Hair Transplant Surgery
Hair transplant surgery is used to treat certain types of hair loss. (1) It involves taking hair from dense growth areas of the scalp and transferring them to thinning or bald areas. Once transferred, the follicles can begin to regrow hair naturally, correcting hair loss.
You may be a good candidate if you:
- Are an adult with an established pattern of hair loss
- Have a stable supply of donor hair on the back or sides of the head
- Realistic expectations of surgery results (1)
You may not be a good candidate if:
- Your cause of hair loss is due to a known medical condition (i.e. alopecia, trichotillomania, etc.)
- You have a serious medical problem making you unfit for surgery
- Younger patients typically without an established pattern of hair loss (1)
There are many different patterns of baldness. The Norwood scale is used to classify baldness in males, and the Ludwig scale is used for females . Identifying your unique pattern can help your provider select the right type of treatment for you.
Historically, there have been a wide range of hair transplant treatments available, including scalp expansion, flaps, and mini grafts. Currently, the most effective hair transplantation methods are limited to two primary techniques: follicular unit hair transplantation (FUT) and follicular unit extraction (FUE). (3)
The difference between FUT and FUE is based on the manner by which the hair follicle units are extracted: (5)
- Follicular Unit Transplantation (FUT): sometimes called a “strip” procedure. In this procedure, the surgeon removes narrow strip of hair-bearing skin from the patient – usually from the back of the head. Then individual follicular (hair growth) units are removed from the donor skin using high powered microscopes, and those follicular units — or “grafts” — are transplanted individually into tiny incisions in the areas of hair loss on the scalp. Each follicular unit graft consists of 1-4 hairs. The defect created by removing the donor skin is closed with stitches or staples and then covered up with the surrounding hair.
- Follicular Unit Excision (FUE): in this procedure, the donor area of scalp is shaved, and then small (0.8-1 mm) circular (“punch”) tools are used to carefully remove individual follicular units from the donor area. The tiny holes created by graft removal are left open to heal on their own, temporarily leaving tiny dot scars in the donor area. The harvested grafts are then implanted into the recipient region just as they are in an FUT procedure.
The following are some comparisons between FUT and FUE surgery. (6)
|Requires scalpel excision of strip, and sutures/staples||No scalpel, no sutures|
|Longer healing time, requires suture removal||Wounds heal in a few days|
|More postoperative pain||Less post-op pain|
|Linear scar from strip, permanent, may be covered by hair||Numerous tiny dot scars, usually become nearly invisible|
|Hair may have to be kept longer to cover strip scar||Can wear hair short|
|Surgeon must harvest hairs from the strip||Surgeon can target specific hair types: size, diameter, or pigmentation|
|Strip must come from the scalp||Surgeon can harvest hair from any hair-bearing skin on the body|
|Greater yield of follicular units; good for people requiring a larger number of transplants||Good for people who need relatively small transplants|
|No need to shave entire scalp; hair can be kept long enough to cover scar right away after the procedure||Scalp must be shaved|
|Usually quicker (4-12 hours)||Takes longer (10 hours or more)|
|Less expensive||More costly|
|Both are relatively painless, require only a local anesthetic|
Some potential risks and complications this type of procedure include:(5)
- Small cysts in the donor location
- Scarring in the donor area
- Numbness in donor site and surrounding the transplanted hair
- Temporary hair loss
To ensure the best possible outcome, it is recommended that you choose a surgeon who is experienced in performing these procedures.
While hair transplantation is considered less invasive than many other forms of cosmetic surgery, the recovery process should be taken seriously.
If the following steps are not taken, complications may arise, including failed survival of the transplanted hair. However, most patients find that the recovery process goes smoothly and without complications. Recovery time for FUE is shorter than FUT because it is less invasive.
After surgery, most patients are able to return home the same day. You should arrange for someone else to drive you home from the surgical facility in case the anesthesia has not fully worn off.
Spend the first day or two resting at home while concentrating on following the post-op instructions.
The length of your recovery will depend on the specific hair transplantation technique, but most patients are back to work and other daily activities within a week.
During the first few days, you can expect to feel some soreness or tenderness in the donor and transplant areas. Any discomfort can usually be managed by over-the-counter pain medications.
Mild swelling or bruising can also be expected, although in most cases this is camouflaged by the presence of hair.
You may experience itching in the donor or transplant areas. Your doctor may provide a topical ointment to reduce itching.
Temporary numbness or tingling may occur as a result of cutting nerve endings in the skin.
