Hair Loss Advice


Hair Transplantation for Women - Who is a Good Candidate


Hair Transplantation for Women: Who is a Good Candidate

Medically Reviewed On: December 13, 2000

Webcast Transcript

DAVID R. MARKS, MD: What you're seeing on the video here is a woman regaining a head of hair. Hair transplants are very popular among men, but they're becoming increasingly popular among women. To find out who should get a hair transplant, we have two guests. The first is Dr. Michael Reed. He's Assistant Professor of Clinical Dermatology at NYU Medical Center and he direct their hair transplant program.Next to him is Dr. Robert Cattani, one of the founding members of the American Board of Hair Restoration Surgery and he practices in New York. Welcome.

Dr. Reed, how common is hair loss in women because most people think of it in men.

MICHAEL L. REED, MD: As many women carry the genetic trait for common loss as men, it just comes out later, it goes slower and it's a different pattern. Women don't have a receding hairline and a bald spot like men do. They instead end up with see-through hair as they get older. Anywhere from 20-40% of women at some time in their life will experience enough thinning of their hair, or hair loss, to have it be noticeable and a potential problem.

DAVID R. MARKS, MD: Which women should consider hair transplantation?

ROBERT V. CATTANI, MD: David, exactly the same criteria subjectively we would use in men and women, except that I've found that, as men are devastated by hair loss, women are even more so. Especially the fact that they feel singled out. They don't feel this is a common thing. They feel that this is highly unusual and the reaction to it is very profound. There are basically, if I could give you categories, there are two categories of women with hair loss. There is the woman as first described by Dr. Reed, that have a hair loss on top of the head alone, with a persistent frontal fringe. Let us call that type one. That type is very correctable surgically.

The second type are those who have diffuse thinning throughout their whole scalp. Those you cannot. Now, of the type one there are three categories and here they are.

DAVID R. MARKS, MD: Go ahead and show us.

ROBERT V. CATTANI, MD: In medicine we have a way of putting labels and names on things. It's just our way of doing things. So about 25 years ago a physician by the name of Ludwig classified baldness as grade one here, two and three, and it's nothing more than extension from a minimal loss to a maximal one. But you know here, in deference to men, that no matter how bald they get, they persist with a frontal line of hair, and that's very advantageous cosmetically when you restore them. So I think the question that you'd want to know are, are women excellent candidates for hair restoration? Yes, they are. Is it very popular? Yes, and I'm sure Dr. Reed wants to talk about that more.

DAVID R. MARKS, MD: Tell me what would make a woman really decide to go ahead and do it as opposed to a woman who's kind of on the fence in your experience?

MICHAEL L. REED, MD: Fortunately, mother nature has a greater imagination than Dr. Ludwig or myself or any other doctors. I see a lot of women who have an area right behind their hair line which is a round or oval shaped area, maybe three by three inches, which is really quite thin and they've got a pretty good amount of hair around that. A little thin, but nothing horrible. They have a nice, dense donor site and they're great candidates. Not all of them thin out diffusely. The alopecia diffusa, which is this diffuse thinning, is real and it may happen in all women if they live to be 100 years old, but it doesn't happen early in a lot of women. So if any woman has a fairly stable area of noticeably thin hair behind the frontal line, they're great candidates for this and they enjoy the results much more than men because, as Dr. Cattani said, if I lose my hair that's a nuisance but for women it's catastrophic beyond belief. Basically it's cosmetic death for a woman to lose her hair or to think she's going to lose it. Once a woman knows the techniques and knows the details -- women, by the way, are very good detail people. You have to tell them everything in great detail many times. They have to know about the postoperative period, and the intraoperative sensations and so forth. But once they know and accept it, they're really excellent patients and they are actually better patients in many ways than men are.

DAVID R. MARKS, MD: Men start losing their hair very young in some cases, but you alluded to the fact that this happens in older women.

MICHAEL L. REED, MD: Hair loss in a woman can begin any time after puberty. But most of the time women lose it later, especially around the time of menopause, where the male hormones, the androgens, tend to have more of an effect because there's less estrogen in a woman's body. Women also have less receptors for male hormone in their hair follicles and they have another enzyme that converts male to female hormone that protects them, but these things gradually wear off with time and so they have a little bit slower onset, a little bit slower progression and they get see through hair. They don't actually, for the most part, go bald like men do. But they can go thin enough in that area that it's a cosmetic disaster, where they have to wear a hat, or they have to wear a hair lift, or they have to use makeup in that area. Then they're good candidates for transplants.

DAVID R. MARKS, MD: What's the downside of a transplant?

ROBERT V. CATTANI, MD: Let me just expound a little bit more on what Dr. Reed said. The way women look at this, you say it's a profound cosmetic effect. Women come in and say, "Hey, wait a minute. I'm not a guy. Guys lose hair. I'm a woman. I'm not supposed to do this. This isn't supposed to happen to me." So when you can offer them a surgical correction they become excellent patients. They are detail oriented. A lot of people think, "Well, you can always put a hair piece or a wig on women." If you offer them that, they're going to just come back to you and say, "What about the fear of detection when that wig comes off?" So they're excellent candidates. It is not unusual for women to have hair loss and the correction is often among one of the most pleasing of all my cosmetic patients. Hair restoration in women can produce wonderful results.

DAVID R. MARKS, MD: What's the downside?

MICHAEL L. REED, MD: The downside is several things. One, the time off from work. Usually we can perform this over a weekend time, but there is some time removed from work: two or three days beyond that. There may be swelling of the forehead. There may be that four to five month period before the hair starts to grow. There may be and usually is a need for a secondary procedure. Beyond that, it's a very positive thing for women to do.

DAVID R. MARKS, MD: What do you mean by secondary procedure?

ROBERT V. CATTANI, MD: It is my experience, and I think Dr. Reed will second this, that it is seldom that in one procedure, using a great number of micrografts, I can restore a woman who has a grade two or grade three hair loss to a level where she is satisfied. Usually, to get a certain density, it will take a second procedure and that can be anywhere from six months to a year down the road.

DAVID R. MARKS, MD: When should it be done in a woman?

MICHAEL L. REED, MD: I think it should get done when the woman's hair loss is fairly stable and not really active. You don't want a woman who's shedding a lot of hair, there's a lot of hair loss going on. It should be done in women who have been evaluated for other underlying problems such as endocrinopathies and other illnesses that might be contributing toward it. It should be done in women who have considered all the medical treatments that are available to them. Both topical and systemic treatments are available for women of various categories. It should be for women who have a realistic expectation of how they want to look. This is not going to give them more hair than god, but it's going to take them from looking noticeably thin to not being noticeably thin and that is a cosmetic victory beyond belief.

DAVID R. MARKS, MD: The last question that everybody always asks is cost. How much does it cost?

ROBERT V. CATTANI, MD: Depending on the session's amount that we're going to do, I would say anywhere from $3,000, $4,000 to possibly $10,000. That is a relative amount for each individual out there. We all have different incomes and different stages of our life, and we all have different expenditures. The only thing I can tell the patients to offer them some comfort is, the work that Dr. Reed or myself would do will last a lifetime. There are very few procedures that I can say that about in a patient. Let me add one thing for the audience that might be helpful to them, and Dr. Reed, I'm sure, will second this. Both men and women, when they start to notice hair loss, go through the same routine. They stop shampooing their hair. They start wearing hats. They start doing all of these remedies. None of them stop what's inevitable and hair loss is inevitable.

DAVID R. MARKS, MD: That will be the last word. Thank you both for joining us, and thank you for joining our webcast.