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Procedures
Hair transplants for women
A hairline set too high, a facelift scar, a widening parting, an edge worn away by traction. Five situations, and the ones we do not operate on.
A transplant in a woman is not a male transplant scaled down. The pattern of loss is different, the hairline is drawn differently, the donor area is often affected too, and the hormonal question arises every time. Some female requests involve no disease at all: a naturally high forehead, a cosmetic surgery scar, temples worn thin by years of styling.
On top of that comes a practical constraint men do not face, and one that often decides everything: nobody should be able to guess at the procedure when the patient leaves the clinic. That is why the recipient area is never shaved in women, and why trimming of the donor area is limited to a strip the hair above covers.
What we treat
Five situations
Each calls for a different strategy, a different number of grafts, and sometimes medical treatment before any surgery.
Lowering a high hairline
A high forehead is not a disease, it is a proportion. Some women have had one all their lives and find it hard to live with: constrained hairstyles, a fringe by obligation, photographs avoided. A transplant brings the hairline down by one to three centimetres depending on the capital available, drawing a feminine line, rounded in the middle and softened at the temples.
- Between 1,500 and 3,000 grafts depending on the area covered
- A deliberately irregular line, never drawn with a ruler
- Single-hair grafts throughout the first row
- No ongoing loss to treat: the result is stable
Covering facelift scars
A facelift moves the temporal hairline backwards and leaves a scar in front of the ear or within the scalp. The lift itself may be excellent and this area still give it away. Grafts placed in and around the scar make it invisible, and restore the sideburn.
- Well after the lift, once the scar is mature, often a year
- Deliberately moderate density: scarred skin feeds grafts less well
- Often two sessions, the second thickening the first
- Also treats scars from scalp surgery or neurosurgery
Female pattern hair loss
The parting widens, density falls across the top of the scalp, the frontal hairline often stays in place. It is the most common reason for consulting, and the one where selection matters most: the donor area may be affected too, which limits what can be harvested.
- Medical treatment is almost always discussed first
- Hormonal, ferritin and thyroid studies before any decision
- A transplant adds density; it does not restore hair of twenty
- Some patients are best served by medical treatment alone
Traction alopecia
Tight braids, extensions, weaves, buns pulled back for years. The hairline recedes at the temples and around the edges, where the pull is applied. Reversible early on, it becomes permanent once the follicle has been destroyed.
- A good indication at the scarring stage, with a clear result
- On one firm condition: that the practice responsible has stopped
- Otherwise the grafts undergo the same pulling and are lost
- Temples and hairline are treated in a single session
Thinning temples
The area women most often point to in the mirror, and one that medical treatment does not reach. Few grafts are needed, but the angle is very shallow and the work finer than elsewhere.
- Between 400 and 1,200 grafts depending on the extent
- Fine one- and two-hair grafts, placed at a very shallow angle
- Readily combined with lowering the hairline
No visible shaving
The question of shaving
It is the first objection, and the most legitimate one. A woman cannot turn up at work on Monday with a shaved head, and many give up on surgery for that reason alone.
There is no need to. The recipient area is never shaved: grafts are placed between the existing hairs, which takes longer and demands a steadier hand, but leaves the hairstyle intact. Only the donor area at the back has to be trimmed in order to be harvested, and that trimming is limited to a horizontal strip which the hair above covers completely once let down.
Leaving the clinic with hair loose, nothing shows. The crusts over the transplanted area come away within ten days or so, and a fringe or a shifted parting is enough to cover them meanwhile.
The consultation
What is checked before deciding
In women, examination precedes any proposal even more than in men, because the causes of loss are more numerous and often reversible. Recent diffuse shedding is almost never a surgical indication.
- Trichoscopy, showing miniaturisation, the state of the follicular openings and signs of inflammation
- Blood tests: ferritin, thyroid, and hormonal studies according to context
- Assessment of the donor area, which may itself be affected and limit what can reasonably be harvested
- Looking for traction maintained by hairstyling, which must stop before surgery
- Ruling out a scarring alopecia, common in women, which forbids surgery while it is active
What we do not operate on
Shedding that follows childbirth, a diet, a high fever or a shock: it regrows by itself within six to twelve months. Diffuse loss present for less than a year and unexplained. Frontal fibrosing alopecia or lichen planopilaris still active, which a transplant can reactivate. These situations are set out on the page devoted to scalp conditions.
In practice
How a procedure unfolds
- Duration
- 5 to 8 hours depending on the number of grafts
- Anaesthesia
- Local; the patient stays awake
- Shaving
- Recipient area never shaved; donor area trimmed in a strip
- Back to work
- 3 to 5 days
- First result
- 8 months
- Final review
- 15 months
- Patients per day
- One only, operated from start to finish by Dr Seffen
Frequently asked
What patients ask
Will my hair have to be shaved?
No, in most procedures on women. The recipient area is never shaved: grafts are placed between the existing hairs. Only the donor area at the back needs trimming, and it is limited to a strip the hair above covers completely. Nothing shows on leaving the clinic, or the next day.
How long before it shows?
The same timetable as in men. The transplanted hairs shed in the second month, which is normal and expected. Regrowth begins around the third, the result can be judged from the eighth, and the final review is at fifteen months.
Can I take finasteride?
Not in women of childbearing age: finasteride is strictly contraindicated because of the risk to a male foetus. Topical minoxidil remains first-line. Low-dose oral minoxidil is used off-label, and is discussed case by case.
Can hair loss after childbirth be transplanted?
No. Post-partum shedding is a telogen effluvium: it appears two to four months after the birth and regrows spontaneously within six to twelve months. Operating on loss that was going to stop by itself is a mistake. We look for iron deficiency, reassure, and wait.
What if I wear a headscarf or tight hairstyles?
A headscarf in itself poses no problem. What damages hair is traction: permanent tightness, pins in the same place, a bun pulled back under the fabric. This is examined in consultation, because a transplant placed under continuing traction will be lost.
Will the hairline look natural?
A feminine hairline is not drawn like a masculine one: it sits lower, is rounded in the middle, softened at the temples, and deliberately irregular. The entire first row is made of single-hair grafts. It is that controlled disorder that stops anyone guessing.
The package
What is included
Always ask for this list in writing, whatever clinic you are considering. A low package price is usually explained by what it leaves out.
One patient a day, operated from start to finish by Dr Seffen
The pre-operative consultation and the drawing of your line
Local anaesthesia and all single-use instruments
Airport, hotel and return transfers
Lunch and a private rest room on the day
The first wash and the next-day check at the clinic
Follow-up by message and photographs throughout
The final review at fifteen months, included
Seek the advice of a specialist
A diagnosis prepared personally by Dr Seffen from your photographs, before any question of surgery.