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Hair Restoration For Her

At the Irvine Institute of Medicine and Cosmetic Surgery-Orange County Hair Restoration, we recognize women suffering with hair loss require a different approach than men when considering hair and eyebrow restoration. Compared to men, hair loss in women manifests in different patterns, generally is more diffuse, and can occur at any age. In men, there is a strong genetic pattern,  whereas in women other underlying conditions play major role in thinning of the hair.

Hair loss in women is a devastating disorder that can be treated medically or surgically. For women, a thorough disease specific medical evaluation is necessary in treating hair disorders with a trained medical hair specialist. Women typically notice hair loss during the menopausal period with reduced hair density usually in the middle of the scalp that thins laterally. The hair is often miniaturized because of a longer resting telogen phase. Rarely hair loss occurs in the frontal hairline.

The great news for women is female patterned hair loss can be treated successfully medically or surgically. This fact is confirmed by recent research conducted by the International Society of Hair Restoration Surgery. In their recent studies they estimate more women are being treated for hair loss than in the past decade. In 2008, 15% of hair surgery patients were women up from 11% in 2004.

Establishing the Correct Diagnosis

Every patient evaluated in our office undergoes a routine hormonal and medical evaluation for hair loss. The work up and evaluation of female hair loss is quite different than men. We take your hair loss seriously by performing a disease specific medical evaluation. A compete history and physical is the first step in evaluating women with hair loss and this is done at your initial consultation with Dr. Williams.

Diffuse hair loss is caused by a variety of conditions other than "hereditary balding." A disease specific work up is important because it establishes whether hair loss treatment is managed by medical, surgical, or a combination of both treatment options. The final decision to have surgery is generally dependent upon whether your hair loss appears to have stopped, your loss is mainly at the hairline, and balding is concentrated in one or two areas.

When should I consider hair transplantation?

In male pattern baldness the sides and back are still covered with hair. Men who have this balding pattern usually have successful hair transplant surgery. The donor hair from the back of the scalp survives the procedure and continues to grow on the area it is transplanted on the scalp.

DHT is what's responsible for the balding pattern on the top of men's heads. DHT, however, does not have any adverse effect on the hair follicle on the sides and back of the head. Typically, these areas of the head have healthy hair follicles, and the hair in these areas is excellent for use in hair transplant surgery. Referred to as stable sites, the hair follicles in these areas don't shrink or affected by DHT.

Women, on the other hand, typically don't have these stable sites wherein balding-resistant hair follicles can be found. Unlike men, women are likely to go bald not just on the top of their head but also on the sides, back and front. All areas of a woman's head are affected by DHT.

This makes women not good candidates for hair transplant surgery. Since the hair follicles in basically all areas of a woman's head are affected by DHT, any attempt to move them to the balding areas of the head is futile; the transplanted hair is simply going to fall out. Since the hair follicle is already damaged by the DHT in the first place, transplanting them to the balding area on the head is not going to solve the problem of baldness.

Note also that unlike men, women typically don't have to deal with receding hairlines. Instead, baldness in women occurs in a more diffuse manner, with uniformly thinning all over the head. In the case of female pattern baldness, the problem is more of how much hair is left on the head than where the baldness is occurring.

That said, a small percentage of women (approximately 5%) with baldness problems that can benefit from hair transplant surgery. These women tend to have areas (donor sites) in their head that have healthy hair follicles.

Who Is a Candidate For Hair or Eye Brow Restoration?

  • Some women with thinning scalp hair and virtually all women with thinning eyebrows
  • A person who has lost some but not all hair as a result of burns or other scalp injuries.
  • Women who want to restructure their hairline.
  • Women who have suffered hair loss due to mechanical or traction alopecia (non-hormonal).
  • Women who have a distinct pattern of baldness, similar to that of male pattern baldness-hairline recession, vertex thinning (on the crown or top of the scalp), and a donor area that is not affected by Androgenetic Alopecia.
  • Women who suffer hair loss due to trauma, including burn victims, scarring from accidents, and chemical burns.
  • Women who have had previous cosmetic or plastic surgery and are concerned about hair loss around the incision sites.
  • Women diagnosed with traction alopecia or alopecia marginalis.
  • Women who want to thicken or restore eyebrows.
  • Women who experienced hair loss after face lifts or other cosmetic procedures.

Who Is Not a Candidate for Hair Replacement?

  • Women with a diffuse, or wide-spread, pattern of hair loss.
  • Those who do not have sufficient "donor" sites (hair-bearing portions of the head from which hair-bearing skin is taken)
  • Women who form keloid scars or thick fibrous skin tissue that can result from trauma, burns, or radiation injury

Hair Replacement Procedures

Hair grafting, also called hair transplant surgery, is an outpatient surgical procedure performed in a hair surgeon's office. Gone are the days when a hair transplant made a scalp look like a field of newly planted corn. New technology and improved surgical techniques are transforming the hair transplant industry.

Dr. Ken Williams is one of a few board certified hair surgeons that is deeply involved in hair loss evaluations for women. For our patients who suffer from hair loss, the most important decision for you is to have a proper diagnosis and appraisal from a specialist of hair disorders. After the correct diagnosis is made, about 10% of patients elect to go on for surgical hair transplantation.

There are basically two types of surgical procedures available for women who want desire thicker hair or fuller eyebrows. For those women who are eligible to have surgery, the harvesting procedures available are the Strip method and Follicular Unit Extraction (FUE).

There are strengths and weaknesses for both procedures. No one procedure for female hair transplantation is best. Ideally, a surgical consultation is completed and a full examination of the hair and scalp is made before making the decision for hair surgery. FUE is a desirable cosmetic procedure because it does not leave a large linear scar at the back of your scalp for men with short hair styles. For women who have naturally longer hair, strip donor harvesting might be more ideal.

Hair loss occurs in three primary types

Localized Hair Loss

Local hair loss occurs from scaring and non-scaring diagnoses. Alopecia Areata is a genetic condition and is the most common non-scaring etiology of hair loss. Scaring hair loss is seen in Lupus, Lichen Planus, or local radiation. Baldness from injuries, or from local medical problems that have been cured, are usually amenable to hair transplantation.

Patterned Hair Loss

Some women have a hair loss pattern similar to men. Women with male pattern loss typically have thinning in the frontal hairline and the top of the scalp, while the sides of the scalp remain relatively spared. Women with this hair loss pattern make excellent candidates for surgical restoration.

Diffuse Hair Loss

Diffuse thinning of the scalp is the most common form of female hair loss. Diffuse thinning involves a reduction in the diameter and thickness of the hair shaft. The medical term for this type of thinning is "Diffuse Un-patterned Alopecia". These women have thinning that involves the donor area so that women with this type of hair loss are generally not good candidates for surgery.

In order to treat female hair loss, we need to examine the causes. We have three main treatment routes:

a) Medical Treatment
b) Hair Transplant
c) Combination of Medical and Surgical Treatment

The best way to diagnose the female hair loss type is with a personal consultation. The diagnostic procedure most likely will include blood tests to determine whether hair loss is secondary to Androgenetic Alopecia, hormonal imbalances or blood deficiencies. The final diagnosis will determine the benefits of a medical treatment regime and whether a hair transplant is a viable option for resolving the problem.

The following steps are taken before deciding to proceed with hair transplantation:

  • Personal consultation to examine if you are a good candidate for hair transplantation
  • Examination of the donor area to determine how many follicular units can be obtained
  • Examination of the recipient area to determine the final number of grafts needed
  • Cost of the procedure

When the decision is made:

  • Explanation of pre operative instructions
  • Medical history report
  • Photographic record
  • Determine surgical date