Hair Transplant: Everything You Need To Know

A hair transplant (or hair implant) can be your most important decision in the fight against hair loss. Advances in technology allow increasingly natural results and faster, more accessible procedures. But we are talking about a surgical solution, so it is necessary that you know the pros and cons well, since the results (and the consequences) are for life .

We have put together the most frequently asked questions on the subject here to help you learn more about surgery and make your choice in a conscious and thoughtful way. You can read all the answers in sequence or use the list below by clicking directly on the question you want to see.

What is hair transplantation?

It is a surgical procedure in which the hair follicles from a donor area (denser and full of hair) are transferred to a receiving area (less dense than the donor area).

Most surgery is done to improve the appearance of traditional baldness caused by androgenic alopecia . The main donor site is the back of the head, where the hair is less sensitive to the hormones that cause this type of alopecia. The transplanted follicles remain resistant after surgery, even if the native strands of the reception area are lost with the progression of baldness.

The transplant can be done to recover other areas, such as the beard or eyebrows , and hair from different parts of the body can be used (transplantation of hair from the back to the scalp, for example).

Is there a difference between hair transplantation and implantation?

It is common to use the two terms synonymously , but the technically correct would be to transplant hair. In medicine, the word implant usually refers to artificial parts that are inserted into the body. Since follicles are natural parts of our body, the correct thing to do is to say that they are transplanted (like a heart or kidney, for example).

But in practice, clinical surgery goes by the name of both transplantation and hair implantation: if they both deal with natural hair follicles , the names mean the same thing .

(Fun fact: there are techniques to implant artificial hair , only they are considered inferior to transplants in terms of results, possibility of rejection, etc., and therefore they are not very popular or recommended)

Is it possible to transplant hair from one person to another?

Currently, no . In theory, the procedure is possible, but it would have the same difficulties as the transplant of any other organ, such as the risk of incompatibility between donor and recipient (unless you have an identical twin willing to donate their hair to you).

Whoever receives a transplanted organ has to take immunosuppressive drugs for life so that the body does not attack the new part. Medications can cause considerable side effects and make the body more vulnerable to external threats.

They are serious disadvantages, which can be overcome when we are talking about a vital organ, but not cosmetic surgery. Thus, a hair transplant from another donor is considered unfeasible today.

In which case is hair transplantation recommended? How do I know if I can do it or not?

Only your doctor will be able to make an accurate evaluation, but in general the best candidates for transplantation are:

• People with androgenic alopecia Norwood scale 3 or higher , or who have experienced hair loss for at least five years ;
• People with bald spots that have stabilized , who had hair loss many years ago;
• Who is resorting to surgery after they have already tried other treatments for androgenic alopecia (such as finasteride and minoxidil );
• People with permanent hair loss not related to hormonal causes (accidents, surgery, burns, trauma, etc.);
• People who have the previous line deployment hair (area where the hair begins to emerge on the forehead) high , either from birth (without pictures dropping the associated hair) or due to surgical procedures (such as facial);
• Some cases of scarring alopecia , provided they have been inactive and stable for at least a year;
• Some cases of trichotillomania , provided they have been inactive and stable for at least a year.

Other important requirements for safety and satisfaction with the procedure are:

• Have a good density of hair in the donor area ;
• Be in good health (meet the criteria of the pre-surgical evaluation);
• Have realistic expectations about the results of the procedure;
• Choose a well-qualified professional to carry out the surgery;
• Strictly follow the recommended treatment for the period after surgery .

Is there a minimum age to perform the surgery?

Technically not, but many experts prefer to wait until the candidate is at least 25 years old . Many people think that transplantation is the best for young people, because the results are better in the mildest cases of alopecia, but this is not true, it is important to evaluate how your baldness will progress throughout your life so that the transplanted hair look natural in the future.

Imagine a 20-year-old who begins to have hair loss in the front and decides to have a hair transplant. The transplanted hair is resistant and will remain there for the rest of its life, but the native hair in that area continues to fall out. After a few years you can be left with firm and strong transplanted hair on your forehead and a bald area immediately behind it. Bad, right?

