6 common questions about female hair loss

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Consultant hair transplant surgeon Dr Asim Shahmalak from Crown Clinic in Manchester is one of the UK’s leading experts on hair loss.
His celebrity hair transplant clients include the Coronation Street star Jack P Shepherd, model Calum Best, TV doctor Christian Jessen, former footballer Didi Hamann, Homes Under The Hammer presenter Martin Roberts and Gogglebox star Chris Butland-Steed.
Dr Shahmalak also specialises in some more unusual procedures largely used by women including eyebrow and eyelash transplants. These tend to be for women who have permanently damaged their eyebrows by overplucking or have ripped out their eyelashes through an accident or the misuse of stick-on eyelashes. In 2009, Dr Shahmalak performed the first eyelash transplant ever performed in the UK.

1. What are the symptoms of thinning hair and how can you determine whether you’re suffering from hair thinning or hair loss?
In women, hair loss more often involves a general thinning across the entire scalp. Known as diffuse thinning, most women affected loss a lot of their hair volume, making their scalp more visible. In general, the hair remain intact, but in some rarer cases women with hair loss may experience a receding hairline. But more commonly, female hair loss starts in the central area of the scalp and then spreads outwards if it is left untreated.
As with men, the most common cause of female hair loss is genetics. If you have female pattern baldness on the mother or father’s side of the family, there is a greater risk of it happening to the next generation of women in the family. This hereditary hair loss is permanent as opposed to the temporary thinning of the hair which can be caused by other factors such as pregnancy, stress, poor diet, menopause and some medications.
Permanent hair loss tends to happen differently in women to men.
Whereas men typically tend to first start losing their hair in the crown area or in the hairline at the front of the scalp and then go on to develop bald patches, in women hair loss manifests itself through general thinning rather than more noticeable bald patches.
Hair loss tends to be subtler in women than it is in men. Hair may also fall out in large clumps during brushing and showering.
“This kind of thinning hair, while not as immediately noticeable as male pattern baldness, can still undermine a women’s self-confidence and age her appearance appreciably. It is why so many women seek permanent remedies for permanent hair thinning/hair loss. Around 10% of my clients are women.

2. What are the specific causes thinning hair? (do genetics, lifestyle, stress, medicine play a role?)

Below are the most common causes of hair thinning particularly in women.

* Androgenetic Alopecia – hereditary pattern hair loss with a typical pattern of diffuse thinning over the central scalp. It is the most common type of hair loss. It occurs in about 20% of women.
* Alopecia Areata – a recurrent disease of unknown cause that results in patchy loss of hair from the scalp and/or eyebrows.
* Telogen Effluvium – a condition that causes shedding of hair over the entire scalp; it may be chronic but may also be acute following a stressful event such as high fever, sever dietary deficiency, and chronic blood loss from heavy menstruation.
* Loose Anagen Syndrome – a condition that causes hair to shed before its normal growth cycle is completed. Hair can be pulled out by normal combing or brushing.
* Traction Alopecia – tight braiding and corn-rowing can, over time, cause permanent damage to hair and scalp and result in hair loss.
Chemicals – some chemicals used in hair styling can, over time, cause permanent damage to hair and scalp and result in hair loss.
* Trichotillomania – (compulsive hair plucking) – a person feels compelled to pluck hair in regular or bizarre patterns, resulting over time in traction alopecia and permanent hair loss.
* Scarring Alopecia – hair loss due to scarring of the scalp area. Scarring alopecia typically involves the top of the scalp and occurs predominantly in women. The condition frequently occurs in Afro-Caribbean women and is believed to be associated with persistent tight braiding or “corn-rowing” of scalp hair. A form of scarring alopecia also may occur in post-menopausal women, associated with inflammation of hair follicles and subsequent scarring.
* Hypothyroidism – thyroid deficiency can be associated with thinning, patchy hair loss.
* Pregnancy – hormonal changes and stress of pregnancy may cause temporary hair loss
* Menopause – due to hormonal changes in a women’s body from the age of 45 onwards
* Stress – this cause cause temporary hair loss
* Poor diet – another cause of temporary hair loss
* Medicine – cancer treatments such as chemotherapy cause cause the temporary loss of hair.

3. How common is it in women?

Hair loss in women is surprisingly common. Around 40% of women will suffer from hair loss at some point in their lives – for instance during pregnancy or the menopause. But unlike with men, hair loss in women is often temporary and the hair will eventually grow back.
However, permanent hair loss is still a relatively common problem in women and is largely for hereditary reasons.

4. What’s the growth phase/cycle of hair (does it all grow and shed at the same time) and what happens to the growth phase of those experiencing loss of volume?

