Hair Transplant Q&A

There are many causes of hair loss, but in both men and women, the most important factor is genetics. Other factors that can cause hair loss include traction from tight braids or ponytails, scarring, hormonal imbalances, and other medical conditions.

Medical treatment can effectively slow or stop pattern hair loss in many patients. Some individuals may even witness hair regrowth. Key components of modern medical treatment typically involve the use of finasteride (Propecia) and minoxidil (Rogaine). Additional treatment options may encompass injection therapy and low-level laser treatment.

Propecia blocks the action of 5-α reductase, an enzyme that is responsible for the hormonal changes that lead to male pattern baldness. Propecia will stabilize hair loss in approximately 90% of men who take it, but it is generally not prescribed for women. The mechanism by which Rogaine affects hair growth is less clear but is believed to relate to the dilation of blood vessels. Rogaine has been shown to be effective for both women and men.

Propecia and Rogaine appear to work synergistically for male patients, meaning that a more significant effect is achieved by using both medications at the same time. Both medications are thought to be more effective for the crown and mid-scalp areas than for the hairline and temples.
There are numerous other products available that are marketed as hair loss cures. While some of these may have effects, many are unproven, and some can even be harmful. You are encouraged to do your homework and realize that if a “miracle” lotion or potion seems too good to be true, it probably is.

It’s crucial to bear in mind that untreated pattern baldness will continue to advance. While some individuals may see hair regrowth, the primary objective of medical treatment is to hinder further hair loss. If there is no change in the appearance of your hair during the treatment period, this should be viewed as a success, not a failure. Initiating medical intervention for hair loss as early as possible is crucial to preserving your existing hair. While there are effective solutions to restore lost hair, preventing problems is generally simpler than treating them after they arise.

This is an important question because as our patients often tell us how much they regret not starting medical treatment sooner.

Minoxidil, sold as Rogaine is applied directly to the scalp and is effective for both med and women. Finasteride, sold as Propecia is a daily pill that is generally prescribed only for men. Propecia has been shown to stop or stabilize hair loss in about 90% of men who take it and like Rogaine, is most effective in the crown area of the scalp.

We encourage our patients to think of their hair as a non-renewable natural resource. Hair transplantation can achieve impressive cosmetic results by redistributing hair from areas where there is an abundance (like in the back) to areas where there is a need (like at the hairline). What hair transplantation cannot do however, is to create new hair. Consequently, what can be accomplished with transplantation is limited by the supply of donor hair that is available and the area of bald or balding scalp that needs to be covered.

Given the above, it makes sense to stop ongoing hair loss early in order to preserve existing hair and conserve natural donor reserves. We are fortunate to have proven and safe medical treatments including minoxidil and finasteride at our disposal. Starting medical treatment early may eliminate the need for a transplant in the future, or limit the area that requires transplanting, thereby allowing us to maximize coverage and density. In those patients who ultimately undergo a transplant, medical treatment gives us a more “stable canvas” to work with by limiting progressive balding.

At Follicle HT, we recommend consideration of medical treatment to stop ongoing hair loss at the soonest possible time even if surgical treatment is not currently and option. Remember that by the time an area has a thinned appearance, 50% of the hair in that area has already been lost.

When observed through a microscope, hair typically grows in natural clusters, known as follicular units (FUs), normally consisting of one to four hairs. At Follicle HT, we ensure natural-looking and generally permanent results by exclusively utilizing single follicular unit grafts.

Follicular units are sourced from the more permanent regions located at the back and sides of the scalp through one of two methods. Follicular Unit Strip Surgery (FUT) entails removing a strip of skin-bearing hair from the donor area, which is then divided into follicular units for transplantation into the hairline or other places. When executed with careful surgical precision, this procedure results in a fine-line scar along the back of the scalp, typically inconspicuous unless the hair in that area is trimmed very short. On the other hand, Follicular Unit Extraction Surgery (FUE) involves manually extracting donor follicles one by one using a precise, motorized surgical punch. This technique avoids a longer fine-line scar, allowing the hair in the donor area to be trimmed to a fade or even shaved with minimal to no visible scarring.

FUT and FUE surgery each have advantages and disadvantages. Unlike some clinics, our team at Follicle HT is highly experienced in both techniques, and our surgeons will help you decide which method is suitable for you.

