If you’re experiencing hair loss, especially if you’re nowhere near retirement age when hair loss is expected, you are probably not very happy about it. Hair loss can negatively impact our self-confidence and sense of well-being and even lead to anxiety, depression and other emotional issues. Maybe you’ve seen intriguing ads for hair transplant surgery, or you know someone who has had it with positive results. If you’re considering hair transplant surgery, you should know what you’re getting into — it’s not for everyone, and as with all surgical procedures, it has risks. Here’s what you need to know about hair transplant surgery.
Why Do We Lose Our Hair?
The medical term for hair loss is alopecia, and there are two categories, scarring and non-scarring. Scarring alopecia occurs after trauma, burns, infection or inflammation destroys hair follicles (tiny capsules embedded in our skin and scalp that produce hair strands). This type of baldness is permanent because once the follicles are damaged, they can’t grow hair. Non-scarring alopecia accounts for up to 95 percent of hair loss. Androgenetic alopecia (AGA) is the most common form, aka male or female pattern baldness. If caught early and treated with topical formulas containing the FDA-approved drug Minoxidil, AGA-induced hair loss can be reversible.
Doctors sometimes prescribe an oral medication called Finasteride to treat AGA — however, only men can take it. Finasteride, commonly sold as Proscar or Propecia, often causes several undesirable side effects, including reduced libido and erectile dysfunction. Both men and women can use Minoxidil formulas and usually experience no or minimal side effects since it is applied directly to the scalp instead of ingested.
Medication, pregnancy, hormonal changes, illness, emotional or physical trauma and even chronic stress can cause temporary hair loss, aka alopecia effluvium. Often, once the triggering event has passed, hair grows back. If you’ve suffered hair loss due to one of these triggers, you can help your hair grow back faster by using a Minoxidil treatment. Autoimmune disorders such as alopecia areata can also cause temporary hair loss.
How Do Hair Transplants Work?
In a nutshell, hair transplant surgery involves moving healthy hair from one part of your scalp to an area with less or no hair. Physicians surgically remove either a section of the scalp or individual follicles and then embeds them in the bald areas. The removed parts are called grafts. Japanese dermatologists began experimenting with surgical hair transplants in the late 1930s, initially to treat burn victims. The technique remained unknown to the rest of the world due to World War II challenges, but beginning in the 1950s, an American dermatologist began performing the operations. By the 1960s, surgical hair transplants had become part of the growing field of cosmetic surgery.
What Are the Differences in Hair Transplant Procedures?
Unfortunately, the somewhat crude early techniques didn’t always produce favorable outcomes, and surgical hair restoration earned a questionable reputation. You might have heard the term “hair plugs,” where surgeons removed large, pencil-eraser-sized clusters of hair and planted them spaced out. The result resembled the fake hair you’d see on a toy doll. It wasn’t until the mid-1990s that surgical hair restoration techniques improved enough to produce excellent, often undetectable results.
Today, surgeons primarily use two transplant methods and will choose one over the other based on your specific conditions. Both methods are usually performed in an outpatient setting. In both methods, your doctor will numb the treatment areas on your scalp with a local anesthetic.
Follicular Unit Transplant (FUT)
In FUT restoration, the physician removes a several-inch-long strip of “donor” scalp containing healthy hair follicles, typically along the back of your head where hair tends to be thicker. He or she will stitch the wound closed. In the balding areas on your head, the doctor makes tiny holes or slits. Using a magnifying lens and a sharp knife, a technician divides the donor strip into several tiny grafts containing one or two follicles. He or she carefully places the grafts into the prepared holes. Doctors have been performing FUT surgery for a few decades, and the results are generally favorable.
The primary negatives with the FUT procedure are that the wound created by the donor strip can be painful and vulnerable to infection. It also leaves a scar, which is sometimes visible, especially in short hairstyles. FUT treatment also leaves a bald patch, but usually, the remaining hair covers it. FUT surgery can take several hours, especially if the number of grafts is large.
