Hair Transplantation in Women: A Practical New Classification System and Review of Technique

In 2002, James E. Vogel, MD, introduced a new classification system for female hair loss and reviewed hair transplantation techniques for women. The system, which categorized hair loss into five types, aimed to improve surgical evaluation and treatment. The review highlighted the necessity of a thorough preoperative evaluation, including donor and recipient analysis, and the psychological effects of hair loss. It was noted that significant hair loss affects 30 percent of women over 50, and only about 50 percent of women with type 1 or 2 hair loss are suitable candidates for transplantation due to various contraindications. The techniques for hair restoration were similar to those used in men, focusing on conserving donor hair and minimizing damage. The paper also detailed the use of a hair densitometer, strip harvesting for donor hair, and 18-gauge No-Kor needles for recipient sites. It discussed eyebrow and sideburn restoration, hair graft growth in scar tissue, and transplantation success in various ethnicities. Complications like postoperative telogen effluvium were noted, especially in women with generalized thinning. The document concluded that advancements have increased women's candidacy for hair restoration surgery, but patient selection and expectation management remain critical. A case study of 800 follicular unit transplants in a type 1 hair loss patient showed satisfactory results after 18 months.