Female Pattern Hair Loss: Why the Follicular Unit Transplantation Surgical Technique Remains a Good Option.

Background Female pattern hair loss is a common nonscarring alopecia that can present with several patterns of decreased hair density. The condition is very bothersome to affected women, and although there are multiple nonsurgical options, surgical follicular unit transplantation remains one of the most effective options. Methods A retrospective chart review was performed of the senior author's (C.O.U.) experience and technique of follicular unit transplantation for treatment of female pattern hair loss. Results A total of 751 patients with female pattern hair loss underwent follicular unit transplantation over the past 31 years. Average patient age was 48 years. Patients with small areas of hair loss made up 40 percent of the group (Ludwig stage I), those with medium-sized areas constituted 45 percent (Ludwig stage II), and those with large areas constituted 15 percent (Ludwig stage III). The average operative time was 3 hours 21 minutes. One hundred thirty-five patients (18 percent) underwent a second replacement, at an average period of 4 years after the procedure, because of the progressive nature of female pattern hair loss. Complications included donor-site scar widening in six patients and folliculitis in 17 patients. Conclusion Follicular unit transplantation is an excellent option for treatment of female pattern hair loss patients, as there is no need to shave the recipient sites, operative times are shorter than for follicular unit excision techniques, and the incidence of complications is very low. Clinical question/level of evidence Therapeutic, IV.