Follicular Unit Extraction (FUE)
FUE restoration is a newer procedure where the physician shaves the donor area on the back of the scalp and collects individual hair follicles. As in FUT, he or she creates tiny recipient holes or slits in the balding areas and then gently plants the individual follicles. During one treatment session, a doctor may transplant hundreds or even thousands of follicles.
FUE surgery is generally considered less invasive than FUT. The FUE procedure has a lower risk of complications, such as postoperative pain and scarring. Another benefit is that instead of creating a scar and large bald strip, the physician can take follicles from a broader, dispersed area, so the remaining hair doesn’t have any noticeable bald spots. Recovery time is often faster with FUE procedures. FUE treatments can take longer than FUT — and are usually more expensive. If you only need treatment in a small area, FUE is often the top choice.
You’ll see branded FUE procedures such as NeoGraft® and Robotic FUE. NeoGraft® uses a machine that reduces the time but still requires manual manipulation to remove hair follicles. Robotic FUE automates the harvesting and recipient site creation by using an optical three-dimensional guidance system. Robotic FUE procedures are thought to be the most accurate and reduce the risk of human error.
What Happens After a Hair Transplant Surgery?
You’ll likely experience some swelling, discomfort and even pain, especially after the FUT procedure. You may also have to wear bandages on your head for the first few days. Your doctor may prescribe pain medication, anti-inflammatories and antibiotics to reduce infection risks. Many doctors will prescribe Minoxidil to promote new hair growth once the incisions have healed. Any stitches are removed in about 10 days. Most people can return to work within three to seven days. You should avoid physical activity that causes increased heart rates and sweating, and you’ll need to be very careful about washing, styling and wearing headgear for the first several days.
The transplanted hair typically falls out between three and six weeks after either procedure. This hair loss is normal, but it often takes people by surprise because they grew accustomed to their new look. It can take several weeks or even a few months to grow back. The new growth is very short at first. You won’t see the full results of your transplant surgery until about eight to 12 months after the procedure. You may also need minor touch-ups to create more natural-looking results. And many people need multiple treatments to achieve the results they want.
What Are the Risks of Hair Transplant Surgery?
When performed by board-certified, experienced doctors in reputable clinics, both FUT and FUE procedures are generally low risk. The primary risks include infection, excessive bleeding, follicular inflammation, scarring, bumps on the scalp and unnatural, patchy growth. Sometimes the transplanted hair follicles “die,” and the surgery needs to be repeated.
How Much Does Hair Transplant Surgery Costs?
The costs for hair restoration surgery varies quite a bit as many factors are involved. Your geographic location, type of procedure, number of hair grafts required, and the popularity or expertise of your doctor influence the costs. You can expect to pay between $4,000 to $25,000 for hair restoration surgery. Since hair loss is usually considered cosmetic, most insurance plans will not cover it.
Is There a Way to Lower the Cost of Hair Transplant Surgery?
The short answer is not really, if you want to prevent potential catastrophes. One way to avoid costly, risky surgical procedures is to use FDA-approved nonsurgical treatments such as formulas that contain Minoxidil. ScalpMED® makes a whole line of non-invasive, affordable, patented, FDA-approved Minoxidil treatments for men and women. The sooner you begin treating areas where your hair is thinning, the longer you can preserve your hair while the hair follicles are still active.
If your hair loss is accelerated and you feel the need for surgery, you may be seeking lower-cost options. You might see ads for low-cost hair transplant procedures, including overseas clinics, but industry watchdog groups will advise you to avoid these doctors and clinics. Hair loss surgery is unregulated in the U.S. — meaning any licensed physician can legally perform hair transplant surgery, even if they don’t have prior surgical training or any kind of accreditation. Hair restoration surgery is a lucrative business, and many doctors add it to their range of services for monetary gain. Large “hair loss specialty” clinics can afford to pay for splashy advertising — but often employ contract physicians who lack the proper training and experience. Practitioners may also be performing outdated and dangerous hair restoration procedures.
