Women and Hair Transplants

Written By Raymond J. Konior, MD For The IAHRS Info Center

I am curious to know what qualifies a woman as being a candidate for hair restoration. It seems that there are bunch or opposing views about this floating around on the internet and I just wanted to clear it up for myself. I am confused as to why some doctors state all women, or most women, are candidates even with androgenetic alopecia. Is it not the nature of female pattern hair loss that the thinning is overall, and because of this the donor hair is not stable? I ask on behalf of sister who is seriously considering this as a viable option. I think she stands a chance of being severely disappointed and perhaps in a worse hair loss spot than she is now. Her hair loss has been steadily occurring over the last 10 years and the thinning is equally distributed all over her scalp with perhaps more thinning on the sides. Please help to clarify the women’s hair transplant debate. Thanks.

I believe that hair loss in female patients is a much more complicated issue than it is for male patients. Most often I encounter three basic categories of female hair loss – two that are good candidates for surgical restoration and one that is not.

First off, women with high hairlines are plain and simply the best candidates for the procedure. Most of these patients have a stable pattern, outstanding donor supply and good residual density throughout the remainder of the scalp. These patients simply need follicular-unit restoration to reposition the high hairline into a more aesthetic lower position.

The other two categories of female hair loss that I commonly see are patients with a diffuse hair loss process which may or many not include involvement of the donor region. Some patients are fortunate in that their hair loss is limited only to the top of the scalp. When thinning involves the donor region, there are patients where thinning is located only in the temporal region (the sides of the scalp), and there are those unfortunate patients where thinning is located throughout the entire donor region (the sides and back of the scalp). Female patients with diffuse hair loss, especially those with any evidence of donor thinning, are not so straight forward and need to be approached with caution.

The crux of the matter when choosing a good candidate with these patients is highlighted by your comments regarding the stability of the donor hair. The success of surgical hair restoration is basically dependent on the principles of supply and demand. Patients with diffuse hair loss that extends throughout the scalp, including the donor region, are poor candidates for surgical restoration. Any attempt to harvest hair from a thin donor region can have the following effects: 1) the donor region will thin even further following removal of the graft material; 2) donor scars may become visible as density is lowered in the donor region; 3) the low density grafts may lead to a suboptimal density in the recipient site. It is my opinion that patients with diffuse hair loss throughout the scalp are not candidates for surgical restoration.

Patients with thinning hair that is limited to the frontal, midscalp and / or crown regions may be eligible for surgical restoration depending on the availability of donor hair. Patients without any evidence of hair loss in the donor site will often have ample donor supply so that their coverage and density expectations can be met. Patients who demonstrate excellent donor supply in the occipital region (back of the scalp), but show evidence of diffuse thinning in the temple region, may be good candidates for surgical restoration if: 1) the ratio of donor supply to recipient needs is favorable, i.e., there is plenty of donor material in the occipital region to satisfy the patient’s density and coverage expectations in the thinning zones of cosmetic concern; 2) there is no potential for the donor site to undergo a progressive, diffuse thinning process with age. The problem here is our inability to make absolute predictions on the potential for changes in the donor region that may take years to occur. It is much easier to make a prediction on the nature of a hair loss process or pattern in an older patient. All patients with signs of diffuse loss in the donor region, especially those of young age, need to be approached with caution. Common sense suggests that one should defer surgical restoration until the nature of the hair loss process can be fully appreciated.

It is also very important to realize that female patients are more likely to experience a medically treatable cause for hair loss than are male patients. I recommend that all female patients with diffuse hair loss undergo a thorough physical examination with appropriate laboratory testing to screen for anemia, thyroid dysfunction, hormonal imbalance, collagen-vascular disorders, etc prior to undergoing any surgical intervention.

Fortunately, many female patients do make excellent candidates for surgical hair restoration. The keys to success are thorough preoperative evaluation, proper patient consultation on what can realistically be achieved over the short-term and long-term, and meticulous restoration using microscopic, follicular-unit techniques.

Raymond J. Konior, MD
Member, International Alliance of Hair Restoration Surgeons