Approximately 90% of your hair is growing at any one time, while the other 10% enter a resting phase. Every two to three months the resting hair falls out and allows new hair to grow in its place.
Telogen effluvium is the excessive shedding of hair that occurs one to five months following pregnancy. This is not uncommon, as it affects somewhere between 40% to 50% of women; but like most changes during pregnancy, it is temporary.
Hair loss that is connected to pregnancy usually occurs after delivery. During pregnancy, an increased number of hairs go into the resting phase, which is part of the normal hair loss cycle.
This condition is not serious enough to cause bald spots or permanent hair loss. The rise in hormones during pregnancy keeps you from losing your hair. After delivery, the hormones return to normal levels, which allows the hair to fall out and return to the normal cycle. The normal hair loss that was delayed during pregnancy may fall out all at once.
Up to 60% of your hair that is in the growth state may enter into the telogen resting state. After around five months after birth hair follicles rejuvenate themselves and the hair grows back.”

Menopause is a natural biological process that all women experience at some point in their lives. During this time, the body goes through numerous physical changes as it adjusts to fluctuating hormone levels. Many women have unpleasant symptoms during menopause, including hot flashes, mood swings, and insomnia. Hair loss is another common occurrence.

Research suggests that hair loss during menopause is the result of a hormonal imbalance. Specifically, it’s related to a lowered production of estrogen and progesterone. These hormones help hair grow faster and stay on the head for longer periods of time. When the levels of estrogen and progesterone drop, hair grows more slowly and becomes much thinner. A decrease in these hormones also triggers an increase in the production of androgens, or a group of male hormones. Androgens shrink hair follicles, resulting in hair loss on the head. In some cases, however, these hormones can cause more hair to grow on the face. This is why some menopausal women develop facial “peach fuzz” and small sprouts of hair on the chin.

For women going through menopause, the cause of hair loss is almost always related to hormonal changes. However, there are many other factors that can contribute to hair loss during menopause. These include extremely high levels of stress, illness, or a lack of certain nutrients. Diagnostic blood tests that can help rule out other causes of hair loss include thyroid tests, and/or a complete blood count.

5. Can you self-treat or should you always seek a doctor/ trichologist?

It is always best to see a doctor or trichologist to get to the root causes of the problem. However, there are some over-the-counter remedies that can treat hair thinning and hair loss in women.
“Minoxidil [Rogaine] hair loss products are available over the counter in a weaker concentration than the 5% that is prescribed by doctors. It is usually applied directly to the scalp and is most effective as part of a treatment programme devised by a hair regeneration specialist. It is more effective in women than men and although has been proven to arrest hair loss is not particularly effective in the regeneration of hair.
Toppik Hair Building Fibrescan can instantly fill in balding or thinning areas, providing a temporary solution to the problem. Made of pure organic protein, Toppik is  undetectable and resistant to wind, rain and perspiration; yet easily washes out with shampoo.
If you’re a woman with thinning hair, Toppik hair products can have an immediate positive effect and help to restore confidence.
Toppik fibres are made of all natural organic keratin protein, the same protein that hair is made of. The fibres in Toppik are charged with static electricity so they intertwine with your own hair and bond securely.”

How long does it take to see results using your treatments, how many sessions?

Minoxidil does take some time to work. Users won’t start to see visible results after three months and it will probably be up to six months before you see a noticeable improvement. Toppik can provide immediate relief.

The only long-term solution to permanent hair loss is a hair transplant. Around 10% of my patients are female and hair transplants can be just as effective on women as men.”

Our Surgeon

Dr. Asim Shahmalak

Dr Asim Shahmalak is a world-renowned hair transplant surgeon who performed the UK’s first eyelash transplant in 2009. He runs Crown Clinic – one of Britain’s most successful and best known hair transplant clinics. He has treated a number of high-profile industry leaders and celebrities including the medical broadcaster Dr Christian Jessen, best known for Channel 4’s Embarrassing Bodies.

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Spurs manager Antonio Conte is one of a number of people in football who have benefitted from a hair transplant.

Another is the Liverpool manager Jurgen Klopp, who has been very open about seeking help with his hair.

Conte, 52, looks completely different in the before and after pictures shown on this page and is likely to have had several procedures to boost his hair.

Like a lot of men, Conte started losing his hair in his late 20s and early 30s when he was a successful player in the Italian league and playing for the Italian national team.

He was pictured several times during this time showing all the signs of advanced male pattern baldness.

Since becoming such a successful manager, Conte has had at least two hair transplants to cover up the bald areas at the front of his hairline.

It is likely he would have opted for a FUE (follicular unit extraction) procedure. This is where the grafts are removed individually from the back and sides of the scalp and then replanted in the balding areas.

Around 80% of patients coming to Crown Clinic to our consultant surgeon Asim Shahmalak now opt for FUE.

This is a big change on five years ago when the majority of our patients chose the more traditional method of hair transplantation known as FUT (follicular unit transplantation) or strip surgery.

