Surgical Hair Replacement

The Hair Transplant Process

Surgical hair replacement techniques have come a long way. In 1955, Dr. Norman Orentreich performed the first hair transplant in the U. S.  At that time, he used a small round punch to remove the donor hair from the back of the scalp. While early transplants looked “pluggy”, the process worked.  In the early 90’s, we realized that scalp hair grew from groups of follicles containing 1 to 4 hairs, which were labeled “FOLLICULAR UNITS”. When these units were transplanted, they grew hair in a way so natural that you could not see any difference between transplanted and original hairs.

The removal of follicular units from the back of the scalp (donor area) can be done by cutting out a strip of scalp and removing the follicular units under a microscope (Follicular Unit Transplant or FUT) or by removing the follicular units directly with a tiny punch (Follicular Unit Extraction or FUE). This extraction process is known as “HARVESTING” .

The second part of this surgical hair replacement procedure is called the “PLACEMENT”. Tiny incisions are made in the bald “recipient” areas. and the follicular grafts are inserted manually.

The Science

If hair follicles are removed from the scalp and placed anywhere on the same person’s body, whether it’s the bald scalp or the top of one’s hand, the follicles will thrive and produce hair. Unfortunately, this doesn’t work if someone else is the donor, even if it’s a family member. In a surgical hair replacement transplant, the follicles removed from the back of the scalp have the ability to grow hair for a lifetime. Because they cannot be rejected, they can be placed in the bald scalp where they will survive and thrive.

Surgical Hair Replacement, FUT/FUE Transplants

The FUT (Follicular Unit Transplant) is the original Follicular Unit (FU) surgical hair replacement procedure. Click here for a full description of FUT transplants.

The FUE (Follicular Unit Extraction) is a newer surgical hair replacement method of Follicular Unit (FU) harvesting. Click here for a full description of the ARTAS ROBOTIC FUE.

Results of Surgical Hair Replacement

In my FUT/FUE Hair Transplant Center, as well with most well-trained transplant surgeons, today’s surgical hair replacement results should be, and usually are, undetectable. When hair grows in the scalp, it usually grows in groups of one to four hairs. These 1-4 hair bundles are called FOLLICULAR UNITS. As long as these units are moved from the rear of the scalp (“safe” or “donor” area) to the thinning or balding scalp (“recipient” area), it should be virtually impossible to tell the difference between the older and newer (transplanted) hairs.

The way the follicular units are harvested varies. In a FUT procedure a strip of donor scalp is removed and the follicular units are dissected out under a microscope. In a FUE procedure, the follicular units are “punched out” from the donor area individually. The final result, however, is the same. The new hairs grow and should continue to recycle for the same amount of time as they would have in their original location. There is an esthetic result that cannot be taught. The variability in the look of a transplant depends upon the artistry and care of the surgeon.

Hair Transplant Surgery FAQs

HOW LONG DOES IT TAKE THE TRANSPLANTED HAIR TO GROW?

Hair grows at different rates, but most people have reasonable growth and coverage in six to ten months.

WILL I NEED TO REPEAT THE PROCEDURE?

Depending upon the area to be covered and continued hair loss, future sessions may be required to increase density and fill in newer bald areas.

WHAT IS A COMBINED FUT/FUE HAIR TRANSPLANT?

When someone has lost most of his hair and is left with a narrow rear fringe, because the hairs in this “safe” area are fewer in number, two methods of HARVESTING can be utilized.

This “safe” or donor scalp is unique because those follicles are capable of growing hair for most of a person’s lifetime, even in the baldest individual.

First, the FUT method may be used once or twice. In an FUT procedure, a strip of scalp is removed and the 1- 4 hair grafts (Follicular Units or FUs) are removed under microscopes. There is a limit to how wide a strip of scalp can be removed, and in most cases, after one to two removals, the scalp is too tight to allow for more strip removals.

Because there is still usable follicles left, they can be removed individually with a small punch (Follicular Unit Extraction or FUE). Combining these two procedures in selected individuals, allows us to maximize the amount of hairs from a limited donor scalp.

AM I A CANDIDATE FOR A HAIR TRANSPLANT?

Not everyone who is losing his or her hair is necessarily a hair transplant candidate.

Age is an important consideration when evaluating a potential patient. As a general rule, age 22 is considered a minimum for transplanting because, in most individuals, by that age, it’s easier to predict the degree of future balding. This, however, can vary with different people and an experienced physician can often predict future balding in a younger individual and get a head start by filling in thinning to balding areas.

