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DAVID R. MARKS, MD: What you're seeing on the video
here is a woman regaining a head of hair. Hair
transplants are very popular among men, but they're
becoming increasingly popular among women. To find out
who should get a hair transplant, we have two guests.
The first is Dr. Michael Reed. He's Assistant Professor
of Clinical Dermatology at NYU Medical Center and he
direct their hair transplant program.Next to him is Dr.
Robert Cattani, one of the founding members of the
American Board of Hair Restoration Surgery and he
practices in New York. Welcome.
Dr. Reed, how common is hair loss in women because
most people think of it in men.
MICHAEL L. REED, MD: As many women carry the genetic
trait for common loss as men, it just comes out later,
it goes slower and it's a different pattern. Women don't
have a receding hairline and a bald spot like men do.
They instead end up with see-through hair as they get
older. Anywhere from 20-40% of women at some time in
their life will experience enough thinning of their
hair, or hair loss, to have it be noticeable and a
potential problem.
DAVID R. MARKS, MD: Which women should consider hair
transplantation?
ROBERT V. CATTANI, MD: David, exactly the same
criteria subjectively we would use in men and women,
except that I've found that, as men are devastated by
hair loss, women are even more so. Especially the fact
that they feel singled out. They don't feel this is a
common thing. They feel that this is highly unusual and
the reaction to it is very profound. There are
basically, if I could give you categories, there are two
categories of women with hair loss. There is the woman
as first described by Dr. Reed, that have a hair loss on
top of the head alone, with a persistent frontal fringe.
Let us call that type one. That type is very correctable
surgically.
The second type are those who have diffuse thinning
throughout their whole scalp. Those you cannot. Now, of
the type one there are three categories and here they
are.
DAVID R. MARKS, MD: Go ahead and show us.
ROBERT V. CATTANI, MD: In medicine we have a way of
putting labels and names on things. It's just our way of
doing things. So about 25 years ago a physician by the
name of Ludwig classified baldness as grade one here,
two and three, and it's nothing more than extension from
a minimal loss to a maximal one. But you know here, in
deference to men, that no matter how bald they get, they
persist with a frontal line of hair, and that's very
advantageous cosmetically when you restore them. So I
think the question that you'd want to know are, are
women excellent candidates for hair restoration? Yes,
they are. Is it very popular? Yes, and I'm sure Dr. Reed
wants to talk about that more.
DAVID R. MARKS, MD: Tell me what would make a woman
really decide to go ahead and do it as opposed to a
woman who's kind of on the fence in your experience?
MICHAEL L. REED, MD: Fortunately, mother nature has a
greater imagination than Dr. Ludwig or myself or any
other doctors. I see a lot of women who have an area
right behind their hair line which is a round or oval
shaped area, maybe three by three inches, which is
really quite thin and they've got a pretty good amount
of hair around that. A little thin, but nothing
horrible. They have a nice, dense donor site and they're
great candidates. Not all of them thin out diffusely.
The alopecia diffusa, which is this diffuse thinning, is
real and it may happen in all women if they live to be
100 years old, but it doesn't happen early in a lot of
women. So if any woman has a fairly stable area of
noticeably thin hair behind the frontal line, they're
great candidates for this and they enjoy the results
much more than men because, as Dr. Cattani said, if I
lose my hair that's a nuisance but for women it's
catastrophic beyond belief. Basically it's cosmetic
death for a woman to lose her hair or to think she's
going to lose it. Once a woman knows the techniques and
knows the details -- women, by the way, are very good
detail people. You have to tell them everything in great
detail many times. They have to know about the
postoperative period, and the intraoperative sensations
and so forth. But once they know and accept it, they're
really excellent patients and they are actually better
patients in many ways than men are.
DAVID R. MARKS, MD: Men start losing their hair very
young in some cases, but you alluded to the fact that
this happens in older women.
