How does hair transplant work?
Hair transplantation is a surgical procedure that moves hair follicles from a part of the body called the ‘donor site’ to bald or balding part of the body known as the ‘recipient site’. It is primarily used to treat male pattern baldness. In this minimally invasive procedure, grafts containing hair follicles that are genetically resistant to balding, like the back of the scalp, are transplanted to the bald areas like the top of the scalp or crown. Hair transplantation can restore a natural appearance to areas with hair loss that develops from age, genetics, injury, or skin conditions.
The process
Hair transplantation involves the following steps:
- Local anesthesia is administered to numb the scalp during transplant surgery.
- The surgeon then removes strips of bald resistant donor hair from the back or sides of the scalp.
- The grafts are separated into individual follicular unit grafts containing 1 to 4 hairs.
- Recipient sites are created by dividing the bald area into different parts and meticulously planting the grafts.
- The grafts heal into the skin’s surface and after 3 to 4 months, new permanent hair growth starts emerging.
Types of hair transplant techniques
There are two main types of hair transplant techniques:
- Follicular Unit Transplantation (FUT): Also called strip harvesting, this technique involves removing a 6-10 inch long strip of skin from the donor area. The strip is dissected to obtain hundreds of grafts to implant on the bald sections.
- Follicular Unit Extraction (FUE): In this technique, the surgeon extracts each follicle individually from the donor area using a punch tool. The hairs are implanted into the recipient sites one by one.
FUE is more advanced, minimally invasive and enables transplanting hair in delicate recipient areas like the temples and forehead.
How many grafts do you need for a hair transplant?
The number of grafts required in a hair transplant depends on:
- The extent of your baldness determined by the Norwood scale
- The area of transplantation e.g. receding hairline or bald crown
- The desired density or fullness of hair regrowth
- Your existing hair and scalp laxity
According to the American Board of Cosmetic Surgery, on average, a patient needs around 2,000 to 3,000 grafts for a transplant session. Here’s an estimate of the number of grafts needed per Norwood stage:
| Norwood Stage | Grafts Needed |
|---|---|
| Level 1 | 500 – 1000 grafts |
| Level 2 | 1000 – 1500 grafts |
| Level 3 | 1500 – 2500 grafts |
| Level 4 | 2000 – 4000 grafts |
| Level 5 | 3500 – 5000 grafts |
| Level 6 | 4500 – 6000 grafts |
| Level 7 | 5000 – 7000 grafts |
However, your surgeon will determine the exact number of grafts needed after evaluating your level of baldness and hair loss goals.
How many hair transplant sessions will you need?
The number of transplant sessions depends on:
- The amount of your hair loss
- Available donor hair supply
- The number of grafts transplanted per session
According to experts, here’s an estimate of the typical number of sessions needed as per the Norwood scale:
| Norwood Stage | Sessions Needed |
|---|---|
| Level 1-2 | 1-2 sessions |
| Level 3 | 2-3 sessions |
| Level 4 | 3-4 sessions |
| Level 5-6 | 4-6 sessions |
| Level 7 | 6-8 sessions |
Each session is usually spaced 8-12 months apart to allow the scalp to heal. Approximately 1000-1500 grafts can be transplanted per session. With an average of 5000 total grafts needed for advanced hair loss, you may require around 3 to 5 sessions.
How many donor hairs do you need for a transplant?
The number of donor hairs needed depends on the total grafts required. Each follicular unit graft contains 1-4 hairs. On average, you need:
- 2 donor hairs per graft if transplanting single hair grafts
- 3-4 donor hairs when using 2-3 hair grafts
So approximately 6000-8000 donor hairs are needed for a 3000 graft hair transplant session.
The back and sides of the scalp have about 15,000 hairs available as donor hair. So most patients have sufficient permanent healthy hair in the donor zones even for multiple sessions.
How many hair transplants can you get in a lifetime?
There is no definitive limit to the number of hair transplant procedures you can get over your lifetime. However, some considerations include:
- The total amount of donor hair available is finite. Head has about 100,000 hairs with 50% available for transplant.
