Hair Transplant: An Overview of the Surgical Procedure

Hair loss may occur due to aging, hormonal imbalances, or various health conditions. Hair transplantation offers the opportunity for hair restoration in areas of balding for male and female patients burdened by hair loss.

While hair transplants have been performed in the United States since the 1950’s, new and improved methods and the advent of social media have made hair transplantation a more common procedure than in years past. Currently, 13 percent of Americans have considered having a hair transplant or would consider it in the future.

With the advent of new technologies, hair transplants have become more successful, with a more natural appearance and better treatment outcomes.

An Overview of Hair Transplants

While the majority of hair transplant procedures are male, both men and women alike experience hair loss that may be treated by a hair transplant procedure.

Transplants for Male Pattern Baldness

Transplants for male pattern baldness are a very common procedure in the area of hair transplantation. This is not terribly surprising, given that over 60% of men will incur some degree of noticeable hair loss by age 35. Male pattern baldness accounts for 95 percent of hair loss in men, and is, for many men, not simply a degree of cosmetic concern.

For many men, the condition that may affect self-esteem, mood, and social behavior, and contribute to anxiety or depression. Hair transplantation can restore hair’s natural fullness and diminish the appearance of hair loss in men experiencing male pattern baldness.

Eyebrow transplant

Although most hair transplant procedures are performed on the scalp, eyebrow transplant or eyebrow restoration is also performed in both men and women. Eyebrow transplantation is typically performed by extracting units of 1-4 hair follicles from the scalp, then dividing the follicular unit into individual follicles for transplantation in the eyebrow, following the brow’s natural line for a natural looking appearance.

Frontal Hairline Reconstruction

While male pattern baldness may occur in various areas on the scalp, frontal hair loss refers to hair loss at the front of the head, with hair loss gradually increasing as the balding area works its way towards the back of the head. Hair transplantation can resolve hair loss in this area, restoring the natural hairline.

Different hair transplant surgery techniques

There are multiple techniques used in hair transplantation surgeries. These techniques include strip harvesting, follicular unit extraction, and, rarely, hair plug procedures. Each individual physician may use their own individual techniques in hair transplantation. However, these are the most common techniques currently in use for their reliability and efficacy.

Strip Harvesting

Strip harvesting is a term that refers to a technique used in hair transplantation in which groups of 1-4 hair follicles (also known as follicular units) are harvested and transplanted during a procedure. For this reason, strip harvesting is also commonly referred to as Follicular Unit Transplant or FUT.

While we typically think of individual hairs as the physical appearance of a solitary strand of hair, follicular units include hair strands as well as sebaceous (oil) glands, nerve cells, and a small amount of muscle tissue and fine vellus hair. In harvesting larger follicular units, surgeons are able to transplant a larger amount of hair during a cosmetic procedure.

Strip harvesting typically produces a linear scar that is hidden by the hair above the scar line. Typically, these scars are not readily visible unless one was to carefully inspect the scalp and move hair around the scarred area.

Because a larger amount of tissue is extracted in strip harvesting, some surgeons believe that procedures performed using the strip harvest method tend to be more viable than other extraction or harvesting techniques. However, preferences surrounding harvesting techniques will largely vary from surgeon to surgeon.

Follicular Unit Extraction (FUE)

Hair Transplant

Follicular unit extraction (FUE) may also be referred to as follicular transfer. Alongside strip harvesting, follicular unit extraction is one of the two most common methods to obtain hair follicles from a donor site for transplantation elsewhere on the body.

Follicular unit extraction offers an alternative to patients who worry about the linear scarring associated with strip harvesting. While these scars are typically well concealed with hair above the scar line, not all patients wish to wear their hair in a longer style. For patients who wish to wear their hair in a shorter style, follicular unit extraction offers an alternative with minimal scarring by transplanting individual follicular units using a small punch, resulting only in small dot-like scars not readily visible to the naked eye.

While there are advocates for both techniques, proponents of the strip harvesting method argue that the rate of survival for follicular units obtained through the strip harvesting process is higher than that of units obtained through follicular unit extraction.

However, proponents for the follicular unit extraction technique argue that the minimal recovery time, reduction in postoperative discomfort, and reduced visibility of scars make the follicular unit extraction technique superior to that of the strip harvesting method.

Hair plugs vs Hair Transplant

While the terms “hair plugs” and “hair transplants” are commonly considered to mean two different things, hair plugs are in themselves a type of hair transplant. However, hair plus are not a commonly performed transplant procedure in today’s surgical climate, as the hair plug procedure has since been replaced with the more effective strip harvesting and follicular unit extraction techniques.

Prior to the advent of strip harvesting and follicular unit extraction, hair plug procedures were the most common form of hair transplantation procedure. Hair plug procedures are performed by removing small, circular “punches” of hair and tissue from the donor site (typically on the back of the head). A small, 3-4 mm punch typically removes around 20 or so hairs, which are then transplanted to the balding area by creating an additional “punch” in the balding area and inserting the transplanted hair and tissue into the new punch.

Hair plug procedures have largely been replaced due to the large amount of tissue removal, subsequent scarring, and the advent of more natural extraction and transplantation techniques in the strip harvesting and follicular unit extraction procedures, which result in less scarring and a more natural appearance.

