Examples of Female Hairline Variations

There are many types of female hairlines that exist in nature. It is important for every serious hair-transplant surgeon to study these natural variations before considering to undertake a hair-transplant procedure on a woman to ensure that the result is natural and also appealing.  Some of the basic tenants of a female hairline is that it is shaped in an opposite fashion to a man’s hairline, i.e., the hairs typically aim in a circle, known as a cowlick, in the center and sometimes with hair shooting straight backwards in this region.  Also, the fronto-temporal region is more rounded and closed rather than receded like in a man’s hairline.  Besides these fundamental elements that describe most women’s hairlines, there can be variations obviously.

Female Hairline Variations (from Dr. Lam's textbook, Hair Transplant 360)

In the three examples taken from my textbook, Hair Transplant 360, you can see that all three have a central cowlick and closed fronto-temporal angles as described.  However, there are subtle but obvious differences as well.  In the image on the top right, there is a moderate widow’s peak and a squarer configuration to the overall hairline shape.  In the image to the top right, the entire hairline has a very closed off fronto-temporal region making the hairline appear much rounder.  In addition, the cowlick is further recessed without a very strong widow’s peak.  In the bottom left image, the widow’s peak is prominent and tightly packed with a less prominent cowlick.  In addition, there are finer hairs in the fronto-temporal region making the hairline look as if there is a slight fronto-temporal recession even though there is none.

Samuel M. Lam, MD, FACS, a board certified hair transplant surgeon in Dallas, Texas. To learn more about Dr. Lam’s female hair transplant procedures, female hair loss, female hairline lowering, or to schedule a consultation please call 1-888-866-3388, or visit www.HairTX.com for more info. To ask Dr Lam a question please visit our hair loss forum.

Understanding Traction Alopecia and The Role of Hair Restoration

Traction alopecia refers to hair loss that arises from hair being pulled too tightly for too long causing permanent destruction to that hair.  Most typically, this condition is caused by tight hair braiding, as seen more commonly in African-American women.  Fortunately, this kind of hair loss is known as a non-scarring type of hair loss, i.e., the damage is only to the lost follicle and not to the surrounding skin.  Therefore, hair restoration for traction alopecia is highly successful.

Traction alopecia oftentimes affects the temple hair where a woman will tie back her hair causing loss of blood supply to this temple fringe.  In men who are Sikh, the hair loss can be circumferential around their head since their religion does not permit them to cut their hair and they must tie it up to be covered by a turban.  Accordingly, the tension is greatest to the hair around the periphery of the knot causing this unusual pattern.  Obviously, this is not a problem until they want to remove their turban when they abandon their religion.

Traction Alopecia Correction through Hair Transplant in an African-American Female

However, the most common indication still remains hair restoration for African-American women in the temple region.  Although donor hair density is typically low in Africans, the hair curl covers quite a bit of surface scalp distance.  Therefore, it is not as critical to dense pack the area when transplanting for traction alopecia.  I have found that transplantation for traction alopecia works very well with a high patient satisfaction.

Samuel M. Lam, MD, FACS, a board certified hair transplant surgeon in Dallas, Texas. To learn more about Dr Lam’s African hair restoration procedures and African hair loss disorders, or to schedule a consultation please call 1-888-866-3388, or visit www.HairTX.com for more info. To ask Dr Lam a question please visit our hair transplant forum.

Most Common Reasons for Hair Loss in Women

Although it is more acceptable to see hair loss in men as normal, it is not considered so in women.  30% of women over the age of 30 lose hair to some extent but sometimes it is not a genetic condition but related to hormonal changes that should be investigated. I rarely perform surgery on a woman without at least this initial laboratory and/or scalp evaluation to rule out other conditions.  This article will not explore all the reasons for hair loss in women but will cover some of the most frequently encountered conditions.

In young women of childbearing age, perhaps the most common condition leading to hair loss is a low iron level because of menstruation.  If the physician can elicit from the woman, a history of significant menstrual blood flow, then this can trigger a laboratory evaluation to determine whether this is the culprit.  Iron replacement is an ideal way to help a woman restore hormonal balance but thereby aid with her hair loss condition.

The second most common condition that can lead to hair loss is a low thyroid level.  If a woman looks significantly overweight, then this can be either due to a hypothyroid state or to a condition known as polycystic ovary disease if it is not related to the just overeating.  Generally, the degree of hair shedding and hair loss is not as profound as in those women who have severe iron deficiency but it still can be in certain cases.  Appropriate thyroid replacement would obviously be the method of choice to correct the hair loss.  Of note, there can be thinning of hair in the outer portion of the eyebrows as further indication of a low thyroid condition.

Besides these two conditions, hormonal imbalances are another major reason that hair loss can occur in women.  A high testosterone and lower estrogen ratio can affect women, especially in the peri-menopausal and post-menopausal period of time.  Evaluating all women for hormonal imbalances and correcting that condition can be very important as part of a protocol for evaluating women with hair loss.  The type of hair loss that is evident in these types of women can resemble male pattern baldness with recession in the fronto-temporal region.

