Currently, there are two types of hair transplant surgeries – FUE and FUT. Follicular Unit Excision (recently modified from Follicular Unit Extraction) is the type of surgery where we excise each follicular graft one by one. In contrast, Follicular Unit Transplantation is a surgery where a thin strip of skin is excised from the scalp and sutured back together, similar to when you need stitches in the ER. For both types of surgeries, we then splice those follicular grafts down to the number of hairs we wish to use at specific areas of your scalp.
So what’s the difference? Well, it predominantly depends upon how you wear your hair in the back. Of course with FUT, we are creating a scar so if you wish to ever wear your hair short in the back there is always the possibility of a linear scar showing. With FUE, we are making microscopic “holes” essentially in the scalp which will heal over. Once the hair grows back around the holes, they are undetectable on the back of your scalp. Similarly, if you’ve had the FUT and are healed from your surgery, if your hair is long enough to cover the incision scar, that will be undetectable as well.
Both types of surgeries are completely safe with minimal risks involved – if performed at an accredited facility with a specialized Hair Restoration Surgeon.
How Long is the “Downtime” After Hair Transplant Surgery?
The downtime for hair transplants is actually quite minimal. We tell our patients to expect one one week to 10 days of “professional downtime.” That means if you have to be on-air, have a special event, a professional meeting, etc. then give yourself a solid week to 10 days for no detection. This is because the implanted grafts will scab initially and your scalp appears as a mild sunburn. That look, as I mentioned, typically lasts about a week. If you work from home or have the time off, then you can return to activities of daily living the next day (no working out or oceans yet!). Patients often don’t need anything other than Extra Strength Tylenol and/or Ibuprofen at home for tenderness to the scalp. FUT patients tend to have pain on the back of their scalp a few days longer than the FUE patients.
Is a Hair Transplant Permanent?
I am often asked: is a hair transplant truly permanent? The short answer is yes. Now, if you have an underlying medical condition that will not allow the transplanted hairs to grow (such lupus, scarring alopecia, autoimmune disease, metabolic issues, etc.) then no. Of course this is something we will rule out before we’d even consider a transplant.
The reason WHY hair transplants are permanent: the hair on the back of our heads are subtly different from the hair on the rest of our scalp. The hair on the back of our head is programmed to never fall out—this is why you’ll see men who are bald but still have that horseshoe-curved hair on the back of their heads.
Once we excise the graft from the back of the head and transplant it to its destination on the scalp, it will grow there forever. This is because the hair doesn’t know where it is, so it will now grow where we’ve carefully placed it. On the flip side, it will not grow back on the back of your scalp (or wherever we take the grafts from) because we just moved it! So no, a new hair will NOT replace the one we just took.
What’s it Like to Have Hair Transplant Surgery?
Let’s talk about the actual surgery. You’re here for pretty much half to a whole day depending on how large your case is. You’ll need a ride because we give you medicine to relax during the procedure. Most people sleep, some watch a movie, some listen to music—it’s actually a very calm and quiet atmosphere. At the beginning of the day, we go over your desired hairline and coverage area (beard, chest, eyebrows, crown/vertex of the head) and you, with our surgical team and myself, all agree upon the appropriate design and then we get rolling.
Once your scalp is numbed, we begin the excision process of taking the grafts from the back of your head and start splicing them under a microscope and keeping count. Further, we are checking to see how many hairs are in each of these follicular units we just got. Each follicular unit has anywhere between 1 to 5 hairs in it, so we splice them according to how many should be placed together when we implant.
For example, if we are strengthening your hairline, we will use 1 to 2 hair grafts to finely tune and feather them so they grow in naturally. In contrast, if we are filling in density to thinning areas, such as your crown or hair part, we could use grafts that have 3 to 5 hairs in them. We also check to see: how do the grafts look? Are they transected, cut, or damaged? How is the surrounding tissue around the follicular root and bulb? How long are these follicular units? The angle and direction of the grafts, coupled with precise graft placement, must be exact to result in a natural-appearing transplant. These are just a few of the meticulous steps we take to ensure each graft is treated like the little sliver of gold it is! This is critical for your hair transplant to be a success.
Once all of the grafts are excised, we create the few hundred to thousands of recipient sites where the new grafts will be placed. Again, placement of every one of these individual grafts at a specified angle and direction is tedious, but is also why we get phenomenal results. Additionally, after your grafts are excised and being prepared, they are in a holding solution to preemptively nourish the grafts while they are out of the body for a short time. Details, details, details!
Once the grafts are safely in place, I then perform the Bioenhancement treatment of the patient’s choosing, which is typically decided upon during our consult. We finish the surgery off with a spray of an additional Bioenhancement preservative, called Liposomal aTP. Think of this spray as the best fertilizer for your lawn— it’ll help it grow in sooner, grow more dense, and grow more robust. You are then totally cleaned up and ready to go.
What Happens After My Transplant?
After a transplant, the majority of the newly transplanted grafts will fall out, which is expected. A new follicular unit with anywhere between 1 to 5 hairs in it will begin to grow in its place. Something we always educate our patients about is the potential for something called “shock loss.” Because the newly transplanted hairs need blood supply the most, the blood vessels from your current hair divert to the newly implanted hair. It recognizes the new follicular unit as needing the most oxygen, nutrients, and blood supply. Therefore, the blood supply to the hair on your head now gets cut off temporarily – which can cause THOSE hairs to fall out! I know, this is a double negative. The GOOD news is that it will all grow back. The new hairs will start to sprout at about 3 months, as each hair’s blood supply creates its own network of oxygen & nutrients for that new hair follicle. At about 6 months, we typically will see about 70% of the new growth and full growth of all the transplanted grafts after a year.
Many patients wonder when they can return to doing the things they love, work, etc. On average, 7-10 days is the amount of time recommended to allow your grafts to take to your scalp and heal properly. During that time, we don’t want you working out at 100%, going swimming, being in the sun, etc. Take this time to let the grafts take to your scalp and heal properly. After Day 3, our patients can resume their prior other hair restoration treatments (laser therapy, topical medications, injections, etc.). We have a regimen of gentle washing after surgery for the grafts and a full shower at 10 days. At this point, you’ll also resume whichever long-term maintenance option you have chosen (CapillusRx, Regenerative Therapy, ACell, Medicated Topicals, etc.).
How Much Does it Cost to Have a Hair Transplantation?
The cost of hair transplantation isn’t straightforward and I know that is an answer no one likes to hear. Unfortunately, it’s the truth. Why? Well, first you’re you. Your personal desired outcomes, extent of hair loss, amount of coverage needed, and/or donor density are different from every other patient. We don’t view these as “surgeries.” We are working with you, our patient, and if surgery is part of your plan, then we begin the discussion of complementary surgical treatments.
We have a number of therapies with evidenced-based research showing improved hair growth and retention when performed at the time of the hair transplant surgery. If that’s not your thing, then we discuss our other options. The surgery in and of itself is just a part of your entire hair restoration regimen to us—you’re not coming in for an oil change to never be seen again. We incentivize our patients to incorporate different treatments into their regimen since each treatment impacts the hair cycle in a different manner. This leads to an incredible synergistic effect and robust hair regrowth.