What to Expect From Hair Transplant Surgery

Smiling man walking down the street running a hand through his hair

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Hair transplant surgery is performed to replace hair loss in areas that are either thinning or balding. It involves removing the hair on one part of the head (such as the back or sides of the head) and filling in an area that is thinning or has no hair. Hair transplant surgery 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, the surgeon will administer a local anesthetic, then remove a strip of hair from the healthy area of the scalp (this usually involves an area that is approximately 10 inches in length) to use for transplant.

For the FUE procedure, the back of the scalp will initially be shaved, and then individual hair follicles will be removed, one at a time. This procedure will leave very small dots, which the surrounding hair will cover and hide.

The price of hair transplant surgery can run anywhere from $4,000 up to $15,000,  and most insurance plans do NOT cover the expense.

Selecting a Surgeon

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

  • If the physician is specifically trained in plastic surgery and certified by the American Board of Plastic Surgery
  • How many years the physician 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:

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

Who Is Not a Good Candidate?

Contraindications are conditions or circumstances in which a specific drug or treatment should not be performed. A hair transplant procedure may be contraindicated for those who have:

The surgeon should be informed when a person has any of these conditions, or if any prescription drugs, over-the-counter medications, or natural supplements are being used, particularly any that affect blood clotting, such as Warfarin (coumadin) aspirin, or others. Anyone who smokes cigarettes should also inform the surgeon before the procedure.

Surgical Process

Hair transplant surgery is usually performed on an outpatient basis, in the physician’s office or in an outpatient surgery center.

The surgeon will select the transplant method. The hair to be transplanted is removed using either the FUSS or the FUE method.

The scalp is sewn closed in the area where the healthy hair was removed (the area will be covered by healthy hair surrounding the incision site). The team of medical professionals, assisting the surgeon, will divide the hair on the healthy strip of the part of the scalp that was removed into tiny grafts (each containing just a few healthy hairs).

The prepared grafts will be inserted in tiny areas (holes or slits from a scalpel or needle); each graft will be placed in a single hold. 

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

Usually, the hair transplant process is repeated later for those who continue to experience thinning of hair, or who want thicker hair.

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 is possible, though 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 site. Saline spray, topical (on the skin) aloe vera, and oral (by mouth) antihistamines have been shown to reduce itching. 

Infection, though rare, can occur. Prophylactic antibiotics given right after the procedure may reduce the risk of infection. 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).

The symptoms of folliculitis may include:

  • Clusters of small red bumps or white-headed pimples that appear at the site of the hair follicle
  • Pus-filled blisters (that break open then form a crust on the scalp)
  • Itchy, burning scalp
  • Painful, tender skin
  • A large swollen mass

The treatment for folliculitis is antibiotics and warm compresses.

After Surgery

Immediately after the procedure, the scalp may be slightly painful; the healthcare provider will prescribe pain medications or suggest over-the-counter pain relief medication (such as Tylenol or 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.

Your healthcare provider will provide instructions on when normal activity can be resumed. Most people can go back to work two to five days after the procedure. 

Some healthcare professionals prescribe Rogaine (minoxidil) or other types of hair regrowth medication to enhance the hair growth process, after the hair transplant procedure.

Prognosis

Generally, a couple of weeks after the procedure, the transplanted hair will start to fall out. New hair growth may begin within two to three months after hair transplant surgery. After six to nine months, most people who get hair replacement surgery will attain approximately 60% hair regrowth. 

You should expect that you will probably need an additional procedure; this is 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.

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Article Sources

  1. American Society of Plastic Surgeons. Hair Transplant Surgical Hair Replacement.  PlasticSurgery.org. Last updated in 2019.

  2. American Society for Dermatologic Surgery (ASDS). Hair Transplants. Updated in 2019.

  3.  Kerure AS, Patwardhan N. Complications in Hair Transplantation. J Cutan Aesthet Surg. 2018;11(4):182-189. DOI;10.4103/JCAS.JCAS_125_18

  4.  American Society of Plastic Surgeons. Hair Transplant Surgical Hair Replacement.  PlasticSurgery.org. Last updated in 2019.

  5. Kerure AS, Patwardhan N. Complications in Hair Transplantation. J Cutan Aesthet Surg. 2018;11(4):182-189. DOI;10.4103/JCAS.JCAS_125_18

  6. American Society of Plastic Surgeons. Hair Transplant Surgical Hair Replacement.  PlasticSurgery.org. Last updated in 2019.

  7. American Society of Plastic Surgeons. Hair Transplant Surgical Hair Replacement.  PlasticSurgery.org. Last updated in 2019

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