Hair Loss in Women
Up to half of all women will experience hair loss at some point in their lives. Severe hair loss, while not as common in women as in men, is arguably more devastating in women.
The social, psychological, and emotional impacts are profound. So as part of treating the aesthetic concerns of my patients, I have chosen to focus special attention to this area of concern.
Patterns of hair loss in women vary. Hair loss tends to be widespread, with thinning across the entire scalp beginning with a widened “part” line. A percentage of women will present with preservation of a normal frontal hairline (the first inch) but thinning behind. Some perimenopausal women experience thinning that is worse towards the front of the scalp and then progresses back over time. The Ludwig classification system is used to describe the typical female patterns of hair loss.
The most common cause of hair loss in women is the same as it is in men, called androgenetic alopecia. There is often a familial relationship between mothers and sisters concerning hair loss. In some women, hair loss is associated with an increase in male sexual hormones (androgens) such as testosterone and DHT, but most often the hair loss occurs in women with normal hormone levels. Unfortunately, the mechanisms of hair loss are less well understood because it is not as directly correlated to DHT levels as it is in men.
In either sex, androgenetic alopecia occurs because of a genetically determined shortening of the hair’s growing phase (anagen), and a lengthening of the time between the shedding of a hair and the start of a new growth phase (telogen). The hair follicle atrophies and produces a shorter, thinner hair shaft. This process is called "follicular miniaturization." As a result, thicker, pigmented, "terminal" hairs are replaced by shorter, thinner, non-pigmented hairs called "vellus” hairs.
During pregnancy, estrogen levels increase which prolongs the length of hair growth cycles resulting in thicker more lush hair. However after delivery, estrogen levels drop and women may note more hair loss and thinning as the hair follicles switch from the growing phase (anagen) to the resting phase (telogen) which can last up to six months. While distressing, this is often temporary and will eventually return to normal when the hormone levels have returned to baseline. This can take longer in nursing moms, but don’t worry, this is normal.
Excluding genetic causes of hair loss, medical causes should be investigated and treated if possible when treating hair loss in women. Some common medical conditions that can cause hair loss include: anemia, thyroid disease, iron deficiency, rapid weight loss, autoimmune diseases, and medications including oral contraceptives. Lab tests may be ordered to check the levels of certain antibodies, iron, sex hormones, and thyroid hormones. Other medical causes such as the various types of alopecia should be ruled out.
More than half of women will experience hair loss during menopause. As estrogen levels decrease more hair follicles enter the resting phase. This effect is worsened in women with a family history of hair loss.
Telogen effluvium is a condition whereby rapid hair loss is experienced. This is more commonly seen in women due to hormonal fluctuations. This is a temporary and self-limiting condition, but it can take up to a year or more to resolve. Typically a traumatic event precedes telogen effluvium. The trauma damages the follicles and halts the growth phase. But the damage is done and when the trauma is over, the hair must be shed and the resting phase completed before new hair grows. Trauma can be physical or psychological in nature. Examples include acute or chronic illness, sudden life changes such as divorce, death of a loved one, loss of a job, or sudden dietary changes. Most of the time my patients just need to understand what is going on and reassurance that their hair will come back!
Medical treatment options in women include Minoxidil (Rogaine), anti-androgens, and PRP.
Minoxidil helps to increase blood flow to the hair follicles and supports hair growth. It can produce the growth of new fine hair but it cannot restore full hair density. It should be used twice daily to see the best results and can take 4 or more months to see results.
Anti-androgen medications include spironolactone and finasteride. Both work via different mechanisms to reduce the hair follicle’s exposure to androgens such as DHT (di-hydroxy testosterone). Since these medications can interfere with normal fetal development, women of childbearing age should be prescribed oral contraceptives along with these medications.
PRP, or platelet rich plasma is another very popular treatment for hair loss.
This advanced and FDA cleared hair restoration technique uses a patient's own blood to effectively treat hair loss, stimulate new hair growth, as well as enhance the recovery and results of hair transplant surgery. PRP injections reverse the shrinkage of hair follicles that occurs during androgenetic alopecia and stimulate inactive or newly implanted hair follicles into an active growth phase. PRP treatment is a non-surgical, totally natural, alternative medical procedure used for the treatment of hair loss or hair thinning due to androgenic alopecia (common baldness). The treatment involves withdrawing a sample of the patient’s own blood, processing it so only the PRP growth factors remain, and injecting it into the scalp to stimulate natural hair growth.
Dr. Cappuccino also uses PRP therapy as a beneficial supplement in hair transplantation. PRP not only promotes wound healing at the surgical site, but it also stimulates hair growth immediately following hair transplant surgery. PRP injections can be used in many ways during and after hair transplant surgery. Often the extracted hair grafts are soaked in this concentrated platelet rich plasma and PRP is also injected back into the recipient scalp sites.
