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Hair loss affects millions of people, so you’re not alone if you notice thinning hair or bald patches. Fortunately, several treatment options can help combat thinning and promote hair regrowth. A hair transplant may be a potential solution for some people. Usually, this surgical procedure is combined with medical treatments to maximize hair growth. Read on to learn more about this procedure.
What is a hair transplant?
Balding or thinning hair affects up to 85% of males and 40% of females over time. The most common cause of hair loss is male pattern baldness, also called androgenic alopecia. Medical hair loss treatments like minoxidil (brand name Rogaine) or finasteride (brand name Propecia; see Important Safety Information) are popular, but some people prefer a more permanent solution like hair transplantation (Zito, 2021).
Hair transplantation involves moving hair (grafting) from an area of the scalp with good hair growth (called the donor area) to thinning or balding spots (the recipient site). Techniques have changed since the procedure was introduced, and the cosmetic appearance has improved dramatically from the unappealing “hair plugs” of several decades ago. Now, people who undergo hair restoration surgery can have natural-looking results.
How do hair transplants work?
Your hair transplant surgeon can perform hair transplant surgery while you are awake and your head is numbed with local anesthesia. There are two hair restoration techniques for harvesting hair grafts (Zito, 2021):
- Strip harvesting, also known as follicular unit transplantation (FUT)
- Follicular unit extraction (FUE)
Follicular units are naturally occurring groups of 1–4 hairs along with their oil glands (sebaceous glands) and other connective tissue. It’s more than just an individual hair follicle; these follicular units are the basis of most modern hair transplant techniques (Zito, 2021).
Follicular unit transplantation
With FUT, the surgeon removes a strip of scalp skin from a hair-bearing donor area with healthy hair growth, usually the back of the head, where it won’t be as visible. Then they’ll meticulously remove the follicular units under a microscope—this is a delicate process, as they must be removed carefully to avoid breaking the hair grafts. Then, fine scalpel blades or needles puncture the recipient areas, allowing the follicular units to be transplanted into their new locations. Finally, the donor site wound is sutured closed, leaving a linear scar (Zito, 2021).
Why is my hair falling out? How can I stop my hair loss?
Follicular unit extraction
A newer technique has emerged: follicular unit extraction (FUE). This technique uses some of the same principles as FUT, but instead of removing an entire strip of skin and cutting out the follicular units, the FUE procedure removes the follicular units from the donor site individually, using a small (0.8 to 1.2 mm) punch device.
Most people will need multiple sessions of transplanting several hundred grafts to get satisfactory results. Alternatively, FUE can be performed in fewer “mega sessions” that take longer but allow the surgeon to transplant 2,000–2,500 grafts in a single sitting (Zito, 2021; Garg, 2018).
Hair transplant cost
You should consider cost when deciding whether to undergo a hair transplant procedure, as most insurances do not cover it. For both techniques, the charge is broken down to price per graft.
In FUT, the rate can be as little as $2 per graft/follicular unit; your total cost will depend on how many grafts you need to get the desired result. On average, most people need 700–1,500 grafts (depending on the degree of hair loss), making the cost between $1,400 and $3,000. The cost will also vary based on the surgeon you choose.
Who is a candidate for hair transplantation?
Hair transplants are not for everyone but are an option for both men and women. You will need a consultation with your dermatologist to see if you are a candidate for the procedure. You need to have enough healthy hair to transplant, and the recipient areas need to be able to receive and grow that new hair.
People with thick donor hair and clear areas of thinning in the front of the scalp (receding hairline) are ideal candidates. Your provider may still recommend medical hair loss treatments to prevent ongoing balding, such as minoxidil or finasteride, as hair loss will continue as you age (Zito, 2021).
Speaking of age, most surgeons do not perform surgical hair restoration on people younger than 25, as hair loss patterns are less predictable at younger ages (Zito, 2021).
Discuss your short-term and long-term expectations of the surgery with your hair transplant surgeon before undergoing any procedures.
