Figure 10-1. Ludwig scale of balding for women (3)
Female pattern hair loss is not uncommon. More than a third of all women will eventually start losing their hair. Most specialists believe both female and male patterns of hair loss result from 5-DHT -a hormone derivative of testosterone. However, female pattern hair loss also has unique characteristics that differ from the male variant. First and foremost, it is far less likely to result in balding. Such hair loss, instead, causes diffuse thinning at the top of the scalp. This lack of baldness made female hair loss particularly challenging to restore until not long ago.
Hair restoration procedures for female pattern hair loss were only viable beginning in the early 2000s. At this time, Follicular Unit Extraction (FUE) finally started gaining prominence. An innovative and precise technique, FUE finally enabled hair restoration specialists to sufficiently repair diffuse hair thinning. An early practitioner of the method, Dr. Cole both instructs specialists in proper technique and researches new advancements. His namesake innovation, Cole Isolation Technique (CIT®), is minimally invasive to further reduce scarring and maximize yield.
Female pattern hair loss has its own form of spreading. Most women notice a diffuse hair loss pattern on their crown. Such thinning may continue but females retain their frontal hairline. Some men can also undergo this pattern of hair loss. However, Dr. Norwood and Dr. Cole published a paper that questions if androgenic alopecia is the same condition but in different genders. The paper includes some important points we detail below.
Figure 10-2. Female with loss of hair in the hairline, the temples, and the crown similar to male pattern baldness.
Some women can undergo male pattern baldness too. This type of recession often follows a generic path, leading to hair recession over their temples. This hair loss pattern on a female also leads to hair thinning throughout the scalp's vortex. This kind of hair loss has a number of similarities with male pattern baldness and is treatable with androgen (testosterone) hormonal therapy.
Males may try a few common treatments to prevent hair loss. Females, though, do not always find the same success using these treatments.
Propecia does not work well with female pattern hair loss. The only exception is if the patient's hair loss resembles the male variant and they also have high levels of androgenetic hormones. This, however, is not very common.
Rogaine, or minoxidil, helps stop any further hair loss. Hair, upon regrowth, will tend to be short and fuzzy. Forhair advises most female patients to use the 5% Rogaine labeled for men instead of the 2% version for women. The FDA, in fact, approved 5% Rogaine for females in 2014. This concentration is a far more effective solution and does not pose any serious threats. An itchy red scalp is the only potential side effect. Patients must regularly use Rogaine or hair loss will likely resume.
Spironolactone, often under the brand name Aldactone, is another option. This heart medicine is an androgen blocker that primarily targets circulating androgens. As already mentioned, though, not all forms of female pattern baldness derives from androgens. Only a small percentage of female patients, therefore, will find the treatment useful. Patients should not conceive while using spironolactone, as the side effects may include breast tenderness, mood swings and irregular menses. Similar to Rogaine, patients must continue taking spironolactone or hair loss will likely resume.
A revolutionary new treatment, WNT Act is the first option available that is equally effective for both men and women. This leave-in spray uses methyl vanillate and other all-natural ingredients to spur WNT channels -a chemical pathway responsible for generating and activating hair follicles. People who apply the treatment typically enjoy a 7% increase in hair density and a 10% increase in hair diameter.
Many hair restoration clinics are beginning to offer Platelet Rich Plasma (PRP). Clinics derive this serum from the patient's own blood to help spur hair growth and thickness. Maintaining the effect requires injections anywhere from month-to-month to every season. ACell, an extracellular matrix, also helps prolong PRP's effect. PRP+ACell injections, typically, require bi-annual or annual injections to maintain hair growth and thickness.
Dr. Cole and Forhair are also researching ways to make PRP more potent. Good for encouraging a fuller head of hair, PRP also contains a lot of matter that does not encourage hair growth. By condensing the serum Dr. Cole and Forhair are now offering a concentrate that is six to eight times more potent than PRP. Dubbed Cytokine Rich Plasma (CRP), this new serum is proving far more effective. CRP offers faster growth and greater thickness than PRP. Forhair continues evaluating the results of CRP+ACell through analyzing its effect on Cole Isolation Technique, or CIT®, patients.