Follicular unit hair restoration entails relocating hair follicles from the durable regions at the back and sides of the scalp to areas experiencing baldness or thinning. Typically, this involves the frontal hairline, mid-scalp, temples, and crown. Hair transplantation can also be utilized to restore or establish facial hair and is integral to the gender affirmation process for transitioning individuals. Transplanted hairs typically offer a permanent and long-term solution for pattern baldness.

Every patient that is considered for a hair transplant at Follicle HT will have a thorough consultation with one of our experienced surgeons. This will allow us to identify the cause of your hair loss and rule out any underlying, treatable conditions. Other factors that will be considered include age, extent and rate of hair loss, and availability of donor hair. Non-surgical options such as medical treatment and injections therapy will also be considered.

Men and women experiencing noticeable hair loss, without any underlying medical conditions that require further examination or treatment, are eligible candidates for hair transplantation.

While we do not have an absolute cutoff for age, we are cautious about recommending hair transplants to very young patients. It is sometimes challenging to predict what the eventual extent of hair loss will be in patients presenting in their teens and early 20s, so we often recommend at least a year of medical management to stabilize the situation before considering a transplant. Suppose a transplant is undertaken on a relatively young patient. In that case, we create a conservative hairline that will continue to look natural even if the patient loses the surrounding non-transplanted hair over time.

Considering the above factors, it’s appropriate to contemplate a hair transplant when your reflection in the mirror or a photograph fails to match how you feel or the image you desire to present to the world.

This is by far the biggest concern among those coming to see us for hair restoration. Our patients almost invariably tell us that the only thing that they would find worse than baldness would be a bad hair transplant. The sight of unacceptable, obvious, pluggy, and frankly embarrassing results produced by older, outdated techniques would give anyone second thoughts.

The field of transplantation has come a long way from the days of “corn-rows” of hair plugs. Grafts have gradually gotten smaller, hairline design more sophisticated, and technology more advanced. The advent of follicular unit transplantation with stereo-microscopic graft preparation is now generally regarded as the end refinement in surgical technique, able to yield results that are predictable and undetectable.

When examined under a microscope, hair can be seen to grow in natural groupings that generally contain between one and four hairs. These natural groupings are called follicular units (FU’s). When donor hair is harvested for transplantation, preservation of the integrity of these FU’s allows the hair to be placed in a way that maintains a completely natural appearance.

In addition to preserving the natural follicular units, the transplanted hairs are transplanted in an artistic fashion that mimics and re-creates the way that hair normally grows on the scalp with all of its natural angulations, swirls and patterns. This is in stark contrast to the unacceptable appearance of historical hair transplants that paid no attention to FU groupings and simply inserted coarse plugs which could contain more than 20 random hairs and often ended up looking like rows of doll’s hair.

Using the most modern techniques, our standard is total naturalness with balanced density and coverage. Often, patients’ own hair stylists are not able to tell that a transplant has been performed.

Unfortunately, the answer is no. Hair replication is not currently a viable option in humans and hair transplanted from another person would be rejected by your body’s immune system. The follicles used in hair transplantation can only come from the same individual.

The key to modern hair restoration surgery lies in the “follicular unit.” Under microscopic examination, the scalp reveals hair growing in natural clusters, typically containing one to four hairs, known as follicular units (FUs). Preserving the integrity of these FUs during donor hair harvesting ensures that the transplanted hair maintains an entirely natural appearance. This approach contrasts “hair plugs” and large “minigrafts,” often producing unsatisfactory cosmetic outcomes.

At Follicle HT, we exclusively utilize single follicular unit grafts to ensure completely natural and undetectable results. During a follicular unit hair transplant, these grafts are meticulously placed into tiny recipient sites using ultra-fine needles or micro-surgical instruments in the bald or thinning area. No tissue is removed in the recipient area, allowing for the creation of natural hairlines and the insertion of grafts between existing hairs to enhance density in thinning areas. The two main techniques available are follicular unit strip surgery (FUT) and follicular unit extraction surgery (FUE).

Follicular unit strip surgery (FUT) entails extracting a strip of skin-bearing hair from the donor area and then dividing it into follicular units for transplantation into the hairline or other regions. When conducted with precise surgical technique, this procedure results in a fine-line scar along the back of the scalp, typically challenging to detect unless the hair in that area is trimmed very short. At Follicle HT, our board-certified head and neck surgeons frequently use a method known as “trichophytic closure,” allowing surrounding hairs to grow directly through the scar, significantly minimizing its visibility.

