Hair loss in men, women and transgender

Men    Hereditary reasons are often behind a receding hairline, thinner hair or hair loss as people get older, with men being affected more than women. This leads to them not just feeling older than they actually are, but also looking that way. Restoring hair as if it were natural is therefore one of most important and frequent applications of hair therapy. Restoring a person's natural hairline always has a positive effect on his appearance. Key importance is attached to the region around the temples, for a hair transplant here is a great boost to a natural appearance, taking into account the harmonious and aesthetic principles governing the face. A further area easily seen is the middle of the head. Hair loss here does not just have an effect on one's overall appearance, but also changes one's face. A hair transplant in this area therefore has a very positive effect on one's whole appearance.

Women  Whether due to illness or experienced from birth onwards, hair loss is often a decisive experience and great problem for women. In contrast to men, the pattern and causes of women's hair loss differ, entailing different forms of treatment. In most cases hair loss in women is diffuse, often greatly reducing the donor area. Convincing results have been achieved in women through supporting medication. The majority of female patients react well to a combination of medication and surgery.

Transgender  The natural hairline of a man differs from that of a woman. Male transsexuals and women after hormonal transition and sex reassignment surgery often want their hairline changed, making it a lot more womanly. A hair transplant does not just lead to a harmonious appearance, it also has a positive effect on one's own body feeling. Attention should be paid to the hormonal reassignment treatment being completed before any hair transplantation takes place, as hormonal ups and downs can cause transplanted hair to be rejected, with hair loss making further inroads. Generally speaking, an in-depth and competent consultation is to be recommended. 

Reconstructive hair transplantation

The treatment of patients who have been through prior treatment

A hair transplant is a highly complex and demanding form of surgery. Unfortunately not all treatment is performed using state-of-the-art techniques and technology. There are many possible reasons for this:

  • Hair transplants are time-consuming operations requiring a lot of effort and work. This in turn entails a great amount of know-how, years of experience, and intuition.
  • Hair transplantation results often do not meet up to a patient's expectations, or a patient is not fully satisfied with the results. For instance, visible scars can remain where donor hairs have been removed, or the hairline might not look natural. These are just two consequences patients may be confronted with.
The choice of the right hair surgeon is of crucial importance

A hair surgeon needs to possess a wide range of characteristics and abilities. These include utmost care, the right professional qualifications and knowledge of all hair restoration surgery techniques and methods, along with the right sense of the principles of aesthetics and harmony. Correcting or repairing a hair transplant that has gone wrong is therefore a treatment placing extremely high demands on the physician. It is not just a case of correcting the bad results and consequences (for instance, scars or an unnatural appearance) of a previous transplant, but also of achieving a result looking completely natural.

The team supporting the physician is also a crucial factor, for a hair surgeon's employees need not just to fully master the techniques used and have years of experience, but also need to be able to work for a period of 8 - 10 hours - the duration of a hair transplant - in full concentration and without making any mistakes. A well-established surgery team working flexibly as a team represents a key success factor for any hair transplant.
Another factor is membership of an internationally recognized association such as IAHRS; Members of this association are always experts in the field of corrective hair transplantation.
Dr. Feriduni has already successfully performed hundreds of corrective hair transplants in his clinic and therefore has the necessary experience and know-how. This is confirmed by the fact that some 20% of all hair transplants involve correcting previous transplants.

Reasons for correcting a previous hair transplant

The reasons for a previous hair transplant needing to be corrected are mostly associated with the usage of out-of-date methods, the wrong advice and/or treatment or a lack of knowledge about the aesthetic and harmonious design of hairlines and how to achieve a natural look. The most common reasons why patients want to have a previous hair transplant corrected involve an unnatural appearance or too much scarring. Further reasons include: The hairline being too low or too high, making it look unnatural; The exit angle and the arrangement of the grafts having been chosen wrongly or badly; The appearance of the transplanted grafts, arranged in such a way that they look like cobblestones or a chess-board, heavily scarred tissue or a bristle-like appearance reminiscent of a cleaning brush.

