Hair Transplants: Things to Consider First

by Kevin Rands | May 15, 2016 9:42 pm

HairlossTalk’s Science Writer, Dr. Deborah O’Neil gives an overview of the hair transplantation process, and some editorial insight into the benefits and pitfalls of such a procedure…

A permanent solution

Hair transplantation is the only guaranteed permanent solution for the reversal of pattern-baldness. You may have come to the end of the road in terms of the options left open to you. The drugs and lotions haven’t worked and as a consequence, you’re left considering surgery as the way forward. So what does it actually involve? How does it work? How will you look following transplantation and will it really be a permanent reversal of your hair loss?

Surgical options

There are actually four types of surgery that can be employed to correct baldness or thinning. The first and most common is hair transplantation or grafting. This procedure involves the removal of live, hair-bearing follicles from the sides or back of the head and transplanting them to the balding areas of the scalp. The next is flap surgery, where a large hair-bearing portion of scalp is partially detached and used to cover an adjacent bald area. Scalp Reduction is another option, in which a section of bald scalp is removed and adjacent hair-bearing sections are sutured together. This surgery can be performed in combination with transplantation to fill in the remaining bald areas. Finally, Scalp Expansion in which silicone implants are inserted underneath the skin to expand sections of hair-bearing scalp, after which, flap surgery can be performed to replace adjacent balding areas of scalp with this extra hair-bearing tissue.

A natural-looking result

The evolution of hair transplant surgery has been such that physicians now produce more natural results with this technique than ever before, from which a larger than ever cross section of thinning or bald men and women can now benefit. Techniques have now been refined such that the hairs available for transplantation are used most efficiently. This is due to a combination of improvements in methods of harvesting hair, graft preparation, the creation of recipient sites in order to ensure maximal survival of transplanted hair.

Hair harvesting

Transplants are carried out on an out-patient office basis. You’ll be sedated before the process begins (generally with oral, valium-based medicines) and will receive local anesthesia (injections into the scalp). Donor hair at the back or sides of the scalp is first prepared by shaving. Transplanted hair will actually be less than one quarter of an inch in length in order for it to be more manageable during harvesting and graft preparation. This of course, means that you won’t actually see much hair immediately post-transplant. Patience is a big factor in this procedure. Once the anesthesia has taken hold, a scalpel is used to remove an area in the side or back of your scalp around half an inch wide by six inches. The small gap this leaves is then stitched back together. The tiny scar that results will be covered by your natural hair-line and in time, it will be virtually impossible for you, let alone anyone else, to detect where your new hair was grafted from.

So what’s so different about this hair that it too won’t fall out if moved around to my “bald patch”?

Your genes and androgens have conspired to rid you of a good proportion of your hair. The follicles they’ve wiped out were genetically programmed, even before you were born, to become sensitive to your hormones and eventually die as a consequence. In short, this means no more hair. However, in almost all cases of pattern baldness, you’ll have an area of healthy, full hair along the side and back of the scalp. These follicles were pre-programmed very differently; to not become sensitive to androgens and to continue to grow throughout your lifetime. These areas of hair demonstrate what is referred to as donor dominance. This means that it doesn’t matter where you move them to, these tough little follicles will grow permanently, even in an area where their predecessors where of a more fickle, kamikaze nature!

Graft preparation

This is the area that’s progressed in leaps and bounds technologically to bring much better transplant results. This is largely due to the advent of microtransplantation in which “plugs” of scalp containing large clumps of follicles have been replaced with combinations of mini- and micro-grafts. Micrografts or follicular units are the smallest of transplant grafts. These contain only one or two hairs within a live follicle. Minigrafts are slightly larger, with up to six hairs within each. More often than not, the lower the hair density per transplant, the more the results will better resemble natural hair growth. The number of grafts and type used will be dependent on your hair type, quality, color and the area to be transplanted. Specially trained technicians or generate these graft units by preparing the area of scalp your surgeon has removed under a specialist dissection microscopes and separating it into natural groupings of follicles containing between one and six hairs. Because over a thousand of these can be grafted in one transplant, it’s a labor-intensive step that requires many trained technicians. It’s not uncommon for 1,500 grafts to be implanted during the course of a single transplant procedure. You can expect as many as three of these graft sessions, each five to six months apart to allow for the healing and growth of the newly transplanted hairs, to achieve the results you and your surgeon are seeking.