Take into account the difference between the front surface and the bald part immediately above (and imagine that this difference tends to increase over time). It is far from the result you want for your hair transplant, right?

This lack of planning means that many people need corrective hair transplants in the future. To avoid the risk, the ideal is that the baldness has already stabilized when you decide to do the surgery, or at least make a projection of how the clinical picture should evolve in the future to maintain satisfactory results in the coming years.

A good exercise is to look at the people in your family and imagine that your baldness will progress in the same way as the most bald person of all : this way you will have “a plan for the worst” and a margin of safety. If you are already at a level close to that person, you can perform the surgery knowing that your chart should not go much further than that. Or, if you’re still a long way off, you can try other treatments before considering a transplant. You can also ask your doctor to screen your hair loss pattern for more natural and long-lasting results.

Remember that the amount of hair in the donor area is limited : you do not want to waste it doing surgery that can weigh you down in the future.

Is hair transplantation in women different from men?

The procedure is the same, but surgery is not always an attractive option for women .

Female pattern baldness tends to be more diffuse and distributed throughout the scalp, and sometimes affects the back of the head as well . In such cases, it is not possible to expect the same stability and resistance from the donor area that is observed in male pattern baldness, and the transplanted hair may end up being lost over time.

On the other hand, transplantation serves precisely to remove thicker hair from an area and use it to fill the most “scattered” parts. If the hair loss is distributed over the entire head, and the density is similar in all areas, the surgery loses its purpose. So the ideal is that you make an evaluation so that the doctor reviews your case and you know if the procedure will benefit you or not.

The hair implant in women is still a great option in cases of:

• Traction alopecia (excessive waxing of the eyebrows or the use of very tight hairstyles such as braids flush with the scalp or ballerina buns, for example), burns or other trauma ;
• Plastic or other surgery that caused the loss of conductors in the area near the scars ;
• Baldness similar to that of male pattern (in more localized areas and the preservation of the hairs on the back of the head, which is the donor area);
• Reduction of the forehead area (those with naturally very high hairline);
• Some stable pictures of scarring alopecia and trichotillomania.

What are the necessary procedures and care before surgery?

The first step is the evaluation that the doctor will do for your case. The cause and degree of hair loss, the quality of the donor area, and determine if the transplant is the ideal solution for you must be analyzed. He will also talk about your expectations, discuss what can be done, what are the results you should expect, etc.

Before the doctor does the transplant, he should ask some traditional pre-surgical tests (chest X-rays, echocardiography, blood count, coagulation tests, etc.), and ask if you take any medication, if you have any chronic disease, etc.

After these two stages, surgery can be scheduled. The most common recommendations for transplant preparation are:

• Leave hair as long as possible for the day of surgery (the doctor will trim the required area, and the rest of the hair will help cover the scars in the donor area);
• Protects the scalp to avoid sunburn on the day of the procedure;
• Do not take aspirin, ibuprofen or other anti-inflammatory medications, vitamin supplements (especially type B and E ), and avoid smoking and alcoholic beverages a week before the transplant, because they can stimulate bleeding during the procedure and alter healing (if you have any questions about any medicine, consult your doctor);
• Wash your head with shampoo the day of the surgery and do not use products such as gel, spray, conditioners, creams, perfumes and makeup (if you use a hair prosthesis you must also remove it);
• Wear loose clothing that does not have to be removed over the head, in order to avoid friction with bandages after surgery (a button-down shirt is ideal);
• Eat well before surgery, according to the doctor’s guidance (some patients may experience nausea if transplanted on an empty stomach), but avoid caffeine (it can stimulate bleeding);
• Do not bring valuables to the clinic the day of the transplant (the place cannot have the condition and guarantee the safety of your belongings)
• Sedation can cause drowsiness after the procedure, so driving after surgery is not recommended (ask someone to drive you home, or take a taxi);
• Talk to your doctor about the products that you may have to use after surgery (medicines to control pain or prevent infections, ice pack to reduce swelling, etc.), and thus buy them in advance to have everything at home when you return from transplant.

