Hair Transplant Surgery – 15 Things You Must Know In 2019

Hair loss affects millions of men and women around the world every year. Besides causing social disruption, balding can be associated with low self-esteem in both men and women.

In the last 30 years, there have been great strides towards developing a permanent solution to these problems. Although the search for an effective, all-round solution remains inconclusive, one successful development has come in the form of hair transplant surgeries.

1. What is Hair Transplant Surgery?

Hair transplantation is a surgical procedure used to treat hair loss permanently. It involves harvesting hair-bearing skin from one part of the scalp called the ‘donor site’ and grafting the skin onto a bald or balding part of the scalp, called the ‘recipient site’.

The donor site is usually the lower side of the head while the recipient site is usually the top or front part of the head. The procedure is carried out in a medical chamber under local anesthesia.

2. Is Hair Transplant Surgery a Cure For Male Pattern Baldness?

No. All what the procedure succeeds in is to cover the already bald scalp with hair grafts, but it does not protect you from further hair loss if you don’t follow what I teach here at Hair Loss Revolution.

3. Who is a Good Candidate for Hair Transplant Surgery?

A person is considered to be a good candidate for a hair transplant if they have a stable supply of donor hair, sufficient to cover the area that has already suffered from lost hair, as well as any areas that might lose hair in the future.

Patients over the age of thirty are usually the best candidates for a hair transplant because they have a well-established balding pattern compared to younger patients. Other good candidates include:

  • Women with thinning hair or pattern baldness;
  • Men with androgenetic alopecia, commonly known as male pattern baldness;
  • Anyone who has experienced hair shedding after a surgical procedure, such as a facelift;
  • Anyone who has had hair loss resulting from burns or some other form of scalp injury;
  • Men and women who wish to change the shape of their hairline.

The procedure is not a good option for:

  • People who have lost hair in the process of using certain medications and treatment like chemotherapy;
  • People who form thick and sometimes fibrous scars after surgery;
  • People without enough donor sites that can cover bald areas of the scalp;
  • People with very widespread hair loss throughout the scalp, especially women.

4. Is a Hair Transplant Surgery Worth It?

There are many hair growth treatments that have been developed over the years but none of these treatments has been found to offer a permanent and natural solution. More and more patients are turning to hair transplant surgery because it offers better results compared to other treatments.

According to the results of a study published in the National library of Medicine, hair transplants offer significant aesthetic benefits to both men and women. Hair replacement surgery has evolved so much so that a combination of minigrafting and micrografting has resulted in health practitioners finding more efficient ways to utilize donor hair.

Improvement in technology has, in turn, improved methods of harvesting hair, creating and placing grafts leading to a high percentage of hairs being able to thrive under transplantation. Other benefits of a hair transplant include:

  • The surgical process itself is painless and only requires local anesthesia. The discomfort experienced after the process is generally tolerable and you’re likely to be treated on an outpatient basis.
  • The surgery brings with it astounding emotional benefits. Patients attain a look that makes them feel more confident and self-assured.
  • Results are achieved faster, safer, and more pleasingly, thanks to today’s advanced technology.

5. Things That You Should Consider before Deciding to Undergo a Hair Transplant Surgery

Before making the decision to take your scalp under the scalpel, there are a few important issues you will need to keep in mind:

  • Have realistic expectations – a hair transplant is unlikely to give you a full head of hair, especially if you start off without much of it. Results generally depend on the thickness and the density of the remaining hair. There have been reports of unsuccessful transplant attempts around the world. Sometimes one has to undergo surgery for up to three times before transplantation is successful
  • Cost – Transplantation costs depend on the technique used, the extent of hair loss, the physician’s reputation and expertise among other factors. It is common practice for Medicare and private medical insurers to exclude cosmetic surgery from rebates. However, hair replacement resulting from burns or trauma is considered a reconstructive treatment and may qualify for financial support.
  • A hair transplant is not a cure for male baldness. The grafted hair will cover the bald scalp but cannot protect you from further balding.
  • Medications – You are advised to disclose any medication that you take on a regular basis or have recently used, including over-the-counter supplements like vitamins.
  • It does not provide instant results – the grafted hair can take up to 9 months before it has developed roots and began to fill in.
  • You might experience some complications/side-effects after undergoing surgery. In addition, there are some habits that have been found to increase the risk of complications, especially smoking.
  • After surgery, you might be subjected to continuing medical treatment for a certain period of time.