The advantage of FUE over FUT is that there is less scarring. Most FUE patients are simply left with some red pin pricks where the donor hair is harvested and replanted which go away after a few weeks.

Famous Crown Clinic FUE patients include the Coronation Street star Jack P Shepherd, model Calum Best, and the football pundit Didi Hamann.

FUE is slightly more expensive than FUE because it requires more time to carry out. This is because the donor grafts are removed individually rather in one single strip of skin which is surgically removed, which is what happens under FUT.

Crown Clinic’s most famous FUT patient is the TV doctor Christian Jessen who has had two FUT transplants with Dr Shahmalak. Scarring is greater with FUT and all patients are left with a lined scar on the scalp where the strip for the donor hair is removed. This soon heals and if you wear your hair relatively long, like Christian Jessen, it is very difficult to see the scar because the hair grows over it. However, the scar is visible if you like to wear your hair short or shaved, like Calum Best, so we recommend FUE for all patients who like their hair short. Around 20% of Crown Clinic patients still prefer FUT. There is evidence to show that slightly few grafts are lost in the donor hair harvesting process by removing the grafts in one go – so that is an advantage of FUT.

Conte has not spoken about his hair transplants, so we don’t know for sure which method he chose.

Whichever one it was, he is to be congratulated on his choice and the work of his hair transplant surgeon because he has an excellent result.

Dr Asim Shahmalak from Crown Clinic is one of the world’s leading hair transplant surgeons.

He is the surgeon to the stars and has performed procedures for celebrities including Jack P Shepherd from Coronation Street, the model Calum Best and the TV doctor Christian Jessen.

He has pioneered new hair transplant procedures in the UK such as eyelash, eyebrow, beard and sideburn transplants.

His main clinic is close to Manchester Airport and he also has consulting rooms in Harley Street.

A former general surgeon in the NHS, he switched to hair transplantation private practice 15 years ago and is one of the most acclaimed surgeons globally in FUE (follicular unit extraction) and FUT (follicular unit transplantation) hair transplant procedures

Are more women enquiring about hair transplants/procedures/treatments and if so why? Is demand growing?

Asim Shahmalak said: “Yes, more women are enquiring about hair transplants. They are still far outnumbered by men but around 10% of my patients are female.

“Most of them come because they have permanent thinning hair and this can be even more damaging to a woman’s self-esteem than a man’s simply because it is more unexpected and it can have a devastating impact on a woman’s confidence.

“I also treat increasing numbers of women for eyebrow and eyelash transplants. Most eyebrow transplants are down to women permanently damaging their brows due to over-plucking. Hair is transplanted from the scalp and replanted in the brows.

“I also do eyelash transplants on women. I was the first surgeon in the UK to perform an eyelash transplant here – way back in 2007 on a young woman from Greater Manchester. Most eyelash transplant patients seek treatment after suffering from trichotillomania – a condition where sufferers rip out their eyelashes due to psychological issues. Hair is extracted from the scalp and replanted in the upper eyelid. Because it is scalp hair, it goes as it would on the scalp when replanted in the eyelid so it can curl when longer and needs to be straightened. I provide kits so patients can do this themselves.

“Demand is growing for general female hair transplants. The reason for this is greater awareness that hair transplantation is the only long term solution to permanent hair loss in women.

“There is also a lot of concern about hair extensions and the damage they can cause to the scalp. Women can wreck their hair with hair extensions which can pull out their natural hair and cause permanent damage to the scalp.

“Lots of women have seen successful male transplant patients such as Calum Best or Jack P Shepherd and thought, ‘That could work for me, too.’”

Why have women been slower than men to enquire about hair procedures?


Asim Shahmalak said: “I think women have been slower than men to enquire about hair transplants in the past because they thought that hair transplants were a ‘man thing.’ You didn’t read about women having procedures and there was this assumption that while women could benefit in lots of ways through plastic surgery – breast enhancements or browlifts or facelifts – hair transplantation was not for them. One of the reasons is that a lot of female hair loss is hormonal and non-permanent. The hair eventually grows back and so hair transplantation is not necessary.

“However, a significant number of women do suffer permanent hair loss for a number of reasons including the same hereditary reasons which is the main factor in men going bald. A receding hairline at the front ages a woman far more quickly than a similar condition in men. You expect some women in their eighties or nineties to have thinning hair, but not in their forties or fifties. It is those younger middle aged women who are coming to me for help in increasing numbers.”

Are more younger women enquiring about hair transplants/procedures/treatments and if so why?

Asim Shahmalak said: “Yes, more young women are inquiring about treatments and there is a simple reason: vanity. In the age of social media, where we can all enhance our appearance with photographic filters, a hair transplant is like having a permanent positive filter on your hair. You can wave goodbye to bad hair days and have the hair you have always wanted every day.