An advantage of FUT is its meticulous dissection of each graft under a stereotactic microscope, resulting in minimal rates of transected follicles and ensuring optimal graft health and growth. Another benefit is that only the hair harvested for transplantation is clipped short, unlike FUE, which requires trimming a larger area. Consequently, with FUT, the donor scar remains concealed by the surrounding hair and is not visible, even immediately after the surgery, which is especially significant for our female patients. However, the drawback of the FUT technique is that it leaves a linear scar that may become visible if the hair is cut shorter than a #3 razor guard.

The alternative to FUT surgery is known as follicular unit extraction (FUE). In FUE, donor follicles are individually extracted by hand using a precise, motorized surgical punch typically measuring only 0.8-0.9mm in diameter. The donor sites are small enough that they do not require sutures for closure; instead, they naturally heal within a few days.

The advantage of the FUE technique is its ability to avoid a longer, more noticeable scar, possibly cutting the hair in the donor area to a fade or even shaving it with minimal to no visible scarring. However, a potential disadvantage of FUE surgery is that it may take longer, and there is a theoretical risk of higher follicle transection rates, especially with certain automated graft harvesting systems that utilize rotating sharp punches. At Follicle HT, we use state-of-the-art hybrid punches to minimize graft transection while maximizing viability and growth. Another drawback of the FUE technique is that a larger area at the back and sides of the scalp needs to be trimmed short for the graft harvesting process, which may pose an issue for female patients or males with longer hair who prefer not to cut short.

FUE surgery is occasionally promoted as a “no cut” or “no-scalpel technique.” However, we believe this characterization can be misleading for patients. While it’s accurate that FUE doesn’t entail a lengthy, linear incision or necessitate stitches, it results in tiny scars that may be noticeable in some patients if the hair is trimmed short or shaved.

Approximately 80% of our male patients choose to undergo FUE surgery. However, it’s crucial to acknowledge that FUT and FUE procedures have advantages and disadvantages. Unlike certain clinics, our team at Follicle HT is exceptionally skilled in both techniques, and our surgeons will assist you in determining which approach best suits your needs.

Utilizing local anesthesia, we perform hair transplantation procedures in a comfortable, fully accredited outpatient clinic. As our techniques typically involve minimal discomfort, there’s no need for general anesthesia, allowing patients to remain awake throughout the procedure. To minimize any discomfort, patients are administered pain medication and light sedatives orally. Additionally, we employ advanced methods of local anesthesia administration, resulting in most patients reporting only minimal pain.

The length of the procedure will depend on the number of grafts that are required to achieve the goals that we have set out. An extensive session may take 8-10 hours and a smaller or more targeted session only 2-3 hours. Most patients find that the time passes quickly as they read, watch Netflix or a movie, or simply relax and enjoy the experience.

Patients can return home on the same day as the hair transplant procedure. Typically, we apply a gauze dressing over the donor area, while no dressings or bandages are necessary in the recipient area. Upon leaving the office, some wear a baseball cap, bandana, or scarf. We recommend having a friend or family member drive you home, or we can arrange a car service for your convenience.

After undergoing strip surgery (FUT), it’s common to experience tightness and discomfort in the donor hair area. For those who have had an FUE procedure, temporary discomfort may still occur despite the absence of a scalpel incision, stitches, or linear scar. Typically, minor pain can be alleviated with acetaminophen (Tylenol) or ibuprofen (Advil) and cool compresses. However, we offer prescription pain medication for individuals who may require it during the initial one or two days.

The recipient area where the grafts have been placed will tend to form crusts and scabs, generally present for about one week. Swelling in the transplanted area may persist for several days following the procedure, occasionally extending to the eyelids and cheeks, resulting in a temporary puffy appearance. This is a common post-operative effect and should not cause concern. Typically, it resolves within 2-3 days.

You will receive detailed, written instructions regarding the care of both the donor and recipient areas following your transplant. Hair washing can typically begin on the first or second day. While most patients take a few days off from work, essential activities such as talking on the phone and using a computer can be resumed on the first day. Typically, any swelling and redness subside within a week, rendering the transplant virtually undetectable. Light exercise and other activities can normally be resumed within 5-7 days, although we advise refraining from strenuous exercise and swimming for 2-3 weeks.