Minimally invasive, CIT® is Dr. Cole's proprietary FUE technique. An advancement that minimizes scarring while also leaving stem cell remnants in donor areas, CIT® in conjunction with CRP+ACell offers radical benefits over other FUE techniques. ACell further minimizes scars, usually ensuring that no marks are visible to the naked eye. Its unique composition also encourages follicular regeneration in donor areas, where stem cell remnants help regenerate follicles. 30% to 40% regeneration is the average. Put simply, for every 1000 single grafts patients can expect 1300 to 1400 new strands of hair. This is both cost effective and encourages hair density.
CRP, meanwhile, further encourages thickness and growth. FUE recipients who undergo CRP enjoy 99% regrowth in 4.5 months rather than 100% regrowth in a year. The combination of CRP+ACell helps ensure that such growth continues with only the need for injections bi-annually or annually. Such advancements are making hair transplantation for females, via CIT®, far more feasible.
A groundbreaking new method to encourage hair restoration, Follicular Stem Cell Infusions encourage hair growth, hair diameter, and hair count. The latter is particularly significant. Aside from hair transplants, no other procedure or method enables patients to increase the number of follicles that grow head hair -until now. Follicular Stem Cell Infusions are still a developing treatment but recipients are showing dramatic results. Studies indicate that recipients of Follicular Stem Cell Infusions enjoy anywhere from a 34% to 24% increase in total hair density within 23 weeks of injection.
The procedure itself involves taking biopsies from the scalp. From there, specialists divide tissue containing follicular stem cells from regular adipose. Then specialists create a serum from the tissue containing stem cells and inject it into thinning or balding areas of the scalp.
Research indicates that Follicular Stem Cell Infusions have major potential. In the future, they may actually replace hair transplants as the go-to method for hair restoration. Research shows the method, as it matures, may not only reinvigorate follicles but also generate new ones. Put simply, such generation means patients may be able to increase their hair count beyond the number of follicles they have on their scalp -perfect for those with a low amount of follicles.
A number of differences exist between transplanting hair for men and women. First is the expectation of results. Women often have one goal: the appearance of full, thick hair. Unfortunately, such thickness is often impossible even in the case of moderate female hair loss. CIT®, CRP+ACell, and stem cell infusions are all helping to change this reality. Female hair restoration, however, is still a developing field. The difference between hopes and possibilities, and how patients handle them, is the main reason why Forhair may refuse female patients more often than male patients.
Figure 10-3. Transplants should concentrate on areas prone to thinning if a patient has significant hair loss now or, potentially, in the future. Further, patients may find that only some hairstyles proficiently mask thinning. In most cases of advanced thinning, we concentrate the transplant in the front of the crown, behind the hairline. The patient will then let the hair in front grow long and pull it back over the thinning area.
If a female's hair loss is not too advanced then there are possibilities. We typically recommend using Rogaine regularly. If open minded to certain hairstyles there are even more possibilities. For example, Ludwig Type I and Type II patients can grow out their hairline and then pull it back to create a style that keeps in place. This helps us focus on follicular units in particular zones, mainly behind the hairline. Such procedures increase hair thickness to better facilitate the appearance of a full head of hair.
Both men and women can color their hair darker to decrease the contrast between their scalp and hair, helping to conceal hair loss. Increasing the hair's length and curl can also add volume. Generally, women have particular leeway to style the hair in a way that conceals hair loss. Women with such hairstyles are often happy with whatever results in a hair restoration procedure yields.
Scalp Micro Pigmentation (SMP) is a procedure that adds all-natural, temporary, tattoos to the scalp. Such tattoos replicate the appearance of growing hair, making it excellent for anyone who wishes to buzz cut their hair. Of course, a vast majority of males prefer this route. Even for females that prefer longer hair, though, SMP is a viable option. The mere coloration of the scalp adds the appearance of thicker hair, helping to negate any appearance of thinning or balding areas. Those with lesser to moderate hair thinning are particularly viable for this procedure.