Remedial options available to reconstructive hair surgery

With the hairline forming part of a face's frame, achieving a natural hairline is an art needing to be mastered by any good hair surgeon. An unnatural or unaesthetic hairline can be greatly improved by an expertly performed FU transplant. This will optimally design the hairline, taking into account natural hair density and achieving optimal harmony through expert fine-tuning. The possibilities open to corrective surgery are however not just dependent on the competence and know-how of the surgeon, but also on the availability of appropriate donor hair. The corrective methods used to repair an unnatural hairline include completely removing any disturbing grafts, removing individual undesired grafts or placing follicular units between the mini-grafts. A hairline that is too low looks unnatural and unduly "wastes" donor hair. This is why grafts below the natural hairline are completely removed, restoring the hairline's natural look. The grafts removed can be recycled, extracting from them individual FUs and using these elsewhere. The complete removal of grafts can also be necessary when the grafts have resulted in undue scarring, when hair grows out of them in the wrong direction, or when their arrangement looks unnatural. In some cases it is possible to hide or correct such deficiencies by implanting individual follicular units, though in many cases the grafts need to be completely removed. Grafts implanted in the right direction and aesthetically arranged can still look unnatural from an overall perspective. Such a so-called ‘pluggy look’ can be alleviated by using FUE to remove individual follicular units from the affected area. In cases where larger areas are affected by unnatural-looking grafts and where more is involved than just removing individual hairs, the traditional punch technique can be used to remove the hair.

Correcting hair transplants performed using the strip or flap technique

The flap technique was developed as an alternative to the then usual punch graft technique. In the strip or flap technique, a strip of the scalp is removed and transplanted to the bald patch on the head. Negative results of a hair transplant performed using the strip or flap technique are visible scars, unaesthetic or unnatural hairlines, or unnaturally high hair density. Another consequence is that the transplanted hair often grows in the wrong direction, other than desired. Though not immediately, the flap technique often leads over time to an unnatural appearance, as the hairs belonging to the transplanted strip often greatly contrast with the surrounding hair which falls out due to natural ageing. This in turn leads to baldness appearing behind the transplanted strips, making the scalp look very unnatural. Correcting hair transplants performed using the flap technique is a difficult process generally requiring a combination of different corrective methods to achieve an aesthetically pleasing result. These include follicular unit transplantation (FUT) and follicular unit extraction (FUE), as well as various strip and scalp reduction techniques: Unaesthetic scars can often be corrected by scar correction, possible in conjunction with a micro-surgical hair transplant. To achieve a natural hairline, the flap is partially removed, possibly with follicles being extracted and used elsewhere. In cases where the hairline looks unnatural, the artificial look can be somewhat alleviated through an FUE operation. Bald patches on the scalp can be removed to create an aesthetic appearance. Another way of achieving a more natural and harmonious appearance is to make changes to the transplanted strip. This can only be done to a certain extent. When sufficient donor hair is available, the hairline and hair density can be corrected via a simple FUT.

Methods for correcting existing scars

Unaesthetic and/or unduly wide scars can be corrected, though there are certain factors needing to be taken into consideration: the width of the scar; the position of the scar in relation to the donor area; scalp elasticity in the area surrounding the affected patch; FU density in the area immediately surrounding the scar.

Trichophytic Closure

Unaesthetic and unpleasant scars in the donor area are often the result of the use of outdated techniques or even the wrong ones. A further problem involves the wound not closing properly, meaning that the scar gets overstretched. One of the main reasons for this is that no account is taken of the different levels of scalp elasticity in the different areas. Where there is sufficient elasticity in the area of the scar, the existing scar can be removed. A combination of scar removal and the concurrent use of trichophytic closure is often appropriate here. In cases where the scalp lacks elasticity, we recommend massaging the scalp daily for several months prior to the corrective hair transplant. Such stretching exercises are a proven help, directly increasing scalp elasticity and having a positive influence on the treatment.

Follicular Unit Extraction (FUE): transplanting individual FUs

FUE is an option used successfully to make scars practically invisible. The method involves extracting individual hair roots, the so-called FUs, and implanting them in the scarred area. By doing so, the affected area - including the scar - will later be covered by own hair.

Combinations of different techniques

Not all scars are fully suitable for an FUE. In certain cases a renewed scar correction with a subsequent FUE, generally within 6 - 8 months, is the method of choice. Whether FUE alone is appropriate for a hair transplant is to a certain extent dependent on the size of the scar, the consistency of the scalp and the hair, and also on how long the patient wants his or her hair to be. Hair normally grows very well on scarred tissue.


