What to Expect From Hair Transplant Surgery

Hair transplant procedures are performed to replace hair loss in areas that are either thinning or balding. They involve removing the hair on one part of the head (such as the back or side) and filling in an area that is thinning or has no hair.

The hair transplant process has been performed in the United States since the 1950s, but the technique has evolved quite extensively.

Types of Hair Transplant Procedures

There are two basic methods of transplantation: follicular unit strip surgery (FUSS) and follicular unit extraction (FUE).

With the FUSS method, surgeons remove a thin strip of hair-baring skin from a healthy area of your scalp (usually the back of the head) to use for transplant. The strip is divided into small groups of tissue with just a few hairs on each.

The prepared grafts are individually transplanted where you have thinning hair or bald areas. It leaves a linear scar in the donor area, which would be visible if you wear your hair short.

For the FUE procedure, the back of your scalp is shaved and individual hair follicles are removed from the area with 0.8- and 1-millimeter micropunch instruments, one at a time. Each graft consists of about one to six hairs. The grafts are then transplanted to the desired area.

FUE leaves small dots in the donor area that don’t require stitches and cause minimal scarring. The procedure typically costs about three times as much as the FUSS method.

Who Is Not a Good Candidate?

If you don’t have much hair on the sides and back of your head, you may not be a good candidate for a hair transplant. You might also not be a good candidate if you have a medical condition, including:

• Uncontrolled hypertension (high blood pressure)
• Blood clotting problems
• A history of forming excessive scar tissue

Selecting a Surgeon

When choosing a surgeon for a hair transplant procedure, it's important to consider:

• If the medical professional is specifically trained in plastic surgery or facial plastic surgery and certified by the American Board of Plastic Surgery
• How many years the healthcare provider has been performing hair transplant surgery
• If the office-based (outpatient) surgical facility is accredited by a state-recognized agency
• How the surgeon plans to perform the procedure and what the expected outcome is
• How complications that may occur will be managed
• What the surgeon has in mind if the surgery is unsuccessful

Before Surgery

Before the hair transplant procedure is performed, there are a few vital steps that are necessary. These include:

• Meeting with the surgeon and ask any last-minute questions
• Avoiding smoking for at least two weeks before the surgery
• Finding someone who agrees to provide transportation for you after the procedure
• Being prepared to stay home and rest for a couple of days or more after the procedure is done
• Finding someone who can help you out, if necessary, after the surgery

Let your surgeon know if you are using any prescription drugs, over-the-counter medications, or natural supplements, particularly any that affect blood clotting, such as Coumadin (warfarin), aspirin, or others.

Surgical Process

Hair transplant surgery is usually performed on an outpatient basis in the healthcare provider’s office or an outpatient surgery center. Your practitioner will help you decide whether the FUSS or FUE method should be used.

With both procedures, your surgeon will clean your scalp and inject a local anesthetic. After you receive the anesthesia, you won’t feel pain, but you may feel tugging or pressure during the procedure. In more complex cases, general anesthesia may be used. 

During the FUSS procedure, your surgeon will remove a thin strip of skin from the back of your head and then use stitches to close the wound. With the FUE procedure, the back of your scalp will be shaved before the grafts are harvested, leaving tiny holes that won’t require any suturing.

With both procedures, the skin grafts will then be inserted in tiny holes or slits in the scalp, which are made with a scalpel or needle. 

The entire process should be completed in around four to eight hours, depending on the size of the transplant.

Complications

As with any other type of surgery, there are risks and side effects that may occur as a result of hair transplant surgery. These may include:

• Reaction to anesthesia (dizziness, fast heart rate, pain)
• An allergic reaction to the anesthesia (which is rare)
• Bleeding
• Pain
• Swelling
• Scarring
• Unnatural looking hair regrowth (additional surgery may be required)

Itching is common in the donor as well as the recipient sites. Saline spray, topical aloe vera, and oral antihistamines have been shown to reduce this symptom.

Infection, though rare, can occur. Prophylactic antibiotics given right after the procedure may reduce this risk. Occasionally an abscess forms along the incision line or on the graft site. Septicemia (a severe infection that is life-threatening) has also been reported after hair transplant surgery.

Folliculitis is an infection in the hair follicle that often develops around the time the hair begins to grow back (between two to three months after the hair transplant procedure). Symptoms include a rash, itching, and pimples or pustules.

The treatment for folliculitis is antibiotics and warm compresses.

After Surgery

Immediately after the procedure, your scalp may be slightly painful. Your healthcare provider will prescribe pain medications or suggest over-the-counter pain relief medication, such as Tylenol (acetaminophen) or Advil (ibuprofen). Bandages may be kept on for several days after the procedure.

Proper washing and wound care procedures should be thoroughly explained to reduce the risk of infection. Antibiotics and anti-inflammatory medications may be prescribed to prevent infection and reduce swelling. Stitches will probably be removed in a week to 10 days.

Your healthcare provider will probably want to see you for follow-up appointments during the first month to make sure you're healing properly.

Results

Generally, within six weeks after the procedure, the transplanted hair will start to fall out. New hair growth may take another five to six weeks.

You should expect that you will probably need an additional procedure, often called a "touch-up." Your surgeon may be able to anticipate in advance how extensive the follow-up procedure may be. This is a good question to ask during the screening process before selecting the surgeon.

A Word From Verywell

Hair transplant procedures are relatively safe and usually have few complications. Talk with your healthcare provider beforehand about your goals for the procedure. They can tell you what methods will work best for you and help give you an idea of the results you can expect.