Hair transplant

A hair transplant (hair transplantation) is a surgical procedure in which we move healthy hair follicles to areas of hair loss or thinning. Because the transplant uses your own tissue, the medical term for this is autologous grafting.

We harvest follicles from the scalp and place them in small channels we create in the recipient area. We can also use follicles taken from the scalp to fill areas of missing eyebrow, beard, or mustache hair. During the consultation, you can describe your expectations for your hairline or any other areas where you are considering transplantation.

What are hair follicles and grafts?

The part of a hair visible above the skin is the hair shaft. The follicle (the structure containing the hair root) lies within the skin and includes the parts where hair is produced. During transplantation, the root is moved together with a small piece of surrounding tissue. The distinction between the part above the skin and the root explains why the procedure involves tissue transplantation.

A follicular unit is a group of hair follicles that naturally occur together in the scalp. A graft (a piece of tissue harvested for transplantation) may contain the follicles in this unit. Because the number of hairs in a graft can vary, graft count and hair count do not mean the same thing.

Suitability for a hair transplant

The cause of hair loss is the starting point for a transplant decision. A receding frontal hairline, a bald area at the crown, and thinning throughout the scalp have different distributions. The examination assesses this distribution and the condition of the scalp to determine whether further testing is needed.

A hair transplant requires enough healthy hair in the area from which follicles can be harvested. The donor area (where hair follicles are taken from) and the recipient area are examined separately. The number of follicles available for transfer sets the limits of the transplant plan.

Androgenetic alopecia (hair thinning associated with genetic and hormonal factors) is one pattern encountered during hair transplant assessment. There may be recession of the frontal hairline or thinning at the crown. Transplantation may also be considered for women. Suitability depends on the cause and distribution of hair loss and the condition of the donor area.

If the donor area also has diffuse thinning, the number of healthy follicles available for transfer may be limited. Active scalp disease, unexplained hair loss, or an uncontrolled medical condition requires assessment first. Clarifying the cause of hair loss helps determine whether follicle transplantation suits the person’s expectations.

During the examination, you can share where you noticed hair loss, any family history of hair loss, and previous treatments. The scalp surface, follicle distribution, and hair shaft thickness are examined. Trichoscopy (magnified examination of the hair and scalp) may be used to assess these features in detail.

Views of the scalp from the front, above, and the back of the head can show the general distribution of hair loss and potential donor areas. The direction in which hair is combed or whether it is wet changes the appearance of thinning in photographs. Follicle condition, hair shaft thickness, and the scalp surface are assessed through direct examination and, when needed, magnification.

Assessing the donor area

The donor area is usually selected from the hair-bearing scalp at the back and sides of the head. Its boundaries are not the same for everyone. Areas of dense follicles, hair shaft thickness, and thinning within the region determine where harvesting can take place.

The amount of tissue available for harvesting is considered alongside the size of the area where transplantation is desired. If there is hair loss along the frontal hairline, mid-scalp, and crown, the distribution of follicles among these areas is decided in advance. Follicles allocated to the frontal hairline and those allocated to the crown come from the same donor source. Explaining which area you would most like to change helps clarify this distribution.

If you have had a previous hair transplant, you can share information about where the follicles were harvested. If a strip of tissue was removed, the linear incision site in that area is also examined. A new harvesting plan is based on the areas where follicles remain.

Planning the hairline and recipient area

The areas of thinning and their size are determined during the examination. Hair loss at the frontal hairline, temples, and crown requires different placement patterns. Follicle distribution depends on the number that can be harvested and the surface area to be treated.

The shape of the hairline and the direction in which follicles will be placed are considered in transplantation. The growth direction of existing hair guides the direction of the channels.

The frontal hairline is drawn according to forehead height, temple shape, and the distribution of existing hair. Its central height and transitions at the sides are parts of the same plan. The position of the line also changes the size of the surface to be covered. The markings can therefore help explain how your expectations and the available follicles could fit within a plan.

Grafts with different characteristics may be selected for the front edge and the areas behind it. Grafts containing a single hair may be used at the front of the hairline, while those containing multiple hairs may be used in other parts of the planned area. The angle at which hairs emerge and their direction in relation to neighboring hair complete the placement plan.

