It should be well known by now that hair loss isn’t something that only affects men. By the age of 40, around 40 percent of women have some amount of hair loss. The number of women coping with hair loss rises sharply after menopause. It might not be a threat to a woman’s life, but hair loss does have a big impact on a woman’s emotional health and self confidence that can end up impacting a woman’s physical health. Although plenty of people would be happy to sweep the issue of women’s hair loss under a rug, the condition is so life altering that it can’t be ignored.
More Than Just Female Pattern Baldness
Although women do experience androgenetic alopecia, also known as female pattern baldness or AGA, that is not the only cause of hair loss in female patients. AGA is a genetic condition that a person inherits from her mom and or dad. When a person experiences female pattern baldness, androgens, or male hormones, bind to receptors in certain hair follicles, changing the type and size of those follicles. Once the follicles are miniaturized, the hair that grows from them is finer. When a woman sheds hair from the affected follicles, new hair grows much more slowly.
In female patients, hair loss related to AGA is usually further complicated by several factors. A woman’s diet, a recurring illness, low levels of certain vitamins and minerals, and some medications can also play a part in hair loss.
In some cases, the factors can trigger telogen effluvium, or extensive hair shedding. Usually the shedding occurs several months after the illness or other incident. While hair lost due to telogen effluvium usually grows back on its own, once the contributing factor is taken care of, if a woman is dealing with AGA and telogen effluvium, it’s possible that the shed hair will not grow back.
Types of Alopecia
Alopecia, or hair loss, can be categorized into two major types, scarring or non-scarring. AGA is a type of non-scarring alopecia, as is telogen effluvium, anagen effluvium, trichotillomania, and alopecia areata. Non-scarring simply means that the hair follicles aren’t completely destroyed when the hair is lost.
Next to AGA, alopecia areata might be the type of alopecia people are most familiar with. It’s a type of autoimmune disorder, meaning that a person’s immune system attacks the follicles on the scalp and other areas of the body, causing hair loss.
In many cases, the condition causes a person to lose hair in patches from the scalp. Some people do lose hair all over their scalp or even all over their bodies. Alopecia areata is often diagnosed by looking at the type of hair loss a woman is experiencing, examining the shape of the hairs, or by biopsy. It is often treated with steroid injections, though in many cases patients see their hair grow back on its own without further treatment. Hair transplant is not usually recommended for people with alopecia areata, though it might be an option in very specific cases.
Compared to non-scarring alopecia, cases are scarring alopecia are rather rare, although there is a wide variety of different types. Scarring alopecia damages the follicles, as a result of inflammation or trauma, such as a burn or incision made during surgery.
The large number of causes of hair loss means that it is critical that a hair restoration surgeon be able to determine when the cause of a woman’s hair loss is related to AGA and when it is due to some other issue. While AGA responds well to hairtransplants, some other forms of hair loss do not.
Diagnosing and Treating
The process of diagnosing the cause of hair loss can be quite involved. Usually the surgeon will ask a patient for a medical history and perform a physical exam. A scalp biopsy may be performed, and the surgeon may use a trichoscope to take images of the woman’s scalp for evaluation.
Hair restoration surgery isn’t the option for women who are experiencing hair loss. Depending on the diagnosis, a few other therapies might be helpful.
In instances where the hair loss is a direct result of a medical condition, such as a thyroid issue, treating the medical issue means that the hair is able to regrow on its own or at least stop falling out. The same is true in cases where a woman’s hair loss is related to a nutritional deficiency, such as low iron levels or insufficient vitamin D levels.
Some women experiencing AGA have benefited from treatments such as laser light therapy or platelet rich plasma injections. Medications can also be helpful in treating hair loss. Minoxidil and spironolactone are just two examples of medications that can reduce hair loss or encourage hair growth. It’s worth noting that finasteride, a medication that can be helpful to men experiencing hair loss, has had little effect in female patients.
Hair Restoration for Women
Female patients dealing with hair loss can benefit from hair restoration surgery in a number of ways. Currently, there are two general techniques used to transplant hair, follicular unit grafting and follicular unit extraction (FUG and FUE, respectively). The techniques are very similar. The only major difference is how the surgeon harvests the hair grafts.
During FUG, the grafts are removed in a strip from the back of the head. During FUE, hair grafts are removed one by one. FUG usually leaves a fine line incision scar on the scalp, which can be easily concealed if a woman wears her hair long.
Hair restoration can be performed on a female patient to fill in thinning areas of the scalp. Due to the type of miniaturization that takes when a female patient has AGA, there is a risk for there to be “shock loss” of existing hairs. An experienced surgeon takes certain precautions to reduce the risk of loss of otherwise healthy hairs.
A hair transplant can also be performed to lower a woman’s hairline. There are two methods of reducing a high hairline. The first option is to transplant hair from the back of the scalp to the front. The second option is to surgically reposition the hairline, called a surgical hairline advancement/forehead reduction procedure. A woman needs to have enough laxity and mobility in her scalp for a surgical advancement procedure to be effective.
Hair restoration isn’t reserved for the scalp. Women who have thin or sparse eyebrows may choose to have a hair transplant to create a fuller brow. A woman who has undergone a facelift and who has lost hair on the sides of the face due to the position of the incisions, might decide to have a surgeon restore her lost sideburns.
Having a full understanding of the causes of hair loss in women and the various treatment options available makes it possible for a surgeon to provide the best care and treatment to a specific patient. Dr. Jeffrey Epstein is a board certified hair restoration specialist and the director of the Women’s Center for Hair Loss and the Foundation for Hair Restoration. He is joined by hair loss expert Dr. Goran Kuka, a board certified plastic surgeon from Europe, in treating women. If you are a woman who is dealing with hair loss and who wants to know more about the potential causes and available treatments, call (305) 666-1774 for a consultation at the center in Miami or (212) 759-3484 for the location in New York.