Be Aware of Overseas Hair Transplant Clinics
Many countries outside of the U.S. and Europe have gained reputations as medical tourism destinations, meaning they promise high-quality medical treatments at far lower costs than we can find in the U.S. While there is some legitimacy in some medical tourism due to our bloated U.S. health care costs, you should be especially wary of hair transplant surgical treatments.
Turkey, Mexico and India have become popular hair transplant medical tourism destinations, and the number of clinics has exploded in recent years. Competition is fierce between clinics, which means many will do whatever it takes to offer the lowest cost hair transplant procedures. Instead of paying several thousand dollars in a U.S. or European medical facility, patients are lured into having treatments done that cost only $600 to $2,000. Often, patients meet with a doctor for the consultation, but unbeknownst to the patient, unqualified nurses or technicians end up performing the procedures. And as in unscrupulous U.S. clinics, under-qualified practitioners may be performing outdated and dangerous hair restoration operations that are less time-consuming and costly.
Hair Transplant Procedures to Question
A state of the art FUT or FUE procedure takes from five to 10 hours and practitioners need several months of training to do it safely and effectively. One way hair loss practitioners can lower costs is to perform procedures other than FUT or FUE operations. Most of these procedures are legitimate and are sometimes best for patients who have experienced significant burns or physical trauma. They may not be the best options for AGA hair loss, according to the American Hair Loss Association.
Ask for explanations if your doctor suggests any of the following:
Hair Flap: Somewhat similar to FUT, a surgeon slices a several-inch-long flap of hair-bearing scalp from the side of the head but leaves one end attached. Instead of completely removing the strip and splitting it into tiny grafts, the surgeon twists it, so the hair side faces up. He or she stitches the flap into place over the bald part of the top of the head. The area where the strip was twisted and remained attached to the scalp forms a bump that can be noticeable.
Since this is considered major surgery, hair flap procedures are usually performed in a hospital. Risks include infection, scarring and permanent hair loss in the donor area, and partial or complete death of the flap, which leaves an unsightly scar. Hair can grow in the opposite direction of the normal hairline, and additional grafts are needed to cover the front hairline scar.
Scalp Reduction: This procedure only works for bald spots on top and the back of the head, not the front hairline balding pattern. After administering a local anesthetic, the physician slices off a bald segment of the scalp, and then loosens, pulls and stitches the adjoining hair-bearing sections together. This procedure has many risks, including pain, tightness, infection, permanent hair loss, unnatural hair growth pattern and “dog ear” visible scars as the stretched scalp eventually loosens and spreads out.
- Scalp/Tissue Expansion: This procedure is usually limited to burn and disfigured patients, according to some experts. A doctor inserts a silicone balloon-like device beneath hair-bearing scalp adjacent to a bald area. Over time, he or she injects saline solution into the device, which gradually inflates it. The expansion causes the scalp to grow new skin cells, and after a few months, patients undergo a hair flap or scalp reduction procedure to cover the bald section. During inflation, the device creates a large, visible bulge.
Who Is a Good Candidate for Hair Transplant Surgery?
If you’ve lost a lot of hair, topical treatments containing Minoxidil can still help, but surgery should be your last option due to the cost, recovery time and risks of infection, permanent scarring, unnatural hair growth and permanent hair loss. Surgery can produce positive results for many — however, many patients continue to use Minoxidil or other medication to promote hair growth after the procedure. Not everyone makes a suitable candidate for surgical hair restoration.
Here are the factors that determine who will be most likely to achieve favorable results:
Type of Hair Loss: Surgery often works well for male pattern baldness (AGA) if you have robust, healthy hair along the sides and back of your head to be donor areas. You will continue to lose hair as you age, so your doctor will consider your future hair loss patterns since they will affect long term results.
Gender: Many females with AGA aren’t good candidates. Females with AGA tend to lose hair all over their scalp, aka diffuse un-patterned alopecia, instead of on top or in the hairline like men do, so they often lack adequate donor sections. This doesn’t mean hair restoration surgery is for men only, as many women undergo procedures with favorable results.
