hair to complement existing hair and recreate an appearance of density in an area of diffuse hair loss.
If donor hair is limited by overall hair thinning, hair transplantation may be able to offer an improvement in recipient areas by creative use of hair characteristics, but may not be able to offer full density that returns the patient to complete pre-hair loss appearance. Another consideration-applicable to both women and men-is the rapidity and extent of hair thinning. Rapid and extensive hair loss may deplete the amount of donor hair available for future use in keeping pace with continued loss of hair. If this appears to be a possibility, the patient and physician hair restoration specialist should discuss realistic expectations for hair transplantation over a period of years. The patient must determine whether the anticipated result justifies the time, cost and discomfort of hair transplantation.
Women more than men are bombarded with advertising images of models with luxuriously dense hair-images that establish a standard which women are challenged to emulate. These unrealistic images may be in the background when a woman discusses realistic expectations for hair transplantation with her physician hair restoration specialist. Unrealistic images promoted by hair-product advertising should not cloud judgments regarding realistic expectations for cosmetic improvement from hair transplantation.
In the great majority of cases, women who have hair transplantation performed by a skilled, experienced physician hair restoration specialist are highly satisfied with the result. While satisfaction is due in large part to the physician’s technical skill and expertise, it also reflects the feeling of patients who find that their realistic expectations were achieved.
Hair Transplantation Technique
Hair transplantation techniques are adapted to the necessity for placing grafts in multiple areas of patchy hair loss. The types of grafts used and the number of transplantation sessions scheduled for the patient are decisions influenced by the patient’s objectives for hair density in the final result.
The topically-applied hair loss remedy minoxidil (Rogaine®) is sometimes used in selected female patients (1) to complement hair transplantation by stimulating new hair growth, or (2) to prevent the temporary postoperative loss of transplanted hair that occurs in a percentage of transplant patients.
When donor hair is limited and hair loss areas are relatively extensive, the patient and physician hair restoration specialist may agree on a treatment plan that combines hair transplantation and hair styling. If all hair loss areas cannot be effectively treated by transplantation, the transplanted areas may be configured to maximize the future use of hair styling to achieve maximum cosmetic improvement.