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If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Losing your hair can be devastating. It affects your self-esteem, confidence, and day-to-day life. The good news is that if you’re looking for a solution, there are many options. Hair plugs, however, might not be the best one.
Hair plugs are a type of hair transplant technique used to treat androgenic alopecia, more commonly known as male or female pattern baldness. But hair plugs have largely fallen out of favor because of their unnatural appearance.
The procedure works by taking round patches of skin with hair follicles from the back of the head and transplanting them into the scalp in other areas to create a fuller hairline at the front (Gupta, 2015). Each plug is roughly 4 mm, which may sound small, but actually holds multiple hair follicles. Since this isn’t how hair grows naturally, after the areas where hair is thinning is filled in with these clusters, the end result looked something like the hair on Barbie dolls.
Typically, hair plugs are permanent as long as the transferred hairs aren’t affected by androgenic alopecia. This common condition is hereditary and causes hair follicles to shrink over time due to high levels of a type of testosterone called DHT. Eventually, the hair becomes too thin and short to make it past the skin’s surface. If hairs affected by androgenetic alopecia were transplanted via hair plug, those too end up thinning.
If you’ve had hair plugs and don’t like the look, it’s possible to make your hairline look more natural using newer hair transplantation methods, which we’ll get into below (Vogel, 2008).
Treatments start at $20/month
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Hair plugs vs. hair transplants: what’s the difference?
Medical experts have since developed different hair transplantation methods that mimic the way hair naturally grows. More commonly used today, follicular unit transplantation (FUT) and follicular unit extraction (FUE) are techniques that move individual hair follicles from donor sites at the back of the head to whichever spots are bald or thinning. FUTs use thin strips cut from the back of your head, while FUEs use a tool to punch individual hair follicles out of the skin (Zito, 2020).
If that sounds like a lot of work, that’s because it is. Medical professionals performing a hair transplantation surgery have to carefully move each follicle to its new home—a process that can take up to eight hours. But all that time and effort could have a big payoff. When healthy hair follicles (unaffected by androgenetic alopecia) are moved, a hair transplant should last a lifetime (Gupta, 2015).
How long does it take to see results after a hair transplant?
You shouldn’t expect to see a perfect new hairline right away.
Donor hairs are trimmed to a very short length so the surgeon can easily access and extract hair follicles. It can take anywhere from six to 12 months for the hair grafts to regrow and mature to their final appearance (Zito, 2020). It’s also common for transplanted hair to fall out before it regrows, a process called donor shock loss (Kerure, 2018).
FUE is used more often than FUT because it has a faster healing time, causes less pain after surgery, and doesn’t leave behind any large scars (Zito, 2020).
However, FUTs have advantages, too. This option may be better for people who need a larger number of hairs transplanted in a shorter time. These procedures are performed under local anesthesia, which means your scalp is numbed but you’re awake the whole time. While you may feel some pressure or discomfort, you shouldn’t feel pain. Hair transplants also have a very low rate of complications (Zito, 2020).
Other options for regrowing your hair
If you’re not ready to consider a hair transplant, there are other treatment options.
Some types of hair loss, like androgenic alopecia, are reversible. Medications like finasteride (brand name Propecia; see Important Safety Information) and minoxidil (brand name Rogaine) help this process along by promoting hair growth (Adil, 2017).
Can taking vitamin D help with hair loss?
Finasteride is a prescription medication taken as pill you swallow daily. It works by stopping your body from turning testosterone into DHT, the hormone that drives androgenic alopecia. Common side effects of finasteride are low libido, erectile dysfunction, and swelling of breast tissue in men (Zito, 2020).
Women who haven’t gone through menopause shouldn’t take oral finasteride since it can cause birth defects if you become pregnant while taking it, but a healthcare provider may allow you to take it if you are on a reliable form of birth control. For postmenopausal women who want thicker hair, a combination of topical finasteride and minoxidil has been found to be a promising treatment (Ho, 2020; Rossi, 2020).
Minoxidil is available over-the-counter and comes in two forms: liquid and foam. Both are available in 2% and 5% strengths. Higher strengths are more effective, but cause more side effects, such as application site itching and irritation (Ho, 2020).
