- Best Results10-12 months+
- Treatment RecoveryVariable
- Procedure Time2-6 hours
- Skin SpecialistDermatologist
- Duration of ResultsYears+
- AnaestheticBlocks, sedation
- Back to Work3-7 days
- Cost$$$-$$$$$
Hair Transplantation - Women
Over a third of women will experience significant hair loss over the age of 50. Most cases can be treated with medical management including the use of minoxidil & antiandrogen tablets. Good regrowth can be expected with microneedling & PRP. FUE hair transplantation can be considered for stable refractory cases with good donor site density. Candidate selection is important.
FactsFacts On Hair Transplants for Women
- PRP, microneedling & lasers can be adjunctive therapy
- Females are more likely to have diffuse or global hair loss
- Diffuse patterns are not great candidates for hair transplantation
- Post transplant telogen (limited hair loss) is more common in women
- Female pattern hair loss patients are best treated with medical therapy including minoxidil, spironolactone, cyproterone acetate & hormone modulators
- Careful selection of suitable candidates is paramount
What is the logic behind hair transplantation?
Hair transplantation means shifting the location of your hair follicles from a more densely populated area to an area of thinning, or in some cases absolute hair loss. Transplantation just repurposes the existing hair follicles. Medical science is not at the stage of ‘growing’ new hair.
The most common area we harvest hair from is the back of the head, known as the occipital area. Gone are the days of hair plugs, as now we use follicular units. Each unit contains hair shafts (between 1 to 4), the sebaceous or oil gland, the hair muscle known as the arrector pili as well as the blood & nerves that supply the unit.
What is FUE hair transplantation?
FUE or follicular unit extraction is a minimally invasive surgical procedure that transfers hair follicles from a high-density donor area, to a poor density recipient area- typically the front of the scalp.
The majority of hair transplants in women employ this method. Strip or unshaven FUE is the most common sub-method as this enables women to keep their hair long & hide the recovery areas.
FUE involves manually harvesting one, two & three group hairs within a ‘follicular unit.’ Each unit contains terminal hairs, an oil gland (sebaceous gland), the arrector pili muscle, as well as tissue containing the neurovascular sheath. These units are then repurposed to areas of low hair density using either micro incisions or a follicular unit hair implantation device (Choi or modified Choi implanter).
Why is hair transplantation much more difficult in women than in men?
It is because hair loss in men follows certain patterns called the Norwood pattern of hair loss. This means blokes have hair loss that favors the front, temples & vertex of the scalp. Hence the donor area at the back is largely spared from the balding process.
Women on the other hand experience hair loss from many areas, known as diffuse hair loss(type 2). This is classified as the Ludwig scale of hair loss. This means that the occipital area donor site has less density to work with. The other important point is that for males, we are able to construct a high hairline that looks natural. Not a great look for women- hence the importance of hair styling to hide less dense areas.
How do I know if I am a good candidate for FUE transplantation?
Here is a checklist.
- Is the diagnosis certain? FUE is not indicated for conditions such as telogen effluvium, chronic TE, hair loss due to medications, nutritional deficiencies or rare inflammatory conditions. A diagnosis from a medical dermatologist is the first step.
- Are you on optimal medical therapy? This includes minoxidil, cyproterone acetate or off label finasteride. You do require medical therapy to maintain your hair growth.
- Is the pattern of hair loss conducive to hair transplantation? Only some forms of androgenic alopecia in females are amenable to FUE. Women with diffuse hair loss including Ludwig Type 2 (global thinning) are poor candidates for FUE, as are patients with predominantly single follicular units.
- Have you tried less invasive procedures that are cost effective? Microneedling & PRP can give good results in most cases.
- Are you willing to be guided by your hairdresser as to what hairstyle is best for coverage?
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Will hair loss stop once hair is transplanted?
No. Hair loss usually continues. This is why it is vitally important that patients should be on medications lifelong. This includes minoxidil & in some cases anti-hormone medication. If you stop these medications, hair loss will return within 4 to 8 months.
How long is the procedure of hair transplantation?
Procedure time is directly related to the number of follicles transplanted. It can range from 2 to 6 hours. As most cases are FUE strip shave or limited shave techniques, treatment time is extended by 20%. Unshaven FUE harvests individual donor follicles that are precut on the day. This adds another 20% to the operation time.
How many sessions will I require?
1-3, depending on the extent of hair loss. In some cases, transplants are conducted several years apart as hair fall is progressive.
Is the procedure painful?
No. Sedation, local anaesthetic & ring blocks are used during the procedure.
Post procedure swelling & pain can be easily managed with paracetamol. Avoid anti-inflammatory medications & aspirin as these may cause postoperative bleeding.
What is post procedure telogen & is it commonly seen?
