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 slow or stop pattern hair loss in a large proportion of patients. Some patients will even experience re-growth of hair. The mainstays of modern medical treatment include finasteride (Propecia) and minoxidil (Rogaine). Other treatments can include injections 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 is generally not prescribed for women. The mechanism by which Rogaine affects hair growth is less clear but is believed to relate to 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 greater 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 they are for the hairline and temples.

There are numerous other products available that are marketed as hair loss cures. While some of these may have effect, 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 is important to remember that if left untreated, pattern baldness will progress relentlessly. While some patients experience re-growth, the primary goal of medical treatment is to prevent additional 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. The key to medical prevention of hair loss is to start as soon as possible and preserve your existing hair. Although there are effective options to restore hair that has already been lost, our philosophy is that problems are almost always easier to prevent than they are to treat.

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 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). At Follicle HT, we achieve completely natural-looking results that are generally permanent by using exclusively single follicular unit grafts.

Follicular units are obtained from the more permanent areas at the back and sides of the scalp using one of two techniques. Follicular unit strip surgery (FUT) involves removing a strip of hair bearing skin from the donor area and then dividing that strip into follicular units for transplantation to the hairline or other areas. When performed using meticulous surgical technique, this procedure leaves a fine-line scar along the back of the scalp that is generally difficult or impossible to detect unless the hair in that area is cut very short. Alternatively, follicular unit extraction surgery (FUE) involves extracting the donor follicles by hand, one by one using a precise, motorized surgical punch. The advantage of this technique is that it avoids a longer, fine-line scar so that the hair in the donor area can generally be cut to a fade, or even shaved with little or no visible scar.

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

Follicular unit hair restoration involves transferring hair follicles from the more permanent areas at the back and sides of the scalp to areas that are bald or thinning. This generally involves the frontal hairline, midscalp, temples and crown. Hair transplantation can also be done to restore or create facial hair, and as part of the gender affirming process for transitioning individuals. Hairs transplanted are generally permanent and provide a long term solution to 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 who have visible hair loss, are healthy, and in whom there is no underlying medical condition requiring further investigation or treatment are 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 very difficult to predict what the eventual extent of hair loss will be in patients presenting in their teens and early 20’s so we often recommend at least a year of medical management to stabilize the situation before considering a transplant. If a transplant is undertaken on a relatively young patient, we create a conservative hairline that will continue to look natural even if the patient continues to lose the surrounding non-transplanted hair over time.

Taking the above into account, the right time to consider a hair transplant is when you look in the mirror, or at a photograph of yourself, and the hairline that you see does not reflect the way that you feel or the image of yourself that you wish to project 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 is the concept of the “follicular unit. When the scalp is 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. This is in stark contrast to the “hair plugs” and large “minigrafts” that could yield unacceptable cosmetic results.

At Follicle HT, we perform we use only single follicular unit grafts. This allows us to achieve results that are totally natural and truly undetectable. During a follicular unit hair transplant, the grafts are placed into very tiny recipient sites that are created in the bald or balding area using ultra fine needles or micro-surgical instruments. No tissue is removed in the recipient area and because of the refinement of the technique, it is possible to create very natural hairlines and to insert grafts in between existing hairs in order to add density to thinning areas.
There are 2 main techniques available: follicular unit strip surgery (FUT) and follicular unit extraction surgery (FUE).

Follicular unit strip surgery (FUT) involves removing a strip of hair bearing skin from the donor area and then dividing that strip into follicular units for transplantation to the hairline or other areas. When performed using meticulous surgical technique, this procedure leaves a fine-line scar along the back of the scalp that is generally difficult or impossible to detect unless the hair in that area is cut very short. At Follicle HT, our board certified head and neck surgeons often utilize a technique called “trichophytic closure” that allows the surrounding hairs to grow directly through the scar, making it very difficult to detect.

The advantage of FUT is that each graft is dissected individually under a stereotactic microscope leading to minimal rates of transected follicles and optimum graft health and growth. The other main advantage is that with FUT, only the hair that is being harvested for transplant is clipped short, unlike FUE that requires a larger area to be trimmed. This means that with FUT, the donor scar is covered by the hair above and is not visible, even on the day of surgery. This is particularly important to our female patients. The disadvantage of the FUT technique is that is does leave a linear scar that can be visible if the hair is cut very short (i.e. shorter than a #3 razor guard).
The alternative to FUT surgery is what is referred to as follicular unit extraction (FUE). This involves extracting the donor follicles by hand, one by one using a precise, motorized surgical punch that is generally only 08-0.9mm in diameter. The donor sites are so small that they do not need to be closed with sutures, but rather heal over on their own after a few days.
The advantage of the FUE technique is that it avoids a longer, fine-line scar so that the hair in the donor area can generally be cut to a fade, or even shaved with little or no visible scar. The disadvantage of FUE surgery is that it can take longer, and that theoretically, follicle transection rates can be higher. This may be particularly true with some of the automated graft harvesting systems that use rotating, sharp punches. At Follicle HT, we use state of the art hybrid punches that minimize graft transection and maximize viability and growth. A further disadvantage is that with the FUE technique, a larger area at the back and sides of the scalp needs to be trimmed short for the graft harvest process. This can be an issue for female patients, or males who have longer hair that they do not wish to cut short.