The recovery duration following hair transplantation varies depending on the procedure’s scope and the transplant locations. Discomfort is typically mild and manageable. The time needed off work also hinges on one’s job type. While we usually advise taking at least 2-3 days off, many patients return to handling phone calls, emails, and computer tasks on the day following the procedure. Some patients even manage business calls or work on their laptops or phones during the procedure!

As the swelling subsides and the minor scabs at the recipient sites naturally shed, most patients appear normal for in-person work or Zoom calls within 7-10 days. Following a strip (FUT) procedure, where only the donor area is trimmed, it remains entirely concealed by the surrounding hair and is not visible in the case of an FUE procedure, where a larger area is cut at the back and sides of the scalp, surrounding hair quickly grows over the donor sites, resulting in a “high and tight” haircut appearance within a few days.

You can resume light duties within 5-7 days if your job involves physical labour. However, we advise taking 2-3 weeks off from strenuous work, intense exercise, and swimming.

As previously mentioned, it’s common to experience mild swelling and redness for approximately a week, prompting many individuals to take a few days off. Once any temporary redness or swelling subsides, your appearance will return to its pre-procedure state. Following a strip (FUT) procedure, where only the donor area is trimmed, it remains entirely concealed by the surrounding hair and is not visible. Conversely, with an FUE procedure, a larger area at the back and sides of the scalp is typically trimmed. However, the surrounding hair quickly grows over the donor sites, resulting in a “high and tight” haircut appearance within a few days.

After the initial recovery period, the transplanted hair follicles remain dormant in the scalp. Consequently, your transplant will become inconspicuous, and it will be virtually undetectable to others that you have undergone the procedure.

Within a few days of the procedure, the results are essentially undetectable. Within about 3 months (sometimes a little longer for women), the transplanted hairs will start to come in and will continue to grow at the same rate as they did in their original location – usually about 1cm per month. Within a year or so, the full effect of the procedure can be seen. Because the change is gradual as the transplanted hairs grow in, there is never a sudden change in your appearance. As the hair begins to thicken, often patients begin to have friends and colleagues comment that they are looking younger or more fit, asking questions like “Have you lost weight?” or “Have you been working out?”. Some patients will elect to use medical treatments to enhance graft growth and prevent future loss of the surrounding non-transplanted hair.

The transplanted hairs are essentially permanent and will continue to grow for as long as they would have in their original location. In men the donor area at the back and sides of the scalp is generally highly reliable and is effectively permanent. Women tend to have more diffuse patterns of hair loss so while the transplant is expected to be very long lasting or permanent, the donor area can be slightly less reliable than it is in men.

It is important to remember that while the transplanted hairs are generally permanent, as time goes on, there may be ongoing loss the surrounding non-transplanted hair, especially if medical treatment is not used. For this reason, some patients return for further transplant sessions to catch up with progressive hair loss in the transplant area, or to add thickness, density and refinement. At Follicle HT, our approach is to have each session continue to look completely natural for the rest of the patient’s life regardless of the extent of future hair loss or future surgery.

The number of the sessions that you will need depends on the extent of your hair loss and your treatment goals. Natural looking results can be achieved with only one procedure but those with a large area of baldness, or those that desire a great deal of density may require more than one session to achieve their goals.

Although advancements in medical treatment with medications such as Propecia and Rogaine have given us a much more stable canvas to work on by slowing or stopping progressive hair loss, if you continue to lose the surrounding non-transplanted hairs over time, you may find that you eventually want to consider a further session in order to address ongoing thinning of the non-transplanted hair.

It is important to understand that regardless of the number of procedures that are ultimately performed, each session is designed to “stand alone” so that even if all of the surrounding hair is eventually lost, the permanent transplanted hairs will continue to look natural (albeit thinner) for the rest of your life.

At follicle HT, our goal is to achieve satisfying results for our patients. We are not dogmatic and believe that a surgeon should “never say never and never say always”. Our approach is to consider the patient’s wishes, as well as technical factors such as gender, hair and skin color, donor supply, hair caliber and curl. We help each individual patient decide what specific techniques will yield the most appropriate balance of coverage, density and naturalness for his or her hair transplant.