The U.S. Food and Drug Administration (FDA) has approved the 2% topical solution and the 5% topical foam for use in women, however, the 5% topical solution is only approved for use in men. This is because women are more prone than men to experience excessive hair growth using 5% minoxidil, which is why 2% is generally recommended (Suchonwanit, 2019). Some forms need to be applied twice a day, others only once a day.
It’s important to keep in mind that your hair loss may get worse before it gets better after starting treatment with minoxidil or finasteride. Don’t worry—this is normal with these medications. The worsening hair loss is a byproduct of your hair shifting from one growth phase to another, and typically subsides in two weeks (Badri, 2020).
Still, it can take some time to see the results. Both minoxidil and finasteride typically take around four months to show improvement, but it can take six months to a year to see the full effects.
Another non-surgical option for treating hair loss is low-level laser light therapy (LLLT). This procedure is performed by a dermatologist, and causes chemical changes in your cells that can prompt follicles to regrow hair (Colter, 2015; Adil, 2017). Sometimes a combination of LLLT and minoxidil is used to treat hair loss (Faghihi, 2018). Speak to a healthcare provider to learn about which treatment option is best for you.
- Adil, A., Godwin, M. (2017). The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysis. Journal of the American Academy of Dermatology, 77(1), 136-141.e5. doi:10.1016/j.jaad.2017.02.054. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28396101/
- Badri, T., Nassel, T. A., Kumar, D. D. (2020). Minoxidil. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing: 2021 Jan-. Retrieved on Feb 4, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK482378/
- Cotler, H. B., Chow, R. T., Hamblin, M. R., Carroll, J. (2015). The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ Orthopedics & Rheumatology, 2(5), 00068. doi:10.15406/mojor.2015.02.00068. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743666/
- Davis, D. S., Callender, V. D. (2018). Review of quality of life studies in women with alopecia. International Journal of Women’s Dermatology, 4(1), 18-22. doi:10.1016/j.ijwd.2017.11.007. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986111/
- Faghihi, G., Mozafarpoor, S., Asilian, A., Mokhtari, F., Esfahani, A. A., Bafandeh, B., Nouraei, S., Nilforoushzadeh, M. A., Hosseini, S. M. (2018). The effectiveness of adding low-level light therapy to minoxidil 5% solution in the treatment of patients with androgenetic alopecia. Indian Journal of Dermatology, Venereology, & Leprology, 84(5), 547-553. doi:10.4103/ijdvl.IJDVL_1156_16. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30027912/
- Gupta, A. K., Lyons, D. C., & Daigle, D. (2015). Progression of Surgical Hair Restoration Techniques. Journal of Cutaneous Medicine and Surgery, 19(1), 17-21. doi:10.2310/7750.2014.13212. Retrieved from https://journals.sagepub.com/doi/abs/10.2310/7750.2014.13212
- Ho, C. H., Sood, T., Zito, P. M. (2020). Androgenetic Alopecia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing: 2021 Jan-. Retrieved on Feb 4, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK430924/
- Kerure, A. S., Patwardhan, N. Complications in Hair Transplantation. (2018). Journal of Cutaneous & Aesthetic Surgery, 11(4), 182-189. doi:10.4103/JCAS.JCAS_125_18. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371733/
- Rossi, A., Magri, F., D’Arino, A., Pigliacelli, F., Muscianese, M., Leoncini, P., Caro, G., Federico, A., Fortuna, M. C., Carlesimo, M. (2020). Efficacy of Topical Finasteride 0.5% vs 17α-Estradiol 0.05% in the Treatment of Postmenopausal Female Pattern Hair Loss: A Retrospective, Single-Blind Study of 119 Patients. Dermatology Practical Conceptual, 10(2), e2020039. doi:10.5826/dpc.1002a39. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190559/
- Suchonwanit, P., Thammarucha, S., Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug Design, Development, and Therapy, 13, 2777-2786. doi:10.2147/DDDT.S214907. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691938/
- Vogel, J. (2008). Hair Restoration Complications: An Approach to the Unnatural-Appearing Hair Transplant. Facial Plastic Surgery, 24(04), 453-461. doi:10.1055/s-0028-1102908. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.562.4836&rep=rep1&type=pdf
- Zito, P. M., Raggio, B. S. (2020). Hair Transplantation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved on Feb. 4, 2021 from https://www.ncbi.nlm.nih.gov/books/NBK547740/
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.