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.

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.

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 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.

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.

My mentor always taught me, “Sam, no amount of ice can replace the gentle hand of a surgeon.”  Those words have remained fixed in my mind every time I approach a patient and his/her tissues.  Training for many years as a surgeon, I saw the full gamut of surgeons at work:  some with delicate hand movements and those that seemed to be Neanderthals struggling with bricks in their hands.  I have always tried to emulate the former.  It is so important that a surgeon no matter how technical and artistic he or she is that the surgeon remain extremely feather touch with one’s hands.  Brutal application of fingers can lead to inordinate swelling, discomfort and recovery time that would otherwise be avoided with gentle handling.  As my mentor said to me, there is no amount of postoperative ice that will cover the tracks of an aggressive, unrefined surgeon.

Gentle Graft Placement Illustrated

The consequence of being gentle in the world of hair restoration also involves the care of the graft-preparation team.  If the grafts are mangled during dissection and placement, the grafts either grow poorly or grow unnaturally.  The act of squeezing the hair shaft during insertion into the scalp will lead to a kinky, pubic-hair appearance.  All my team members are trained only to hold the graft along the cuff of fat and never by the hair shaft itself that leads to the aforementioned damage.  Being gentle in all things is a prerequisite to being an excellent surgeon and in the world of hair restoration is mandatory also for the accompanying surgical team.

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

One of my passions is female hairline reconstruction.  A large reason why is that it is one of the technically most challenging and artistically demanding parts of the head to do and to do right.  Unlike a male hairline in which all the hairs angle perfectly straight forward, the female hairline if done correctly goes in all different directions to make it appear as feminine and natural as possible.  In this article, we will discuss the two elements of a female hairline:  the macro hairline (overall shape) and the micro hairline (the details of how each of the angles are created when making recipient sites into which the hair grafts are placed).

The macro hairline, or overall hairline shape, in many respects is the exact opposite of a male hairline.  Men tend to have a more pronounced fronto-temporal recession with the curvature of the hairline aiming backward into these points of recessions.  A beautiful female hairline curves in the opposite direction with a rounded and closed fronto-temporal angle.  In addition, whereas it is important to create a conservative male hairline, a female hairline should potentially arc downward aggressively and be situated right at the forehead and scalp transition.  The goal is to create a rounded hairline to accentuate the beauty of a feminine face.

Female Hairline Restoration

Continuing on with the macro hairline, the hairline also consists of small protuberances that refine and break the linearity of the hairline itself.  In the midline a small widow’s peak will complement the female cowlick.  The design of the female cowlick will be reserved for the discussion of the micro hairline.  There can also be small protuberances approximately halfway between the cowlick and the end of the temporal hairline.  These are known as lateral mounds, a distinct entity found in many female hairlines.  These protuberances like the widow’s peak are only very slight:  take a look at women without high hairlines or without hair loss to observe what I am talking about.

The micro female hairline like the macro female hairline can be viewed almost as the opposite of the male hairline in many respects.  Whereas the male hairline typically is uni-directional, the female hairline is multi-directional.  Whereas the male hairline aims forward entirely, the female hairline principally sweeps to the side and back.  When designing a female hairline, the surgeon should look at ghost hairs (residual hairs that remain) as a guide or for female hairline lowering.  When there are no ghost hairs, the direction of the hairs behind the to-be-reconstructed hairline can be used as a guide for the design work.  In general, female hairlines sweep from the left to the right (in 70% of women) with the sweeping going in a whorl in the center of the scalp known as the cowlick.  The cowlick circles with the hair pointing backward toward the center of the scalp, which then must aim back forward as the hairs start to go back farther to the central-forelock region.  The hairs on either side of the central cowlick principally go to the side so for a left to right part the hairs from the left go across the hairline all the way from left to right and vice versa for the opposite design.  There are also less pronounced micro undulations in the female hairline as compared with the male hairline (what I termed the coastline effect in other blog articles.)  All of these nuances are important to remember as one designs a female hairline.  Matching experience with artistry is the key to creating both natural and feminine-appearing results.

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

A close-up video of a hairline after a hair transplant is about the closest thing that is possible for a prospective patient to evaluate the naturalness of a result shy of being able to see the person live.  Notice in this video the fine hair grafts that are allocated to the front of the hairline for the most natural results and also the stronger 2 to 3 hair grafts placed behind it in the cosmetically sensitive area of the central forelock to provide visual hair density.  The sweep and shape of the female cowlick and the closed rounded shape of the hairline are all attributes to the female hairline that have been carefully and passionately recreated for an optimal aesthetic result.

Hair loss in women comes in three types.  The first type is a male pattern loss in which hair is receded in the hairline principally in the fronto-temporal region and rarely in the crown area.  The second type is a Ludwig pattern in which hair is lost as a diffuse pattern across the top of the scalp that can extend into the temporal region.  The third type, which is shown by Mary’s example, is known as a “Christmas tree” pattern in which the loss is principally along the front of the head tapering to be less involved posteriorly.  The Christmas tree pattern is observed with the woman looking down and the hair parted in the middle.  Mary’s loss was primarily in the central forelock, causing her considerable embarrassment and a loss of a facial frame to the face.  By targeting the central forelock and the anterior hairline, Mary has a much better frame to the face and easier styling options for her hair now.

*All video testimonials on this Web site are unpaid and uncompensated in any way.

Please also note that this video is exceptional in that in most cases at 4 months there should be little to no hair growth.  Most individuals need to wait approximately 6 to 9 months to see significant growth.  Clarice was fortunate to see growth much earlier than most individuals so that point should be emphasized so as not to mislead anyone.  Further, not every female is a suitable candidate for a hair transplant procedure.  Clarice had exceptional density in the donor area that helped considerably in being able to cover the lost hair.  If the donor area in a woman is severely compromised so will the result of the procedure.  With considerable experience in women who lose hair at the Lam Institute for Hair Restoration, Dr. Lam is able to apply the appropriate judgment to explain to a prospective individual the odds of success in a specific clinical scenario.