FUE surgery is sometimes marketed as a “no cut” or “no scalpel technique”. In our opinion, this is potentially misleading to patients. While it is true that FUE does not involve a long, linear incision and does not require stitches, it does leave very tiny scars that in some patients, can be visible if the hair is cut very short or shaved.

At this point, about 80% of our male patients elect to undergo FUE surgery but it is important to recognize that both FUT and FUE have advantages and disadvantages. Unlike some clinics, our team at Follicle HT is highly experienced at both techniques and our surgeons will help you to decide which technique is right for you.

We perform hair transplantation using local freezing in a comfortable, fully accredited outpatient clinic setting. Since there is normally only minimal discomfort associated with our techniques, a general anesthetic is not required and patients remain awake throughout the procedure. Pain medication and light sedatives are given orally to ensure that any discomfort is minimized and we utilize advanced techniques of local freezing administration so most patients report that they experience only minimal pain.

Dr. Korman is the Lead Assessor for Cosmetic Surgery for the College of Physicians & Surgeons of Ontario and is himself a professional inspector of out of hospital surgical facilities so you can be assured that at Follicle HT, we adhere to the highest standards of safety and sterility and comfort.

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 are able to go home on the same day as a hair transplant procedure. Generally, we place a gauze dressing over the donor area, but no dressings or bandages are required in the recipient area. Some people choose to wear a baseball cap, bandana or scarf out of the office. We ask that a friend or family member drive you home, or we can arrange a car service for you.

If you have had a strip surgery (FUT) procedure, it is normal to have some tightness and discomfort in the donor hair area. If you have had an FUE procedure, while there is no scalpel incision, stitches, or linear scar, there can still be some temporary discomfort. In general, minor pain can be managed with acetaminophen (Tylenol) or ibuprofen (Advil) and cool compresses, but we do provide prescription pain medication for those that need it for the first one or 2 days.

The recipient area where the grafts have been placed will tend to form crusts and scabs which are generally present for about 1 week. There can be some swelling in the transplanted area for several days after the procedure and this can sometimes track down to the eyelids and cheeks leading to a puffy appearance for a few days. This is a normal effect of the operation and is nothing to worry about. It is expected to resolve within 2-3 days.

You will be provided with clear, written instructions on how to care for the donor and recipient areas after your transplant. Hair can be washed on the first or second day. Most patients elect to take a few days off work but normal light activities such as talking on the phone and working on a computer can be resumed on day one. Typically, within a week or so, any swelling and redness has settled down and the transplant is invisible. Light exercise and other activity may be resumed in 5-7 days and we recommend 2-3 weeks off of strenuous exercise and swimming.

The recovery time from hair transplantation depends on the extent of the procedure performed and the location of the transplants. Discomfort is generally minor and easily controlled. The amount of downtime from work also depends on the type of work that you do. We generally recommend taking at least 2-3 days off, although most patients resume taking phone calls, answering emails and doing computer work on the first post-procedure day. Some of our patients even take business calls or work on their laptops or phones during the procedure itself!

As the swelling settles and the small recipient site scabs fall away, most patients look normal for in-person work or Zoom calls within 7-10 days. If you have had a strip (FUT) procedure, since only the donor area has been trimmed, it is completely covered by the surrounding hair and not visible. If you have had an FUE procedure and a larger area has been trimmed at the back and sides of the scalp, the surrounding hair grows in quickly over the donor sites so within a few days, it generally looks like a “high and tight” haircut.

If your occupation requires physical work, light duties may be resumed in 5-7 days. We recommend 2-3 weeks off of strenuous work, intense exercise and swimming.

As noted above, there is typically some mild swelling and redness for about a week and most people choose to take a few days off. After any transient redness or swelling has settled, you will look exactly as you did before the procedure. If you have had a strip (FUT) procedure, since only the donor area has been trimmed, it is completely covered by the surrounding hair and not visible. If you have had an FUE procedure, this generally requires trimming a larger area at the back and sides of the scalp. The surrounding hair grown in quickly over the donor sites so within a few days, it generally looks like a “high and tight” haircut.

The transplanted hair follicles remain dormant in the scalp for a period of time so after the initial brief recovery, your transplant will be difficult to detect and nobody will be able to tell that you have had anything done.

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.