View Full Version : Brad Limmer, MD "more women pursuing transplantation"

Limmer HTC
08-31-2010, 11:26 AM
Earlier this month I performed five female transplant cases in a row. While for years women have been a part of my transplant practice, what these five successive cases goes to show is something many transplant surgeons are seeing…more women pursuing transplantation as an option to address problems with their hair! What I am seeing in my own practice is that women represent approximately forty percent of my consults, but only about twenty percent of my transplants. While both of these numbers will increase, unfortunately for women many of them are not good candidates for transplantation. So while women more often than men might not be candidates, I encourage women to seek help, find out their diagnosis/options and even if surgery is not the answer, maybe medical therapy can be started and used to improve their situation.

The most common diagnosis women present for transplantation is androgenetic alopecia (just like men), but some of the other common diagnosis are…traction alopecia from prior hair styles, scars/hairloss following facial plastic surgery, lichen planopilaris (LPP) and being born with their father’s hairline (high with deep temporal recessions). Of the five women I mentioned earlier, they all fell into one of these categories.

The case presented below is that of a woman who happen to finally be back in San Antonio nearly two years after hair transplant and initiation of medical management (July 30, 2008). It just so happened that she followed up the week I had the five female transplant cases and I felt she represented what women can expect from combine surgical and medical management of anrdogenetic alopecia.

Her story began on July 10, 2008 when she presented in consultation. She noted that her hair loss progressed slowly throughout much of her adult life and while she had become quite adept at covering up her loss through various hairstyles over the last couple of years, even with the most creative styling, she could no longer hide her problem. She was tearful as she described all she has gone through in dealing with this and how much it would mean to her if she could do something, even in a limited fashion, to improve her situation.

After full exam and work up it was concluded she has classic andro-genetic female pattern ludwigs grade II-III. The good news for her was that she had good donor availability and while her hairline had weakened a bit was in pretty good shape along the very leading 5-6mm edge. All her options were discussed from accepting what she had, wearing a full-partial system, medical therapy alone or in combination with transplantation. She chose the latter and on July 30, 2008 she moved forward with transplantation combined with Rogaine Foam and oral Finasteride.

As she was from out of town we kept track only through a series of phone calls checking her progress and encouraging her to maintain her full medical program. Finally, nearly 2 years post op she was able to make it back to San Antonio and proudly showed us her results and relate to me how life changing all this has been and how much happier she is. Below will be presented her pre operative/post operative photos and while her nearly 1600 grafts made a tremendous difference in her frontal forelock, I cannot stress enough how much better quality of hair she has across her entire scalp as a result of her two years commitment to medical management.

Her case was fairly straight forward. Seventeen squared centimeters of donor was harvested from the left/mid-post scalp. Closure was performed in a layered fashion and we were able to generate just under 1600 grafts from the donor which had a f.u. density of 94. The good news for her was that a majority of her grafts contained 2-3 hairs, compared to many women with advanced loss whose grafts are often more 1-2 hair f.u. Basically, she was getting more numbers and volume of her hair per grafts than some women…which in turn makes her a better candidate and more cosmetically successful case. These grafts were all placed in sites ranging in size from 0.6-0.8 mm and all located in her frontal zone behind her relatively intact hairline. In addition to the results obtained through her transplant, she feels the volume and quality of her hair continues to improve on medical therapy, even though she is already two years into her medical regiment. From my clinical experience many women over age fifty seem to take a little longer to see response to the initiation of medical management and continue to slowly improve over a few years. For those who were at the Brazilian hair meeting, I think all would agree that Dr. Russell Knudsen gave a great lecture on the similarities/differences between women and men regarding the science behind why androgenetic alopecia occurs. Also, he showed how multiple different medications impact different aspects of the hairloss equation in women, concluding that multiple medications should be used to address hairloss in women like androgen antagonists, DHT blockers, antagen phase prolonging medications and OCPs.

Brad Limmer, MD/jac

*photos are posted side by side - before/after*