6. Hair Transplant Surgery for Women

According to the American Hair Loss Association, nearly 90% of men with baldness make good candidates for hair transplantation but very few women can make good candidates. There are two main reasons for this:

  • Most women have diffuse hair loss which means that they experience an overall thinning of hair in all areas of the scalp, including the lower side of the head where hair grafts are commonly harvested. This means that the donor site in women is unstable and cannot be relied upon to provide healthy hair grafts that can be transplanted successfully without falling out soon after surgery. In fact, any physician who attempts to transplant hair from an unstable donor site is considered unethical and just taking financial advantage of the patient.
  • Unlike men, women will usually lose hair at the top and back of the head but tend to keep the frontal hair line still intact. Thus, most women are not worried about their facial appearance and are more concerned about hair volume in general. Unfortunately, hair transplants don’t do much to increase hair volume. Transplantation largely succeeds in moving hair from one part to another.

Experts contend that the only women who are potential candidates for hair transplants are:

  • Women who suffer from lost hair due to burns, accidents, or some other form of trauma;
  • Women who have a distinct pattern of hair fall that is similar to that in men. This includes vertex thinning, hairline recession and having a donor site that is not affected by androgenetic alopecia;
  • Women who have lost hair due to mechanical or non hormonal alopecia;
  • Women who have suffered from alopecia marginalis, a condition that has characteristics similar to those of traction alopecia.

7. Types of Hair Transplant Surgeries

There are two main techniques for harvesting hair follicles and each method has its own unique advantages and challenges. These are:

Regardless of the technique used, the scalp is shampooed and injected with local anesthesia. In addition, the scalp must be treated with an antibacterial agent so as to keep infections at bay. We now look at each technique in detail:

Follicular Unit Transplantation

This method, commonly known as strip harvesting, involves harvesting a strip of the skin from the donor site, usually the posterior scalp. Hair around the donor area is initially clipped to a length of about 2mm.

Immediately the donor site is numb, a physician uses a scalpel to remove ‘strips’ of hair-bearing scalp. Each strip can be 1.5cm by 30cm in size. The donor site is then sealed immediately and attention shifts to the hair-bearing strips that have been removed.

Under microscopic visualization, the physician or assistant technicians dissect the removed tissue into individual follicular unit grafts. Any excess fatty or fibrous tissue is removed at this point, while still avoiding damage to the fine, single-haired grafts. The goal is to produce grafts that are healthy and have a natural appearance.

Using small blades, the surgeon then punctures the scalp in a predetermined pattern so as to produce a realistic hair pattern. The grafts are then delicately inserted in place. This procedure leaves a linear scar at the donor area that can take up to two weeks to heal completely.

Follicular Unit Extraction

Follicular unit extraction involves harvesting of individual follicular units. Each unit contains 1 to 4 hairs. The physician makes tiny punches on the scalp of between 0.5mm and 1.0mm in diameter. Next, the receiving sites are punctured using very small blades or fine needles.

The grafts are then put in place in a predetermined pattern and density. The surgeon angles the wounds in a consistent manner so as to produce a realistic hair pattern. Recovery from the procedure takes less than 7 days.

Follicular unit extraction consumes more time compared to strip surgery, with the actual amount of time depending on the surgeon’s expertise, the extent of hair loss and speed in harvesting.

The results of this procedure appear more natural when compared to FUT, especially because it leaves behind negligible scarring. However, the technique requires more expertise and only a few surgeons have the skills to perform the procedure.

