Hair Loss and Restoration in Women

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.

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.

What Causes Hair Loss in Women?

The most common type of hair loss in women is female androgenetic alopecia (female pattern baldness).

The underlying cause of female androgenetic alopecia is believed to be related to production of androgenetic (male) hormones and the effect of androgenetic hormones on the hair follicle—the same underlying cause responsible for male androgenetic alopecia (male pattern baldness). The pattern of hair loss in female androgenetic alopecia has some distinctive features that differentiate it from male-pattern hair loss. In general, there are three patterns of hair loss in female androgenetic alopecia:

Grade I : Thinning hair on the central scalp (top of the head).

Grade II : Thinning hair and patches of greater scalp hair loss.

Grade III : Male-pattern alopecia with hair loss at the front of the scalp to mid-scalp. However, it is very rare to see complete male-pattern "cue-ball" baldness in a woman.

Other causes of hair loss in women include scalp scarring from injury or an underlying disease, traction alopecia due to injury from tight braiding or corn-rowing of hair, and trichotillomania (compulsive hair plucking). See About hair loss for detailed information on these causes of hair loss.

Consultation with a Hair Restoration Doctor

A woman who is experiencing hair loss should consider consulting a hair restoration doctor. The consultation has both medical and esthetic aspects.

Medical

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 diseases that cause overproduction of androgenic (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.

Aesthetic

The rationale for hair restoration is primarily Aesthetic—how a woman feels about her appearance and how she wants others to perceive her. The Aesthetic consultation with the physician hair restoration specialist is every bit as important as determining the reason for hair loss. The patient has Aesthetic 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 Aesthetic consultation:

• What hair styles has the patient been using to minimize the appearance of thinning hair?
• What hair styles would the patient hope to use after hair restoration?
• Would the patient change her hair style, curl, color, etc., to get the most out of hair restoration?
• 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?
• What can hair transplantation accomplish and is transplantation an option for the patient?
• 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 Aesthetic consultation are the primary considerations that guide the selection of a surgical or non-surgical hair restoration treatment appropriate to the patient’s needs.

Treatment of Female Hair Loss

Hair restoration treatments for women are primarily surgical, or treatments such as hair weaving or extending. Medical treatments for hair loss are largely directed at male androgenetic alopecia. A surgical treatment for female androgenetic alopecia may occasionally be combined with minoxidil, the product approved by the Food and Drug Administration (FDA) for non-surgical treatment of androgenetic alopecia.

Hair Transplantation in Women

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 pattern hair loss. Like male pattern hair loss, female pattern hair loss is genetic in origin and "runs in the family". It is the most common form of permanent hair loss in women.

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 pattern hair loss 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 pattern hair loss is the most frequent indication for hair transplantation in women. No treatment should be undertaken until the patient thoroughly understands the rationale for treatment.

What Causes Hair Loss in Women?

Androgenetic alopecia-inherited pattern hair loss-is the most common cause of permanent hair loss in women as it is in men. Female pattern androgenetic alopecia usually occurs as diffuse thinning of hair rather than the frank baldness often seen in men. However, patterns in hair loss vary greatly in women and every case of hair loss in women should be considered for individual diagnosis. Correctly diagnosed hair loss can usually be treated medically or surgically.

Other common causes of hair loss in women include:

• Alopecia areata-patchy loss of hair from the scalp and sometimes eyebrows or other hair-bearing areas of the body; thought to be due to an autoimmune disorder. Hair loss can be episodic and recurrent.
• Traction alopecia-hair loss associated with consistent traction pressure on hair follicles, as may occur with tight braiding or corn-rowing of hair.
• Trichotillomania-compulsive hair plucking, believed sometimes associated with emotional stress or a psychological disorder.
• Telogen effluvium-unusually accelerated hair loss that may have hormonal, nutritional, drug-associated or stress-associated causes.
• Loose-anagen syndrome-a condition in which scalp hair is easily pulled out by normal combing or brushing; more common in fair-haired individuals.
• Triangular alopecia-due to unknown cause, hair is lost from areas around the temples.
• Scarring alopecia-caused when physical trauma or burns damage scalp hair follicles. Traction alopecia can lead to scarring alopecia.

Remember that most female hair loss can be treated medically or surgically, but successful treatment requires correct diagnosis by a physician hair restoration specialist.

When is a Woman with Female Pattern Hair Loss a Good Candidate for Hair Transplantation?

After it is determined that a woman's thinning hair is due to female pattern hair loss 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 physician 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.

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.

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.