Vive le difference is a phrase that celebrates the features making us individuals. Features contributing to an individual’s include gender (male-ness or female-ness) and ethnicity (for example, East Asian, South Asian, sub-Saharan African, North African, Mediterranean Caucasian, Nordic Caucasian among many ethnic “types”).
Gender and ethnic differences are manifested most prominently in the overall appearance of an individual—the “look” that an individual presents to others. At different levels, gender and ethnicity influence an individual’s life and appearance in multiple ways:
- Physical features—e.g., body size and shape, skin color and tone, hair color and characteristics;
- Biology—e.g., hormonal patterns, genetic inheritance patterns (see Gene Driven but Not Your Genetic Fate:); and,
- Cultural—e.g., food choices, clothing choices, hair styling.
These are all considerations that have to be addressed by an individual seeking hair transplantation, and the physician hair restoration specialist who will work with the patient to plan and carry out hair transplantation. Some of the gender and ethnic considerations are obvious, others may not be immediately obvious but can be brought out in preoperative discussions and planning between the patient and the physician.
Common ethnic considerations that influence planning for a successful outcome of hair transplantation include:
- Head shape—e.g., a “long” head shape and a “round” head shape require different approaches to placement of transplanted hair;
- Hair characteristics—e.g., hair color, hair caliber (diameter), hair shape (straight, wavy, curly, frizzled) all influence the appearance of transplanted hair (see Black Hair Transplant);
- Hair density—e.g., differences in numbers of hairs per square centimeter of scalp—for example about 200 hairs per square centimeter in East Asians versus about 130 hairs per square centimeter in Caucasians (see Hair Transplantation in East Asians:);
- Skin thickness—thickness and other genetically programmed features of skin influence technique for setting donor hair into the transplantation site, and may predispose a patient to postoperative formation of the type of scarring called keloids; and,
- Cultural preferences—e.g., ethnicity may influence a patient’s preferences regarding where a transplanted hairline should be placed, and how much “baldness” is acceptable.
Gender has major implications for patterns of hair loss and preferences for hair restoration:
- Patterns of hair loss—hair loss due to androgenetic alopecia is diffuse in women (see About Your Hair Loss: and Female Pattern Baldness:), whereas hair loss in men has a more well-defined shape (see Male Pattern Baldness:). Typical patterns of hair loss in women are the “Christmas tree” pattern in mid-scalp and a temporal pattern above the forehead and ears;
- Hair characteristics—hair of women is typically of smaller caliber and lower density than that of men. These differences have implications for the quality of donor hair available for transplantation (see Donor Site: Savings and Loan of Hair Transplantation:), and for creation of acceptable density in transplanted areas; and,
- Cultural influence—the female “culture”, and what a particular culture expects of a female, tends to place more emphasis on full hair density than is expected of men (see Science and Medical Articles and Women and Hair Transplantation:). A man may not insist on restoration of full density if hair restoration gives him an improved appearance, whereas a woman is more likely to insist that restoration of full density is the only acceptable outcome of hair transplantation; and,
- Predisposal for postoperative telogen effluvium (“shock loss”) of transplanted hair—a temporary loss of some transplanted hair postoperatively can occur in both men and women, but is more likely to occur in women. The condition is called telogen effluvium (see Other Causes of Hair Loss:), and when it occurs postoperatively it is sometimes described as “shock loss” of transplanted hair—that is, transplantation is a “shock” that temporarily interferes with the normal cycling of hair growth and loss.
Gender and ethical considerations regarding hair loss and hair restoration can be manifestly obvious (e.g., hair characteristics), or they may not be readily apparent (e.g., cultural expectations). They can be addressed satisfactorily when the patient and physician hair restoration specialist engage in open and frank discussions for preoperative planning.