By Basto, Fernando MD,
(Brazil)

ESHRS® Journal. Volume 8 - Number 1. Winter 2008. Page 12 – 13.

Female baldness creates disorders in medical, aesthetic and mainly in psychological aspects. Female baldness is more serious when compared with male one. Women look older than they really are, so they are considered attractive physically and socially, and this interferes negatively in their personal and professional lives.

Lately, because of the aesthetic demands and more information about baldness surgery the number of female patients has increased to solve the baldness problems. Because of this trend we have noticed a larger variety in cases of female baldness that are not included in the current classifications. The proposal of this paper is to present a simple and complete classification, making possible to diagnosis all types of female baldness.

According to scientific reports, 4 types of classification are found:

THE CLASSIC LUDWIG CLASSIFICATION
It is the most used and best known; it is simple and divided in 3 degrees only.

UP TO DATE LUDWIG CLASSIFICATION
This is an evolution because it presents different degrees, but it still does not include all types of female baldness found in daily experience.

HAMILTON'S CLASSIFICATION
This classifies in 9 degrees; it is very complex and also it does not include all types of female baldness.

OLSEN'S CLASSIFICATION
Simple and practical classification in 3 degrees.

	DEGREE Ia Thinning hair. This is the most common form found in a female.
	DEGREE Ib Increase thinning in the upper area of the head, however, in this degree show to the skin glabra of the scalp.
	DEGREE Ic Severe thinning, characterized by a diffuse loss of hair, involving the full extension of the scalp.
	DEGREE II Mixed - Frontal alopecia and parietal thinning. It reaches the frontal area with the skin glabra and it is associated with the hair thinning of the top of the head in any degree.
	DEGREE III Temporal alopecia. This type of baldness can only reach a temporal area or both sides, similar to baldness entrances in males.

BASTO'S CLASSIFICATION
We propose a new wide and more didactic classification including all cases of female baldness found in our daily experience. It is divided into 9 degrees, it varies from a simple hair thinning to a female front-parietal-occipital baldness, as illustrated in the pictures below.

	DEGREE IVa Frontal alopecia. Frontal area hair loss, widening of the forehead from the glabella, the feminine face becomes austere.
	DEGREE IVb Front-temporal alopecia. This type of baldness affects all the anterior head area. Compromising frontal and temporal regions.
	DEGREE V Parietal alopecia. This is a advanced alopecia form, with the appearance of the skin glabra of the scalp in the upper area of the head reaching the level of the parietal bones, preserving some hair in the frontal area.
	DEGREE VI Front-parietal alopecia. This is the most severe alopecia form. The hair loss reaches all the top of the head, compromising the frontal and parietal areas. It rarely reaches the upper occipital area (vertex).

CONCLUSION
The proposal of this study is to present a simple and didactic classification, which will facilitate clinical diagnosis and prioritize a better and more objective denomination before surgery for all types of female baldness in our daily experience.

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