8. FUT Vs FUE: Which One is Better?

Both methods have unique advantages and challenges. Perhaps it’s best to summarize the differences between the two techniques before making a decision:

Follicular unit transplantation(FUT) Follicular unit extraction (FUE)
Procedure
Donor source
Length of surgery
Wounds
RecoveryScarringCost
A surgeon uses a scalpel to harvest a strip of graft hair from the donor site. Technicians can perform extraction

 

Main source is mid-rear scalp where the patient’s hair is thickest

5-7 hours

 

Stitches/sutures are used

 

Up to 2 weeks

Linear scar

$$

Microsurgical tools are used to extract individual hair follicles from the donor site. The law usually prohibits individuals unlicensed to carry out surgery from performing extraction

Any area on the scalp

 

Longer times including the possibility of multiple sessions

No stitches/sutures are used

 

Up to 7 days

Negligible scarring

$$$

Table1: Summary of the main characteristics of FUT and FUE

Overall, most people prefer FUT to FUE because of several reasons:

  • Less damage to hair grafts: Follicular damage is experienced in both techniques. However, in the FUT technique, extraction of hairs from the harvested strip is done under a microscope increasing the chances of safe removal of healthy follicles.
  • The surgery takes less time: The FUT technique allows the surgeon to perform surgery together with technicians who can carry out extraction of follicles from the harvested strip as the surgeon covers the wounds left on the scalp. This way, the team works faster than the FUE surgeon who cannot be allowed to seek assistance from unlicensed individuals.
  • Affordability: The fact that FUE can only be carried out by experts means the cost is likely to be higher compared to FUT.
  • Less traumatizing: FUT provides fewer traumas to the scalp because the grafts are removed in one strip. In FUE, the surgeon makes multiple punches on the scalp to singularly remove follicles. The multiple punches are more traumatizing to the head.

The cost notwithstanding, FUE can also be a good option because it is less painful than FUT. You might also opt for this technique since there are no stitches required and it does not leave behind a linear scar on the scalp. Other factors to consider when choosing a hairline restoration technique are:

  • Country in which to undergo the surgery
  • Distance from your home or living area to the clinic of your choice. It’s advisable to choose a clinic that’s near your residence because it makes post- surgery care more convenient.

Choosing between the two techniques can be tricky.

However, the best thing to do is to seek professional consultation from a physician who should be able to determine the best technique for you taking into account the amount of hair lost, the size of the thinning area and the quantity of donor hair available.

I’ve written about hair transplant timelines here.

9. Hair Transplant Surgery Complications

According to research results published in the National Library of Medicine, hair transplants are associated with postoperative complications in the donor or recipient area due to idiopathic or surgical causes. These complications include:

  • Bleeding: Although bleeding is rare, it can be stopped with simple pressure and is usually solved by additional stitching
  • Numbness: the donor area might experience transient numbness for up to 18 weeks but it is usually not troublesome and should go away without any harm
  • Hiccups: About 5% of hair transplant patients experience hiccups which can last for several hours after surgery
  • Infection: This happens in just one person out of a thousand cases and can be solved by use of antibiotics
  • A crust may form on the donor site
  • Itching
  • Swelling of the scalp
  • Scalp laxity i.e. loose scalp
  • Tufts of hair that look unnatural

10. Self-Care After Hair Transplant Surgery

  • You are advised to follow all instructions given to you by your physician. Follow stipulated guidelines on looking after the wounds.
  • You should not hesitate reporting any severe pain, bleeding or some other symptoms.
  • Surgeons advise you to keep away from strenuous activity that might bring about a surge in blood pressure, making you bleed. It might also be necessary to avoid sex for up to 10 days because of similar reasons.

11. Hair Transplant Costs

For many people, cost is one of the most important factors that they consider when deciding whether to have a hair transplant. While FUT and FUE have made a hair restoration surgery very effective, the cost is not insignificant. Preparation for your hair transplant should include financial budgeting.

However, the good news is that the average restoration cost has reduced considerably due to competition. The cost itself is influenced by the following factors:

  1. Number of grafts needed: The cost is greatly influenced by the number of grafts that the patient requires. The number of grafts is itself influenced by the extent of hair loss. More grafts mean more money and vice versa
  2. Reputation of the surgeon: Surgeons with excellent reputations usually charge more, but their level of service is likely to be outstanding.
  3. Location of the surgeon: Cost varies depending on location. Surgeons based in countries where cost of living is high generally charge more. For instance, the cost of hair transplant in Mumbai, India is likely to be less than the cost in Vegas, USA.
  4. Surgical technique: FUT and FUE have different costs
  5. The number of sessions needed: While some clinics price hair transplant surgeries based on the number of grafts, some consider the number of sessions that you need, especially if the technique used is FUE
  6. After-care costs: After surgery, you are likely going to be provided with a special shampoo or antibacterial agent. These items will push up the cost of surgery even further.

