Techniques have become so advanced in recent years that FUE and FUT hair transplants can reverse female – or male -pattern baldness to the point where no one will know that you were ever losing your hair.
Breaking down the embarrassment-factor, a number of public figures have also spoken about having had hair transplant procedures.
That said, it's not a decision to rush into: the cost is not insignificant and the effect will be dependent on who carries out the operation. So you need to know the different types of procedures and what questions to ask a hair transplant surgeon before making your decision. But first, we need to understand what causes hair loss.
Around one in three men experiences male-pattern baldness to varying degrees by the age of 30. Hair grows from follicles below the surface of the skin and a single hair will normally last between three and five years before itsshed and a new hair grows from that follicle. This cycle continues throughout life.
Male pattern baldness occurs when a modified form of testosterone, Dihydrotestosterone (DHT), begins to attack the hair follicles. This results in the follicles miniaturising and producing thinner and shorter hairs. As your thicker hairs fall out and are replaced by these weaker ones, you start to thin out on top. Whether you go through this process depends on your genes. If they are coded to resist DHT, you’ll keep your hair. If they are coded to be susceptible, you’re in trouble.
The follicles on the back and sides are usually coded to fend off Dihydrotestosterone, which is why it’s common for men to keep their hair there. The genes for hair loss can come from either parent.
Male-pattern hair loss is progressive, so if you start losing your hair happens at an early age, the overall effect is likely to be a very bald pate.(1)
Hair loss among women is more common than you might think. It can be caused by a number of factors, including, like male-pattern hair loss, hormonal change.
Specifically, these are male hormones (androgens) so the hair loss can happen any time from adolescence onwards, but is most likely to occur post-menopause when female hormones decrease and male hormones increase. As in male-pattern baldness, testosterone is converted to DHT and these results in the follicles producing smaller hairs.(1)
There are two main types of hair transplant procedure, Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT), which work in a similar way. Because the hair follicles on the side and back of the head are more resistant to DHT, and therefore usually keep producing strong and healthy hairs when the follicles on top of the head are shrinking; those healthy follicles are taken from the back and sides and transplanted into the balding areas of the scalp.
FUE transplants are the gold standard procedure. Single follicles are removed from the donor area of the scalp with a specialized cutting tool. These individual follicles are then inserted into tiny cuts made into the recipient site where they bed down. The skilled surgeon ensures that the recipient cuts are angle to reproduce the natural direction of your normal hair. The follicles then grow strong and healthy hairs in the previously bald patch.
With FUT surgery, instead of taking individual follicles from the donor site on the scalp, your hair transplant surgeon cuts away a strip of them. This strip is then divided up into single follicles or small groups which are inserted as with the FUE procedure into the recipient area. Hence it’s sometimes referred to as “strip harvesting”.(2)
There are two types of hair transplant methods:
The best option for you will depend on your individual needs and the recommendations of your physician.
The FUT method of hair transplantation involves taking a strip of skin with hair follicles from the donor site, typically the back of your head where hair is naturally fuller and less prone to balding. From this skin, small groups of tissue containing hair follicles are separated and prepared for transplantation. While this is happening, tiny, individual holes are made in the recipient site where you are experiencing thinning or balding. The prepared grafts are then individually placed into the recipient site.
This method has been around for over two decades and was a revolutionary technique for restoring a natural looking hairline when it was first developed and for many years after. But while it provided previously unachievable results, Dr. Sober explains that this technique is not without its downsides. This type of surgery can take many hours, depending on the number of grafts placed, and there is no way to avoid the resulting horizontal scar across the back of the head. While healing, this incision will be prominent, and patients will need to take care of both the linear incision on the back of the head and the recipient sites during recovery.
The FUE technique of hair transplantation was developed as a means to achieve the same results of FUT while addressing the disadvantages. Like FUT, FUE involves harvesting hair follicles from a donor site at the back of the head and moving them to create a fuller, natural-looking hairline. Unlike FUT, this method doesn’t involve removing a strip oftissue from the back of the head but rather collecting individual hair follicles directly from the scalp and inserting them into small incisions made in the recipient site.
