Month: May 2006

I am a woman considering hair transplant surgery. I have hair loss from prior cosmetic surgery. I just read a Q from a man who had more hair loss after hair transplant surgery. You recommeded he take propecia.
Could this type of hair loss happen to me? If so, would you recommend propecia or anything else to prevent it?

If you have lost hair secondary to a cosmetic surgery procedure, it would be worthwhile to determine if you have female genetic hair loss as a cause. Some women with hair loss from a face or brow lift may lose hair without the genetic propensity for it. By mapping our your scalp hair for miniaturization that can be simply determined on an office visit. You need to know this, because there is a different outcome potential between the two. If you do not have genetic hair loss then you can expect that no significant reactive hair loss will occur from a hair transplant. Drugs like Propecia do not work in women and may not be safe for women (not approved by the FDA for either safety or effectiveness in women). Any good doctor should be able to make such an assessment for a hair transplant candidate like you. I see you are in Los Angeles so I would be happy to make that assessment for you in my Los Angeles office. You can contact my office at 800-NEW-HAIR to setup a free consultation.

I’m a 55 year old female suffering with androgenetic alopecia since the age of 13-14. My hair have been very thin on the front and top for a long time, and I’ve gone through menopause in the last 10 years, which has exacerbated the problem.I had a scalp biopsy in February – there is nothing beyond a female pattern balding. I do not wear wigs or systems hiding the bolding spots but will have to if I don’t get a transplant. My dermatologist said I would need not less than 1000 units. I visited one (strip) surgeon and was assured that I have enough donor hair on the back and would need around 1200 units. If both of them are right and I won’t need more than 1200-1600 units, which method would you recommed – FUT or FUE? I have made research on the web and know that women may go through a terrible shock loss during the surgery. Since FUE is less invasive, wouldn’t it be more beneficial for females? I am ready to wait for a year and get a FUE later once the prices go down if it is really more beneficial.

I would appreciate your advise, Dr.Rassman. Thank you so much.

The first issue should be whether or not you are you a candidate for hair transplantation. More than 80% of women are not candidates for hair transplants, because the hair loss is diffuse and the donor area is not healthy (highly miniaturized hairs are often present). First, you need a quantification of how much miniaturization you have and what your donor density is. This is done by mapping your scalp for miniaturization and then you can calculate what can be harvested (methods for harvesting are less important than the decision to transplant of not). Then when you know the value of the donor supply, you need to have an assessment made for the recipient area asking, “Is the amount of good donor hair (total hairs less the miniaturized hair) adequate to address the balding area?”

What is woman’s hair loss anyway? Woman’s hair loss must be approached differently than men’s, as most women rarely lose all of the hair in their affected areas. In fact much of the hair remains, but the thickness of the hair shaft is smaller than normal hair. This reduction of hair thickness (miniaturization) causes the hair to appear thinner.

What does a transplants actually accomplish when a woman has generalized thinning? Because a relatively large area is often subject to thinning, it is important to place the hair in areas where it is cosmetically most significant and where it can augment a specifically “defined” styling plan to increase the appearance of fullness. For this reason, we generally confine the entire transplant process in women to a localized part of the scalp such as behind the “frontal hairline” or “along the part”. For those who accept this notion, we will tailor the transplant procedure to meet a specific styling need.

Since hair transplants in women with diffuse hair loss will be transplanted into a part of the scalp that is thin, but not completely bald, there is a risk that some or all of the original hair in this area may be lost. This process is called “telogen effluvium” and is usually (but not always) reversible. In addition, if the donor area continues to thin as the genetic female hair loss progresses, then the transplanted hair will also thin over time, since it came from the same area. Limited transplants in defined areas may be improved by subsequent procedures, but with significant loss, there is a limit to the improvement that can be achieved and for this reason, women are often discouraged from having hair transplants when they come to my office unless they recognize what I just discussed above. In hair transplantation, as in all surgical procedures, it is important to balance the potential gain against the possible risks when making a decision to go forward with the treatment. An educated patient is even more important for a woman who may get no benefit than for a man who may get less of a benefit than he expected.

FUT (strip harvesting) vs FUE/FOX technique (direct follicular extraction with a punch type instrument) is tied to carefully selecting a physician who is capable of doing both methods of harvesting. Be careful of the many physicians who claim that they are experts on this FOX/FUE/FIT technique. I know and trust only a handful of physicians to do this technique. Physicians who are not well trained in this technique can destroy more follicles than they extract and even some of the so called experts, are charletans when they tell the public that they were either one of the founders of this technique or that they ARE the founder and/or the inventor of this technique. I suspect that if you research this expertise on the internet, you will find more than one doctor claiming the ‘inventor’ status of this technique. The percent yield can be as low as 20% of the total transplanted hairs and in women with a great deal of miniaturization, that would be a disaster.

Again I state with great emphasis Let The Buyer Beware!