Consider follicle transplantation for women with hair loss

Key takeaways:

• Demand for hair transplantation among women has increased.
• New techniques and adjunctive therapies are transforming the field.

Women with androgenic alopecia and other forms of hair loss can derive meaningful benefits from a combination of follicle transplantation and adjunctive medical management, yet many people remain unaware that transplant is an option.

“Hair loss affects anyone negatively, but especially women,” Marc R. Avram, MD, clinical professor of dermatology at New York-Presbyterian Hospital/Weill Cornell Medical Center and a hair loss and transplant specialist in private practice in New York City, told Healio. “Men have more options. Men can shave their hair; men can go short. For women, hair loss causes a lot of stress, yet there is still not a lot of awareness — even in dermatology among dermatologists — that transplantation is an option. There is a public perception that surgery to correct hair loss is mostly for men. That is not true.”

Avram and Dawn Queen, MD, of the department of dermatology at Columbia University Irving Medical Center, coauthored a review on advances and adjunctive techniques for hair transplant in women, published in the Journal of Drugs in Dermatology.

Evaluating hair loss in women

The most common type of hair loss is female pattern hair loss, affecting between 20% to 40% of women in the U.S. and globally, Avram said. Other types of hair loss in women include traction alopecia, typically caused by external factors like chemical relaxants, keratin treatments or repeated use of bleach, and scarring alopecia, which is due to inflammation from skin diseases.

Data suggest men present earlier for an initial consultation about their hair loss, Avram and Queen wrote. Data from a 2022 International Society of Hair Restoration Surgery Practice Census showed peak ages for presenting for transplantation were ages 30 to 39 years for men and ages 40 to 49 years for women.

“For women, it is especially important to take a thorough gynecological and hormonal history, focusing on potential systemic contributors such as iron deficiency, thyroid disorder, and polycystic ovary syndrome,” Avram and Queen wrote. “Control of underlying hormonal imbalances or medical conditions may significantly improve hair loss in affected women.”

Preparing for transplant

There are notable differences in preferences for hair transplantation procedures between men and women, Avram and Queen wrote. Although men often prefer follicular unit transplantation, which requires resection of individual hair follicles, women “overwhelmingly” prefer follicular unit extraction, which typically involves taking a strip of hair from the back of the scalp.

“We take that hair that we removed and, under magnification, create individual follicular units,” Avram said. “We numb the front of the scalp with local anesthesia, and then, using magnification, make hundreds of small incisions between the existing hairs, and then we place the hairs in one at a time.

That is why I can look someone in the eye and say, ‘When we repopulate the frontal part of your scalp, it is going to look completely natural.’

The transplanted hair grows in over about 1 year, Avram said.

“This is not like Botox or fillers, where you see the result right away,” Avram said. “The trade-off is, once the hair grows in, it is going to grow as long as that hair in the back was growing, which for most people is years and even decades.”

Because hair continues to thin after a transplant, Avram said he typically recommends complementing surgery with either topical or oral minoxidil, platelet-rich plasma (PRP) injections or laser therapy to promote maximum long-term hair density.

“Be aware that hair transplantation can help restore a natural frame of hair for women just like it can with men,” Avram said. “We can do this for women with female pattern hair loss, traction alopecia and scarring alopecia. This is a great option to think about for the right candidate.”

Innovations in treating hair loss

Researchers are investigating novel techniques to address hair loss, including long hair transplantation, which could provide immediate visual results, and customized grafting techniques aided by robotic or AI-assisted procedures. Other investigational treatments such as exosomes and stem cells may help maintain the density of donor areas for future procedures. These therapies could also potentially enhance graft survival and stimulate hair regrowth in transplanted areas, Avram and Queen wrote.

Hair follicle cloning could be another promising area of research, Avram said.

“If you could take a biopsy, send it to a lab and say, ‘I want 2,000 of these [follicles] made,’ and then have the patient come back in a few days and we implant them, that is a game changer,” Avram said. “That does not exist in 2025 nor will it in 2026, but people are researching and working on that in biotech companies.”

Adjunctive medical therapy options for hair loss have also improved, Avram said. In addition to minoxidil, spironolactone or finasteride for postmenopausal women, low-level laser therapy, high-energy laser and PRP injections can stimulate hair regrowth and complement surgical procedures, Avram said.

Avram compared recent advances in hair loss therapies to improvements in other medical specialties, where surgery can now be avoided with optimal medical treatment.

“If your hair is thinning, see a dermatologist and ask about medical therapy,” Avram said. “With PRP, laser and minoxidil, we have many good options now as opposed to 20 years ago to keep the hair so that you never need a surgery. You can actually get ahead of this. We are in that era already right now.”

For more information:

Marc R. Avram, MD, can be reached at mavram@dravram.com; Instagram: @drmarcavram.