What kind of anesthesia is used?

Most of the procedures are performed under local anesthesia and mild sedation (which is optional but highly recommended due to the long duration of the transplant sessions).

What are the types (or techniques) of hair transplantation?

Trade names can vary greatly, but there are basically two methods on the market: the most common is follicular unit transplantation , or FUT . This technique removes a strip of scalp from the donor area, from which the follicular units (natural groups of up to 5 hair follicles) are selected to be implanted in small holes made in the recipient area.

The second method, which has been gaining popularity in recent years, is follicular unit extraction , or FUE . The difference is that this technique removes the follicular units one by one, directly from the patient’s scalp , with the help of a small cylindrical tool (like a tube). The inclusion of units in the reception area is done in the same way for both methods. There is a variation of the technique in which the removal of the UF is performed by a robot , which helps to increase the precision and quality of the procedure.

Some clinics advertise the use of laser hair implants , but this technique is considered of lower quality: the laser is only used in the opening of the holes in which the hairs are inserted and ends up burning the tissues, which makes the possibility of causing the loss of new follicles is greater .

The laser is used more when the transplanted parts are larger and need holes considered large by today’s standards (the implanted strands give a super artificial, “doll’s hair” effect ). The follicular unit holes in current procedures are small, and small incisions are made in the receiving area to cause as little damage to the scalp as possible.

What are the advantages and disadvantages of each method? Which is better? (Infographic)

It is difficult to say that one method is better than the other because they have very different characteristics. To help you compare, see the infographic below (and then a list of the strengths and weaknesses of each method):

FUT Method – Positive Aspects:

• It is generally cheaper than the FUE method;
• More follicular units transplanted per session , making it ideal for covering larger areas ;
• The surgery is faster (some important procedures with large amounts of transplanted FUs can be performed in a single day with the FUT method; with the FUE method it would be divided into two sessions);
• The risk of damage to the follicles is greatly reduced as the FUs are removed one by one on the strip of skin that was removed with the help of powerful microscopes;
• There is no need to shave the hair near the donor area (which facilitates the camouflage of scars after surgery);
• If the patient undergoes more than one FUT surgery, in some cases the anterior scar may be removed in the next procedure; In other words, you can do several surgeries and obtain only one scar (with the FUE method, each procedure creates more micro scars , the accumulation of which can end up significantly reducing the density of the hair in the donor area).

FUT Method – Negative Aspects:

• The method is considered more invasive than the FUE technique, and recovery can be slow and painful for a longer time ;
• The head is the only viable donor site (hair from other parts of the body cannot be used for transplantation);
• It is only possible if the applicant has good flexibility in the scalp (and each surgery reduces a little more of this flexibility by limiting the number of FUT transplants that can be performed in the future);
• The linear scar is more visible than the micro scars in the FUE method (although it can be camouflaged with the hair) and can be unsightly if the healing is not ideal (either due to lack of skill of the surgeon, due to lack of respect for post-treatment care). surgical or because the patient’s body does not respond well to the procedure);
• It is necessary to avoid physical exercise and strenuous activities that can cause stress on the scalp for about 10 months after surgery , to allow the incision area to fully recover and reduce the chances of scar enlargement;
• The incision will probably damage some follicles at the ends of the strip of skin removed from the donor area, and the surgery causes some of the hair that is in the telogen phase to be lost (temporarily empty follicles that do not show and are transplanted during the procedure);
• It may be that parts of the scalp joined by the suture have hairs that grow in different densities and directions , leaving an unnatural appearance (which is more easily camouflaged when the hair grows a little).

