Hair Transplant or Topical Treatment?

my mom is 45 years old and has a dreadfully thin crown area. does she need a transplant or should she try to work with a derm for a more topical treatment?

Doctor Answers 11

Surgical versus Non-surgical Treatment

Your mother has typical hair loss seen in women.  If your mom has been working with her dermatologist using topical treatments for 6 -12 months without improvement then surgery would improve her results dramatically.   She must be healthy and willing to undergo surgery.

Dr. ES

She needs to see an endocrinologist first for hair loss in the female.

She needs to find out if there is a medical condition causing her hair loss from an endocrinologist. If this is negative she can try rogaine, but I have never seen good before after photos of good results. Hair transplants may not give her enough hair to justify the cost and she may prefer extensions.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Women with thinning hair

Women with thinning hair are best treated with scalp micropigmentation rather than a hair transplant, see below

William Rassman, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 27 reviews

You mom need an examination to understand why she is losing hair. She needs a diagnosis before considering treatment.

You mom need an examination to understand why she is losing hair. She needs a diagnosis before considering treatment.  Hair transplant surgery is not an automatic solution for hair loss.

Jae Pak, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 100 reviews

Crown Hair Restoration

Androgenic alopecia, or pattern baldness, is the most common form of hair loss in men and women. For men, there is a well-defined pattern of hair loss that begins above both temples, followed by a receding hairline and crown hair loss. Women typically experience hair thinning over the entire head.

For your mother, I would first have her consult with her doctor about the cause of her crown hair loss to rule out of other possibilities. If it is pattern baldness, she is definitely a candidate for follicular unit extraction (FUE). Hair restoration of the crown is complex since it serves as the scalp’s merging place. Hair grows forward from the top of the head; hair grows toward the nape on the back of the head. Hair growth is in a circular pattern, so it’s also different on the sides. To create a natural-looking whorl during restoration, surgeons must use care vision and artistry.

Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 32 reviews

Hair Transplant or Topical Treatment?

She may be a better candidate to see a dermatologist first since there are many causes of hair loss in women.

Jack Fisher, MD
Nashville Plastic Surgeon
5.0 out of 5 stars 4 reviews

Surgical vs. Non-Surgical Hair Restoration Treatment

She first needs a medical workup, then consider minoxidil and possibly laser light therapy, then possibly a procedure by a surgeon experienced in transplanting women.

Jeffrey Epstein, MD, FACS
Miami Facial Plastic Surgeon
4.7 out of 5 stars 132 reviews

Hair Transplant in women

Before considering hair transplant, your mom first needs a good physical examination to determine why she is losing her hair. We see a lot of women in our practice and this is the protocol we follow. The initial exam would consist of a full medical history, scalp examination, the pull test, etc. Further testing such as hormone levels, thyroid levels and blood levels are required to determine whether Any underlying medical condition is contributing. Then, we would consider hair transplant.


Ben Behnam, MD
Santa Monica Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Multiple treatment options for thinning hair

Several FDA approved medications are available for the treatment of patterned hair loss in men and in women. These included OTC products like minoxidil 2-5%, oral medication such as finastseride (Propecia), as well as several new ones under development. Once hair loss acceleration is controlled, evaluation for surgical hair replacement can begin.

Remember to consult a medical hair loss expert and he or another physican may also be able to evaluate the patient for micro-graft surgical hair restoration.

Peter Goldman, MD (retired)
Los Angeles Dermatologic Surgeon
5.0 out of 5 stars 1 review

This may not be a clearcut case of female pattern baldness

Although I am not a dermatologist, I am a board-certified hair transplant surgeon meaning that I understand basic pathologies when it comes to hair loss that may preclude the success a hair transplant procedure.  Since you and your mother appear by the photo to be African-American, there are certain conditions that may be more prevalent in AAs than in Whites and that may or may not be helped with a transplant procedure.  Typically, traction loss that is due to tight braiding occurs more along the hairline and the periphery which appears less to be the case here.  This is a condition that responds well to hair transplantation.  When it is more toward the central scalp and into the crown, a common condition known as CCCA central centrifugal cicatricial alopecia may be the culprit which is NOT a surgically amenable condition, at least not when the disease is active.  This may or may not be what your mother is experiencing.  My suggestion is to find an excellent dermatologist for evaluation and possible biopsy to rule this out and possibly to help with any treatments of the condition.  Hope that helps.


Dr. Sam Lam
Dallas, Texas

Sam Lam, MD, FACS
Dallas Facial Plastic Surgeon
4.6 out of 5 stars 57 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.