Gender important in hair transplantations

July 1, 2005

San Diego — Dermatologists have to take into account the gender of a patient if they are going to perform hair transplantation, says a Netherlands-based dermatologist.

San Diego - Dermatologists have to take into account the gender of a patient if they are going to perform hair transplantation, says a Netherlands-based dermatologist.

Speaking here at the American Academy of Cosmetic Surgery annual meeting on the topic of hair transplantation, alopecia evaluation and follicular unit grafting, Loek Habbema, M.D., medical director at a private dermatology clinic in Amsterdam, says that female patients have higher expectations from hair transplantation than their male counterparts and might be more satisfied with using non-medical hair adjustment or hairpieces.

Available options "You won't be able to achieve growth of a full head of hair through medical treatment and hair transplantation," Dr. Habbema says.

Because most women's goals of hair transplantations exceed what the procedure can produce, it's crucial to provide them with non-medical options during the consultation, Dr. Habbema says. By contrast, men are pleased with the results of treatments such as the use of finasteride and follicular unit grafting.

"Men who are bald are happy to grow some hair," Dr. Habbema says. "They don't mind if the result is that there is some skin of the scalp that is shining through. Women should be informed about non-medical hair adjustments, such as hairpieces."

Hairline placement Androgenetic alopecia generally begins in the 20s and 30s and is fully expressed by the 40s. It affects about half of all men, and it is characterized as common balding. While the disorder is primarily cosmetic, it can allow more ultraviolet light to reach the scalp, which would cause actinic damage. Androgenetic alopecia is reported to affect 13 percent of premenopausal women and is expressed as hereditary thinning in women. The incidence in women greatly increases following menopause.

Dermatologists do need to devote time to communicate about the placement of the hairline. The majority of patients ask that the hairline be placed low, but such placement will lead to cosmetic appearance that is less natural.

"It's a mistake when the frontal hair line is placed too low," Dr. Habbema says. "Our goal is to place it as high as possible. Given how androgenetic alopecia will progress, it is important to be conservative when placing the hairline."

Ideally, transplantation should occur when the skin is in good condition and the patient is in good condition as well. Patients are advised to stop smoking and indicate their medical history to ensure no previous treatments will affect the outcome of hair transplantation.

It's also important to indicate the potential side effects of finasteride that include impotence, decreased libido, abdominal pain, back pain, diarrhea, dizziness and headache.

Grafting pearls Key aspects to the success of follicular unit grafting include ensuring that the grafts are cut and handled properly and that they maintain moisture. Dry grafts will not grow properly, according to Dr. Habbema. If staff involved in the procedure are more experienced, they will likely be more meticulous with placement of the grafts and not damage the follicle itself, he says.

He notes that there is a debate between what size grafts should be used to create a look of density on the scalp.

"Grafts now have one to four hairs, but some surgeons recommend that the grafts contain a larger number of hairs, such as 10 or more in the center of the head, to achieve density," he says.

"The outcome is more natural with smaller size grafts. Bigger patches create a more unnatural look," he says.