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Hair
Restoration in Women
1) Consultation with
a Hair Restoration
Doctor
A) Medical aspects
B) Aesthetic aspects
2) When is Hair
Transplantation an
option for a woman?
3) Realistic
Expectations for
Hair Transplantation
4) Hair
Transplantation in
women
A) Be certain about
the cause of Hair
Loss
B) Hair
Transplantation
Technique
C) Combination
Treatments
1) Consultation with
a Hair Restoration
Doctor
A woman who is
experiencing hair
loss should consider
consulting a hair
restoration doctor.
The consultation has
both medical and
esthetic aspects.
There are two simple
"bedside" tests that
a doctor can use to
help support a
diagnosis of hair
loss. The first is
the "hair pull" in
which a fingerling
of hair is gently
pulled and the hairs
that easily pull out
are counted. The
second is
"densitometry" in
which a small area
of the scalp is
clipped short and
examined under
magnification
(usually 30x). The
hair density (number
of hairs per cm) can
then be measured and
the approximate
percentage of hairs
that are in a
miniaturized state
(and subject to
being lost) can be
assessed.
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A) Medical aspects
The focus of the
medical examination
is the reason for
hair loss. In a
healthy woman the
most common reason
for hair loss is
Female Androgenetic
Alopecia in a Grade
I, II or III pattern
as described
earlier. If the
patient’s medical
history and physical
examination indicate
no underlying
medical conditions,
and the hair-loss
pattern is clearly
that of Female
Androgenetic
Alopecia, no further
tests may be
necessary. However,
if the hair-loss
pattern (1) is not
clearly that of
Female Androgenetic
Alopecia, or (2)
suggests the
possibility of an
underlying medical
condition, further
medical tests and
inquiry into
personal and family
medical history may
be indicated. A
scalp biopsy can be
helpful in
establishing a
reason for hair loss
when the reason is
not immediately
apparent.
While the primary
reason for the
medical examination
is to determine the
reason for hair
loss, the
examination may
occasionally result
in diagnosis of a
previously
unsuspected
underlying disease.
Hair loss can be a
symptom of certain
autoimmune diseases
and conditions that
cause overproduction
of androgs (male
hormones). An
underlying disease
does not necessarily
preclude hair
restoration.
However, it may be
necessary to treat
the underlying
condition before
hair restoration can
proceed.
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B) Aesthetic aspects
The rationale for
hair restoration is
primarily
esthetic—how a woman
feels about her
appearance and how
she wants others to
perceive her. The
esthetic
consultation with
the hair restoration
specialist is every
bit as important as
determining the
reason for hair
loss. The patient
has esthetic goals
that she hopes hair
restoration can
achieve. The
physician helps the
patient refine her
goals within the
context of what
surgical and/or
nonsurgical hair
restoration can
accomplish. Many
questions can be
raised and discussed
in the esthetic
consultation:
1) What hair
styles has the
patient been using
to minimize the
appearance of
thinning hair?
2) What hair
styles would the
patient hope to use
after hair
restoration?
3) Would the
patient change her
hair style, curl,
color, etc., to get
the most out of hair
restoration?
4) Does the
patient want a
"luxurious head of
hair" that might
require procedures
such as hair weaving
or hair extenders?
Does the patient
want to be able to
swim and/or exercise
heavily without
worrying about her
hair?
5) What can
hair transplantation
accomplish and is
transplantation an
option for the
patient? 6)If
transplantation is
not an option
because of scalp
scarring or
underlying disease,
what options for
hair restoration can
be considered?
Results of the
medical and esthetic
consultation are the
primary
considerations that
guide the selection
of a surgical or
non-surgical hair
restoration
treatment
appropriate to the
patient’s needs.
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2) When is Hair
Transplantation an
option for a woman?
Hair Transplantation
is universally
accepted as a
treatment for hair
loss. While it was
developed and first
offered as a
hair-loss treatment
for men, women have
increasingly found
Hair Transplantation
a viable option to
correct the cosmetic
deficit of thinning
hair. Advances in
Hair Transplantation
techniques and
better understanding
of the biology of
female hair loss
contributed to the
evolution of Hair
Transplantation in
women.
Many women today are
proactive about
seeking Hair
Transplantation.
They are unwilling
to accept hair loss
as an unavoidable
fact of life. Scalp
hair is a major
component of the
image women project
to the world and
they do not wish to
have hair loss
detract from that
image. Almost worse
than hair loss in
some cases is hair
miniaturization (the
fine-caliber, wispy
hair that grows out
a follicle when the
follicle is no
longer able to
produce hair of
normal size).
Miniaturized hair is
hard to style and
difficult to
conceal. It begins
to appear in the
course of female
pattern hair loss,
the female form of
the most common type
of hair loss in men.
So, the answer to
the question-"When
should a woman
consider Hair
Transplantation?"-is
"When Hair
Transplantation is
the right hair loss
treatment for this
woman at this time."
