A: The majority of women present with diffuse hair loss (i.e. thinning all over) rather than the patterned hair loss seen in men (where the hair is localized to the front and top of the scalp).

Diffuse thinning presents two problems for a potential hair transplant candidate.

The first is that there is no permanent area where the hair can be taken from. If hair is taken from an area that is thinning, the transplanted hair will continue to thin after the procedure, since moving it doesn’t make it more permanent.

The second problem is that since the areas to be transplanted are thin, rather than completely bald, the existing hair in the area of the hair transplant is at some risk to shedding as a result of the procedure.

When women have a more defined pattern (i.e. more localized thinning on the front part of the scalp with a stable back and sides), they can make excellent candidates for surgery. This pattern occurs in about 20% of women. A small percentage of men have diffuse thinning and are, therefore, poor candidates for a hair restoration surgery as well.

A: Hair transplants work because hair removed from the permanent zone in the back and sides of the scalp continues to grow when transplanted to the balding area in the front or top of one’s head. The reason is that the genetic predisposition for hair to fall out resides in the hair follicle itself, rather than in the scalp. This predisposition is an inherited sensitivity to the effects of DHT, which causes affected hair to decrease in diameter and in length and eventually disappear – a process called “miniaturization.” When DHT resistant hair from the back of the scalp is transplanted to the top, it will continue to be resistant to DHT in its new location and grow normally.

A: If it turns out that you have female pattern hair loss, you may be a candidate a hair transplant, but would need to be evaluated by a doctor who specializes in surgical hair restoration.

In the evaluation, you should have your degree of hair loss assessed and donor supply measured, using an instrument called a densitometer, to be certain that you have enough permanent donor hair to meet your desired goals. For more information about hair loss in women, please see the Diagnosis of Hair Loss in Women page of the Bernstein Medical – Center for Hair Restoration website.

If you are thinking about your hair loss and would like to be evaluated, go to the physician evaluation page of the Bernstein Medical – Center for Hair Restoration website.

A: You can have shedding in the donor area from an FUE procedure, although it is not common. In FUE, the hair must be taken from the permanent zone and if there is too much wastage in the extraction process, too large an area may be needed to obtain the hair. This can leave a thin look even without shock loss (shedding).

A: We generally do not consider hair transplantation until a person is at least 25. There are a number of reasons why hair transplants are not indicated in someone younger than this.

When hair loss starts at an early age, the pattern is unpredictable and the hair loss has a greater chance of being extensive in the future. Also, the permanency of the donor area cannot be determined (see the Diffuse Unpatterned Alopecia (DUPA) page on the Bernstein Medical – Center for Hair Restoration website).

If hair loss is going to be extensive, then the best that one can expect from a hair transplant is to replace hair on the front and top of the scalp. There would usually not be enough hair to fill in the temples or the crown. This look is fine for a person in their 30’s or 40’s who is losing hair, but having a thin or bald crown is not generally acceptable for someone in their 20’s.

Hair transplants are more efficient if performed in relatively large sessions. Multiple, small incisions in the back of the scalp (either by Follicular Unit Transplantation (FUT) or Follicular Unit Extraction (FUE)) consume more hair than when the hair is harvested through a single incision. In addition, when hair loss is early and there is a lot of miniaturized hair in the area to be transplanted, the hair transplants can actually accelerate hair loss in the area in the vicinity of the procedure.

If one were to try and fill in the temples of a young person, a substantial amount of hair would be needed so that the density of the transplanted hair would match the density of the surrounding (already existing) hair. As the person continued to lose hair in the center, the densely transplanted hair in the temples would stand out as two permanent “horns” of hair. Hair placed in the crown would create the same problem, as enough density to satisfy a young person would result in a pony tail as the hair loss in the crown progressed and the bald area expanded around the transplanted area. With advanced baldness, there may not be enough donor hair to connect these areas together, so the result will be a very unnatural look.

In the adult male, the frontal hairline is normally recessed at the temples, so this should not be restored unless the patient’s donor density is very high and the ultimate hair loss pattern limited – two conditions that cannot be determined when a person is young.

On the other hand, medical therapy with finasteride (Propecia) can be very effective in early hair loss by possibly growing some hair back and more importantly by slowing or halting the balding process for many years. The sooner the medication is started the more useful it is, because it works far better in preventing hair loss than bringing it back once the hair is gone. Unfortunately, it will not grow hair back in the temples if this area is completely devoid of hair. Medications work by reversing the miniaturization process, so there must be some existing hair in the area for it to act on.

In sum, it is best to wait until you are a bit older before considering surgical hair restoration. By having hair transplants at a slightly older age, your expectations may be closer to what can actually be accomplished, and your eventual hair loss pattern will be easier to determine. In the meantime, medical treatment with Finasteride, is a good option.