Hair plugs for hair loss: cost, risks, and more
Risks and side effects of hair transplant surgery
As with any surgical procedure, hair transplantation has some risks and side effects. These may vary somewhat based on the harvesting technique (FUT vs. FUE). The most common side effects include (Zito, 2021):
- Swelling (most common)
- Asymmetry (unevenness of hair restoration)
- Scarring (linear scars in FUT and pinpoint scarring in FUE)
- Folliculitis (inflammation of the hair follicle)
- Shock loss (loss of the transplanted hair, not the follicles themselves)
- Numbness in the donor and recipient areas
These risks are relatively minor, and most are temporary.
Recovery after hair transplantation
After the procedure, you may experience some scalp pain, and your head will be bandaged overnight. Once the bandage comes off, you will be allowed to shower and need to apply petroleum jelly to your scalp to keep the skin moist. You may be given antibiotics and steroids to help decrease swelling and the risk of infection. You should avoid vigorous physical activities for two weeks following surgery (Zito, 2021).
You can keep taking hair loss medications throughout this process—they may even help maximize your hair growth (Zito, 2021).
Results—do hair transplants work?
Hair transplants work—one study found that over 87% of people who had the procedure were “satisfied” or “strongly satisfied” with their postoperative results. It is a safe and effective way for people bothered by their alopecia to get a younger and more healthy-looking head of hair (Liu, 2019).
You may see the transplanted hair falling out (shock loss) two to eight weeks after surgery—this is normal and is called telogen effluvium (TE). While TE may occur with both FUT and FUE, the new hair usually regrows within 3–4 months. After three months, your hair may look thinner than before the transplant—don’t worry. The new hair will grow back, but it can take 6–12 months to see the full results of the hair transplant (Zito, 2021).
Does wearing a hat cause baldness? What research tells us
Consult a reliable and experienced hair transplant surgeon (not just the cheapest one) to maximize your results. Other causes of hair loss, like medicines or medical conditions, should be ruled out before considering this surgery. Lastly, maintain realistic expectations and have an honest discussion with your provider.
The decision to have a hair transplant is not something you should make lightly. You should meet with a dermatologist who understands the nuances of hair loss and has experience performing hair transplant surgery. During the consultation, you will be examined and have the opportunity to ask questions; together, you and your provider will decide on the right treatment path. Hair loss and thinning continue as we age; a hair transplant can restore hair that has fallen out, but it does not affect future hair loss.
Alternatives to hair transplant
After consulting with your dermatologist, you may decide that hair restoration procedures are not for you. The good news is that there are other effective hair loss treatments available, including (Ho, 2021):
- Topical treatments: minoxidil applied directly to the scalp each evening
- Oral medications: daily finasteride or spironolactone (the latter can only be used in women)
- Low-level laser therapy (LLLT): uses red light to stimulate hair growth
- Platelet-rich plasma (PRP): blood plasma is injected into the scalp to encourage hair growth
- Stem cell therapy: stem cells injected into the scalp
- Cosmetic treatments: scalp micropigmentation (tattoos), wigs, hairstyle changes, etc.
Is there a cure for baldness?
Deciding whether to get a hair transplant is a personal decision. Speak with your hair loss specialist to determine whether medications or underlying illnesses are causing your alopecia and what treatment options are appropriate. Discussing hair transplant surgery risks and benefits will help you make an informed decision.
- Bicknell, L. M., Kash, N., Kavouspour, C., & Rashid, R. M. (2014). Follicular unit extraction hair transplant harvest: a review of current recommendations and future considerations. Dermatology Online Journal, 20(3). Retrieved from https://pubmed.ncbi.nlm.nih.gov/24656268/
- Garg, A. K. & Garg, S. (2018). Donor harvesting: follicular unit excision. Journal of Cutaneous and Aesthetic Surgery, 11(4), 195–201. doi:10.4103/JCAS.JCAS_123_18. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371717/
- Ho, C. H., Sood, T., & Zito, P. M. (2021). Androgenetic alopecia. StatPearls. Retrieved on Feb. 18, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK430924/
- Liu, Y., Liu, F., Qu, Q., et al. (2019). Evaluating the satisfaction of patients undergoing hair transplantation surgery using the FACE-Q scales. Aesthetic Plastic Surgery, 43(2), 376–382. doi:10.1007/s00266-018-1292-x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30607569/
- Zito, P. M. & Raggio, B. S. (2021). Hair transplantation. StatPearls. Retrieved on Feb. 18, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK547740/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.