I couldn't find a specific women's section or a place to ask questions on women with hair loss and hair transplants. Am I in the right area? Is there a difference between a man getting a hair transplant and a woman?

DWB44,

Our online hair transplant forum is open to both men and women seeking real hair restoration solutions.

Technically there is no difference in the hair transplant procedure for men and women, though there are certainly specific things to consider for women that aren't applicable to men.

Feel free to ask any question you would like in our hair restoration question and answers forum.

Best wishes,

Falc

Hair loss in women IS a little different than in men, and the approach for transplanting is often different for most physicians. In our practice, women make up about 15-20% of our patients. I find that around 70% of the women who present for consultation are able to be offered hair transplantation. The two key requirements are sufficiently dense, high-quality donor hair AND realistic expecations.
First of all, hair loss is far more psychologically devasting for a woman than for a man. Part of their body self-image is to have a full head of hair. Many men look fine without hair on top and it doesn't bother them at all.
Somewhere around 20% of women will eventually have significant thinning of their hair. Their rate of hair loss, compared to the typical male who has hair loss, is much more gradual and over many years. There often are other females in the family history with similar hair loss. They also have a somewhat higher incidence of medical factors causing hair loss, which have to be carefully looked for before assuming it is hereditary "female pattern hair loss." Scalp biopsies are done much more often in women. There are a few different patterns of hair loss in women, but the commonest is for the front hairline hairs to be preserved and for there to be a general thinning all through the top, central area. This thinning often extends to the side areas of the scalp in the temples and above the ears. Fortunately, the majority of these women retain good density in the rear occipital region of their scalp, and this can be used for hair transplantation if there isn't too much miniaturization present. Another common pattern, present mostly toward the front, is the "Christmas tree" pattern, which is loss down the front-center of the scalp. Women's hair loss doesn't seem to be that related to DHT's presence as in men, and finasteride is not usually of benefit. We know women have higher concentrations of the enzyme aromatase in the front hairline area.
In transplanting women, expectations are important. How they will style their hair later is a key factor. Normally the priorities have to be filling in the front-central "frontal core" area with hair so the front view of a woman is a "full" appearing one and the scalp can't be seen through the hairs. Depending on which side or down the center that they intend to part their hair, this area will be transplanted more densely. These hairs will then be styled off to either side, which creates overlap and the illusion of density. Perming the hair is another option that works well to create a fuller appearance.
In transplanting women, one of the key pieces of information that must be communicated and accepted by the patient is that there is greater incidence of "shocking" to native hairs present in the area being transplanted. I would say it occurs to some extent in 30-40% of the women we transplant. It is severe in only 5% and in the others it is mild or moderate. The majority of the shocked hairs will after a few months, regrow and contribute to the hairs present on top. But a lot of the more vulnerable hairs, especially the wispier ones on their last life-cycle, will not return. For many years we used multi-FU small slit grafts in the center and FU's all around. This gives a wonderful density result, but I am presently trying to determine if the larger slits in the middle have anything to do with the 30-40% incidence of shockin, and so we are now taking a two year period in which we are going to transplant most of our females with 2000-2500 FU's, using a dense-packed stick-and-place method in the front center for "instant density" there, and we will see if the density results and perhaps reduced incidence of shocking comes about. If not, I would return to my former way of tranplanting, as it is more economical for the patient and gives very predictable density results. The good news is that as early as 5-6 months after the procedure, the area transplanted has the strong donor hairs from the occipital area growing and appearing filled in.
Paradoxically, I find that the women who are very early in their hair loss and don't actually appear that bad are the ones who are most sensitive to shocking and are much more distressed when it happens. The women with moderate to severe hair loss are almost always happy they went through with it, especially at the 15 month point after the second session.
Mike Beehner, M.D.