Telogen effluvium is more commonly seen in female hair transplants compared to men. This most frequently occurs at the recipient site, but can affect the scalp globally. Hair shedding is due to follicles entering the sleeping phase in the first few weeks or months after transplantation. Over 2-4 months these follicles are shed. This results in marked hair loss that is extremely stressful for the patient (and dermatologist). Telogen effluvium is self-limiting. Hair density returns within 4-8 months.
This is not a complication of hair transplantation, but an anticipated outcome. Your dermatologist will discuss this event with you prior to surgery.
Why should you consider medical treatments?
Medical treatments will slow down your hair loss. In some cases, it may regrow hair. Your dermatologist will guide you as to the best combinations based on the diagnosis of hair loss, the clinical examination & your lifestyle.
The aim of treatment is to preserve the remaining hair follicles as quickly & safely as possible. Medical treatments are life-long. Cessation of treatment will result in regression over a period of 4 to 12 months.
Disclaimer: I am a procedural dermatologist. I do not treat hair loss with medical therapy (lotions/tablets). Please consult one of my colleagues at Clinic Cutis.
What is the usual combination of hair loss medications for women?
Do not consider hair transplant if you are unwilling to undertake medical treatments. This is equivalent to having an organ transplant without post procedure care. Hair follicles can be considered as skin organs. Once they expire, you are not going to get new follicles back.
Your dermatologist will prescribe one of the following combinations-
Topical applications: Minoxidil 5% standalone, foam or lotion. Some add finasteride 0.1 to 0.25% off label.
Oral tablets: Minoxidil 1 to 2 mg tablets, option for cyproterone acetate pulsed monthly. Off label finasteride or dutasteride (category X).
Disclaimer: My work is surgical, I do not prescribe. Please see a medical dermatologist for options. Be guided by their decision. There are many variations of the above. Each dermatologist will have their own preferred treatment based on current research, as well as other factors including FDA-TGA approvals & safety data.
What are other non-surgical methods to treat hair loss?
The next stage up the ladder (after initiation of medical therapy) is PRP & microneedling. This combination can be successful in improving hair density as it has the potential to transform telogen (dormant hairs) to anagen (growing hairs). PRP can also reduce miniaturization of hair follicles & increase hair size, including hair diameter.
The usual prescription for PRP is three treatments, spaced a month apart, followed by maintenance every 4-8 months. Adjunctive clinical scalp microneedling can provide additional benefits.
Can lasers help regrow hair?
Yes. Lasers can have a limited role in maintaining & in some cases regrowth of hair on the scalp & eyebrows. Lasers are divided into two main types, low level & clinical lasers.
Low level laser therapy is known as LLLT, it is used by most cosmetic clinics & hair loss centers. It can also be used at home using devices in the 600 to 1050 nm wavelength. The most common spectrum is red. This treatment is applied weekly, however it can be used every day to second day, depending on the power of the unit. Hair growth is marginal at best.
Clinical lasers include non-ablative & ablative laser resurfacing. The most common laser we use is the 1927 thulium. 8-12 sessions are required over a period of 2 to 3 months. Hair growth can be demonstrated in most. Adjunctive medical therapy is required for all.
Why is hair styling important for women with hair loss?
Along with medical & surgical techniques to correct hair loss, hair styling is super important in women. Correct styling, hair dye & hair can can markedly improve the perception of hair loss in women. In some cases you will need to compromise as to how you normally comb your hair, compared to what is the best way to hide thin areas. Your hairstylist can discuss these options with you.
This is one of the most important steps of camouflaging hair loss that is underestimated by most patients & dermatologists.
What is the go with laser therapy for hair loss?
I have used, & still do use lasers for hair loss as part of ongoing research papers. He is the go.
Low level laser therapy (all the rage in hair loss clinics) has been shown to be effective in slowing down hair loss, & in rare cases growing hair. Results clinically are disappointing. Nevertheless they can be useful as adjunctive management.
Real lasers (as opposed to LLLT which are essentially light emitting diodes), may offer better results, in particular the thulium 1927 laser which we are currently using in some research papers. This is often combined with PRP & growth factors. The aim of this laser is to stimulate stem cells in dormant hair follicles as well increase absorption of growth factors.
A clinically effective laser program for male pattern hair loss is- thulium low density laser, weekly for 10 weeks. Lasers are always combined with medical management.
Davin’s Viewpoint on FUE for women
As with all sexes, prevention of follicular miniaturization is paramount. Far, far easier to halt early progression than to deal with thinning, especially globally.
Your first point of contact is a medical dermatologist. They can confirm or exclude other causes of hair loss including telogen effluvium, chronic TE, drug induced hair loss, metabolic/endocrine cases, & rare conditions such as diffuse alopecia areata, loose anagen syndrome etc. In many cases there are two concurrent hair loss conditions, the most common being telogen effluvium (or CTE) & androgenic alopecia. Treatment can be complex, & in many cases FUE hair transplantation is not the answer.
Note: I am a procedural dermatologist. For hair loss conditions that are medical please see my colleagues at Clinic Cutis.