At the crown, hairs may spread in different directions to form a whorl. These directions and the hair surrounding the area of loss are considered when the recipient area is marked. The frontal hairline position and distribution at the crown are planned together around how the same donor source will be used.

Hair follicles may still be present in a thinning area. The positions and growth directions of existing hairs are marked in the channel plan. Placement patterns differ between completely bald and thinning areas according to the positions of remaining hairs. The spaces where grafts will be placed are determined by the distribution of existing follicles across the recipient surface.

Hair shaft thickness, straight or curly texture, and the color contrast between hair and skin contribute to the visible appearance of hair loss. Recipient areas of the same size therefore cannot be described by graft count alone. Donor hair characteristics and the appearance of existing hair are considered together when explaining how follicles will be allocated.

The surgical procedure and team

We perform hair transplantation in operating room conditions, following sterile working practices. Harvesting follicles, preparing them for transplantation, and placing them in channels are consecutive stages of the procedure. We aim to protect the follicles as we transfer them through these stages.

We perform graft harvesting and channel creation ourselves and are present throughout the operation. Nurses and operating room technicians assist the surgeon.

Local anesthesia can be used to numb the areas where follicles will be harvested and implanted. Because the donor and recipient areas are in different locations, the anesthesia plan includes the boundaries of each. Current treatments, overall health, and previous experiences with anesthesia are details that can be shared during the preparatory consultation.

As harvested follicular units are prepared for placement, they may be sorted by the follicles they contain and their tissue structure. Grafts for the frontal hairline and those to be used behind it are selected to match the markings. This preparation takes place between harvesting tissue from the donor area and placing it in the scalp.

FUE and FUT methods

Hair transplantation methods include FUE (individual harvesting of small tissue units containing hair follicles) and FUT (removing hair-bearing tissue as a single piece and preparing it for transplantation). Both use the person’s own hair follicles. The main difference is how the follicles are harvested from the scalp.

In FUE, hair follicles (the structures containing the hair roots) are collected individually with the help of a micromotor. The harvested follicles are placed into small channels created in the marked recipient areas.

In FUT, a strip of skin containing hair follicles is taken from the back of the head. This tissue is divided into small grafts (pieces of tissue to be transplanted) and prepared for placement. The prepared grafts are placed into small channels created in the scalp.

In FUE harvesting, small circular incisions are made around follicular units in the donor area. Strip harvesting involves a linear incision and closure in the hair-bearing scalp at the back of the head. The small entry sites for grafts in the recipient area are planned separately from the harvesting method.

The difference between FUE and DHI

The term DHI (direct hair implantation) may be used for different approaches to follicle placement during hair transplantation. FUE describes the way follicles are harvested individually from the donor area. Follicles harvested with FUE can be transplanted using a placement approach described as DHI.

An implanter (a pen-shaped tool that carries a hair follicle and places it in the skin) has a channel into which the graft is loaded. With a sharp-tipped tool, creating the entry site and placing the graft can be done with the same instrument. Other placement approaches use channels created beforehand.

The distinction between FUE and DHI becomes clear when harvesting and placement are considered as separate stages. During the consultation, you can ask about the method’s name, how follicles will be harvested, which tool will create the channels, and how grafts will be placed. Donor capacity and hairline design are planned separately for every placement approach.

The terms shaved and unshaved transplantation describe how hair in the donor or recipient area is prepared for the procedure. Leaving hair long does not mean that harvesting or placement is a separate method. The boundaries of the area to be trimmed relate to the length of existing hair and visibility of the surgical working area.

Eyebrow, beard, and mustache transplantation

If restoration of missing eyebrow, beard, or mustache hair is being considered alongside scalp transplantation, the needs of each area are determined separately. Follicles allocated to these areas also come from the same donor source, so distribution is planned together with the scalp’s transplant needs. The shape and directions of a scalp area with hair loss differ from those of an area with missing facial hair.

In the eyebrows, the way hairs lie close to the skin and change direction across the inner, middle, and outer sections affects placement. In the beard and mustache, the growth direction of existing hair and the boundary lines are taken into account. The structure of the graft and its entry angle in each area are selected according to the arrangement of surrounding hairs.