How Does Hair Transplant Works?

Many people come to a point in their lives which they think about getting a hair transplant. Although it is a popular subject, the details of hair transplants are not known and bring many questions and hesitations. “How painful is the hair transplant procedure?”, “How much time will hair transplantation take?”, “Will my hair look natural after the surgery?”. Learning how hair transplants work can give you an idea about the questions you got and what you will go through if you decide to get a hair transplant. 

In very simplified terms, hair transplant is the transportation of hair from one part to another. Baldness progresses through a pattern. In male-pattern baldness, for example, hair loss occurs in the top or front of the scalp. Hair on the back and the sides of the scalp is not lost. These areas are called balding-resistant areas. The surgeon extracts hair follicles from a balding-resistant area and plants them in the balding area. Follicular unit extraction method (FUE) and Follicular unit transplantation method (FUT) are the two approaches for the plantation.

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What Is a Hair Follicle?

The hair follicle sits in the skin and is responsible for hair growth and production. Living cells in the hair bulb divide and form the hair shaft. The hair shaft sticks out of the skin surface and makes up the visible part of the hair. Blood vessels near the follicle deliver the hormones and nutrition required for hair production and growth. Sebaceous glands are also a part of the hair follicle, and they produce a matter called sebum. Hair and the skin need sebum to stay healthy.

Follicular Unit Transplantation Method (FUT)

The surgeon starts by cutting a strip of skin from the hairy part of the scalp (donor area), large enough to cover the bald area. The cut area is stitched and covered with the surrounding hair. Then, the surgeon separates the strip into hair follicle units under a microscope. Generally, a hair follicle unit consists of 1 to 4 strands to obtain a more natural look. And at the last step, the surgeon plants the follicle units into the bald area one by one.

FUT Surgery Step by Step

  1. Marking the hairline and the hair extraction area.
  2. Trimming of the hair at the donor area down to 2 millimeters. 
  3. Cutting strips from the donor area.
  4. Removal of individual hair follicles from the strip.
  5. Stitching up the donor site.
  6. Plantation of the hair follicles into the balding area.
  7. Application of antibiotics and bandages to the scalp.

The procedure takes place under local anesthesia and lasts about 4 to 8 hours. You won’t feel pain during the operation. Depending on the size of the bald area, you may need more sessions. In that case, you need to wait for a month or two before the next session to allow your scalp to heal. 

Hair starts to grow 4-6 months after the procedure. It takes about 12 months for the hair to thicken and attain a healthy look.

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What Are the Requirements for FUT Surgery?

  • If your hair loss is due to a medical condition such as chemotherapy or thyroid dysfunctions, FUT surgery will be ineffective. 
  • You need to have enough hair available to use as a graft.
  • FUT gives better results if you are over 25 years old because your baldness pattern will be more obvious.
  • It will look better if the bald area is the front of your scalp.
  • If your hair is thick, FUT will yield a better look.

What Are the Advantages of FUT?

If you need a hair transplant in a wide area, FUT is a more viable option because the surgeon works with a high number of grafts at once. Therefore, FUT is a quicker technique than FUE. The cost of FUT surgery is often less than FUE.

Follicular Unit Extraction Method (FUE)

The surgeon does not need to cut a strip from your scalp with the FUE method, unlike the FUT method. Hair follicles are extracted directly from the donor site and manually planted in the recipient site. Generally, the surgeon uses about 2500-5000 grafts. You will lose most of the implanted hair within 5-6 weeks after the surgery, and new hair will grow from the roots.

FUE Surgery Step by Step

  1. Marking the donor and recipient areas.
  2. Shaving and cleaning of the donor area.
  3. Application of local anesthetics.
  4. Punch dissection of grafts from the donor site.
  5. Placement of extracted grafts into a solution until their plantation.
  6. Plantation of the follicular units into the recipient area.

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What Are the Advantages of FUE?

FUE technique is less invasive than the FUT technique. It leaves small circular scars on the scalp that can heal very quickly. There are no sutures involved in the FUE process. You can recover from FUE in a couple of days, while it may take up to two weeks with FUT surgery.

How Painful Is the Hair Transplant Surgery?

Now that we have talked about the hair transplant techniques, you may wonder, is hair transplant surgery painless? Thanks to the local anesthetics, you feel nothing but a slight discomfort during the process. Some people claim that they don’t feel even that. The only painful thing about the surgery is the local anesthesia needle, and it is like a bee sting that lasts for a very brief period.

You may ask about the post-surgery period, whether it is painful or not. It is not all beds of roses afterward the hair transplant, to be fair. Although nothing serious, your scalp will be physically traumatized. Because of that, you will feel tenderness, and of course, a slight pain will arise once the anesthetics wear off. But don’t worry because your doctor will prescribe you painkillers in case you need them. And it will probably comfort you to know that many people do not feel the need to use painkillers when they get back home.

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What Are the Potential Side Effects of Hair Transplant Surgery?