Besides these three reasons for hair loss in women, inflammatory hair loss conditions like lupus occupy the remaining types of non-genetic hair loss in women.  A workup evaluation in the suspected patient who may have scaly red patches or other skin issues should be considered.  With good clinical judgment, the physician can also rule out reasons for hair loss other than the above like post-pregnancy hair loss; hair loss related to stress or stressors like general anesthesia, major weight loss, etc.; and chemical or infectious damage to the scalp; among other types of problems that can lead to female hair loss.

Samuel M. Lam, MD, FACS, a board certified hair transplant specialist in Dallas, Texas. If you would like to to schedule a consultation please call 1-888-866-3388, or visit the following links to learn more about Dr Lam’s female hair restoration procedures and female hair loss conditions, or Ask Dr. Lam a question in our Hair Loss Forum.

Female Hair Restoration Strategies:  The T and the L Design

Female hair restoration is always a special topic that is far different from how hair restoration is performed in men.  Starting with the pattern of hair loss, many women typically lose their hair along the central forelock anteriorly with gradually less hair loss going backward toward the crown, which Elise Olsen has referred to as a Christmas-tree pattern.  In addition, many women lack sufficient donor hair to create a good result if the hair is not judiciously allocated to areas of maximal hair loss.  With these two facts combined, it is important to strategize on how to create the most favorable hair restoration possible given these limitations.

What I have devised is a simplified method of helping a prospective female patient understand how I can address her hair-loss situation with maximal efficiency.  Unlike men who lose hair everywhere and continue to do so until they are frankly bald.  Women just have hair that gradually thins out but do not progress typically toward total baldness.  Therefore, I am able to create a pattern of hair restoration that specifically targets the area of baldness and can leverage the benefit of how the hair is parted for optimal camouflage, as will be described.

Female Hair Transplant Design Strategies (from Hair Transplant 360, Lam SM, Jaypee Brothers, 2011)

The T-shape design, as illustrated, permits the ideal shape for a woman who has central hair loss that tapers back to the crown and would desire to wear her hair with a central part.  For a woman with a right-sided hair part, an L-shape design may be more ideal so that the bald part is covered as well as the central forelock.  The part should be addressed since with hairs splayed open here the area can look particularly bald. Also, hair that is parted can travel over to cover the other areas of baldness effectively.  (See the concept of the cascade effect to understand this better). Obviously, the backward-L shape would accommodate a part that goes on the left side of the head for all of the reasons enumerated for a right-sided part.

Samuel M. Lam, MD, FACS is a board certified hair transplant surgeon in Dallas, Texas. To learn more about Dr Lam’s female hair restoration and female hairline lowering procedures and female hair loss, please visit our website www.HairTX.com or call 1-888-866-3388 to schedule a consultation.

Hair Loss After Pregnancy: When and Why

I have encountered many patients who experience hair loss after pregnancy and wonder what is going on.  What happens during pregnancy is that the body is sustained at a high level of estrogen.  Estrogen causes the hairs to stay in a prolonged state of anagen, or growth phase.  When the estrogen is reduced at the time of delivery, the hairs cycle back toward a more normal distribution in each of the three hair phases:  anagen, catagen, and telogen.  This condition of related hair loss is known as telogen effluvium.  At the time of childbirth, the hairs appear to shed because the percentage of hairs that were intended to be in a different hair phase rapidly cycle into that phase and hairs are then shed all at once rather than in smaller waves as they do in non-pregnant individuals.

Typically, this hair loss does not make anyone bald, but noticeable thinning can occur.  It is also a self-limiting problem that tends to rectify itself in the first few months after childbirth.  It is oftentimes worse after the first child is delivered than in subsequent pregnancies.  Minoxidil, or Rogaine, can be used to help stabilize the hair loss and shorten the period of shedding.  However, two words of caution should be extended.  Sometimes additional shedding can be noted at 3 to 4 weeks after starting minoxidil because the hairs can cycle back into the growth phase again causing hairs that move into this phase to be shed.  In addition, after stopping minoxidil, hair shedding can be noted again as hairs cycle out of the growth phase. Sometimes not intervening and just waiting it out may be a preferred course of action if there is not significant and socially embarrassing hair loss related to post-pregnancy shedding.  Remember whenever you experience hair shedding it is oftentimes worth seeing a dermatologist on internist just to make sure that it is in fact a benign condition like telogen effluvium and not indicating something more serious.

Samuel M. Lam, MD, FACS is a board certified hair transplant surgeon in Dallas, Texas. To learn more about female hair loss, and Dr Lam’s female hair transplant procedures please visit our website www.HairTX.com or call 1-888-866-3388 to schedule a consultation.