A very recent advance in improving transplant outcomes at this stage of the process is the storage of donor graft units in solutions containing chemicals that inhibit programmed cell death (such as aminoguanidine, insulin, hydrocortisone, and 14,15-epoxy-eicosatrienoic acid) while they await transplantation. Hair shaft elongation has shown to be significantly increased in micrografts that have been stored in this way, so preventing programmed cell death of grafted follicles in this or similar ways may become routine in transplantation order to increase the viability of grafts and thereby the outcome of the transplantation procedure. Another way forward in terms of improving graft viability at the preparation stage may be frozen storage of harvested follicles at -20oC. A recent study has shown that grafts treated as such remain healthy for at least fifteen. This method may not only improve minigraft and micrograft viability, but may remove the need for second, even third graft harvesting, so that enough grafts are prepared and safely stored from one donor session, allowing more rapid and less traumatic sequential graft procedures.


Following several shots of anesthesia into the area in which the grafts will be implanted, numerous tiny incisions will be made into your scalp. To create hair that grows in a naturally random pattern, incisions will be made in irregular and varied patterns. The angle and direction of the incision will determine in which direction the hair will grow. Each graft is placed in this rather random pattern into the micro-incisions. This is a lengthy process as thousands of grafts are put in place. Automated transplant systems are now being developed to speed up this process. One such example is the Calvitron system, which with only one technician operating the machine, studies have shown it takes the surgeon and an assistant less that four hours to harvest and implant around eight hundred mini- and micro-grafts. Time and labor-saving systems such as these should certainly drive the cost of transplant surgery down and minimize the impact each session takes on your time.

What should you expect after each graft?

Once the last graft is implanted and you’re cleaned up and free to go, you’ll most likely be given pain pills to take with you just incase you have any discomfort. You’ll also be given an antibiotic to prevent infection of the donor and recipient sites and mild anti-inflammatories to reduce or eliminate swelling of tissue around the newly-grafted scalp. Ice packs also help to keep swelling down around the forehead. After two to three days, you’ll be able to rinse the graft region with sterile saline solution. You’ll have tiny scabs dotted around your new hair, covering the incision sites and saline helps to wash these away. After around ten days, you’ll have your stitches removed from the donor site and for the first time, will be able to wash the transplanted hair. After a month, you’ll be nicely healed. Be warned, as this is the time when your transplanted hair will shed. This is completely normal, so don’t panic! As tiny as they were, it wasn’t actually the hairs, but the follicles that were transplanted. By this stage the new follicles should be alive and well and taking hold beneath your scalp. You’ve gone back to looking just as you did pre-transplant, but this is just the beginning. After two to three months, you should start to see the results of this whole process; new hair starting to grow from a previously bald area of scalp. Lots of “mirror time” will be involved at this stage! Your new hair will gradually thicken up and although it’s not going to be as dense as your existing hair at first, it will look just as natural. Subsequent transplants will fill in this area and thicken out and expand your hairline back to something resembling its former self.

Hair transplantation Surgery Risks

As with any surgery, risk is a factor you must take into consideration before going ahead with hair transplantation. These include reactions to the local anesthetic and sedatives, infection of the donor and transplant sites, numbness around the donor or recipient site (usually temporary) and in the worst case, failure of the hair to survive the procedure. You must only ever consider using an experienced, reputable specialist dermatological surgeon. Do your homework, shop around, make visits to their offices for consultations and ask to see plenty of before and after photos of their previous work. The results of your surgery will be permanent and this is a procedure for which you’ll have to part with the best part of tens of thousands of dollars. For the sake of a couple of extra months wait while you do your research, be patient and get it right. Follow the links on this web site to see how you take the first steps.


Hair transplantation is a permanent solution to pattern baldness. It’s a major step to take however, and one that involves a lot of perseverance. Great results are almost guaranteed, but the process is long haul. It could take three years until your grafts are complete and your new hair is growing. Consider all of your options before taking the plunge, consult with the experts and do your homework. Choose the best surgeon available and together, plan your grafts down to the very last detail. Approach the whole process with the right frame of mind, be positive but realistic and the results will be more than worth the wait; the end result being the permanent restoration of your natural hair-line. If hair transplantation surgery is the route for you, think of it as a long-term investment (the cost and not just the surgeries will sting more than a little). Years of anguish over hair loss reversed in three years isn’t too bad a deal, particularly when the results and consequent boost to your self-esteem will last a lifetime.

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