Hair Transplants for Females
Half the women in the world experience hair loss in their lifetime. By the time they’ve reached 50, 40% will have experienced the most common cause of hair loss – androgenetic alopecia or female pattern baldness.
While most patients undergoing surgical hair restoration are male, many females can also have this procedure successfully.
It is commonly done using the follicular unit extraction (FUE) technique, in which small groupings of hairs, known as grafts, are extracted from the back of the scalp and then redistributed to the balding areas.
Can Women get a Hair Transplant?
If you have a strong and stable donor area – a permanent strip of hair at the back and sides of the scalp – hair transplant surgery is possible in the following cases:
Progression:
#1 thinning around the crown and middle part, with the latter widening slightly;
#2 hair gets thinner and less dense, with the scalp showing through; and
#3 extremely bald crown and top, but a frontal fringe is retained
Appearance: Visible when hair is parted in the middle. Starting at the vertex (which forms the top of the tree), there is a gradual widening towards the front.
For feminisation and lowering of the hairline.
Appearance: Hairline recession and crown hair loss.
Traction alopecia, high forehead, congenital triangular alopecia, traumatic injury (e.g. burn scar), or camouflaging a surgery scar (e.g. facelift).
Contradictions
There are some instances where a hair transplant surgery may not be indicated, such as:
Diffuse hair loss
If your hair loss affects your entire scalp, you won’t have a stable donor area to extract from (any hair extracted will be lost), in which case the surgery is not possible.
Temporary hair loss
Telogen effluvium is a type of temporary hair loss that can occur due to childbirth, hormonal imbalance, nutritional deficiency (like iron), hair dyes, crash diets, etc. If the hair loss is temporary, it does not require surgery.
Unpredictable hair loss
Alopecia areata is an autoimmune condition that can cause unpredictable and patchy hair loss. If a hair transplant is done in this case, your immune system can attack the transplanted hair, causing it to fall out.
Trichotillomania
It’s a hair pulling disorder. While such patients can undergo surgery for permanent hair loss, it is performed only after the condition has been treated to prevent compulsive hair pulling
Active scarring alopecia
If you’re seeking a hair transplant after losing hair due to conditions such as frontal fibrosing alopecia, central centrifugal cicatricial alopecia, and lichen planopilaris, you need to wait for them to go into remission and stabilise.
Unrealistic expectations
It is essential for you to understand the limitations of what can be achieved through this surgery. Patients with body dysmorphic disorder often have unrealistic expectations, which is why a hair transplant is contraindicated for them.
Graft Planning
An essential consideration in female hair transplantation is meticulous planning regarding the number of grafts to extract. Women may face the challenge of having a limited supply of donor hair since the sides are often susceptible to thinning and not always suitable for extraction.
Therefore, to ensure efficient use of donor hairs, you should have a clear idea of the areas that concern you the most so that your surgeon can focus on improving their density. These can include the frontal hairline, midline, temple areas, crown and/or a side part.
For instance, if you like to part your hair to one specific side, more grafts can be inserted in that area so it works well with your preferred hairstyle. Implanting hair across the entire scalp may result in lower overall density. Remember, the goal of a hair transplant is to create a satisfactory illusion of density.
Besides defining the areas you are concerned about, your surgeon will assess how many grafts you need and how many can be extracted. One of the things to do in this regard is to measure the area of baldness, which can be done by approximating geometric shapes to your recipient area.
Additionally, the recipient density has to be determined. Generally, it can vary from 25 to 40 follicular units per cm2 or even more. However, some factors influencing this calculation include:
Graft planning also involves determining the density and size of the donor area. Keep in mind that 40-50% of follicular units per cm2 will be extracted, so if you have a very poor donor density, extraction can lead to permanent bald patches at the back of your head, which is why careful assessment of the donor area is necessary.
Hairline Design
A woman’s hairline is quite different from a man’s. The absence of frontotemporal recession is one of the most significant differences between male and female hairlines.
In males, the hairline is commonly M-shaped with a small triangular recess at each corner. However, a female hairline is typically round and curves at the corners (although there are other hairline shapes, for instance, oval, rectangle, and heart).
A closer look at the female hairline also reveals the presence of additional features, such as a cowlick in the centre, widow’s peak, and lateral mounds (small, subtle peaks).
To outline it, a central point is marked using the centre of the nose as a reference. The surgeon then draws a line between the eyes and the forehead, and a laser device is used to make it perfectly straight.
During hairline design, the surgeon may ask you to raise your eyebrows to ensure the hairline is positioned above your forehead muscles. The hair will move when you make certain facial expressions if it is implanted into these muscles, which looks unnatural. It is also a reason why your hairline cannot be too low.
From this central point, the lines on each side of the hairline can either be relatively straight or gently curved, depending on its shape. As the hairline bends downwards, there can be a small jutted area for the temporal peak, and then, with a slight curve, it can taper down to the sideburn.
Shaving
For many women, shaving their entire head for a hair transplant can be off-putting. Fortunately, it is not always necessary to do so.
If you need 3,000 grafts or fewer (women typically require fewer grafts as complete baldness is rare), you can opt for a unshaven direct hair implantation (DHI) procedure.
It’s important to note that while your recipient area remains unshaven, a small patch or window of your donor area will still be shaved for graft extraction. Even so, with long hair, you can easily conceal the bald patch until your donor hair grows back long.
Donor Harvesting
Before the donor area is harvested, a “safe donor zone” is marked at the back of the scalp. It’s the area where permanent growth is expected, making it suitable for transplantation to balding regions. There, it can continue to grow without a change in its original characteristics – a concept called donor dominance.