FUE Method – Positive Points:

• The method is considered less invasive , has a faster recovery and does not require sutures (microincisions heal);
• Allows hair from other parts of the body to be used (restoration of eyebrows, beard or transplantation of hair from another place to the scalp);
• The microscars are easier to camouflage and allow styles of short hair (especially in minor procedures that do not require many FU);
• Allows you to return to work normally in a few days;
• It is a good option for those who do not have good flexibility in the scalp and therefore cannot do follicular unit transplantation surgery, m FUT

FUE Method – Negative Points:

• It is generally more expensive and time consuming than the FUT method;
• Fewer FUs are implanted per session (the time it takes to extract and prepare the FU is longer);
• UFs are taken from a larger area , which can increase the risk of grabbing hair outside of the region considered “safe” (some of these hair may be susceptible to hormones that cause hair loss and future shedding ) and staying with obvious micro scars in an area that could become bald in the future;
• The density of the donor area is reduced in each procedure (so it is difficult to do new FUE or FUT procedures in the future);
• The risk of damaging the UF is higher , because the surgeon has no vision under the skin follicles during the extraction (if the incision is too large it can cut the neighboring follicles, if it is too narrow or too shallow it can damage the UF being extracted);
• The entire donor area must be shaved for the transplant (which, in the main procedures, may end up forcing the patient to shave the entire head so as not to be left with a visual lack of harmony).

How long does the surgery take?

Varies based on:

• The technique (the FUT method is generally faster than the FUE method);
• The number of follicular units transplanted;
• The team that will do the procedure (larger and more experienced teams usually take less time).

A small part (less than 800 FUs) with the FUT technique can take about 3-4 hours , while a major surgery (more than 2,500 FUs) can take 6-8 hours (in the FUE technique, the larger procedures can be divided into two sessions held on consecutive days).

Will the hair fall out again after transplantation? I know of people who have less hair after surgery!

It is very likely that there will be some hair loss soon after the transplant, but this is typical and usually completely reversible .

Transplanted hair is believed to fall out because when the follicular unit is removed from the donor site, its blood supply is cut off. This would be interpreted by the follicles as an “emergency” situation: without receiving the necessary nutrients to maintain hair production, which tend to interrupt the process.

The fall does not happen immediately, and is usually only noticed between the second and sixth week after surgery. After the follicle is fully integrated into the reception area and circulation is restored, it begins to produce new hair, which should appear between the second and fifth month after transplantation.

As the transplanted hair falls out and permanent hair emerges: follicle stage 1 was extracted in phase 2 (and disconnected from the blood source) to be implanted in the recipient area in phase 3 (where it does not have connection with capillaries). This period of no movement interrupts the growth line, which is released in step 4. Keep in mind that the follicle will have regained its blood supply and is beginning to produce new hair that will appear on the scalp in phase 5.

In some cases, hairs that do not participate in the transplant may also fall more sharply. Surgery is always a shock to the body, no matter how small and well executed, and one of the ways in which our body tends to react is by losing a little hair. This reaction is called telogen effluvium , and it is a temporary effect: as soon as it fully recovers, the hair resumes its normal growth (unless it is already sufficiently miniaturized and ready to stop growing in any case). This does not happen overnight: it is common for the biggest drop to only become apparent some time after surgery.

In cases of androgenic alopecia , some doctors recommend the use of other treatments to help strengthen and preserve the native threads (such as finasteride and minoxidil ) that are usually started before transplantation (so the effect is already working when the transplant is performed. surgery).

When will long hair grow back?

In the entire second or third month after surgery, new hairs begin to emerge, and are gaining body until approximately the eighth or ninth month. Some changes in the texture of the hair may appear, but between the first and the second year after the transplant they are often regularized. After this period is when the final result of the procedure is well appreciated and can be evaluated in more detail.

Are the results good?

With advances in transplantation techniques, we have seen more and more excellent results. Current procedures seek to play with maximum fidelity, which would be a natural distribution of hair for each patient, taking into account the angle of hair density, direction and growth, in addition to a deployment line compatible with age and profile. individual.