PRP contains specific growth factors that stimulate the hair follicle:
Dr. Cappuccino takes a sample of blood which is then prepared in a centrifuge so that only activated platelet rich plasma (PRP) remains. Care is taken to concentrate the PRP to 6X normal levels. Topical and local anesthetic is used to numb the scalp to be treated. The PRP and its essential growth proteins are injected into the scalp with a very fine needle with care being taken not to damage surrounding hair. The entire procedure takes approximately 45 minutes. 3 sessions are required, each 1 month apart. A maintenance treatment is recommended every 6 months or one year as needed. In addition to the PRP therapy, it is recommended to use Minoxidil and DHT blockers. It is possible to use PRP hair restoration therapy alone to promote hair growth or it can also be used in combination with hair transplant or restoration surgery.
PRP is a potential emerging non-surgical based therapy for natural hair follicle stimulation for thinning hair. Larger clinical studies are pending but the current medical literature contains numerous optimistic results. One recent study of 100 patients undergoing PRP hair restoration showed an increase in hair density of 30% at 3 months following treatment. The life cycle of a hair follicle can last from 2-8 years and has 4 stages: anagen (growth phase), catagen (regression phase), telogen (resting phase), and exogen (shedding phase). New hair only grows in the anagen phase so it may take a few months to see new hair growth after your PRP treatment.
In some women, hair loss has reached a point where only transplantation can restore the lost hair. FUE (follicular unit extraction) techniques have evolved to result in a minimally invasive, office based transplantation procedure that yields perfectly natural results. Using hair typically harvested from the back of the scalp, hair is transplanted to areas of decreased density. In my practice, we use the NeoGraft FUE system.
The NeoGraft® system is the first and only FDA cleared follicular unit harvesting and implantation system. The NeoGraft® system delivers automation of the FUE technique, the most advanced technique in the hair transplant industry.
This revolutionary system uses pneumatic controls to precisely extract complete individual hair follicles which can be immediately transplanted to the selected areas of the scalp. The NeoGraft® automated hair transplantation system is the only complete harvesting system on the market and has the only ‘NO TOUCH’ implantation technology. A natural looking head of hair is created with this minimally-invasive procedure. Hair restoration with the NeoGraft® procedure is unnoticeable, making it your secret to tell.
NeoGraft’s technology provides:
There is very little or no discomfort during the procedure. Dr. Cappuccino will numb the areas with local anesthesia at the beginning so you almost feel nothing. In fact, many patients dose off or sleep during the procedure. Catch up on your favorite movies or TV shows as we perform the procedure. Afterwards, you may be a little sore but it really is nothing compared to the pain that many patients experience after having the traditional strip method.
Prior to the procedure, a transplant plan is created to ensure that the grafted hair follicles are placed in accordance with natural hair patterns, angles, and orientations. Hairline creation and areas to be covered will be decided with input from the patient. Using the NeoGraft device, follicles are smoothly extracted without pulling, twisting, or potentially damaging them. This process is faster and less tedious than previous methods, making it easier for both patients and surgeons. The follicles are then artistically placed into balding and thinning areas on top of the head, one at a time to maximize the success of the procedure.
If you are a man or woman with thinning hair and still have enough hair on the back of the scalp to transfer into the balding areas then you are a good candidate. If you have a busy lifestyle and can’t afford the time off associated with the old “strip method” where a long incision is made on the back of the scalp then NeoGraft is a great option. Even if you had the strip hair transplant in the past and you are unhappy with the scar, we can use NeoGraft to fill in hair to camouflage the scar. Call Dr. Cappuccino now to get back the confidence and the look that you want.
After the follicles are transplanted, most of the newly transplanted follicles will shed the hair shaft a few days after the procedure then regrow after about 3-4 months. This is part of the normal growth cycle. It usually takes about 6-12 months before 95% of the hair follicles are growing again and you really begin to see your results. While hair restoration does not completely stop hair loss, the regrowth that is experienced from NeoGraft will last permanently. Dr. Cappuccino recommends the addition of PRP during and after the procedure to potentially decrease the shedding and minimize hair shock loss.
It is possible for the transferred hair follicles to grow for the rest of your life. We take some of the hair follicles from the back and sides of your scalp, which are usually genetically programmed to resist baldness- this is the concept of “donor dominance”. Once the follicles are transplanted they will continue to grow in their new location.
The actual cost of NeoGraft hair transplant in Maryland depends on how much hair is needed and how large the area to fill is. We offer a variety of financing options that can allow you to break up the cost into affordable monthly payments. The best way to find out is to come in for a personal evaluation by Dr. Cappuccino and discuss what we can do for you to get your hair back.
Dr. Cappuccino recommends that you take it easy for a day or two before going back to work. However, there are many patients who choose to and are able to go back to work the next day. You should avoid exercise for about a week since vigorous activity may cause swelling that can take longer to recover from.