What Kind of Results Can You Expect With a Hair Transplant?

It’s important to note that the results of hair transplantation are not immediate, as the transplanted hair will shed after transplantation, only to be replaced by the new hair in the months following. Within 6-9 months after surgery, patients should see around a 60% increase in hair growth at the transplant site, although individual results may vary.

Hair Transplant Before And After Results

While individual hair transplantation results may vary, hair transplantation performed by a skilled surgeon should result in minimal scarring, minimal tissue death upon extraction from the donor site, and a natural looking appearance.

Taking Care of Your Scalp for Best Post-Op Results

Following a hair transplant procedure, it’s important that you follow your doctor’s individual set of post-op instructions. Not doing so may result in the failure of the transplant procedure, so be sure that you understand the care protocol before leaving his or her office.

Expect the area to be sore, painful, tender, and bandaged in the days following your procedure. However, many surgeons prescribe anti-inflammatory drugs and/or pain medications to help handle post-op discomfort. Typically, patients are advised to be incredibly careful in handling the donor or transplant site, as not to dislodge the grafts in the delicate post-op period.

What To Expect When Getting a Hair Transplant

Given the great degree of variability in surgical procedures, techniques, and protocol that may occur between individual surgeons and medical practices, always check with your doctor prior to surgery to prepare yourself before your procedure. However, there are generalities that may be applied to the transplantation process.

How Long Does the Surgery Take?

The time required during surgical transplantation procedures will vary depending upon the amount of hair being transplanted, extraction methods, and the individual physician. Given the high level of skill required for successful hair transplantation, fast procedures are not always better.

An average hair transplant procedure takes between 5-6 hours of surgical time, although this may be shorter or longer depending on the factors mentioned above. Always discuss time spent in procedure with your surgeon prior to your surgical date.

What Does The Average Hair Transplant Cost?

As hair transplantation procedures are cosmetic and not of medical necessity, they are rarely covered by medical insurance. Hair transplants vary in cost depending upon the degree of transplantation, individual surgeons, and geographic area. Hair transplants typically cost between $4,000-$15,000 depending upon the aforementioned factors.

How Long Will it Take to Heal?

Healing time varies. Immediately following the procedure, expect that your scalp will likely feel sore, tender, or otherwise painful.

For this reason, many surgeons prescribe pain medications for dealing with post-surgical discomfort. Patients typically wear bandages around the donor site and transplant areas for a number of days after surgery. Many patients are also prescribed anti-inflammatory drugs and antibiotics for a short time following their procedure. Most patients are able to return to work within five days post surgery.

Depending upon the amount of hair transplanted, individual physiology, and extraction methods, the transplanted hair will begin the shedding process within two to three weeks post surgery, with new hair growth in the transplanted area beginning around three months after surgery. At around the six to nine-month mark, the average patient will achieve new hair growth of around 60 percent at the transplant site.

Will There Be a Hair Transplant Scar?

All surgical procedures bring the risk for scarring. However, the degree of scarring depends largely on individual physiology, extraction techniques, and the amount of hair being transplanted.

The now outdated hair plug procedure typically results in the highest degree of scarring, although this procedure is rarely used today. Strip harvesting produces linear scars that are typically well hidden by the hair above the scar line. Follicular unit extraction typically yields the lowest amount of scarring, making it a good choice for patients who choose to wear their hair in shorter styles.

If you are concerned amount scarring, talk to your surgeon about which procedure is best for you, and discuss the manner in which you desire to wear your hair post-transplant, as this will play a factor in determining the best extraction technique for your individual case.

What The Hair Transplant Reviews Recommend

Before choosing a surgeon, consider browsing online review sites to read the experiences of other patients who have undergone both successful and unsuccessful transplant procedures. Individual surgical experience and precision play a large role in the success of any transplant procedure.

Find An Experienced Hair Restoration Surgeon

Surgical experience plays a highly important role in the success of hair transplantation. As is the case for any surgery, hair transplantation comes with risks of scarring or transplant failure. A skilled surgeon with an established practice, before and after photos, and positive patient reviews is generally a good sign.

Use Topical Minoxidil or Other Treatment to Halt Further Hair Loss

Many patients and physicians recommend using Minoxidil (Rogaine) after transplant to minimize hair loss in areas that have not undergone a transplant and to increase the rate of hair growth at the transplant site. However, it’s important to consult your surgeon before using any treatments, as to not upset hair grafts in the postoperative period.

Don’t Expect Instant Results

Many patients reflect the importance of patients in the postoperative period. While it’s natural to desire instant results following a transplant procedure, hair regrowth is not largely noticeable until six to nine months post-transplant, when hair growth typically reaches an increase of 60%.

Should I Get a Hair Transplant?

Hair transplants are expensive and rarely covered by insurance. However, the current surgical procedures used in hair transplants are highly effective and minimize scarring.

Given the large emotional toll that hair loss may cause, hair transplant procedures can be incredibly beneficial to men and women suffering from hair loss, and typically do not produce largely noticeable scars, depending upon extraction technique. It’s important to not expect immediate results in the postoperative period, as hair growth peas six to nine months after surgery.

If you are interested in hair transplantation, seek a surgical consult with a hair transplant specialist to discuss your individual case and determine which surgical techniques are right for your degree of hair loss, desired hairstyle, and individual condition.