These sections focus on the various surgical treatments for women with hair loss. To learn about diagnosing the causes of hair loss please see Hair Loss in Women.
Aesthetic Issues in Treating Women With Hair Loss
The treatment of women’s hair loss must be approached differently than men’s hair loss, as most women rarely lose all of the hair with hair loss. In fact, much of the hair remains, but the thickness of the hair shaft becomes smaller than normal hair and the density of each follicular unit reduces from the normal of 2 hairs per follicular unit to between 1 – 1.6 hairs per follicular unit. When this is combined with the finer hair, then the bulk of hair in each follicular unit is significantly reduced. This reduction of hair bulk from miniaturization and loss of individual hair follicles causes the hair to appear thinner, at times making the patient look sickly. Because a relatively large area can be subject to this thinning, it is important that hair is transplanted in areas where it is cosmetically most significant or where it can enhance a specific styling plan to increase the appearance of fullness. Unfortunately, the process discussed above occurs, at time, even in the area we call the donor area, which in 99% of men, is perfectly normal regardless of the degree of balding present. In women with this donor area looking like the rest of the hair, this makes them significantly different from men whose donor area has normal hair, normal hair bulk and no significant miniaturization. If women have such hair in what we call the donor area, they are not candidates for hair transplantation under any circumstances. Too many doctors transplant such women just for the surgical fees, and these women are never made better, and at time even made worse.
When the hair in this ‘donor area’ is reasonably unaffected by the disease process discussed above, then they might become candidates for hair transplantation. We generally confine the transplant process to a localized part of the scalp where balding is worst (such as behind the “frontal hairline” or “along the part”). When women have a dense, stable permanent zone and a loose scalp, it is possible to provide more coverage over the top of the scalp but far few women are able to get a significant benefit from a limited hair transplant.
Since hair transplantation in women generally involves placing hair into a part the scalp that is thin, but not completely bald, there is a risk that original hair in this area may be lost. This process is called “telogen effluvium” and is usually (but not always) reversible. In addition, if the donor area continues to thin, then the transplanted hair will also thin over time, since it came from the same area. For these reasons deciding when it is appropriate to perform transplantation for women can be difficult and requires the careful judgment of a very experienced and ethical physician.
Restoration After Brow and Face-lifts
When performing repair work in women’s hairlines after a face or brow lift, the same aesthetic challenges present themselves with several additional issues. The first is that a significant amount of scar tissue is often present in the area to be transplanted. This has a decreased blood supply which places a limit on the density of grafts that can be placed in any one session. A second problem is that, after the lift, the hair direction may be altered from the original way that it grew. A third consideration is that hair placement may interfere with subsequent face-lifts so that the planning must be coordinated with the plastic surgeon if future facial surgery is planned. Fortunately, these women often have ample donor hair supply, making this type of surgery very successful.