While the detailed FUE technique requires more time in surgery, this method eliminates the linear scar and advanced wound care needed with FUT. The FUE method also lessens downtime and lowers levels of post-procedure discomfort.Follicular Unit Extraction (FUE) is a method of extracting, or “harvesting,” donor hair in a follicular unit hair transplant procedure. In FUE Hair Transplant procedure an instrument is used to make a small, circular incision in the skin around a follicular unit, separating it from the surrounding tissue.
The unit is then extracted (pulled) directly from the scalp, with tinny micro scar. The extracted follicle is then transplanted in the recipient area. This process gives a natural look. FUE Hair transplant has no large cuts involved and no stitching required.The procedure carried out for hair transplant is simple and takes less time. This minimally invasive process has significantly reduced pain and down time involved. The patients can start their routine work much faster than the traditional strip surgery.(4)
There are two types of medications that are FDA approved to treat pattern baldness in men:
Androgen-dependent hair loss medications, like Finasteride, work by stopping the conversion of testosterone into dihydrotestosterone—a hormone believed to contribute to male pattern baldness—in the scalp. During early stages of hair loss, androgen-dependent medicine typically helps increase hair growth after around three months of use.
Androgen-independent hair loss medications, like Minoxidil, work by dilating small blood vessels in the body. While it is still unknown why this stimulates hair growth, it has been shown to provide hair regrowth in around 40% of men after three months and will continue to support hair growth while the medication is being taken. Unlike androgen-dependent medicines, androgen-independent medicines can be used by women.
Receiving a hair transplant can improve your appearance and self-confidence.
Good candidates for a hair transplant include:
Hair replacement isn’t a good option for:
After thoroughly cleaning your scalp, a surgeon uses a small needle to numb an area of your head with local anesthesia.
Two main techniques are used to obtain follicles for transplantation: FUT and FUE.
In follicular unit transplantation (FUT):
In follicular unit extraction (FUE) the hair follicles are cut out directly from the back of the head through hundreds to thousands of tiny punch incisions.
A hair transplant session can take four hours or more. Your stitches will be removed about 10 days after surgery.(5) You may require up to three or four sessions to achieve the full head of hair you desire. Sessions occur several months apart to allow each transplant to fully heal.
You can expect a hair transplant to take between four and eight hours. If you are having a large amount of hair transplanted, you may need to return for a few hours the next day. Most patients remain awake during the entire surgery and need only an anesthesia that makes the scalp numb. Some patients also take a mild sedative to help them relax.
Hair transplant surgery usually lasts between 4 and 8 hours.The surgery begins with your dermatologist removing the healthy hairs. To give you natural-looking results, your dermatologist may remove the healthy hairs by either cutting a strip of skin with healthy hairs from your scalp or removing individual hairs. (6)
The second option takes a lot more time, but avoids leaving a long, narrow scar on your scalp. This can be beneficial if you prefer close-shaven haircuts like buzz cuts.
Before the surgeon can transplant the hairs, technicians need to prep the removed hairs and the surgeon must get your scalp ready for the transplant. Depending on the number of hairs to be transplanted, two to three members of the hair transplant team may help place the healthy hairs into the area that needs hair. Once all the hairs have been transplanted, your scalp will be bandaged and you will be given instructions for at-home care.
Your scalp may be sore, and you may need to take medications following hair transplant surgery, such as:
Most people can return to work several days after surgery.
It’s normal for the transplanted hair to fall out two to three weeks after the procedure. This makes way for new hair growth. Most people will see some amount of new hair growth 8 to 12 months after surgery.
Many doctors prescribe minoxidil (Rogaine) or the hair growth medication finasteride (Propecia) to improve hair regrowth. These medications also help slow or stop future hair loss.(7)
Stop smoking tobacco, and taking alcohol, tea, coffee and soft drinks 24 hours prior to surgery.
Avoid the use of aspirin or any other medicines with the advice of the five days prior to surgery.
