Hair Restoration in Women

• Consultation with a Hair Restoration Doctor
  • Medical aspects
  • Aesthetic aspects
• When is Hair Transplantation an option for a woman?
• Realistic Expectations for Hair Transplantation
• Hair Transplantation in women
  • Be certain about the cause of Hair Loss
  • Hair Transplantation Technique
  • Combination Treatments

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.

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.

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.

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.

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

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.

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.

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.