In cases where scars in the donor area are too pronounced, scar correction can be very difficult or even impossible. A medical tattoo matching the patient's hair colour is in certain cases an appropriate long-term solution for reducing scar visibility. Make-up can also help, though needing to be regularly renewed. Summing up, there are five different corrective methods:

- The FUE/FUT method 
- Scar correction 
- Scar reduction 
- Lasering 
- Medical tattoos

All five methods are complementary and can be combined. It should however be borne in mind that in certain cases several different forms of treatment will need to be performed concurrently. Any decision on which method(s) to use needs to be taken on a patient-by-patient basis. An in-depth personal consultation is an absolute “must” and always the first and most important step in correcting previous hair restoration surgery.


Reconstruction after trauma or radiotherapy

In the aftermath of an accident, radiotherapy or an operation

In the field of reconstructive hair surgery, major progress has been made over the last 15 years, with hair transplants looking increasingly natural. Hairless areas, the result of an accident, an operation, a burn (for example radiation damage caused by a tumour radiotherapy), or congenital asymmetry (bald patches), can be restored by hair transplantation using either the FUE or the FUT method. It makes no difference what type of hair is involved here - head hair, eyebrows, eyelashes, beards or pubic hair. The important thing about any such treatment involves not just making the patient look better but also making him feel better.

A precise treatment recommendation is dependent on the structure of the skin area affected, as transplanted hair does not grow on scarred tissue as well as elsewhere on the body. Where treatment is performed by an expert, it can be generally said that 60% of transplanted hairs have a good chance of long-term survival, though the nature of the scarring needs also to be taken into account.

Eyelash transplantation

Full and strong eyelashes not only emphasise the eyes, they also contribute to a full complexion. In cases where one's complexion is seen as missing something, this can be the cause of discontent, especially in women.
Generally speaking, anyone wanting stronger or longer eyelashes can undergo an eyelash transplant, independent of one's gender, age, type of skin or colour of hair.

Reconstructive eyelash transplants
In the aftermath of an accident, an operation, a burn (for example the result of radiotherapy), people often lose their eyelashes. An eyelash transplant is then often the only way of regaining one's own eyelashes. There are however certain exceptions where eyelash transplants are not possible:
- Certain hair diseases, such as alopecia areata 
- Obsessive plucking of eyelashes, as seen in patients suffering from trichotillomania 
- A tendency to excessive scar formation, which can negatively affect the final result, with fewer hairs actually rooting 
- In most cases, reconstruction of the lower eyelashes 

- Congenital thin and short eyelashes
- Due to a physical trauma to the face (accident, burns, etc.)
- Trough Traction Alopecia caused by the long-term use of false eyelashes
- As a result of a medical condition
- From medical treatments for cancer (chemotherapy or radiotherapy)
- Trough Trichotillomania
- From aesthetic procedures such as eyelid corrections

Beard transplantation

A full beard is often seen as being handsome, but even more as a factor emphasising manliness. Unfortunately there are many men unable to grow the sort of beard they would like. In particular due to aesthetic defects in a man's natural beard growth or through scarring, for example as a result of an accident or a cleft palate, beard density is not always as good as one might want. In such cases, a hair transplant is a way of obtaining that full beard. This also applies to transsexuals wanting natural beard growth after the reassignment operation. 

Eyebrow transplantation

Alongside the eyes, the eyebrows play a major role in shaping one's complexion. Like the hair on top of our heads, eyebrow hairs attract attention. They underline proportions, though not many people have those perfect sweeping eyebrows with the right hair density. Where eyebrows are too bushy or degenerating, they are plucked into shape.
Plucking eyebrows, perhaps excessively, year in, year out often ultimately leads to a person completely losing his or her eyebrows. Such a loss of one's eyebrows can easily and efficiently be rectified via hair transplantation.

A further treatment option is a reconstructive eyebrow transplant: This can be used as a way of regaining one's own eyebrows when they no longer exist or have become very thin, possibly due to illness, hereditary causes, an accident or an operation. 

Pubic hair transplantation

There are quite a few people who see it as important to have dense pubic hair. This can be related to cultural influences or simply to the fact that genetic factors, disease, an accident or radiotherapy have led to little or no hair remaining in the pubic area. A pubic hair transplant can remedy such a situation, helping a person to feel much better.