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Female Hair Loss

Hair Loss in Women by Dow Stough, MD

Female hair loss is culturally unacceptable despite the fact that up to 40% of the female population experiences some hair loss in their lifetime. It is not uncommon, but the stigma attached to female baldness is an extremely stressful and unwelcome event. In fact, androgenic alopecia in women can be psychologically debilitating. There have been several medical studies which have concluded that although alopecia is clearly a distressing experience for both sexes, its effect is much more problematic in women. Most women go to extremes to conceal and treat their hair loss by using a broad array of creative camouflaging and hair thickening cosmetic techniques in an attempt to mask the condition.

Females who are experiencing hair loss should undergo a thorough investigation by a dermatologist. The medical workup and testing for women with hair loss is very involved and time consuming. The most difficult cases are women with diffuse hair loss; i.e., balding which is not concentrated in the frontal regions of the scalp. In cases of non-patterned alopecia, a dermatologist will usually recommend laboratory tests, which may include a complete blood count, iron levels and thyroid studies. An extensive medical drug history and family hair loss history must also be obtained, and in some cases testing for a hormonal imbalance is warranted.

For those women who do not have diffused alopecia, the diagnosis is simplified and much more direct. These women are classified by the Ludwig classification system. There are three categories: Ludwig I, Ludwig II, and Ludwig III. Those with a Ludwig I pattern are not candidates for any surgical treatment. They are best treated with topical treatments. Patients with more advanced hair loss and who are categorized as Ludwig II or Ludwig III are possible candidates for hair transplantation. They are acceptable candidates if they have an adequate amount of donor density. The donor area is the hair found in the back of the scalp. In those women who have complete balding in the central and frontal of the scalp, hair transplants are a viable option. The results from this transplant can be truly outstanding since many women retain the frontal hairline and it does not need to be recreated.

Transplantation in women with hair loss caused by cosmetic surgery also yields excellent results. By camouflaging the scars resulting from brow lifts or facelifts these patients are able to achieve their expectations.

Women who experience hair loss after undergoing a brow lift procedure lose hair behind the frontal hairline. These scars are occasionally unsightly and noticeably whiter than the surrounding scalp. Hair grafts are placed directly into the scar tissue to cover the area. Generally one or two sessions of grafting are required.

Females who receive a facelift usually do not suffer from hair loss. In some cases though, the hair in front of the ears (the sideburns) and above the ears will be lost due to the tightening and trimming of the skin. These women do very well with hair transplants. By recreating the sideburn area, the patients' previous hairline is restored. At least two sessions are needed to cover the area adequately.

The crown should be approached cautiously. This region is of marginal importance to one's appearance, and transplanted hair in this area does little or nothing to enhance one's appearance. The crown has the capacity to consume an almost endless quantity of grafts which are needed elsewhere. The crown is positioned at a transition point between hairs directed posterior to anterior and superior to inferior. The concealment of grafts of any size is much more easily accomplished in the frontal region than in the crown area. No traditional 3 mm grafts should be used in the crown. We use only one to three hair grafts in this area. Most patients do not receive extensive crown grafting. If possible, we leave this area bald. The patient's overall appearance remains unaffected, since the top of the scalp does not contribute to the framing of one's face.

The bald area in the back of the scalp, also known as the crown area, is of great concern to the surgeon and the patient. This circular pattern of baldness is surrounded on all sides by hair prone to hair loss. This area can be covered with transplanted hair but this results in a temporary quick fix. With time and further hair loss, a tuft of transplanted hair surrounded by a halo of bald skin appears. Eventually, the patient runs out of donor hair to correct this problem, while the halo continues to advance. In retrospect, this problem seems obvious, but these "revelations" have come only after years of evaluating the results. All things change with time.