This question was posed by a female hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.
I saw a very reputable hair transplant surgeon yesterday. I have receding hair at my temples so I went in to inquire about a hair transplant to those areas. Upon inspection, he indicated that I have about 30% or so hair miniaturization in the donor area. I’m very scared and am now thinking “am I going to go completely bald”? I have more questions. Has anyone with similiar problem had hair restoration surgery that can offer me some insight? He says he can do the hair transplant but can offer no guarantee on how long it would last.
Also, how long to miniaturized hairs last and how fast does it progress? Is it normal for a woman at age 46 to have hair miniaturization?
30% is a fairly high percentage of hair miniaturization to be present in the occipital donor area, usually the best hair on most women’s heads who have female pattern alopecia. Most of the time I wouldn’t give a woman a hair transplant with that high of a percentage, simply because it also portends that a lot of the other hairs will probably be following in the same footsteps of miniaturization a hair growth life-cycle or two away from now. The good news is that hereditary female pattern hair loss is a very SLOW process for most women, and almost never occurs as rapidly as its counterpart in males.
The most curious part of your history is the fact that you described being thin in the temple areas only. Usually a woman with 30% miniaturization in the donor area will have an even higher percentage of hair miniaturization in the top recipient area behind the hairline, and yet you didn’t seem to complain about that at all. What degree of hair miniaturization did your hair restoration physician find in the top recipient area? Even if the hair on top was the same and no worse than the back, that degree of miniaturization would still be easy to see through and I would expect that would have been your main complaint ir at least mentioned along with the other temple problem.
Regarding the decision as to whether you should undergo hair replacement surgery, you certainly could, but your expectations would have to be lowered and realistic, especially concerning the number of years of your life you may get to enjoy this additional hair you gain by hair transplantation. For some women entering a critical period of their lives from a social or career standpoint, even 10-15 years of having increased hair density could be valuable to them and worth it. I have been fooled in a few cases in which I initially didn’t want to transplant a particular woman, she insisted on going ahead despite my low expectations for her, and she went on to do well over at least a 5-10 year period up to the present (and still doing well). In some others I can think of, it seemed like a high percentage of the donor hair, even the seemingly strong appearing ones, when they emerged in the recipient area one hair growthy cycle later (after going through the normal “shock” reaction all transplanted follicles undergo), an even higher percentage of them grew out “wispy” and the overall experience was not a forward step for the patient. Theoretically, one additional step that could be taken would be to “cherry pick” only the follicular units that contain at least one strong terminal hair and only use them, putting aside the severely miniaturized ones, as the injury to the scalp of the recipient incision is almost not worth the tradeoff for placing a hair that is unlikely to add to the cosmetic appearance and theoretically could hurt the chances for the good follicles to grow. I have transplanted hair in hundreds of women and must confess not having used this method yet. As per the other suggestions you received, Rogaine (minoxidil) will certainly slow down the hair loss process if taken faithfully. The comments about other medical diagnoses is important for completeness and can be ruled out with a couple of simple blood tests and a good history, but I must emphasize that they are very rare in most of our clinical hair practices.
The bottom line is this: if your expectations are not too high and are realistic and your hair surgeon feels that a positive result is possible, then you have a chance of being reasonably happy with your result for quite a few years.
Mike Beehner, M.D.
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