Scalp Flexibility: The more flexible your scalp is, the better. If it’s very tight, hair transplant surgery might not be an option.
Hair and Scalp Color: Hair and scalp that are similar in color, such as blond hair and pale skin/scalp or dark hair and dark skin/scalp produce the best visual results because the bare scalp between the grafts isn’t as noticeable. When the hair is dark and the scalp light, the contrast is more visible, so results might not be as impressive.
Hair Caliber/Cross-sectional Area: Light reflecting off your scalp plays a factor in how bald you appear. Hair caliber refers to how thick your hair strands are, so even if you have fewer hairs, but your strands are thick, they block more light. People with thick hair strands tend to be better candidates than those with thin hair.
Degree of Curl: Generally, curly hair, especially people of African descent, tend to be better candidates for hair restoration surgery than those with straight hair. In some cases, FUT procedures work better than FUE for curly hair because it’s more challenging to harvest hair follicles when the hair is very curly.
Overall Health: It should come as no surprise your scalp and overall health should be robust and disease-free for the most part. If you’re in poor health or have medical conditions that would interfere with surgery, recovery or hair regrowth, hair transplant surgery is not a viable option.
- Adequate Funds: Remember, many patients require multiple treatments over time, even years. Hair restoration is often an ongoing process, so if you can only afford one treatment, you might end up looking worse than you did before you started down the path.
How to Find a Hair Transplant Doctor
As we noted earlier, hair restoration is a lucrative business because patients who experience hair loss are often so unhappy about it, they are willing to cast aside their concerns about safety and costs.
Unlike many medical specialties that are governed by the American Board of Medical Specialties (ABMS), the field of surgical hair restoration is not one of them. There is no official “board certification” for hair transplant doctors, yet you might see certifications and credentials listed on their websites. Many board-certified dermatologists and plastic surgeons perform hair transplant procedures, but any physician can do them, even if they haven’t received extensive training.
Physicians can join organizations such as the International Society of Hair Restoration Surgery and the American Society of Hair Restoration Surgeons, but membership does not qualify a physician as being certified to perform surgical hair restoration. You don’t need to necessarily avoid doctors who list these credentials or that have other ABMS board certifications such as dermatology or plastic surgery, it simply means membership has no bearings on skills, experience or education.
The only organization that selectively screens hair transplant doctors for membership is the International Alliance of Hair Restoration Surgeons. Its website is an excellent place to start when researching American and overseas doctors. The American Hair Loss Association, a respected consumer organization dedicated to hair loss education, provides a comprehensive explanation of the different hair transplant associations and organizations.
The American Hair Loss Association recommends asking your potential doctor the following:
Ask to see at least 10 sets of before and after photos taken in the same lighting, same angle and same background.
Ask to speak or write to at least six former patients, ideally ones who have similar hair and baldness patterns as you do.
If your recommended procedure is FUT, ask if the grafts are microscopically dissected and how much experience the technicians have.
Check with your state medical board to see if former patients have filed any complaints against the doctor or the practice.
Make sure your consultation includes the doctor who will be performing the procedure. Many practices have patients meet with a “medical consultant” who may not have sufficient medical training to make specific recommendations.
- If the practice isn’t a dedicated surgical hair restoration clinic, ask what percentage of the practice performs hair transplant operations and how much experience practitioners have.
Manage Your Expectations
In addition to the questions above, you should also talk with your doctor about your goals and realistic outcomes. Remember, the procedures we discussed here involve moving hair-loss-resistant follicles around, not adding new ones. You’re never going to have your teenaged head of hair with the current, approved procedures. Having realistic goals about how much hair transplant surgery will affect your looks now and in the future is essential to a favorable outcome. This is why it’s so important to have a thorough consultation with your potential doctor. You may come away deciding that the likely result isn’t worth the risk or the cost.
Regardless of your decision, your most affordable and least risky option is to try to preserve the active hair follicles you still have by following an easy, at-home treatment plan like the ones offered by ScalpMED.