A well done hair transplant can give surprising and very natural results (compare the before and after photo).

It is important to say that the most satisfied clients are those with realistic expectations for transplantation. A patient with older and more advanced baldness should not expect to regain the same hair that he had when he was a teenager. But the fact is that it can be one of the most powerful solutions for severe bald spots.

It’s also worth noting that while there are newer technical advancements today, not all professionals have mastered them. Therefore, a key factor for the success of the procedure and the quality of the results is the choice of a good surgeon .

Does the procedure leave scars?

Both methods leave different scars , but there are characteristics that make them practically unnoticeable. The traditional transplant ( FUT technique ) leaves a linear scar that is camouflaged when the surrounding hair grows long enough to cover it (the trichophytic suture method allows hair to grow in the area of ​​the scar, which helps to hide it even with styles shorthaired – read more about this in the next question).

But the FUE method does not leave a single scar, but several micro scars at the points where the follicles are extracted. If you use the razor, the visual impression that may arise (especially if many hairs have been removed from the donor area) is a less dense area of ​​hair than the rest, but as soon as the hair grows a little more this effect it is also camouflaged.

The FUE technique is generally explained as ” scarless hair implant “, but beware: just because a scar is almost imperceptible does not mean it does not exist!

Will I be able to use my hair very short or shaved after surgery? Will the scar show up?

Both methods (FUT and FUE), if well executed, should generate easy to cover marks. But the fact is that the shorter the hair around the donor area, the more noticeable scars can become . Therefore, it is useless to say that “if the transplant looks bad I can just shave my head”: if you do, the scars will be visible.

The quality of the scar also depends on respecting the post-surgical care guidelines , how each body will react and the healing of the process (which cannot be predicted for sure). The best clinical pictures of scars may be almost imperceptible, but not all scars will be completely covered with a haircut with a 2 or 3 razor.

If you want to keep your hair short and are not bothered by the marks, you can benefit from some techniques such as micropigmentation (small tattoos that dot the area of ​​the scar and leave it with the same visual appearance of the surrounding area) and the surgical revision of the scar (procedure that can reduce the appearance of a large scar).

Another possible solution is to do a small FUE procedure to cover a linear scar from a previous follicular unit transplant surgery (the linear mark is camouflaged and the new surgery generates micro scars in the donor area, which can be a very advantageous exchange).

How is the post-operative?

It is generally quiet in both methods. Some swelling and numbness are normal, and doctors may prescribe medications to relieve pain and help you sleep. The first nights the patient should try to sleep with the head slightly elevated , with more pillows and cushions at an angle of at least 20º. The next day, the bandages are removed.

During the first week the instruction is to wash the head two or three times a day with specific shampoos to keep the scalp clean and facilitate the natural loss of the scabs that form after transplantation, handling the reception area carefully and delicately ( your doctor should advise you on the ideal way to do this).

It is recommended to avoid alcohol for the first three days and cigarettes in the first two weeks after surgery, and protect your head from the sun . Ideally, completely block out the area with hats in the first two weeks; after this period you can use sunscreen, preferably with SPF 30 or higher.

With the FUT technique, the patient may feel more pain , especially in the first week, which is usually easily controlled with medication. The suture points should be removed in the second or third week, and the ideal is to avoid excess tension on the scalp for up to 10 months after surgery to optimize healing and prevent the scar from becoming wider. This includes avoiding very strenuous exercise and activities that stretch or put too much pressure on the scalp.

The FUE technique does not involve suturing and does not require as much attention: the patient can usually return to work within a few days after surgery, as long as direct pressure on the scalp is avoided for the first 10 days.

Can I do more transplants after the first one?

Yes , as long as you continue to have sufficient hair density in the donor area after the first procedure. Ideally, you should wait between one and two years after surgery to fully evaluate the results and decide if you should perform a new transplant.

Because the FUT technique removes a part of the scalp, it will get “tighter” in each procedure, so it is also necessary to assess whether the skin still has enough space and elasticity to remove another strip: if not, the FUE method is ideal. (which does not remove any skin and does not require or depend so much on the flexibility of the scalp).