12. How the Number of Hair Grafts Needed Affect the Cost

The average cost per graft is between £2 and £5. The number of grafts required is categorized into the following scales:

         Scale        Description of hair loss Number of grafts Price range
Norwood 2 Early receding hairline 400-800 £800-£4000
Norwood 3 Receding hair line 800-1000 £1600-£5000
Norwood 4 Androgenetic alopecia 1000-1500 £2000-£7500

Table 2: Categorization of the number of grafts required and costs

Most individuals will fall under one of the 3 categories outlined above. However, patients with severe androgenetic alopecia, at Norwood 7, may find themselves in need of up to 7000 grafts, translating to about £35000. However, most clinics offer discounts to patients thereby slashing the total cost.

Cost of Hair Restoration via FUT

As we saw earlier, follicular unit transplantation requires less time and skill from your physician. As such, the cost associated with this technique is lower. However, most surgeons price FUTs based on the number of sessions that you require. This is because it is often very difficult to predict the number of healthy grafts that will be harvested from each strip.

Cost of Hair Restoration via FUE

Being the most advanced hair transplant technique, follicular unit extraction is more expensive compared to FUT. The cost takes into account the surgeon’s reputation, skill and work required to extract grafts from the donor area. The average FUE session costs between £2000 and £7500.

Cheap Hair Transplant Surgery

To beat the competition, some surgeons result to lowering hair transplant costs significantly. For instance, there are clinics in Manchester, UK, that charge as little as £990 for a full FUE session. In South Africa, you will find surgeons ready to accept £1.5 per graft.

Dangers of Low Cost Hair Restoration Services

While it’s advisable to do your research and find out the cheapest hair transplant services around the world, it is worth remembering that you get what you give! A cheap hair transplant may end up being expensive after all, especially if the grafted hairs fall out soon after surgery prompting more surgeries. In some cases, you could find yourself developing serious complications due to poor service offered by some clinics.

13. Best Hair Transplant Surgeons

There are a number of surgeons who have built themselves excellent reputations in the field of Hair care and surgery. If you are seriously considering a hair transplant, your aim should be to find the best surgeon available. In this article, we shall look at a few of them:

(1) Dr. Scott F. Alexander – USA

Dr. Alexander is credit with founding Biltmore Surgical Hair Restoration which is located in Phoenix Arizona. He has a Bachelor of Science degree from Brigham Young University and underwent residency training in general surgery at Mt. Sinai Medical Center in Ohio.

His clinic offers patients state of the art equipment and latest technology in FUE. His charges are $4 per FUT graft and $8 per FUE graft.

(2) Dr. Raghu Reddy- UK

Dr. Raghu boasts over 6 years of experience performing follicular unit extraction at Restore Hair Clinic in London, England. He, assisted by technicians, can perform up to 2500 grafts per day and 50 follicular units per square centimeter.

He was inspired to study and practice hair surgery after a personal battle with baldness. His pricing policy is based on the hair density desired by his patients. He is also a member of the British Medical association, the International Society of Hair restoration Surgery, and the British association of Hair restoration Surgery.

(3) Dr. John Gillespie- Canada

Dr. Gillespie has performed hair transplantation since 1976. He does all patient consultations in person and at no charge. You can learn more about him and his clinic here.

Other renowned hair surgeons include:

14. Celebrity Hair Transplants

Celebrities have not been left behind as the rest of us embrace hair transplantation as a proven modern way of dealing with hair loss.

In the era of smart phones, digital cameras, and multiple social platforms, it is easy for the public to note even very minor changes in their idol’s hairline and general hair thickness. Here are a few high-profile personalities who have done hair transplants.

