Tricks and Transplants for Women's Hair Loss

Marilynn K. Yee/The New York Times
CATHERINE SAINT LOUIS
New York Times

Published: April 29, 2009

WITH a widow’s peak that grew more pronounced as she aged, Kelly lived in fear that her receding hairline would be discovered. She got perms to disguise it. She tried Rogaine to regrow the bald nooks on her temples. “I hated windy days,” said Kelly, 58, who asked to use only her first name to protect her privacy. “The wind blows your hair up, and there you are.”

Marilynn K. Yee/The New York Times

No woman genetically predisposed to losing her hair considers herself lucky. But in 2005, when Kelly went for a consultation with a hair-transplant specialist, she discovered she was. Unlike women who gradually lose hair all over their scalps, Kelly shed her locks like a man: going bald in the front, but retaining ample growth at the back and sides. Those areas of hair could be used for the transplant she desperately wanted. “I was fortunate,” Kelly said, three years after her $5,200 surgery. “It was not a loss due to hair thinning.”

Hair transplantation has come a long way from the days when doctors excised cookie cutouts of hair from the back or sides of a man’s head to reforest bald areas. Often, the plugs were as conspicuous as a newly sodded lawn. These days, surgeons can transplant tiny groups of one to four hairs called follicular units for a natural look that is less likely to turn heads. The best hair-restoration doctors make sure the hair they transplant mimics the direction and angle of surrounding strands.

Before these latest advances, “a lot of women didn’t think of it — they wore wigs or lived with it,” said Dr. Michael F. McGuire, the president-elect of the American Society of Plastic Surgeons. “Now there’s a recognition that it can be helpful for some women, and so more women are seeking it. Word is getting out.”

Nearly 5,000 women received hair transplants in 2008, a 21 percent increase since 2000, according to the society of plastic surgeons. (That figure doesn’t account for all the clientele of dermatologists, plastic surgeons or hair restoration chains like Bosley.)

Hairstylists, impressed with how realistic the “new” transplanted hair looks, recommend doctors to clients who are tired of hiding their hair loss with layers or high- and lowlights. “I’ve seen bad jobs,” said Seiji Kitazato, the creative director at Frederic Fekkai on Fifth Avenue, who refers clients to a few surgeons. “But now you can’t even tell.”

Still, not every woman of the millions who suffer from hair loss is a candidate. Underlying conditions, including anemia and thyroid problems, that are temporary, treatable or affect the scalp rather than the hair, must be dealt with before a transplant can be considered. If a transplant is ruled out, sufferers must rely on wigs, hairpieces or styling tricks.

What’s more, “most medications can cause hair loss, some more frequently than others,” said Dr. Robert M. Bernstein, a clinical professor of dermatology at Columbia University who has a restoration center in Manhattan.

A transplant is an option only for a woman who has a thick enough area of hair from the back and sides to “donate” to a more paltry part of her scalp. But many women don’t experience this kind of localized balding; instead their entire head of hair thins out during menopause or as they age.

At issue is whether donor hair is stable. “The hair we transplant is only as permanent as it would have been in the area we took it from,” said Dr. Walter Unger, a hair-transplant specialist in Manhattan who operates on up to 50 women annually.

Men are more fortunate in this regard. Many have thick long-haul reserves on the back and sides of their scalps, from which doctors can harvest an ear-to-ear donor strip.

How good a surgeon is at placing transplants at the precise angle of existing hairs also matters, Dr. Unger said. “The guys who can’t do this deny you can,” he said, “but there’s a growing number of people who can operate in hair-bearing areas and get a good result.”

However, “certain fundamental laws you can’t change,” said Dr. Jerry E. Cooley, a dermatologist in Charlotte, N.C., who has been performing hair transplants for 15 years. Success depends on the amount of hair available for harvest, as well as on the quality of the strands. Coarse hair trumps fine in terms of visual impact, he said.

Each hair transplant costs an estimated $3,000 to $15,000, depending on the complexity and the number of grafts, according to the International Society of Hair Restoration Surgery.

So the incentive to treat any and all comers is high. “It’s a big problem,” Dr. Bernstein said. “You shouldn’t go to someone who will give a transplant to anyone who walks in the door.” If your condition is not properly assessed, you could permanently shed more hair after surgery than you gained, he warned, or if the hair transplanted wasn’t stable, “it would disappear.”

Surgeons should have a team helping with the painstaking work of cutting a strip of scalp down to tiny follicular units. “If you don’t have five people working on the grafts,” said Dr. Joseph M. Gryskiewicz, the chairman of the emerging trends committee for the American Society of Plastic Surgeons, “you’re visiting an amateur.”

Marilynn K. Yee/The New York Times

Courtesy of Dr. Walter Unger

BEFORE AND AFTER Surgery helped replace hair in the area marked above.

Managing patient expectations is crucial to successful outcomes. Dr. William M. Parsley, a dermatologist in Louisville, Ky., tells women not to expect the dramatic results that some men have. Improving the density of fine hair is just a quantitative change, he said. Resurrecting a man’s hairline is a qualitative one.

A patient of Dr. Parsley’s spoke on the condition of anonymity because she has hardly told anyone that she had an orange-size sparse patch behind her hairline filled in. She is thrilled with the results, but is also realistic. “There are people who think they’ll look like Cinderella when they are finished,” she said. “Help is there, but it’s not going to make them look like they did before they started to lose their hair.”

If surgical restoration isn’t for you, or your budget, achieving a presentable look is often a matter of securing a skilled hairstylist who can make the most of what you’ve got. Mr. Kitazato, who estimates that 10 to 15 percent of his clients worry about losing hair, suggests that women with thinning locks avoid a cut longer than shoulder-length, and choose a hair color that will lessen the contrast between hair and a too-visible scalp. “It’s all about camouflaging,” he said. Having bangs can give an illusion of fullness that will distract from diffuse hair toward the back, he added.

Switching a part can also appear to bulk up a hairline. “The thinner side is usually part side,” said Sean Chin-Sue, of Pierre Michel salon in Manhattan, who refers clients to Dr. Unger, among others.

The key to making fine hair look fuller is first coloring, which swells the hair shaft, said Jo Blackwell-Preston, the owner of Dop Dop salon in Manhattan who teaches stylists worldwide how to use L’Oréal Professionnel hues. Then, she said, she adds low- and highlights for “movement, volume and thickness that’s not there naturally.”

Nearly daily, menopausal women, some of whom are on hormone replacement therapy, land in her chair and pine for their manes of yesteryear. “It’s the worst kind of conversation to have with someone,” she said. And yet, in the battle to forestall hair loss, women have one advantage, Mrs. Blackwell-Preston said. “A woman can get away with a lot more for longer because they know how to take care of their hair.”