Views Article
Transplanting Females
Hair Transplant Forum International 2001; 11(1): 17.
I have been struck by the instability of the donor areas of many women as measured by the high degree of miniaturization in their donor areas (>30%) as well as high miniaturization in the thinning recipient areas. In addition, I have noted that many women with diffuse thinning have thin scalps and poor scalp laxity. This would certainly be problematic if multiple procedures were required in the face of continued hair loss - and of course these women do continue to thin over the years. It leads to the concern that these factors would pre-dispose to the risk of excessive effluvium in the recipient area and result in transplanted grafts that will continue to thin.
Women who we classify as having DUPA (Diffuse Unpatterned Alopecia) need not have diffuse alopecia that is uniformly thin all over. They just need to have a donor zone than is thinner than normal and a higher degree of miniaturization than normal. In those with DPA (Diffuse Patterned Alopecia), the donor zone is clinically stable.
I would offer that doctors who fail to use densitometry might easily overlook thinning (miniaturization) in the donor area. My concern is that this "oversight" is a very seductive one for surgeons, since it effectively doubles the potential transplant population and will cause doctors to be inclusive rather than selective when deciding which women are appropriate candidates for surgery. Like many other problems in hair restoration, the difficulties will appear years down the line.
Robert Bernstein, MD
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