Female patients can deal with a few hurdles before and after a procedure. Forhair emphasizes thorough examinations for this very reason. Below, we will detail two major conditions that all hair restoration specialists must consider before deciding on a procedure.
Female patients can have a somewhat limited donor supply. This is different from males, who often have a good amount of hair remaining above their ears around their balding scalp. It is unfortunate, but females will have thinning hair in this area. This makes it risky to extract donor follicles, as such thinness can become more visible. CIT® with CRP+ACell makes hair transplants more viable but 30% to 40% donor regeneration is sometimes not enough to compensate for the donor area. Those without thinning above their ears are great candidates for hair transplantation. However, the ultimate result depends on the quality of remaining hair, the degree of hair loss, and patient expectations.
Another difference between men and women lies in telogen hair loss – shedding that happens after physical shock. There is a possibility that hair restoration procedures, even CIT®, can induce this reaction. Males typically deal with a telogen loss of just 5-10%. Females, though, can lose up to 25-50% of their hair.
Healthy hair will return in four to eight months. Miniaturized hair, the result of aging hair follicles creating shorter and finer strands, may not return at all. Those who have indeed lost hair from telogen effluvium will have thinner hair after the operation and regrow it, along with transplants, after four to six months.
There is no way to know who is susceptible to telogen effluvium. Some female patients may experience it after a procedure but not after a subsequent one. This a risk must be willing to acknowledge and take. We always make sure to warn our patients that this condition may occur. We also do our best to minimize those chances.
Forhair often uses two or three follicular unit grafts on female patients. Using larger multi-unit follicular grafts lessens the number of needle sticks by 50%, decreasing the number of grafts and thereby significantly reducing the chances of telogen effluvium occurring. This technique's results can have the slight appearance of plugs, but only if hair loss continues. Multi-unit follicular grafts are always viable for the crown and other areas. However, we often use single follicular units towards the front of the patient's scalp. Doing so is integral for a precise hairline that appears completely natural.
A number of conditions can lead to hair loss in females. Many are similar to the hair loss causes that males suffer. However, some causes of hair loss are more common or profound for females. Your dermatologist or hair restoration specialist will closely consider several possibilities.
As mentioned, telogen effluvium results from some sort of psychological or physical stress. A condition where scalp hair enters the shedding phase, those with telogen effluvium can lose an upsetting amount of volume and coverage. Common causes of telogen effluvium include childbirth, surgery, serious illness, and major social or psychological stress. Such hair loss happens anywhere from one to six months after the event. Hair loss is never fun, but telogen effluvium is not permanent. Lost hair will grow back within half a year. A hair restoration procedure to repair telogen effluvium is both unnecessary and unfeasible.
Women are also more prone to suffer from traction hair loss. This is due to tightly pulling up or otherwise tightly braiding their hair for extended amounts of time. The chronic pull stresses the hair root, eventually killing the follicular system. Resultantly, hair will stop growing in these areas. This kind of hair loss is treatable through hair transplantation. Those prone to losing hair through traction, though, risk losing their hair again if they continue using said hairstyles.
Sometimes facelifts and other procedures can leave scalp scars behind. Similarly, sometimes the hairline may be too high or asymmetric. Such patients are excellent candidates for CIT®.
Female pattern hair loss has its own intricacies and solutions. Skill, thoroughness, and experience are all vital to offer the best possible results. Female patients must be ready to adjust hairstyles and hair care routines so to make the most of their procedures. Further, they must be ready to act upon the first signs of female pattern hair loss -this is when patients often still have a viable donor area.
Forhair will continue researching female-specific hair restoration techniques and treatments. We always look forward to implementing new advancements if viable. Female patients looking to restore their hair are right to choose Forhair. Our years of experience, artistic sensibility, and award-winning skill ensure you have a greater chance of receiving the results you deserve. Count on Dr. Cole and Forhair to continue implementing ways to close the gap between male and female hair restoration.Thank you for rating this article.