Where, exactly, are you losing hair? If your hairline is receding slightly, it might just be the normal change that occurs when a low “juvenile” hairline moves up and indents slightly and becomes a so-called “adult” hairline. Lowering a normal adult hairline is unnecessary and unwise.

How large an area of thinning or balding is present, and how large and full is your donor area? If too large and area needs coverage and there isn’t enough donor hair to adequately fill it in, it’s often wise to settle for transplanting a smaller area with good coverage rather than spreading out your limited supply of donor grafts and achieving coverage with very poor density.

If you’re young and thinning slightly, you may be better served by trying a medical approach using topical minoxidil and/or oral finasteride. While there is no medical cure for common baldness, these medications may slow down the balding process.

FUT OR FUE??

In a Follicular Unit Transplant (FUT) a strip of donor scalp is removed from the back of the scalp and the defect closed with either stitches or staples. It leaves a linear scar on the back of the scalp that, in most cases, is barely noticeable. If, however, you want to trim your hair very close, the scar may show. This dissuades many young candidates from having this type of procedure.

The Follicular Unit Extraction (FUE) method eliminates the linear scar and substitutes very fine dots after the individual grafts are removed, and unless the head is completely shaved, they will never be noticed. Most people who have had both types of transplants prefer the FUE method because the post-op healing seems to be easier.

Another factor for some choosing FUE is its appeal as a more “futuristic” kind of surgical approach, especially when the Artas Robot is available.

Both these transplant methods simply are two different approaches of “harvesting” donor grafts. The second part of the transplant procedure is called the “placement” and it is the same for both. The cost of an FUE in my office is about 50% more than FUT. The numbers of grafts that can be harvested and the final results, however, is similar for both procedures.

SHOULD I LOOK FOR A DOCTOR WHO OFFERS BOTH FUT AND FUE TRANSPLANTS?

The state-of-the-art transplant practice should be able to provide both types of procedures. In my office, because both FUT and FUE methods are available, I feel that I can offer my patients a more reasonable evaluation of their needs. I don’t favor one over the other, because the results are similar. I try to offer a clear and simple explanation of what’s involved with the two approaches and allow the patient to decide.

Patients’ decisions are based on the kinds of hair styles they may desire now and in the future, the comfort factor that favors FUE and the relative cost that often favors FUT.

HOW MUCH DOES A HAIR TRANSPLANT COST?

Most hair transplant surgeons’ charges are based on a cost/graft basis. The “graft” may represent a follicular unit, usually containing 1 to 4 hairs, or the graft may be “split”. For example, a 4-hair follicular unit may be split into 4 “ones”, a “3” and a “1” or two “2”s. So someone receiving 1,500 full FUs may be getting more hair for the dollar than 2,000 split grafts. It’s impossible for me to quote other doctors’ fee schedules because there is a wide variation in charges depending upon a physician’s experience, location and overhead (clinics are often more expensive because you pay for their advertising).

FUE procedures are usually more costly than FUTs. I charge about 50% more for a Robotic transplant than a traditional strip transplant. I do not split grafts and my fees are listed on the home page of this website.

HOW LONG DOES A PROCEDURE TAKE, ARE YOU “PUT OUT” AND CAN YOU DRIVE HOME?

These are three of the most common questions asked by a prospective patient.

In my practice, transplant times average between 4 to 8 hours, with a Robotic procedure taking about 2 hours longer than the traditional strip transplant.

I do not put patients to sleep, but I will use an oral tranquilizer if requested. Local anesthesia is adequate for this type of surgical procedure and certainly much safer than putting a patient out.

Anyone living a reasonable distance from the transplant office can drive home after surgery. If, however, a tranquilizer (usually Valium) is used, then driving oneself is not advisable.

WHAT SIDE EFFECTS ARE THERE AFTER HAVING A PROCEDURE?

The first night after the transplant there may be some discomfort that is usually controlled by a pain medication like Tylenol or a mild narcotic. By the next day, most patients feel fine.

Infection and bleeding is rare, but post-op swelling in the forehead may occur in 2 to 3 days and is gone within another 2 to 3 days.

The transplanted hairs fall out over the first few weeks (“transplant shock” like the leaves falling off a transplanted tree). They start to regrow after several months and usually by the eighth or tenth month most of the hairs have come back.