It must also be remembered that the FUE technique reduces the density of the donor area in each procedure, so if several sessions are carried out and a large number of follicular units are removed, it may be that the final density of the donor area does not is ideal for future transplants. That is why it is important to plan the surgery well, taking into account the long-term results.

How much does a hair transplant cost?

The price can vary widely, especially according to the technique (FUT is generally cheaper than FUE) and the number of follicular units to be transplanted (which implies more time and larger team sessions). From the simplest procedures in small areas to the largest and use of advanced technologies (eg, robotic – assisted FUE) values ​​can range from about 5,000 € to 30,000 € . But it is only with the specific case of evaluation that clinics can provide more accurate estimates.

What should I consider when choosing the surgeon / clinic?

The quality of the transplant depends directly on the skill of the responsible team, and since the surgery has life-long effects, one must choose very carefully who will perform it. There are unethical and exploitative people in every profession – don’t put your head in the hands of those who are more interested in money than your health and safety. Some important points to keep in mind:

How to know the quality of a clinic / surgeon?

An indication from your dermatologist or someone who has had a transplant with the professional is more reliable than an advertisement full of marketing clichés. Searching the Internet for options in your city (or another, if you can travel) can be good to find testimonials (congratulations and complaints), but beware: anyone can publish anything online.

The experience and training of the surgeon

Where did the doctor graduate? What are your specialties? Do you participate in events, conferences, awards or have you published articles on hair transplantation? How long have you worked in the area? How many procedures have you performed before? Do you have experience in similar cases (hair type, cause and degree of hair loss, etc.)?

Record of previous procedures

Are there varied and well-detailed photos before / after the surgery that the doctor has done (preferably with the same lighting angle and in the same environment and both the reception area and the scars in the donor area)? Can you contact some of the patients to ask them how was their experience?

Interaction with staff during the procedure

Does the team that will help the doctor have a lot of people? How long have you worked together? Do the assistants perform the steps? Will the doctor be present to directly supervise or carry out what parts of the surgery?

The environment and physical structure of the clinic

Hygiene, lighting, modern equipment, various microscopes for the preparation of follicular units, are all good signs.

The evaluation of your case

Be wary of any place that does not do a careful examination of your particular case, before saying that you can undergo a transplant. The best professionals will evaluate your baldness history , analyze the density of your scalp, have a realistic point of view of the possible results and will alert you to all the risks and precautions involved. You prefer someone who talks about how the transplant will interact with the progression of your baldness in the future than those who only talk about the immediate benefits.

Fairness in the recommendation method (FUT or FUE)

If the place only offers one type of transplant, hopefully they will argue in favor of this method. Ideally, you should talk to someone who works with both types (or, better yet, several professionals to contrast opinions ). Enjoy the fact that after reading this article you will have more information about the types of transplantation, ask specific questions (about the procedure, scars, post-operative, etc.) and see if the professional gives you a balanced view of the pros and the cons of each method.

The budget offered

Serious clinics usually only talk about prices after carefully studying your case. Compare prices and estimates and be suspicious of those that are very different from the average. In 99% of cases, the one that is much cheaper than the competition is also much worse. And not always the most expensive is necessarily the best (make sure it has the brand and name of a famous surgeon consistent with the quality and professionalism of the services).

The way they treat you

Professionals should give you enough attention, answer your questions clearly, and give you all the time to make your decision. No one should be pressured into making up your mind early , or treating you like any other number on the patient list. If your instincts tell you that the conversation is more like a telemarketing call than a serious medical consultation, find another clinic.

Your security in the decision

You should only perform the transplant if you have enough information, if you do not doubt any stage of the procedure, you know the limitations of each method and the possible long-term result for your case, and you feel confident in the quality of the clinic and the professionals who will do it. your surgery. If there is any doubt or hesitation, wait a bit and seek more information .