- Each transplant session uses up some donor reserves. Approximately 10-15% of donor hair is used per 1000 graft session.
- Too many procedures can lead to overharvesting of hair from the donor area resulting in visible thinning.
- The scalp has a limit for how many grafts it can support due to decreased circulation and tissue stretch.
According to the International Society of Hair Restoration Surgery, it is recommended to limit the number of transplant sessions to:
- 2-4 procedures for early stage baldness
- 6-8 procedures for advanced stage hair loss
Procedures done years apart with modest graft numbers ranging from 500-1500 grafts per session are safer and provide natural looking results over a lifetime.
How long does a hair transplant last?
A hair transplant when done properly can be a permanent solution for hair loss. The key factors determining the longevity include:
- The use of your own natural and genetically resistant hair from the donor area prevents future balding of the transplanted hair.
- The results are permanent as the hair follicles taken from the back of the head are resistant to the hormone DHT causing baldness.
- The transplanted hair can grow lifelong just like the original hair. There is no limit on the duration the transplanted follicles will keep producing hair.
So in the absence of other scalp conditions, the transplanted hair can last indefinitely with proper care and maintenance. However, the non-transplanted original hair may continue to thin over time due to male pattern baldness.
What happens when you run out of donor hair?
In most cases, running out of donor hair won’t happen if you carefully plan your sessions. But in rare cases of excessive procedures, options include:
- Body Hair Transplants: Using body hair from beard, chest, arms etc. as donor grafts.
- Scalp Reductions: Removing the bald scalp areas and stitching the hair-bearing scalp sections together.
- Topical & Oral Medications: Minoxidil, Finasteride, PRP to strengthen existing hair and prevent further loss.
- Non-surgical Hair Replacement: Hair systems, concealers, wig to add the appearance of fullness.
Ultimately, prevention is best by not overharvesting donor hair. Planning procedures properly with modest graft numbers provides you lifelong natural transplanted hair.
How to determine if you are a good candidate?
The best candidates for hair transplants share these qualities:
- Have pattern baldness limited mainly to the front, top or crown scalp sections.
- Have a clearly defined area of stable healthy hair in the donor zone for harvesting grafts.
- Have reasonable transplant goals within the limits of their donor hair supply.
- Are in overall good health with no uncontrolled illnesses.
- Do not have unrealistic expectations from the transplant regarding the look of fullness.
- Are committed to caring for their transplanted hair lifelong.
Your doctor will screen you to ensure you meet the criteria to safely undergo multiple transplant sessions for achieving your hair restoration goals.
Am I too young for a transplant?
Doctors generally recommend a minimum age of 25 for undergoing a hair transplant. Here are some considerations regarding age:
- Allows the hair loss pattern to fully stabilize and confirm it is male pattern baldness.
- Provides adequate donor hair reserves for harvesting grafts.
- Reduces chances of experiencing further hair loss later in unsafe zones.
- Better healing and regeneration occur in younger skin and scalp tissues.
- Being younger lowers risks of surgical complications during the procedure.
In some cases, patients below 25 who have shown hair loss stabilization for a few years may be considered for transplant. But being at least 25 years of age is recommended by the ISHRS before considering a hair transplant.
Should I get a hair transplant for receding hairline?
Yes, hair transplants are an excellent solution for restoring a receding hairline or temple balding. Key advantages include:
- Transplants with follicular unit grafts can recreat a natural looking hairline shape, angle and density.
- Hair extracted from the donor area is resistant to DHT hormone and won’t recede again lifelong.
- FUE transplant technique allows creating customized hairlines with precision and artistry.
- The aesthetic framing of the face is restored improving self-confidence and youthful appearance.
However, stabilizing hair loss with medication first is suggested. Transplants are best suited for receding frontal scalp areas with adequate donor reserves.
Conclusion
In most hair transplant patients, a maximum of 2 to 8 sessions with 500 to 1500 grafts per procedure can provide excellent coverage for pattern baldness over a lifetime. Taking a slow and steady approach avoids depletion of the limited donor hair. Being judicious with each session gives you a natural looking mane you can enjoy permanently.