Johnny Depp Hair Transplant Surgery

Johnny Depp is a Hollywood star who has featured in numerous movies and television shows including 21 Jumpstreet, war drama platoon and as Captain Jack Sparrow in the hit series “Pirates of the Caribbean”.

Now in his 50s, Johnny Depp is famous for his thick curly hair and low hairline but what many people do not know is that he has not always been that way. A comparison of his photos taken during the early, mid and present stages of his career, reveal conspicuous differences in his hair line.

Though he has never publicly acknowledged having undertaken a hair transplant, his pictures give it all away. His pictures back in his early 20s show a receding hairline.

If you compare them with the current ones, there is a notable difference which suggests he might have had a hair transplant at some point in his career. It is believed Johnny must have undergone surgery that came out great, giving him a natural-looking hairline.

Perhaps he offers us the best evidence towards the argument that hair transplants have the ability to produce near-perfect, permanent results.

Wayne Rooney Hair Transplant Surgery

The Manchester United ace is another classic example of successful hair transplantation. You only need to go back to the 2010/2011 English Premier League season match day videos to watch a bald Rooney.

Fast forward to 2016 and the player’s hairline and hair density have undergone remarkable transformation. Wayne Rooney is on record declaring his frustration at losing hair even before his 25th birthday. Thanks to Harley Street Hair Clinic London, the frustration is all gone.

Although Rooney had to repeat the procedure for a reported 3 times between 2011 and 2014, all seems to have finally worked out for him going by his appearance in 2016. He is reported to have spent about £30000 in the process.

Jason Donovan Hair Transplant Surgery

The Australian pop star famously announced to the world that he had done “a Rooney” just a few months after Wayne Rooney himself had spoken out about his own hair transplant. In an exclusive interview with the Sun, Jason Donovan enthused that he had been impressed by the results of the procedure.

Your Hair, Your choice

At the end of the day, you are the only one who can make the final decision on whether to have a hair transplant or not. In this article, we have outlined the issues you need to know so as to make an informed decision.

Hair transplantation is a permanent solution to already lost hair, but cannot save you from losing hair in the future. Although hair transplant cost should always be an important consideration, it should not be the only determinant.

Most importantly, you should remember that it does not work for everybody. The best decision can only be arrived at after consultation with your physician.

15. Are There Any Other Options Than A Hair Transplant?

There are a few other options that you have at your disposal, beside a full-blown hair transplant. Although what I’m about to describe might not be as simple and straightforward as surgery, this method is 100% natural and is clearly much less expensive.

You can learn about non-surgical hair restoration methods here.

There is a way to re-activate dormant hair follicles along the hairline, and typically a cm or so out from the hairline where the follicles aren’t completely dead yet.

I’ve written about the full method, to remove DHT from your scalp and stimulate new hair growth, but here is the summary.

The first thing is to do a salicylic acid peel. This removes the scalp sebum which can stop new hair growth and contains DHT. Or you can use a salicylic acid shampoo, but I recommend the peel instead.

After the peel, we use what is called a derma-roller. This roller has tiny metal spikes that penetrate the first layer of the skin and stimulate collagen production.

The tiny spikes penetrate the outer layer of skin which causes cellular growth and stimulates the capillaries to repair the skin. This increase blood flow and help to re-invigorate the hair follicles.

The next step is to create a a hair growth serum. This serum contains a specially created combination of hair growing ingredients including emu oil, saw palmetto, apple polyphenols and more.

These special ingredients when combined are seriously powerful at creating new hair growth.

When combined with the dietary and lifestyle changes that I teach here you’ll actually be able to re-grow at least some of your hair.

The other thing to keep in mind, if you want to go ahead with a hair transplant you’ll traditionally need to take finasteride combined with minoxidil to keep the remainder of your hair from receding higher.

This essentially means being on these drugs for the rest of your life – not exactly an exciting prospect.

That is why, for any one who wants to have a hair transplant, I recommend following my natural techniques to stop any further hair loss right away.

With your hairline no longer receding you can now make an informed decision about whether you want to fill in any lost hair with transplanted hair.

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