MICHAEL L. REED, MD: Hair loss in a woman can begin
any time after puberty. But most of the time women lose
it later, especially around the time of menopause, where
the male hormones, the androgens, tend to have more of
an effect because there's less estrogen in a woman's
body. Women also have less receptors for male hormone in
their hair follicles and they have another enzyme that
converts male to female hormone that protects them, but
these things gradually wear off with time and so they
have a little bit slower onset, a little bit slower
progression and they get see through hair. They don't
actually, for the most part, go bald like men do. But
they can go thin enough in that area that it's a
cosmetic disaster, where they have to wear a hat, or
they have to wear a hair lift, or they have to use
makeup in that area. Then they're good candidates for
transplants.
DAVID R. MARKS, MD: What's the downside of a
transplant?
ROBERT V. CATTANI, MD: Let me just expound a little
bit more on what Dr. Reed said. The way women look at
this, you say it's a profound cosmetic effect. Women
come in and say, "Hey, wait a minute. I'm not a guy.
Guys lose hair. I'm a woman. I'm not supposed to do
this. This isn't supposed to happen to me." So when you
can offer them a surgical correction they become
excellent patients. They are detail oriented. A lot of
people think, "Well, you can always put a hair piece or
a wig on women." If you offer them that, they're going
to just come back to you and say, "What about the fear
of detection when that wig comes off?" So they're
excellent candidates. It is not unusual for women to
have hair loss and the correction is often among one of
the most pleasing of all my cosmetic patients. Hair
restoration in women can produce wonderful results.
DAVID R. MARKS, MD: What's the downside?
MICHAEL L. REED, MD: The downside is several things.
One, the time off from work. Usually we can perform this
over a weekend time, but there is some time removed from
work: two or three days beyond that. There may be
swelling of the forehead. There may be that four to five
month period before the hair starts to grow. There may
be and usually is a need for a secondary procedure.
Beyond that, it's a very positive thing for women to do.
DAVID R. MARKS, MD: What do you mean by secondary
procedure?
ROBERT V. CATTANI, MD: It is my experience, and I
think Dr. Reed will second this, that it is seldom that
in one procedure, using a great number of micrografts, I
can restore a woman who has a grade two or grade three
hair loss to a level where she is satisfied. Usually, to
get a certain density, it will take a second procedure
and that can be anywhere from six months to a year down
the road.
DAVID R. MARKS, MD: When should it be done in a
woman?
MICHAEL L. REED, MD: I think it should get done when
the woman's hair loss is fairly stable and not really
active. You don't want a woman who's shedding a lot of
hair, there's a lot of hair loss going on. It should be
done in women who have been evaluated for other
underlying problems such as endocrinopathies and other
illnesses that might be contributing toward it. It
should be done in women who have considered all the
medical treatments that are available to them. Both
topical and systemic treatments are available for women
of various categories. It should be for women who have a
realistic expectation of how they want to look. This is
not going to give them more hair than god, but it's
going to take them from looking noticeably thin to not
being noticeably thin and that is a cosmetic victory
beyond belief.
DAVID R. MARKS, MD: The last question that everybody
always asks is cost. How much does it cost?
ROBERT V. CATTANI, MD: Depending on the session's
amount that we're going to do, I would say anywhere from
$3,000, $4,000 to possibly $10,000. That is a relative
amount for each individual out there. We all have
different incomes and different stages of our life, and
we all have different expenditures. The only thing I can
tell the patients to offer them some comfort is, the
work that Dr. Reed or myself would do will last a
lifetime. There are very few procedures that I can say
that about in a patient. Let me add one thing for the
audience that might be helpful to them, and Dr. Reed,
I'm sure, will second this. Both men and women, when
they start to notice hair loss, go through the same
routine. They stop shampooing their hair. They start
wearing hats. They start doing all of these remedies.
None of them stop what's inevitable and hair loss is
inevitable.
DAVID R. MARKS, MD: That will be the last word. Thank
you both for joining us, and thank you for joining our
webcast. |
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