Many women born with a high hair line of have an M-pattern (male pattern hair line in a women) hair line are good candidates for hair transplant surgery. Hair line lowering by transplantation is often a better choice than forehead reduction surgery. In both hairline lowering and repair of m-pattern hair line with hair transplantation artistry of design, recipient site angles and proper handling of grafts are all important in achieving results that you can be proud of.
Female Pattern Balding
A hair follicle sits about 4-6 mm under the skin with a hair protruding through the skin. At any given time about 4% of hair follicles are in a dormant or resting phase called telogen phase of the hair growth cycle. In both male and female pattern balding the hair follicle shrinks over time, resulting in shorter and finer hair and will result in a very fine vellous hair that can only be seen on close examination of the scalp. The follicle at this point will not regrow a normal terminal hair.
The reason for female pattern baldness is not as well understood as with male pattern balding, but may be related to or aggravated by:
- Changes in the levels of male hormones (women before menopause have circulating levels of testosterone). After reaching menopause, some women find that the hair on their head is thinner and experience facial hair growth.
- Family history of male or female pattern baldness.
Hair thinning in women is different from that of male pattern balding. In female pattern balding:
- Hair thins mainly on the top and crown of the scalp and sometimes on the anterior part of the side of the head. Most often we see a widening through the center top of the head.
- Not all hair in an area will fall out completely as in male pattern balding. The front hairline remains at the same level.
- Hair loss rarely progresses to total baldness.
- Itching or skin sores on the scalp are generally not seen.
Female pattern baldness is usually diagnosed based on:
- Ruling out other causes of hair loss.
- The appearance and pattern of hair loss.
- Medical history. How fast you are losing hair, family history, etc.
The doctor will examine you for other signs of too much male hormone (androgen), such as:
- Abnormal new hair growth, such as on the face or between the belly button and pubic area.
- Changes in menstrual periods and enlargement of the clitoris.
- New acne.
A skin biopsy may be necessary and your doctor may order blood tests may be used to diagnose skin disorders or discover conditions that will aggravate or cause hair loss. Untreated Hypothyroidism and low iron are 2 conditions that will aggravate hair loss and should be tested for.
Female pattern balding is permanent, if not treated. In most cases, hair loss is mild to moderate. You do not need medical or surgical treatment if you are comfortable with your appearance.
The only medication approved by the United States FDA to treat female pattern balding is minoxidil:
- It is applied to the scalp.
- Minoxidil (Rogaine) may help hair grow in about 1 in 5 of women. In many women, it may slow or stop hair loss.
- You must continue to use this medicine for a long time. Hair loss starts again when you stop using it.
If minoxidil does not work, your doctor may recommend other medications. Your doctor can tell you more about these if needed. Once you have been diagnosed with Female Pattern Balding your family doctor or dermatologist may refer you to see if you are a candidate for hair transplant surgery. Determining whether or not you are a candidate for hair restoration surgery will be based on the adequacy of your donor hair in the back of your head. If you are a good candidate the results are excellent and permanent if performed by a qualified full time hair restoration surgeon.
Hair Loss investigation in Women
Please see your family doctor or dermatologist for investigation and diagnosis.
Begin your investigation with your family doctor or dermatologist. Never see a “hair transplant business” that has you see a salesperson to try and sell you a hair transplant. You owe yourself a proper investigation to know the diagnosis. Dr. Goertz appreciates his referrals from family doctors, dermatologists and plastic surgeons of patients who have been investigated and referred for hair transplantation when indicated. Many causes of hair loss are amenable to medical therapy and hair transplant is not needed.
Hair loss in a woman can be devastating. It should always be investigated. Start with your family doctor or dermatologist. Acute hair loss can be secondary to multiple conditions and causes including but not limited to telogen effluvium (stress hair loss), alopecia areata, medications, etc. Chronic hair loss may be due to low iron as a result of menorrhagia (heavy periods), hypothyroidism, nutritional issues resulting in low protein, diffuse alopecia areata, cicatricial alopecia and female pattern balding. A full history and examination of your scalp with appropriate blood testing is important for a correct diagnosis. Family doctors and dermatologists are well equipped to begin investigations of hair loss and treatment and referral to Dr. Goertz if needed. When patients are referred to Dr. Goertz they should bring in copies of their lab work.
Common hair patterns for women, the Ludwig Classification:
You need not suffer in silence. You can achieve wonderful results!
If you have been diagnosed with female pattern balding, please contact us for a consultation. Be assured that your privacy is of our utmost importance. For those of you outside of Washington State, we can work closely with your doctor to determine if you are a candidate for hair transplantation.
Dr. Brian O. Goertz, MD