Part 6
Hair Transplantation in Women
Interviewer: In the case of hair loss in women that follows the standard Norwood or Hamilton scale of pattern baldness where you have a receding hairline and a bald spot forming at the crown, we know that transplants can, in many cases, be a good option. But what about cases where a woman is following the Ludwig scale of female pattern hair loss or baldness where the hair loss is generally more spread out? Are hair transplants effective in this scenario where you have this diffuse pattern?
Dr. Bernstein: That’s a really excellent question. Hair transplantation in women is actually very, very different from men. In men most of the hair loss is patterned. We have a permanent donor zone in the back and sides, with hair loss on the front and top. So essentially what you’re doing in the hair restoration is redistributing existing hair. You’re not giving people more hair in a hair transplant, you’re just moving it.
For many women that lose their hair, their hair is actually distributed nicely. They have, as you mentioned, diffuse hair loss, so they still have a persistent hairline. When they groom their hair, they comb it certain ways and doing this they can essentially “look” like they have a full head of hair. And since hair transplantation is an illusion in the sense that you are moving hair around with surgery (rather than creating new hair) if you can successfully move it with grooming, you really shouldn’t do a hair transplant.
So for many women, changing their grooming pattern is really the best thing to do, at least initially.
So what I generally do is to first try to have a woman alter her styling pattern, lighten her hair, change the part, and try to do as much as she can to redistribute her existing hair. If that’s not possible, then we need to decide whether redistributing their hair with surgical hair restoration is going to give them a significant cosmetic improvement.
And basically there are two different situations. In the first, a woman has a relatively stable back and sides. So they do actually have a donor area that’s more stable and denser than the front and top of the scalp. Essentially they have a pattern that is similar to a man’s. In these cases, hair transplantation in women is very, very effective. We basically take hair from the back and sides, we put it in the front and the top, and, voila, the hair transplant significantly improves the woman’s look.
However, it is very important that a woman has a good permanent zone. If the donor hair is not stable over time, the transplanted hair will continue to thin because it is no better than the hair in the area where it came from.
The other issue in women is that we’re usually transplanting into an area that’s thin, but not totally bald, so that there is a little bit greater risk of having some shedding during the hair replacement surgery than if the area was completely devoid of hair, and that shedding, if it involves miniaturized hair, may be permanent. So it’s important to let women know that one hair transplant procedure is often not going to be enough. It usually requires two procedures, particularly if we’re transplanting into an area that has a significant amount of existing hair.
Then the other situation is where a woman really has diffuse hair loss and they’re really not good candidates for surgical hair restoration. But they may have very specific needs. For example, they may wear a hairpiece and want to just have a hairline restored, or they have hair loss all over, but they have marked thinning at the hairline. So if we just reinforce the first inch or two, we can create the appearance of having a full head of hair.
Once we decide that a woman is an appropriate candidate, and then the actual design of the hair transplant is significantly different than in men. The reason is that most women need the entire hairline and temples restored. So where it’s uncommon to restore temples in men, women generally need a much tighter frame to their face. And so not only do we transplant the frontal hairline, but we almost always go down the sides at the sideburn area in women.
Another thing that I think is sometimes not realized is that many women have hair loss from brow lifts and facelifts. And so we often use hair transplantation to either fix the scars or to restore the density in areas of thinning from a brow lift. And we can also restore the temples and make the facelift scars around the ears less visible.