  • An unnatural look. Depending on the skills of the surgeon, your hair may not get the look you imagined. The orientation, position, and frequency of the hair must be controlled carefully by the surgeon. So, choosing a professional, skilled surgeon is a critical task for you.
  • Bleeding & swelling. Incision and plantation on the scalp will cause bleeding during the procedure, and it will cause swelling afterward. Swelling may come down to your face due to gravity, but it will go away after a couple of days of rest.
  • You will feel numbness in your head due to anesthetics and scars from the incisions. It will fade away as a part of the healing process.
  • You may experience pain.
  • Formation of subdermal cysts is possible after the surgery in the donor area. These show themselves generally as painless swellings.
  • Inflammation. Infection of hair follicles, also known as folliculitis, may occur. In that case, you may need to apply antibiotics to your scalp. Although very rare, folliculitis may become chronic.
  • You may suffer from donor hair effluvium (also referred to as shock hair loss). It is the loss of transplanted hair in two months after the surgery. Lost hair will grow back in about four months. 
  • Scar of the donor site will heal with time, but it will be permanent if you undergo the FUT surgery. In the case of the FUE, the scars will be in small, circular shapes that will heal quicker and are almost invisible.
  • If the surgeon harvests more grafts than needed, it may cause thinning in the donor area and patchy hair loss.
  • If you have a vascular problem, you may develop central scalp necrosis. People who smoke or have diabetes are also at risk for central scalp necrosis. It is more common in elderly patients. The reason behind it is not known, but the generally accepted thought is the lack of blood supply in the center of the scalp. 

Although it appears to be a long list of complications, it is possible to eradicate the majority of the risks and complications through proper planning and counseling. So, picking the right, professional team for your hair transplant process is fundamental. Being honest about your medical history to the team is also crucial to eliminate these risks.

Does Hair Transplant Provide a Permanent Solution?

Among all the hesitation whether it is worth the trouble and money or not, probably the biggest question you have: is hair transplant permanent? You will not obtain natural-looking, abundant hair right away. There will be a somewhat long healing period of about a year. Only then you’ll start to see the effects of the hair transplant. And once you get over that healing period, it is a permanent solution for your baldness or thinning hair. The transplanted follicles will continue growing hair in their new position, and you can treat them like they were there your whole life. You can shave, trim, shape your hair any way you like once your scalp has completely healed. There is a possibility of transplanted hair getting thinner or falling off as you get old, but it will probably last for the rest of your life.

Your lifestyle, hair type, age, and medical condition are the factors that may affect the lifespan of your hair transplant. Even though the expected lifespan of hair transplants is a lifetime, it is best to manage your expectations. At this point, discussions between you and your doctor play a critical role. Depending on the state of your hair over the years, you may need another hair transplant surgery.

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How Much Does a Hair Transplant Cost?

Costs of hair transplant surgery vary widely depending on the location, clinic, and patient. The degree and type of hair loss are significant in determining the cost of the surgery. Here’s a brief list of how much hair transplant costs by location:

  • Istanbul, Turkey: $2000-$5000
  • Bangalore, India: $2000-$5000
  • London, UK: $5000-$10,000
  • New York, USA: $5000-$20,000
  • Vancouver, Canada: $12,000-$20,000

FUE is generally more expensive than FUT because it is a more time-consuming technique. The number of grafts you need is the basis of the pricing. Therefore, you will pay more for the surgery if your hair loss is severe, but the cost does not increase linearly, meaning two surgeries with 2000 grafts will not cost the same as one surgery with 4000 grafts. Generally, the more grafts the surgeon use, the less cost you will pay. 

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What Should and Should Not You Do After a Hair Transplant?

Take care of what you do after the surgery to fasten the healing period. Most people go back to their daily routines in about a week, but the doctors advise you to take all the time you need and not rush.

  • Take time off from the exercises for at least a week as exercising increases blood pressure. Increased blood pressure can cause bleeding and knock off the implanted follicles. Avoid exhausting physical activity for at least ten days. You may go for a walk or do yoga if you like, after a week provided that you take it easy. If you start on yoga, avoid the positions that involve your head. Stay upright as much as you can. 
  • Sweating can cause infection, so avoid activities that will produce excessive sweating, like going to the sauna. Try to refrain from hot places and hot weather for about a month after the surgery.
  • Don’t expose your scalp to sunlight until the swellings go away. If you have to be outside, cover your head with a hat.
  • Quit smoking for at least a month as it slows down the blood flow and damages your hair follicles. Some studies also show that smoking interferes the hair growth.
  • Switch to a healthy diet. Your hair follicles need essential fatty acids, minerals, and other nutrients to function. Make sure you eat nutrient-rich meals. 
  • Follow the instructions of your doctor. Take the medication your doctor prescribed. Don’t hesitate to consult your doctor if you have questions or troubles.

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Savaş Ateş

I'm a hair loss expert. The picture was taken 10 years ago :) I have been losing my hair. So I started to learn everything about hair loss and hair transplants. I contacted a lot of hair transplant doctors. We shared our experiences. I'm writing blog posts for people who have the potential of losing their hair. I give some tips about hair transplants and medical issues too.

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