Hair loss is not "an
inevitable sign of
getting older". It
has been reported in
studies that about
80% of women
experience some
degree of hair loss
before menopause.
Much of this hair
loss has a
hereditary basis. A
woman who has a
family history of
hair loss in women
may be especially
aware of the
possibility that she
may also begin to
lose hair as she
matures. And, she
would be correct; a
family history of
hair loss in women
is an indication
that a woman may be
genetically
predisposed to lose
hair.
A woman's hair loss
is not always
genetically
predisposed and is
not always
permanent. Hair loss
during pregnancy has
a hormonal basis
associated with
pregnancy, and hair
growth is usually
restored in a normal
pattern after
pregnancy. Some hair
loss may be due to a
condition such as
alopecia areata that
is a disease process
rather than
genetically
predisposed pattern
hair loss, or to a
condition such as
hypothyroidism that
requires treatment
before hair
restoration can be
undertaken.
Women may experiment
with various herbal
and over-the-counter
remedies for hair
loss. Only one
over-the-counter
hair restoration
medication-minoxidil-has
a track record of
success and is
approved by the Food
and Drug
Administration for
use in women. It is
frequently
recommended by hair
restoration
specialists for use
in a planned program
of hair restoration
after the cause of
hair loss has been
diagnosed. Other
products that may be
tried include (1)
protein fibers that
bond with hair to
give the appearance
of greater fullness,
and (2) a masking
agent that disguises
bare scalp to make
it blend better in
color with existing
hair. If her own
experimentation with
hair loss remedies
proves
unsatisfactory, as
is often the case, a
woman with even mild
to moderate hair
loss may consider
herself a candidate
for Hair
Transplantation.
Whether Hair
Transplantation is a
viable option for a
woman with mild to
moderate hair loss
is a question to be
answered by close
consultation between
the woman and the
hair restoration
specialist. Into
that determination
will go the
patient's medical
history, hair loss
history, family
medical and hair
loss history,
physical
examination, scalp
examination and
laboratory tests as
indicated by other
examination results.
Also into that
determination goes
the question: What
does the patient
want Hair
Transplantation to
accomplish? On the
basis of all
objective
information from
test results, what
is a realistic
expectation for the
short-term and
long-term cosmetic
outcome of Hair
Transplantation?
Planning for
long-term cosmetic
outcome may have to
consider the woman's
hair loss history
and family hair loss
history. A one-time
"fix" may not
provide an
acceptable outcome
over a period of
years if progressive
hair loss diminishes
the result over
time. A family
history of female
hair loss may be
indicative of the
probable course of
the patient's hair
loss. Assessment of
the patient's supply
and quality of
potential donor hair
(the hair that will
be surgically
removed and grafted
into a recipient
area of hair loss)
indicates how much
donor hair will be
available for Hair
Transplantation over
time. A projection
of progressive hair
loss is an
indication that a
one-time "fix" will
not provide an
acceptable long-term
cosmetic outcome.
The woman may also
ask the question:
"If my hair loss is
not too severe and I
can cover it up with
hair styling for a
while longer, should
I be seeking Hair
Transplantation?"
The answer to that
question can only be
subjective on the
part of the patient,
with objective input
from the hair
restoration
specialist. The hair
restoration
specialist may, for
example, agree that
Hair Transplantation
is not an immediate
need; the woman's
mild degree of hair
loss may be treated
adequately with
topical minoxidil
and the question of
Hair Transplantation
delayed to a later
time. If hair loss
seems likely to be
rapidly progressive,
the physician may
recommend early Hair
Transplantation.
An important
difference between
male and female hair
loss is that women
rarely "go bald",
but often have
thinning of hair
over a large area of
the scalp. Spreading
grafts over such a
large area may not
provide a
significant cosmetic
improvement. It may
be more important,
for cosmetic
improvement, to
place grafts into a
key area such as the
hairline.
Transplanting key
areas can be planned
with hair styling in
mind-for example, so
that transplanted
hair can be styled
to layer over other
areas to improve
hair density.
Transplantation and
planned hair styling
is often a more
important
consideration in
Hair Transplantation
for women than it is
for men. Hair
Transplantation is a
surgical procedure
associated with some
degree of discomfort
and a small risk for
complications. The
financial cost of
Hair Transplantation
can be a substantial
consideration. It is
a procedure that
should be undertaken
with due
deliberation.
Hair Transplantation
is also a procedure
with a very high
rate of success in
meeting the
expectations of
patients. For a
woman who is
unwilling to accept
thinning hair as
inevitable, Hair
Transplantation may
be the hair
restoration
treatment of choice
when all the facts
are in hand.
