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    Alopecia is a nongender ailment in Florida surgeon's office

    Dr. Gershenbaum
    Aventura, Fla. -- Sam Gershenbaum, D.O., a board-certified plastic and reconstructive surgeon here believes he has helped build his busy practice by also helping men restore lost hair. But there is a big difference between his hair restoration patient population now and the one that launched him nearly eight years ago: their gender. It used to be exclusively male. Now, 10 percent of his hair restoration patients are women.

    On one hand, Dr. Gershenbaum credits his frequent seminars and consultations that draw mostly men, but often spouses come along.

    After all, in the retirement-heavy region in which he practices, thinning hair is a common problem in both sexes. "As we continue to educate both men and women about hair loss and restoration, more and more women realize they can be ideal candidates as well," he said. Like their male counterparts, women do not want to depend on a hairpiece as their only option. And when he performs procedures on women, the word of mouth support is even more dramatic than with men. "We're seeing more and more middle-aged and older women with thinning behind the hairline as well as hair loss from chemicals and traction alopecia in African American patients. We are also seeing many more women patients requesting hair restoration in areas of hair loss and scars due to cosmetic surgery. It's all a matter of meeting expectations," he said.

    But for any cosmetic surgeon looking to expand his or her practice this way, Dr. Gershenbaum sounds a note of caution. Men are more satisfied with a lower density result than are women. Though women can help boost the caseload, they also often take more time in patient education. "We show them photographs of hair transplant patients, and spend a lot of time talking," he said. "You really want to spend more time, in general, talking about this so that women patients will know what outcome is likely to be attained."

    Patient underwent three procedures after brain tumor removal and radiation. Shown (right) after two procedures totaling 1,249 grafts and a third procedure to provide more density of 476 grafts. (Photographs courtesy of Sam Gershenbaum, D.O.)
    Dr. Gershenbaum, who works with Medical Hair Restoration at the Aventura Center, said he has turned women away when they seem to insist on a result that would make their head look like it was fit for a shampoo ad. "This is the kind of patient that may not be happy even with the finest results," he said. Most women will not be satisfied with light coverage. One stumbling block is that women are bombarded with ways purporting to make their hair bounce and shine again. "You'll hear these things on the radio all the time," he said.

    In women, as in men, the most likely cause of scalp hair loss is androgenetic alopecia. They often show a diffuse thinning of hair, but rarely does it involve the frontal hairline. Traction alopecia from tight braids and chronic use of relaxers and straighteners are other common causes. The best candidates for hair restoration are those with realistic expectations, adequate donor hair and 'see-through' hair loss behind the hairline or traction alopecia. A thorough history and physical and blood analysis is mandatory for each patient.

    Patient education about hair restoration and replacement is a delicate and relatively time-consuming issue. In fact, the International Society of Hair Restoration Surgery in one of its advisories to physicians said, "The aesthetic consultation with the physician hair restoration specialist is every bit as important as determining the reason for hair loss." The society advises asking questions such as:

    • What hair styles has the patient been using to minimize the appearance of thinning hair?
    • What hair styles would the patient hope to use after hair restoration?
    • Would the patient change her hair style - curl, color, -- to get the most out of hair restoration?
    • Does the patient want a "luxurious head of hair" that might require procedures such as hair weaving or hair extenders?
    • Does the patient want to be able to swim or exercise heavily without worrying about her hair?

    Basically, even with all the advances, there are two main hair-restoring approaches for women, Dr. Gershenbaum said. One is surgical, generally relying on hair transplantation for those who are proper candidates. The other is nonsurgical and utilizes such techniques as hair weaving or extending. Currently, the surgical treatment for female androgenetic alopecia is occasionally combined with a nonsurgical one: Minoxidil. In some cases women are very responsive to Minoxidil and dramatically reduce the progression of hair loss.

    Blood tests, thorough patient history a mustFor any woman patient, both blood tests and a thorough patient history are needed to rule out other causes than androgenetic alopecia. If female pattern baldness is truly to blame, the next step is determining whether the patient is a good candidate for transplant. If the woman is a poor-quality donor or has unrealistic expectations, "It's really best not to do transplants," he said. "If several procedures are required, it is advantageous to tell the patient right away that the approach may take a lot of time and still not give her the full head of hair of her youth."

    Derm Pulse
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