Abstain from extensive exercise, including sexual activity, 24 hour prior to surgery.
Discontinue the use of vitamins five days prior to surgery.
On the day of operation, try to take full meal but without tea or coffee.
If you use medicine regularly, you must bring it along.
Wear a front open button shirt on the day of surgery.(8)
Hair transplants are typically more successful than over-the-counter hair restoration products. But there are some factors to consider:
Hair transplants don’t work for everyone. They’re mainly used to restore hair if you’re balding or thinning naturally or have lost hair due to an injury.
Most transplants are done with your existing hair, so they’re not as effective for treating people with:
It’s possible to have natural-looking results thanks to one key advance. Most surgeons now transplant the healthy hairs a few at a time. This eliminates the unnatural doll-like hair that patients saw in the 70s and 80s. Back then, sections of hair called hair plugs were placed in the thinning area. In time, the hair plugs became quite noticeable.
Improvements in creating the hairline and placing the hairs in the thinning areas also help create natural-looking results.
Thanks to these advances, the results can look so natural that a barber or stylist cannot tell you’ve had anything done.(9)
You will have a local anesthetic so the operation will be painless. You might have some discomfort during the healing process. Because FUT strip harvesting is more invasive, there’s likely to be a bit more than with the FUE procedure. Afterwards, any pain should be treatable with standard painkillers.
FUE surgery shouldn’t leave a scar, so if you want to keep your hair short then it’s probably the better option. FUT surgery is likely to leave a scar on the donor site, although it can probably be hidden under medium-length hair.
It depends on the scale of the operation i.e. how many individual follicles you are having transplanted, but normally about eight hours. FUE transplant recovery is fairly quick because there are no stitches. An FUT transplant will normally take around a month for a full recovery, during which time there is likely to be a little more discomfort than with FUE surgery. Your scalp might be quite red for a few weeks, so if you don’t want anyone to know, book a holiday.
Follicular Unit Extraction surgery will cost anywhere from £5,000 to £12,000 depending on the scale of the operation. Follicular Unit Transplantation costs less because the surgeon can harvest a donor hair strip of follicles at once, cutting down the work. Expect to pay £5,000 to £8,000 for FUT.
The first results will be visible after about four months. The full effect of a hair transplant operation should be apparent at the one-year mark. It’s possible that the transplanted follicles will themselves eventually begin to shrink and produce smaller hairs, in which case another transplant procedure is an option.
Quite possibly one, but perhaps a few transplant procedures will be necessary for good coverage on the recipient sites.
With the normal caveat that everyone is different, most people who undergo FUE and FUT hair transplants are happy with the outcome. The success will largely depend on how many good follicles you have left, how big a recipient area you want to cover, and the skill of the hair transplant surgeon – which underlines how important it is to do your research on hair transplant clinics and getting their predictions for the outcome.
Because the transplanted hairs will behave just as they would have done if they had stayed in the donor area, a transplant isn’t guaranteed to last forever. But it will probably last a very long time.
To state the obvious, you need to have some hair left to transplant. The more you have available, the better the resulting coverage. But you might be surprised how few healthy follicles you need for a reasonable effect. Anyone with Diffused Unpatterned Alopecia, which leads to hair falling out, is unlikely to be suitable.
Personal recommendation is very useful. Also make sure you see before and after shots of their work. Speak to one of their past patients if you can. And ask how many hair transplant operations they have performed.
Those awful 1980s hair plugs that made men look like they had doll-like ropes of hair? They don’t exist anymore. You can, if you have some, have them removed and replaced with FUE and FUT surgery.
Yes, although fewer will be suitable candidates than among men because the pattern of hair loss tends to be more widespread, meaning fewer good donor sites.
FUT and FUE transplants are generally very safe, but as with any surgical procedure, complications are possible. There may be swelling, bruising or bleeding; the existing hairs in the recipient area can die due to the shock of the procedure (they will normally return, but not always); small cysts can form, though these usually soon disappear or can be treated quite easily.
Yes, it’s possible for your body to reject the new follicles so the transplant fails. It’s rare, though.