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Last updated September 27, 2019. 4 minute read

Hair transplantation: a surgical hair loss intervention

Hair transplantation involves moving hair (grafting) from an area of the scalp with good hair growth (donor area) to thinning or balding spots (recipient site). Hair transplant surgery first took hold in the U.S. in the 1950s. Techniques have changed, and the cosmetic appearance has improved dramatically from the unappealing “hair plugs” of several decades ago.

Dr Chimene Richa Md Written by Dr. Chimene Richa, MD
Reviewed by Dr. Mike Bohl, MD, MPH

Hair loss affects millions of people, both men, and women. Typically, we lose about 100 hairs a day. Loss of more can lead to the overall thinning of your hair as well as bald patches. There are medical treatments to help combat thinning and promote hair regrowth. However, for some people, a hair transplant is a potential solution. Usually, this surgical procedure is combined with medical treatments to maximize hair growth.

Hair transplantation involves moving hair (grafting) from an area of the scalp with good hair growth (donor area) to thinning or balding spots (recipient site). Hair transplant surgery first took hold in the U.S. in the 1950s (Bicknell, 2014). Techniques have changed, 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.

Vitals

  • Hair transplantation uses two techniques: follicular unit transplantation (FUT) and follicular unit extraction (FUE). FUT is performed in 1 session, whereas FUE typically needs multiple sessions.
  • The price of FUT ranges from $2,000 to $4,000, whereas FUE can cost upwards of $10,000 depending on the number of grafts that are needed.
  • Even after a hair transplant, people still need to be on medications to prevent further hair loss and thinning.
  • It can take up to 6-12 months to see the full results of hair restoration after a hair transplant.

Procedure

Your dermatologist can perform hair transplant surgery while you are awake and your head is numbed with local anesthesia. There are two techniques for harvesting the hair grafts: strip harvesting, also known as follicular unit transplantation (FUT), and follicular unit extraction (FUE).

In FUT, your dermatologist removes a strip of scalp skin from a donor area with healthy hair growth, usually the back of your head. Then the follicular units are meticulously removed under a microscope. Follicular units are the natural groupings of 1-4 individual hair cells growing together (Bicknell, 2014). These units must be removed carefully to avoid breaking the hair grafts. Fine blades or needles are used to puncture the recipient areas allowing the follicular units to be transplanted in their new locations. The donor area wound is sutured closed, leaving a linear scar.

A newer technique has emerged over the last several years: follicular unit extraction (FUE). This technique uses some of the same principles as FUT. However, instead of removing an entire strip of skin and then cutting out the follicular units, the FUE procedure removes the follicular units from the donor area individually using small (0.75mm up to 1.2mm) punch devices (Bicknell, 2014). Several sessions, each transplanting 700-1500 grafts are often needed; alternatively, FUE can be performed in fewer “mega sessions” that take 6-12 hours, allowing for the transplantation of 2000 grafts in a single sitting (Bicknell, 2014).

The cost has to be taken into consideration when deciding 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 then depend on how many grafts you need to get the result you want. This number could be anywhere from 500-2000 grafts, depending on your degree of hair loss, making the procedure price between $2000 and $4000. This cost will vary based on the surgeon you choose. The FUE procedure has a higher price per graft, ranging from $3 to $9 per graft; at an average of 700-1500 grafts needed for hair restoration, this makes the price tag for FUE anywhere from $2100 to $13,500, again depending on the surgeon (Bicknell, 2014).

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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 hair and clear areas of thinning in the front of the scalp are ideal candidates (Avram, 2017). Your provider may still recommend medical treatment to prevent ongoing hair loss, such as minoxidil (brand name Rogaine) or finasteride (brand name Propecia) as the drive to lose hair persists as we age. You should discuss both your short-term and long-term expectations of the procedure with your dermatologist before having any surgery performed.

Risks, side effects

As with any surgical procedure, there are risks/side effects associated with hair transplantation. These may vary somewhat based on the harvesting technique used (FUT vs. FUE). The most common side effects include (Küçüktaş, 2017):

  • Swelling (most common)
  • Pain, especially in FUT due to cutting the nerves in the scalp skin
  • Asymmetry (unevenness of hair restoration)
  • Bleeding
  • Scarring (linear scars in FUT and pinpoint scarring in FUE)
  • Folliculitis (inflammation of hair follicle)
  • Crusting, usually in the first 48 hours
  • Hair graft dislodgement (falling out) can happen in the first three days
  • Hiccups occur 4% of the time
  • Shock loss: Loss of the transplanted hair, not the follicles themselves; occurs in FUT and FUE and the new hair regrows within 3-4 months
  • Itching
  • Numbness in the donor and recipient areas

Expectations and recovery

After the procedure, your head is bandaged overnight. Once the bandage comes off, you will be allowed to shower and need to apply petroleum jelly to your scalp. Any crusting usually resolves in five to eight days, and after one week, you can return to all normal physical activities. Two to eight weeks after surgery, you may see the transplanted hair falling out (shock loss); this is normal. After three months, your hair may look thinner than it did before the transplant — don’t worry. The new hair will grow back; it can take 6-12 months to see the full results of the hair transplant (AAD, n.d.).

In conclusion…

The decision to have a hair transplant is not one that 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 if this is right for you. 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.