Important differences do exist between transplantations in men and
women. If I give a man any hair, he is happy. He may wish for full
thickness, but he understands that most men have some hair loss and
anything he can get back into the balding areas helps. A woman, on
the other hand, frequently will not be happy unless she has the appearance
of full thickness after a transplant. To most women, getting some
hair back to give a thinning look is still unacceptable. If a woman’s
hair loss is even moderately advanced, hair transplants may not be
able to deliver the thickness she desires. I turn many more female
than male patients away after consultation for this very reason.
If a woman’s hair loss is not too advanced, and she is willing
to use Rogaine indefinitely, frequently we can come to a compromise.
If the patient will settle on a particular hairstyle, often I will
be able to concentrate the follicular units in the area where they
are most needed. The most common example of this occurs with Ludwig
type I and II patients. If I can convince the patient not to wear
bangs, but instead let the hair remaining in the hairline grow long
and then use that hair pulled back over the balding area in a style
that keeps it in place, I will then concentrate the follicular units
in a zone directly behind the hairline to give the hair being pulled
back more fullness. Just like with men, if they will either color
or not color their hair so as to decrease the color contrast between
their hair and scalps, they will discover their hair loss is much
less noticeable. If they are
willing to use the remaining hair in specific styles to help cover
the areas of hair loss, then I will recommend increasing the length
and curl of the hair to add volume. Women
typically have a remarkable ability to style their remaining hair
and conceal their hair loss. If women who understand these issues
can even get a little extra hair, they are very grateful.
 Figure
10-3. If a woman now has, or potentially will have
significant hair loss, the transplant will possibly need to
be concentrated in specific areas and
combined with specific hair styles. In most cases the transplant
is concentrated in the front behind the
hairline and the patient will then let the hair in front grow
long and use it pulled back over the thinning area.
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Another big difference between men and women is in telogen hair
loss (loss of preexisting hair due to the shock of surgery) in the
transplanted areas. As noted before, in men this loss is unusual,
occurring in perhaps 5 to 10% of cases. In women, however, I see
it, to some degree, in perhaps 25 to 50% of cases. I stress to the
patient that if it is healthy hair that is lost, it will return,
albeit in four to eight months. If it was hair that had miniaturized,
it might not return at all. I emphasize that if this telogen loss
occurs, the scalp will look even more bald for three to five months
then before the operation. After that, the transplanted hair begins
to grow. The other hair that fell out slowly begins to return soon
thereafter. I further explain that there is no way to determine
in whom this will occur. I have transplanted some women in whom
it occurred one time and not the other. It is a risk that the female
patient must assume. If it occurs, and the woman was made aware
of this possibility before hand, she will be much more understanding
than if she were not warned of it at all.
I will often use 2 and 3 follicular unit grafts in women for this
reason. I feel that with the larger multi-unit follicular unit grafts
and the reduction in the number of needle sticks necessary to plant
them by 50% or more, there is less risk of
a telogen phenomenon occurring. I do stress to the patient that
there could be some plugginess with this technique if she loses
much additional hair in the future. Most women tell me they are
willing to assume this risk because if they lose much more hair
anyway, they plan on wearing a wig. If they do decide to have me
transplant the larger multi-unit follicular unit grafts, I still
utilize single follicular units for any hairline work.
One final disadvantage women must accept is the possibility of having
a more limited donor area. Men typically have good hair remaining
on the sides of their scalps above their ears. Unfortunately, many
women will have thin hair in this area making it unsuitable for
transplantation.
Otherwise, women can be great candidates. Just like with men, it
depends on the degree of hair loss, the quality of remaining hair,
and their expectations.
Next Topics:
Scalp Reductions
Hair Transplant Repair
Follicular Unit Extraction
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