Hair transplant: Compare practices from our network

A hair transplant moves healthy hair follicles from an area where hair grows densely, usually the back of the head, to areas that are thinning or bald. The follicles are taken either one by one (FUE, including DHI) or as a thin strip of scalp that is divided into small grafts (FUT, the strip method).

Because the follicles keep their genetic pattern, transplanted hair continues to grow in its new place, and the result is permanent. A transplant does not stop hair loss elsewhere on the scalp, which is why the design has to plan for how your hair will change over time.

A hair transplant redistributes the hair you have; it cannot create more donor hair. How much can be moved, and how dense the result looks, depends on your donor area.

There are two main ways to harvest hair, and several ways to place it. Your surgeon will recommend the one that suits your hair and goals:

• FUE (follicular unit extraction). Follicles are taken one by one with a small punch, usually after shaving the back of the head. It leaves many tiny scars that are not very noticeable, and is the more common method today. SmartGraft and NeoGraft are devices that automate parts of FUE.
• FUT (follicular unit transplantation, or strip). A thin strip of hair-bearing skin is removed from the back of the head and divided into grafts. The head does not need to be shaved, but it leaves a linear scar that is usually hidden unless hair is worn very short.
• DHI (direct hair implantation). A form of FUE in which a pen-like implanter places each graft directly. It often needs shaving only at the nape.

Hair loss is mainly driven by genetics, hormones and age, and as a rule, the earlier it starts, the more extensive it becomes. A transplant works best once the pattern is clear. The new hair takes months to grow, and the full result is usually seen after a year or more, so patience is part of the treatment. Non-surgical options can be used alongside or instead of a transplant, and your surgeon can explain what suits you.

A hair transplant is generally suited to people with permanent, hereditary hair loss, such as a receding hairline or thinning at the crown, who have enough healthy hair at the back of the head to move. Both men and women have it, and it is also used as part of gender-affirming care.

• Hereditary thinning or a receding hairline in men or women
• Enough healthy donor hair at the back of the head
• Hair loss that has had time to show its pattern
• Scarring from an earlier strip transplant you would like to improve
• Hairline adjustment as part of gender-affirming care
• Realistic expectations about density and timing

Your surgeon may advise caution if you:

• Have patchy hair loss such as alopecia areata, which a transplant does not usually suit
• Have too little donor hair at the back of the head
• Have hair loss with a medical cause that has not yet been investigated
• Are early in your hair loss, when its final pattern is still hard to predict
• Expect the transplant to stop further hair loss

Consultation. Your surgeon examines your scalp and donor area, discusses your goals and medical history, and plans the hairline and the number of grafts. They should explain which method they recommend for you and why.

Preparations. You receive instructions on hair washing, food and clothing for the day. With FUE, the donor area at the back of the head is usually shaved; with DHI, often only a small area at the nape is shaved.

Anesthesia. The scalp is numbed with local anesthesia, sometimes with sedation or a relaxing medication. You are awake but should not feel pain.

Harvesting. Follicles are taken one by one with a small punch (FUE), or a thin strip of hair-bearing skin is removed and divided into grafts of one to four hairs (FUT). Devices such as SmartGraft and NeoGraft automate parts of FUE.

Implanting. The grafts are placed into tiny openings in the thinning areas, following the natural direction of growth. In DHI, a pen-like implanter places each graft directly.

Closing. With FUT, the donor site is closed with stitches. With FUE and DHI, the small extraction sites heal on their own. You go home the same day.

A tight, achy and swollen scalp is common for a few days, along with scabbing where the grafts were placed. Swelling can spread to the forehead and around the eyes for a few days, and numbness or itching is common.

• Treat the grafts very carefully for the first two weeks, as they are not yet secure
• Do not touch, rub or scratch the grafts; follow your clinic's washing instructions
• Wash your hair gently by hand once your clinic says you can, often around day six
• Avoid exercise for about two weeks, and limit it during the first month
• Have any non-dissolvable stitches removed after 10 to 14 days

Most people resume light activities within a day or a few days, and many take one to two weeks off work. The transplanted hairs usually fall out within a few weeks; this is expected, and new growth follows.

A hair transplant is generally safe, but as with any operation there are risks:

• Swelling, scabbing and discomfort, common and temporary: a tight, achy scalp for a few days and swelling that can reach the forehead and eyes.
• Numbness and itching, common in the early weeks, from temporary effects on small nerves in the skin.
• Scarring, A single linear scar at the back of the head after FUT, or many tiny scars after FUE; occasionally a scar is more noticeable.
• Grafts not taking, A small risk that the transplant does not take and the hair falls out.
• Continued thinning around the transplant, your own hair may keep thinning, which can affect how the result looks over time.
• Bleeding, infection or reaction to anesthesia, uncommon, and usually treated quickly.

Contact your clinic promptly if you notice:

• Severe or increasing pain, especially in the donor area
• Fever
• Bleeding that does not stop
• Increasing redness, warmth or discharge from the scalp

Contact your surgeon's practice directly, or seek emergency care, if you experience any of the above.