Most men make good or moderately good candidates for surgical hair restoration. Unfortunately this is not the case for women. Women typically suffer from androgenic alopecia in different ways than men and this makes surgery more difficult for a number of reasons
When considering FUSS one must take into consideration the laxity of the patient scalp. Female patients typically have less donor laxity than their male counterparts. This is strictly a physiological issue. This does not preclude women from considering FUSS but the doctor must take a more reserved approach to donor harvesting compared to male patients in order to reduce the chances of a wide donor scar. The nature of female hair loss also means that the safe donor zone is reduced as most women will also have loss along the bilateral temporal regions and above the ears so the safe donor zone is usually reserved for the posterior donor zone along the occipital bone.
Typically, female hair loss is not in the same patterns as males and in fact, is rarely in a discernable pattern at all. While female hair loss is oftentimes referred to as “female pattern hair loss” it is in fact a diffuse, unpatterned hair loss. The traditional donor zone is greatly limited on female patients where the strongest hair is only found at the back. Male patients traditionally have donor hair on the sides as well as the back thus allowing for longer strips to be harvested for greater numbers of grafts to be transplanted. Combined with the high tension normally found in female patients follicular unit strip surgery is not possible for females as often as it is for males.
When considering FUE the number of female candidates increases as the tension variable is now eliminated. FUE allows for grafts to be taken from all over the scalp but, again, the diffuse nature of female hair loss limits the amount of hair that can be taken due to the reduced density that many female patients experience. However, because density is being reduced on a one to one ratio from the very small safe donor of the female scalp the overall number of grafts available is lower with FUE than with FUSS. This is highly subjective of course but is a valid concern when the goal is maximum graft availability. In general, a hybrid approach is preferred for maximum graft potential and when considering the limited donor potential of the average female patient this makes even more sense. Have multiple conservative strip procedures until strip is no longer viable then switch to FUE while remaining below the density degradation threshold.
Female patients are accounting for a larger percentage of the world wide patient base overall as more and more women that are not suffering from hair loss are looking to surgical hair restoration clinics to lower their natural non-balding hairlines. Females naturally have closed and rounded temples but some will have natural temporal recession without suffering from any form of alopecia. This can oftentimes resemble male temporal recession similar to what is found on a NW2 or even a NW3 in extreme cases. Both FUSS and FUE are excellent options for female hair restoration candidates that are seeking such procedures. However, FUSS is usually the better option since females do not typically wear their hair so short that the donor scar from FUSS becomes visible. Female patients can enjoy the lower cost of FUSS while getting the result they seek.
Females that suffer from hair loss have few medical therapies to choose from as finasteride is typically not recommended due to the potential for birth defects. There are no known instances of such birth defects occurring but it is a concern. However, there are instances where finasteride can be indicated for female hair loss patients. There are cases where women suffer from hair loss due to DHT levels that affect men with male patterned hair loss. These women will lose their hair in patterns just like men do with a well defined and healthy donor zone from which to harvest hair for surgical restoration. Both FUE and FUSS are indicated as discussed earlier but these female patients are also candidates for finasteride (under a doctor’s supervision) if they are aware of the potential of side effects. Finasteride can also be indicated for postmenopausal women that are not at risk of becoming pregnant. Finasteride prescriptions for women are fairly rare so it is best to speak to your doctor, or find a doctor experiences with this subject, to learn more.
Aside from finasteride women have access and are recommended to consider the other hair loss options available to them including minoxidil, laser therapies, PRP therapies, etc. It is also strongly suggested that women suffering from hair loss should speak to their doctor about measuring their thyroid, iron and overall hormone levels as many times these can be issues that contribute to female hair loss. If these do in fact become contributing factors to your hair loss problem having your levels addressed may halt your hair loss but it is not known to reverse your hair loss. This is why early identification and intervention is important.