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3) Realistic
Expectations for
Hair Transplantation
Whenever Hair
Transplantation is
considered, a woman
and her physician
should agree prior
to treatment on
realistic
expectations for
treatment outcome. A
realistic
expectation is to
achieve a
significant increase
in hair density,
satisfactory for
hair styling and
overall cosmetic
appearance. An
unrealistic
expectation is
refusal to be
satisfied with any
result less than
complete restoration
of pre-thinning hair
density.
Female-pattern hair
loss, like
male-pattern hair
loss, is progressive
and relentless. A
woman with
female-pattern hair
loss who wants to
maintain the same
hair density
throughout her life
may consult her hair
restoration
specialist about
wigs or hair
additions.
No currently
available surgical
or non-surgical
treatment can cure
female-pattern hair
loss. There is no
treatment that cures
pattern hair loss in
the way that
antibiotics cure
infection The
purpose of surgical
and non-surgical
treatments is to
mitigate the
cosmetic effects of
progressive pattern
hair loss.
Female-pattern hair
loss can begin at
any age from the 20s
onward. The most
common ages of onset
are the 30s and 50s.
Onset is often
insidious--a few
more hairs than
usual in the comb or
hair brush,
recognition of
places where hair is
no longer dense
enough to conceal
bare scalp. Over
time the loss of
hair will evolve
into one of the
typical patterns of
female-pattern hair
loss.
A woman who is
concerned about
thinning hair should
first find out if
female-pattern hair
loss in the cause.
Examination by a
hair restoration
specialist will
assure a correct
diagnosis and
confirm or rule out
any causes that may
require medical
treatment.
Establishing the
cause of a woman's
hair loss should not
be a guessing game.
The hair restoration
specialist will
present options for
treatment based upon
(1) the correct
diagnosis, and (2)
the woman's wishes
regarding time, cost
and desired outcome
of treatment.
Hair Tansplantation
may or may not be an
acceptable option
recommended by the
hair restoration
specialist. It is
important, however,
that Hair
Transplantation is
now considered an
option available to
a woman. It should
not be overlooked as
a treatment only for
men. It should not
be dismissed because
"pluggy" hair grafts
were often produced
by older
transplantation
techniques. Modern
Hair Transplantation
techniques using
mini-grafts,
micro-grafts,
single-hair grafts
and follicular unit
grafts produce
results that meet
the most stringent
standards for
naturalness of
appearance. Hair
Transplantation may
be reserved as an
option to consider
later, after a trial
of minoxidil
(Rogaine®) to slow
hair loss and
stimulate hair
regrowth. Minoxidil
is also frequently
used in conjunction
with Hair
Transplantation to
enhance hair density
in transplanted
areas of the scalp.
A man may expect to
lose hair as he gets
older, especially if
his father, uncles,
or other near
relatives had
male-pattern
baldness. A woman
does not generally
expect to lose hair
even if there is a
history of hair loss
in male or female
relatives
A woman also usually
feels she must have
a full head of hair
to meet societal
expectations.
Thinning hair is
acceptable only when
a woman is very old.
Societal expectation
run counter to
reality, however.
The fact is, many
women do experience
hair loss at young
to middle age and
the incidence of the
most common type of
female hair loss
(Female Androgenetic
Alopecia) seems to
be increasing. Many
women today
recognize the
reality of hair loss
and choose to do
something about it
by seeking hair
restoration
treatment or
procedures. In the
hands of a physician
specialist in Hair
Transplantation,
most hair loss in
women can be
successfully
treated.
Befor Hair
Transplantation
Surgery
After Hair
Transplantation
Surgery
Befor Hair
Transplantation
Surgery
After Hair
Transplantation
Surgery
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4) 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
Androgenetic
Alopecia. Like male
pattern hair loss,
Female Androgenetic
Alopecia is genetic
in origin and "runs
in the family". It
is the most common
form of permanent
hair loss in women.
A) 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
Androgenetic
Alopecia 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 Androgenetic
Alopecia is the most
frequent indication
for Hair
Transplantation in
women. No treatment
should be undertaken
until the patient
thoroughly
understands the
rationale for
treatment.
Remember that most
female hair loss can
be treated medically
or surgically, but
successful treatment
requires correct
diagnosis by a hair
restoration
specialist.
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 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.
After it is
determined that a
woman's thinning
hair is due to
Female Androgenetic
Alopecia 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
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 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
(the hair that is
taken from one site
on the scalp and
transplanted to a
balding recipient
site) currently and
in the future to
make transplantation
a viable treatment
option.
Inadequate donor
hair could rule out
hair transplantation
as a viable option
for 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
hair restoration
specialist to find
scalp hair that is
dense enough to
provide adequate
donor hair.
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 hair restoration
specialist may be
able to use to
achieve maximum
cosmetic
improvement. For
example, the 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.
2)
if Hair
Transplantation is
undertaken, will the
result meet the
patient's
expectations for
cosmetic
improvement?
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 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 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.
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B) 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.
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C) Combination
Treatments
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.
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