MANY SPECIFIC DIAGNOSES AND PATTERNS OF HAIR LOSS DIFFERENTIATE MEN’S AND WOMEN’S CANDIDACY FOR HAIR TRANSPLANT SURGERY AND ITS FINAL OUTCOME.
Doctors and surgical hair transplant experts agree that hair loss and thinning are much more straightforward to diagnose and predict in men than in women. And they all agree on one more thing: The best result starts with the most thorough diagnosis of the hair loss or hair thinning issue to determine candidacy for hair transplant surgery.
“While the majority of men are good hair transplant surgery candidates because they have a stable donor area on the back and sides of the scalp as well as predictable patterns of hereditary balding, women are prone to have diffuse thinning all over the head, so there is no stable donor area. For that reason, we find that only a minority of women are good candidates for a hair transplant,” states Dr. Robert M. Bernstein, M.D., F.A.A.D., clinical professor of dermatology at the College of Physicians and Surgeons of Columbia University and hair transplant surgeon and director of Bernstein Medical Hair Restoration, also in New York City.
“It’s extremely important to determine which women are good candidates for hair transplant surgery and which are not, so we examine the donor areas using densitometry to measure and magnify follicles while we look for miniaturization of each hair, a change in its diameter, which is the hallmark of genetic hair loss. We make sure women have a stable, suitable donor area; otherwise, the transplanted hair will continue to fall out and will continue to degenerate in the new area.” Bernstein also explains that women who present with diffuse hair loss and many diseases, hormonal abnormalities, medications, and traumas can mimic a thinning hair problem.
“When a woman comes in with hair loss, we do an extended evaluation to make sure she is a viable candidate for surgery,” cautions Bernstein. Some hair loss diagnoses that do make women good candidates for the surgery are traction alopecia or trauma, face-lift scars, and eyebrow restoration. “We tend to stay away from alopecia areata because if it recurs in a new patch, scars may become visible. We’ll wait until patches of loss are stable for three to five years before we will consider a hair transplant.”
Hair transplant surgery for men and women – the differences
Once the diagnosis is determined and stable donor areas are identified, the technical aspects of removing the hair are very similar. The only difference is that women’s scalps are thinner and tighter, so the surgeon has to carefully control the depth of harvest. “If you’re a woman, be sure your doctor has experience working with a diagnosis and hair just like yours — and ask for pictures and for referrals you can call,” advises Bernstein.
The design most men are looking for is first to replace the forelock or front, and receded temples. “We’ll place the hairs in a predominantly forward direction to accomplish this,” says Bernstein. “Then, if we still have plenty of donor’s hair, we will try to fill up the thinning crown area on a man. But on a woman, we want to restore the frame — the rounded hairline around her face. So, if we don’t have enough hair to do everything, we concentrate on the frontal hairline, the temples, and the front part of the scalp that frames her face. Once we get enough density there, this new hair can be styled to camouflage hair loss or thinning just behind it, especially in Caucasian women,” explains Bernstein. “Women’s hair transplants are also more difficult because women tend to have specialized swirls, directional changes, and growth patterns around this front hairline that must be mimicked and can become very complicated. Once completed, a woman can rely on styling techniques, perms, and color treatments to greatly enhance her hair transplant,” he states.
The main complication to avoid is visible scarring, so in men, we will advise them never to buzz their hair short because scars can become visible. In women, the biggest complication is the stability of the donor area. Transplanting areas in transition can be tricky. “Sometimes,” cautions Bernstein, “because hair growth happens in cycles, the trauma of a transplant can cause a short-term shock and some fall-out, even in healthy follicles. We use techniques to minimize this effect, but it is a risk that should be explained so women are not literally shocked by it!