Since 1993, hair transplantation of female patients has been an important part of our hair restoration practice. There still persist in some places the belief that hair tranplants are not helpful for women with hair loss. This view point could not be more wrong. With the use of a large number of small grafts, women can be greatly helped with hair tranplantation.
Approximately 20% of all women eventually develop an “androgenetic” (male-like) pattern of thinning hair at the top of their scalp, which is now more properly termed “female pattern hair loss.” This is almost always caused by heredity but does not share the same hormonal cause as in males (DHT, ect.). In the majority of the women who present to us with this classic pattern of hair loss, the hair on the “back wall” of the head is relatively dense and of much stronger caliber than the hair on top. When looked at with magnification, we note a much smaller number of “miniaturized” hairs in this region, which means that this hair on the back wall will last fairly well over the years, regardless of whether it remains there or is transplanted to the top thinning areas. It is this stronger hair in the back that serves as the “donor hair” for a woman undergoing hair transplantation. In most women, with “female pattern hair loss”, the hair that exists on the side of their head above and behind the ears is in many cases somewhat thin, similar to the hair on top. For this reason, the “strong” donor area that is available in a woman is generally smaller than is available on the head of a typical balding man. Thus, in transplanting women, it is important to use the available donor hair in the mosts strategic areas, which takes advantage of the manner in which she plans to style her hair.
On the plus side, most women usually retain many of the hairs that exist at their own natural front hairline, as well as some of the hair on top. Therefore, we always start by placing our first 1-hair and 2-hair follicular unit grafts just behind the fine, natural hairs at the front hairline. In the more central regions on top, we then use a combination of tiny “slit grafts” (3-4 hairs each), or alternatively, we place a large number of FU grafts closley together, placing them precisely between the existing hairs. As with men, the process of losing one’s hair is somewhat progressive with age, although it usually happens at a much slower pace in women.
The transformation in the appearance of a woman who has been transplanted can be quite dramatic, even after only two sessions. For most women, two or three sessions are required to achieve optimal results.
It is very gratifying to restore the “fullness” to the hair of such patients. While it is possible to transfer quite a bit of hair into the needed areas for any given female patient, it usually is not possible to make the final result as full and thick as the best wigs can achieve. Our patients understand and accept this, and the ones that opt for the transplant route generally feel strongly about having their own natural hair, understanding that the density will be less that what they had when they were 15 years old and less than could be provided with a non-surgical hairpiece.
We work with our female patients to learn how they hope to style their hair and then transplant in such a way that their appearance will look the fullest and most natural.