The safe donor area is located slightly further down the perimeter of the crown area. If it is too close to it and crown hair loss progresses in the future, the grafts in that area would be lost, showing the FUE punches. This is why an experienced surgeon is careful and considers long-term implications when delineating this zone.
The inferior border of this safe donor area is usually around the bony bump at the lower back of the scalp. And as mentioned above, since temples in women can be susceptible to thinning, they’re usually spared.
After the safe donor zone has been determined during the consultation, it is operated on under local anaesthesia with the use of a 0.8-1 mm diameter punch tool and tweezers – one technician frees the grafts from the skin, and the other plucks them out using tweezers.
During harvesting, care is taken to ensure a uniform extraction, considering that removing too many grafts from the same area will leave a noticeable bald patch behind. Furthermore, care is taken to minimise damage to grafts during extraction. The punch tool is angled in the direction in which the hair exits from the scalp so the grafts are not cut.
The entire process can take a couple of hours, but it naturally depends on the number of grafts that need to be extracted. Once the planned number of grafts has been taken out, the donor area is bandaged.
Incision-Making
After the grafts have been harvested, work begins on the recipient area, which, like the donor area, receives both anaesthesia and tumescence before the slits can be made by the surgeon.
In females, this part of the surgery is particularly important because the angles can change significantly, especially in the front part of the hairline. And if these incisions are not made properly, the hair growing out of the scalp will look unnatural.
Unlike in males, where the incisions are angled forward, it goes the opposite direction in women. Even the cowlick at the front and centre reverses back into the hair, which then requires angling the hair in that particular way.
On the sides, the incision sites gently slope downwards while following the direction and angle of the native hair. The orientation of the incisions can be sagittal (parallel) or coronal (perpendicular) – the latter is usually preferred to create a better illusion of density.
In addition to orientation, the size of the incisions also varies in different regions of the scalp. This variation depends on the size of the graft that will be used: smaller incisions are made at the front, while the larger ones are placed at the back.
For single hair grafts, the incisions are obviously smaller and can be around 0.6-0.9 mm. They can be around 0.9-1 mm for grafts with two hairs and go up to 1.2 mm for those with 3-4 hairs in them. The depth of these incisions is no more than 2 mm, although it is adjusted according to the length of the graft itself.
Note that incisions can be made with blades or a Choi implanter pen for female hair transplants. The Choi implanter pen allows for simultaneous site creation and graft insertion with better graft survival. In regular FUE, graft insertion is done after the incisions have been made.
The creation of recipient sites can also take 1-3 hours – it again depends on the number of sites that need to be made but may vary according to the complexity and experience of the surgeon.
Graft Insertion
Graft insertion is carefully performed by experienced technicians to achieve natural-looking results. This can take up to 2 hours as well.
First and foremost, thin 1-hair grafts are placed in the very front few rows to create a feathered hairline. This is followed by a transition to 2-hair grafts and then 3-4 hair grafts while going backwards on the scalp.
Careful handling is very important in this step of the surgery. Damage from the forceps, dehydration or other trauma can impact graft survival and, consequently, your results. Therefore, your medical team will exercise utmost diligence.
Recovery
Your recovery will be followed up by our Aftercare team, and you can also get in touch with them via [email protected] for any help. You can also have a virtual consultation or an in-person one in London.
Some things of note during recovery can include:
Typically 1 week, but it can depend on the nature of your work.
Common side effects are swelling, itchiness, scabbing, dryness, pimple formation, redness, pain, and sensitivity – all of them should get better with time.
Shock loss is a temporary hair loss which can affect both the donor and recipient areas. It can occur 2-3 weeks after your procedure but will not affect your results.
Platelet-rich plasma injections are commonly recommended as they contain growth factors and proteins that can stimulate the growth of thicker, healthier hair and speed up the recovery process.
Usually starts after 3 months with soft, fine hair. Thickness and density will improve with time, and final results become visible after 12 months (18 months for the crown because of slower blood circulation).
Results
Final results become visible after 1-1-5 years. However, since hair grows about 6 inches a year, it can be some time before you can see your results with long hair. Also, note that outcomes can vary between patients.
How much does a Hair Transplant cost for Females?
There can be significant variations in the cost of a female hair transplant depending on the location of the clinic as well as the type of procedure you’re undergoing.
In Turkey, a female hair transplant with regular FUE can cost £1,500, whereas the same can cost around £4,000 in the UK. Done with DHI or Sapphire, the price can go up to £2,000 in Turkey and £4,000-£5,000 in the UK.
With Longevita, the surgery is offered from £1,500 (for FUE) to £1,800 (for DHI and Sapphire) in Turkey for an all-inclusive treatment plan with a fixed price for grafts
Frequently asked questions about Female Hair Transplants
Hair loss in women can occur because of different reasons. The symptoms of female androgenetic alopecia can be like other kinds of hair loss.
So, to rule out the possibility of other causes of hair loss, you need to get a diagnosis from your general practitioner. They may perform a blood test or dermoscopy.
The hair graft survival rate in female hair transplants is 95%, so the surgery has a very high success rate. However, if you have diffuse thinning due to female androgenetic alopecia, you will lose your new hair even after the surgery. In this case, the surgery is not recommended.
Yes, the surgeon performing your female hair transplant will have insurance against malpractice.
Since females have narrower scalps, it’s often impossible to perform a 5,000-graft hair transplant due to a limited donor area. However, a patient’s willingness to shave also determines how many grafts can be extracted.
When a full shave is performed, more grafts can be extracted, but if a patient wants their existing hair to cover the donor area, only a small window is shaved. Consequently, fewer grafts are extracted. The donor area of female patients usually allows the extraction of 3,000 grafts, although this can vary.