“So many young people want to look their best when sharing pictures on Facebook and Instagram and come to me for procedures which will improve their self confidence and how they present themselves to their friends and the world on social platforms.”


Are more women going through the menopause enquiring about hair transplants/procedures/treatments and if so why?

Asim said: “Menopause is a natural physiological process that all women experience at some point in their lives. During this time, the body goes through numerous physical changes as it adjusts to fluctuating hormone levels. Many women have unpleasant symptoms during menopause, including hot flashes, mood swings, and insomnia. Hair loss is another common occurrence.


“Hair loss tends to be subtler in women than it is in men. Most women experience overall hair thinning rather than noticeable bald spots. The thinning can occur on the front, sides, or top of the head. Hair may also fall out in large clumps during brushing and showering.

“Research suggests that hair loss during menopause is the result of a hormonal imbalance. Specifically, it’s related to a lowered production of estrogen and progesterone. These hormones help hair grow faster and stay on the head for longer periods of time. When the levels of estrogen and progesterone drop, hair grows more slowly and becomes much thinner. A decrease in these hormones also triggers an increase in the production of androgens, or a group of male hormones. Androgens shrink hair follicles, resulting in hair loss on the head. In some cases, however, these hormones can cause more hair to grow on the face. This is why some menopausal women develop facial “peach fuzz” and small sprouts of hair on the chin.

“For women going through menopause, the cause of hair loss is almost always related to hormonal changes. However, there are many other factors that can contribute to hair loss during menopause. These include extremely high levels of stress, illness, or a lack of certain nutrients. Diagnostic blood tests that can help rule out other causes of hair loss include thyroid tests, and/or a complete blood count.

“Hair loss may make you feel self-conscious about your physical appearance, but the condition isn’t permanent in most cases. Obviously where it is non-permanent a hair transplant is not appropriate.

“However in some cases the hair loss is permanent and a hair transplant is appropriate. We have seen growing number of post-menopausal women seeking help for the same reasons of vanity that attract younger women to the clinic.”

Do you have any concerns about the hair transplant industry, particularly the popularity of going abroad?

Asim Shahmalak said: “I have great concerns about the numbers of patients of both sexes going to countries such as Turkey for hair transplant procedures.

“Do you really want to take a risk on such an important decision on what could be a completely unregulated clinic? The main drawback of going abroad for a procedure is that patients have almost no recourse if the procedure goes wrong or they don’t get the result they desired.


“Do you really want to start legal proceedings in a Turkish court and would you have the first idea about what to do? If you need further care from the surgeon, you will need to fly thousands of miles for a remedy which again may not work. It may be a little more expensive to have treatment in the UK but it is money very well spent.


“One of the main areas of my work is repair surgery. Patients come to me after having a terrible experience in a country such as Turkey and ask me to repair the damage. In most cases, I can help and sort out their problems but, in a few cases, nothing can be done and patients can severely damage their appearance by going to an unregulated ‘cowboy clinic’ abroad.


And I would be keen to know if you have any case studies of women who have had the procedure who would be able to tell me about their experience?


Asim Shahmalak said: “Most of my female patients would rather not be fully named and pictured when talking about their hair transplant procedures.


“But several have been so pleased with the results that they are okay to share pictures and their experiences in a way where they are not fully identified. Here are some of my very happy former female patients.”

He maybe the world’s richest man, but all those riches could not save Elon Musk’s hair.
That is why the founder of the Tesla car company transformed his appearance with a hair transplant.
You can see the remarkable change in his appearance in the before and after pictures below.

His hair is clearly thinning at the front in the before picture on the left, taken in his 20s.

Fast forward more than 20 years and the 50-year-old Musk has a full head of hair in the after picture on the right.

Musk will almost certainly have had a Follicular Unit Extraction transplant – chosen by 80% of the patients at Crown Clinic.

With FUE, the donor hair is extracted individually from the back and sides of the scalp – keeping any scarring to a minimum.

Celebrity patients of our consultant hair transplant surgeon Dr Asim Shahmalak who have had FUE transplants include Jack P Shepherd from Coronation Street, the footballer Didi Hamann and the model Calum Best.

Dr Shahmalak also offers the more traditional method of hair transplantation, FUT – follicular unit transplantation.

With FUT, all the donor hair is removed in one go by surgically cutting a strip of skin from the scalp. The donor grafts are then extracted from the strip by technicians and replanted in the balding areas of the scalp by Dr Shahmalak in the same way as FUE.

The TV doctor Christian Jessen has had two FUT transplants at Crown Clinic with Dr Shahmalak. We don’t recommend FUT for patients who like to wear their hair short or shaved because the scarring is more noticeable than FUE. If you grow your hair slightly longer, as Christian Jessen does, the scarring cannot be seen.

Whatever method he chose, Elon Musk is to be congratulated on his transplant – his new hair looks fantastic.