Tips to help recovery go smoothly:
- Avoid tugging or pulling on the hair as this may irritate the scalp as it heals. The hair follicles are extremely sensitive when initially transplanted and may be pulled out easily. If the graft is lost, there will be some bleeding at the site of the lost graft. If bleeding occurs, place firm pressure on the area using a clean towel for at least 20 minutes.
- If scabs form, do not pick at them as this can cause permanent damage to the hair follicles. Cysts, pimples or ingrown hairs may also appear in the transplantation area. These can form up to a month after surgery as new hairs break through the skin. These tend to resolve on their own in a few days and do not require treatment.
- Sleep with your head and neck elevated and avoid activities that may disrupt the healing of the hair follicles. This includes avoiding brushing or styling your hair during this time. Do not dye your hair for at least 1 month, and do not use Rogaine or other hair regrowth creams for at least 1 week as they may cause severe irritation during this time. Your doctor may also ask you to avoid washing your hair for up to 2 weeks.
- Avoid smoking during recovery, as this can contribute to poor wound healing and may increase the chance of infection or scarring.
- Avoid direct sunlight. Wear a hat to protect your scalp from sunlight for at least 3 months.
For the first few weeks, you can expect to see some of the transplanted hair begin to shed. It is not uncommon to lose a few grafts after the procedure, and the number of grafts transplanted has been calculated to take this into account.
Most shed hair during this stage does not mean that the follicle has failed to take root in its transplanted location.
Over time, the grafts will root more securely in place. Those in place ten days after surgery can no longer be dislodged.
Below is a general time frame, although individual results will vary. (5, 6, 7)
|Time after surgery||Expectations|
|Day 2||Can begin gentle shampooing (with surgeon’s instructions)|
|First week||Sleep with head propped up on a pillow, and avoid pull-over shirts to avoid trauma to the transplants|
|First 2 weeks||“Shock loss:” all transplanted hair falls out due to the trauma of the surgery. It grows back as soon as the follicles enter the “(see below)|
|Day 10||Most recipient site scabbing resolved|
|Day 14||Sutures/staples out (for FUT)|
|First 3 months||Grafts enter the “telogen” phase of growth: the “resting” phase of the hair’s growth cycle, with no new growth occurring|
|After three months||Grafts enter the “anagen” phase of growth: the active growth phase of the hair follicle. New hair growth occurs, and continues for 2-6 years before some hairs enter a rest phase again|
|8-12 months||Full growth and transplant results cannot be fully assessed until this point|
The cost of hair transplant procedures depends on the specifics of the patient’s hair loss. According to the American Society of Plastic Surgeons, costs can range from $6,000 to $15,000. (4)
Keep in mind additional fees that you may incur, like the cost of anesthesia or the surgical facility; these can vary depending on the specifics of each patient’s case. The best way to get an accurate estimate of the cost is to set up a consultation with a hair transplant specialist who can evaluate your particular situation.
- Konior, J., Simmons., C. Patient selection, candidacy, and treatment planning for hair restoration surgery. Facial Plastic Surgery Clinics of North America. 2013 Oct 01; 3: 343-350.
- Gupta, M., Mysore, V. Classification of patterned hair loss: A review. Journal of Cutaneous and Aesthetic Surgery. 2016 Jan-Mar; 9(1): 3-12.
- Josephetis, D., Shapiro, R. FUT vs. FUE graft survival: A side-by-side study of 3 patients undergoing a routine 2,000+ graft hair transplantation. Hair Transplant Forum International. 2018 Sep; 28(5): 179-182.
- Chaffoo, R. What causes hair loss and what hair restoration procedures are available? plasticsurgery.org. https://www.plasticsurgery.org/news/blog/what-causes-hair-loss-and-what-hair-restoration-procedures-are-available. Published May 15, 2018. Accessed October 17, 2020.
- Vogel, J.E., Jimenez, F., Cole, J., Keene, S.A., Harris, J.A., Barrera, A., et al. (2013). Hair restoration surgery: The state of the art. Aesthetic Surgery Journal, 33(1), 128–151. Retrieved from https://academic.oup.com/asj/article/33/1/128/209891
- Zito, P.M., & Raggio, B.S. (2020). Hair transplantation. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547740/
- Shahmalak, A. (2017). A guide to hair transplantation. The PMFA Journal, 4(5). Retrieved from https://www.thepmfajournal.com/features/post/a-guide-to-hair-transplantation