Hair Transplants
Like good health and youth, most of us take our locks for granted — until they’re gone. For many people, a hair transplant can help bring back what looks like a full — or at least a fuller — head of hair.
A hair transplant is a type of surgery that moves hair you already have to fill an area with thin or no hair. Doctors have been doing these transplants in the U.S. since the 1950s, but techniques have changed a lot in recent years.
Hairline transplant
Hairline transplant is the term doctors use to describe a hair transplant that restores a receding hairline. If you have a receding hairline, the hair along the top of your forehead and the temples starts to disappear. That causes your hairline to move backward, or recede. A receding hairline is a feature of male pattern baldness, the most common cause of hair loss among people assigned male at birth (AMAB).
Is a hair transplant permanent?
Hair transplants are designed to be permanent. When your doctor gives you the okay, you can treat your transplanted hair like the rest of your hair — wash, comb, and brush it as you like. However, there is a possibility that some hair grafts won’t survive and a small number may fall out.
There are two major types of hair transplants. Both procedures are performed in a doctor’s office. First, the surgeon cleans your scalp and injects medicine to numb the back of your head. Your doctor will choose one of two methods for the transplant: follicular unit strip surgery (FUSS) or follicular unit extraction (FUE).
Follicular unit strip surgery (FUSS)
With FUSS, the surgeon removes a 6- to 10-inch strip of skin from the back of your head. They set it aside and sew the scalp closed.
Next, the surgeon’s team divides the strip of removed scalp into 500 to 2,000 tiny grafts, each with an individual hair or just a few hairs. The number and type of graft you get depend on your hair type, quality, color, and the size of the area where you’re getting the transplant. Another term for FUSS is follicular unit transplantation (FUT).
Follicular unit extraction (FUE)
If you’re getting the FUE procedure, the surgeon’s team will shave a section of the back of your scalp. Then, the doctor will remove hair follicles one by one from there. The area heals with small dots, which your existing hair will cover.
Once the hair to be transplanted is harvested, the FUSS and FUE are similar procedures. After they prepare the grafts, the surgeon cleans and numbs the area where the hair will go, creates holes or slits with a scalpel or needle, and delicately places each graft in one of the holes. They probably get help from other team members as well to plant the grafts.
Depending on the size of the transplant you’re getting, the process will take about 4-8 hours. You might need another procedure later on if you continue to lose hair or decide you want thicker hair.
FUSS vs. FUE hair transplantations
FUSS and FUE are both effective forms of hair transplantation. To find out which one is right for you, you may want to consider some of the pros and cons of each procedure.
Scarring. FUSS leaves a scar on the skin from where the grafts are harvested. If you wear your hair long, that might not be a concern, as a scar will be less visible. FUE leaves small scars that are usually concealed by hair.
Time. FUSS procedures usually take less time.
Appearance. In FUSS, there’s no need to shave the back of the scalp.
Risk. In FUE, there is a risk that a surgeon might injure a hair follicle during removal. This damage, called transection, may make the hair follicle incapable of being transplanted.
Cost. FUE tends to be more expensive than FUSS.
Artificial hair transplants
An artificial hair transplant replaces lost hair with synthetic (human-made) fibers instead of a person’s own hair. These artificial fibers are sometimes called prosthetic hair fibers. Artificial hair transplants were developed as an alternative to conventional hair transplants.
More research is needed, but artificial hair transplants may be an option for certain people who don’t have enough hair from donors or have certain types of alopecia. However, artificial hair transplants can have side effects, as the use of foreign materials may cause your body to react.
If you’re considering treatment for hair loss, be sure to see a doctor who’s board-certified and has expertise with hair loss.
A hair transplant has two basic steps: harvesting and implantation.
Harvesting. There are two major methods for harvesting. In follicular unit strip surgery (FUSS), a surgeon removes a band of hair-covered skin from the lower back of your scalp. (Hair in this part of the scalp is less likely to fall out, making it a good site for “donating” hair to bare portions of the scalp.) Tiny “grafts” of hair are dissected from this strip. In follicular unit extraction (FUE), the surgeon takes individual grafts directly from the donor site using a small tool called a micro punch.
Implantation. After a surgeon harvests enough grafts, they use a small blade to make tiny incisions in the portion of your scalp that is bald or has thinning hair. The surgeon then plants a graft in each incision.
The ideal candidate for hair transplantation is someone who has the common form of hair loss that doctors call androgenetic alopecia. If you were assigned male at birth (AMAB), your hairline moves backward (or recedes) and the locks on top of your head become thinner. Over time, the top of your head may become bald. In people assigned female at birth (AFAB), hair usually becomes thinner on top, but the hairline doesn’t change. To get a hair transplant, you also need to have enough existing hair to harvest for replanting on the bare parts of your scalp.
After the surgery, your scalp may be very tender. You may need to take pain medications for several days. Your surgeon will have you wear bandages over your scalp for at least a day or two. They may also prescribe an antibiotic or an anti-inflammatory drug for you to take for several days. Most people are able to return to work 2-5 days after the operation.
Within 2-3 weeks after surgery, the transplanted hair will fall out, but you should start to notice new growth within a few months. Most people will see 60% of new hair growth after 6-9 months. Some surgeons prescribe the hair-growing drug minoxidil (Rogaine) to improve hair growth after transplantation, but it’s not clear how well it works.
As with any kind of surgery, transplants have some risks, including bleeding and infection. There’s also the chance for scarring and unnatural-looking new hair growth.
Around the time new locks start to grow, some people have inflammation or an infection of the hair follicles, called folliculitis. Antibiotics and compresses can ease the problem. It’s also possible to suddenly lose some of the original hair in the area where you got the new strands, called shock loss. But most of the time, it’s not permanent.
Talk with your doctor about these risks and how much improvement you’re likely to get from the surgery. They can help you decide if it’s a good option for you.
As with any type of surgery, hair transplants don’t always work out as planned. Some signs that your hair transplant has gone wrong include:
- Poor growth of transplanted hair
- A weird-looking hairline
- Visible scars on the scalp
- Dead skin (called scalp necrosis)
- The incision wound has opened up
If you have a hair transplant and develop any of these symptoms, contact a doctor as soon as possible:
- Heavy bleeding
- A rash, skin bumps, or cysts (signs of infection)
- Wound incision opening
- Skin that has turned a dusky color and crusty
- Swelling in your face, which may be accompanied by hives and difficulty breathing (anaphylaxis)
References
Hair Transplants: What to Expect – WebMd – https://www.webmd.com/skin-problems-and-treatments/hair-loss/hair-transplants
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