Hair Loss & Transplantation
Hair Loss and Hair Transplantation in Women of Color
There are several causes of hair loss in women – hereditary causes, crash dieting (inadequate protein), childbirth, birth control pills, medications, medical illnesses (thyroid disease, anemia), surgery, cancer treatments and improper hair care. The most common type of hair loss in all women, regardless of race, is female pattern hair loss (FPHL) or hereditary thinning. It occurs in approximately 30 million women in the United States. Most women are 50-60 years of age, but younger women can be affected as well. Although, not surprising, that the younger the women is with hair loss, the more devastating it can be to her. Studies have shown that hair loss in women can negatively impact their self-esteem and social interactions. FPHL presents as a diffuse thinning of hair at the top of the head (crown) and may extend to the front of the scalp. Medical treatment with topical Minoxidil 2% (Rogaine) is available over-the-counter, but must be used continuously in order to maintain the new growth.
Two of the most common types of hair loss in black women, both which are associated with hair grooming practices, include traction alopecia and central centrifugal cicatricial alopecia (CCCA). These conditions can lead to permanent hair loss and hair restoration is the only answer.
Traction alopecia occurs in both children and adult women. It results from various hairstyles and hair grooming practices that are unique to women of color. These include pony tails, braids, weaves, locs and hair rollers that pull the hair tight and eventually, hair loss develops. The areas of hair loss are usually symmetrical and occur along the temples and the above the ears. If caught early on, medical treatment and changing the damaging hairstyle can stop this condition from becoming permanent.
Central Centrifugal Cicatricial Alopecia (CCCA)
CCCA, or formally known as hot comb alopecia and follicular degeneration syndrome, is an inflammatory scarring form of hair loss that is becoming an epidemic in the black female population. The cause of this condition is unknown; however, many of the women have a history of chronic use of hair chemicals (relaxers, jheri curl, texturizers, and bonding glue used for hair weaving) or heat (hot comb or hot curler use). CCCA is a progressive and destructive scalp condition that commonly goes unnoticed. It usually begins at the top of the scalp (crown or vertex) and the most common early signs are hair breakage, itching, scalp tenderness in the affected area. Again, if addressed early, medical treatment along with changing the current hair grooming methods can stop the progression of the hair loss and in some cases, hair regrowth can occur. Unfortunately, most women seek treatment too late and the hair loss becomes permanent.<
Hair transplantation or hair restoration is a popular cosmetic procedure that is commonly performed in Caucasian men with male pattern baldness. According to the American Academy of Cosmetic Surgery, hair transplantation was the most popular cosmetic surgery among men, with 177,998 procedures performed in the year 2000. Most of us have seen the late night infomercials, highlighting the fabulous results of hair transplanting in men, restoring their youth and good looks. However, women of color are never seen in these advertisements, as if this surgical procedure is not indicated for their hair loss. With the increasing incidence of hair loss in black women, the surgical correction of hair loss is an important and necessary component to the overall treatment regimen for this emotionally devastating condition.
What is Hair Transplantation?
Hair transplantation involves removing healthy hair or grafts from the back of the scalp (donor site) and transplanting them into the area of hair loss (recipient site). It is an in-office surgical procedure that is performed under local anesthesia and minimal sedation; so hospitalization is not required. There are various techniques used to remove the hairs from the donor site. The most common technique involves removing a strip of hair bearing scalp (6-8 inches long x 1 inch wide) and then dissecting it into follicular units (1-3 hairs). This procedure is called follicular unit transplantation (FUT) and produces a natural appearing hairline. This technique is extremely important in patients with traction alopecia and female pattern hair loss. In contrast, women of color with CCCA have better results with transplanting larger grafts, containing more hairs, rather than follicular units. Because the area of hair loss occurs on the crown and not the hairline, larger grafts are used to provide better coverage and create an illusion of density.
Racial Differences in Hair Restoration
There are several racial differences in hair transplant surgery. These include (1) reason for the procedure; (2) the shape of the hair; and (3) risk of keloid formation. Most women of color seek hair restoration for the treatment of traction alopecia and CCCA, whereas male pattern baldness in men and FPHL in women is the reason in Caucasians. In general, black hair is curly with a curved hair follicle and removing donor hairs can be very difficult and extremely challenging. Transection of the hair follicle is a constant problem even for the best hair transplant surgeon or surgical assistant so finding a hair transplant surgeon with experience in black hair, such as Dr. Callender, is particularly important. And finally, the risk of keloid formation is increased in the black population and therefore the risk of developing a keloid from hair transplant surgery is a possibility. If a history of keloids is present, the procedure should not be performed. In addition, if a keloid scar develops at the surgery site, then topical corticosteroids or cortisone injections can be administered to flatten the scar.