A Hair Transplant Can Give You Permanent, Natural-Looking Results

If you’re looking for a permanent solution to your hair loss, you may want to consider a hair transplant

Today, 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

 Good candidate for a hair transplant

Men and women of all races can be good candidates for a hair transplant.

To be considered for a hair transplant, you need two things:

  1. Enough healthy hair on your scalp that can be transplanted to the area that needs hair
  2. The ability to grow hair on the thinning area of your scalp

During a consultation with a dermatologist, you can find out if you have both. A dermatologist will give you a thorough scalp exam.

To find out why you have hair loss, you may also need a blood test. This can check for things going on in your body that may be causing your hair loss. Some patients need a procedure called a scalp biopsy. Your dermatologist can quickly and easily take what is needed for the scalp biopsy during the consultation. 

If the exam and tests show that you are a good candidate for a hair transplant, your dermatologist can tell you what results you can expect. A full head of hair may be unrealistic, but a fuller head of hair can be the goal.

During a hair transplant

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. 

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

patients see results from a hair transplant

Most patients see results between six and nine months after surgery. For some patients, it takes 12 months. 

It’s important to know that between two and eight weeks after the surgery, the transplanted hair will fall out. This is normal. By the third month, the hair may look thinner than before you had the transplant. Again, this is normal

Hair Transplants

Like good health and youth, most of us take our locks for granted — that is, until they’re gone. For many people, a hair transplant can help bring back what looks like a full — or at least a fuller — head of hair.

If thinning up top or going bald really bothers you, the procedure can be one way to feel more confident about your looks. But first talk with your doctor about what you can expect during and after the surgery

Hair Transplant

It’s a type of surgery that moves hair you already have to fill an area with thin or no hair. Doctors have been doing these transplants in the U.S. since the 1950s, but techniques have changed a lot in recent years.

You usually have the procedure in the doctor’s office. First, the surgeon cleans your scalp and injects medicine to numb the back of your head. Your doctor will choose one of two methods for the transplant: follicular unit strip surgery (FUSS) or follicular unit extraction (FUE).

With FUSS, the surgeon removes a 6- to 10-inch strip of skin from the back of your head. They set it aside and sews the scalp closed. This area is immediately hidden by the hair around it.

Next, the surgeon’s team divides the strip of removed scalp into 500 to 2,000 tiny grafts, each with an individual hair or just a few hairs. The number and type of graft you get depends on your hair type, quality, color, and the size of the area where you’re getting the transplant.

If you’re getting the FUE procedure, the surgeon’s team will shave the back of your scalp. Then, the doctor will remove hair follicles one by one from there. The area heals with small dots, which your existing hair will cover.

After that point, both procedures are the same. After they prepare the grafts, the surgeon cleans and numbs the area where the hair will go, creates holes or slits with a scalpel or needle, and delicately places each graft in one of the holes. They’ll probably get help from other team members to plant the grafts, too.

Depending on the size of the transplant you’re getting, the process will take about 4 to 8 hours. You might need another procedure later on if you continue to lose hair or decide you want thicker hair.

Expectations and Recovery

After the surgery, your scalp may be very tender. You may need to take pain medications for several days. Your surgeon will have you wear bandages over your scalp for at least a day or two. They may also prescribe an antibiotic or an anti-inflammatory drug for you to take for several days. Most people are able to return to work 2 to 5 days after the operation.

Within 2 to 3 weeks after surgery, the transplanted hair will fall out, but you should start to notice new growth within a few months. Most people will see 60% of new hair growth after 6 to 9 months. Some surgeons prescribe the hair-growing drug minoxidil (Rogaine) to improve hair growth after transplantation, but it’s not clear how well it works.

Different types of Hair Transplants

Hair Transplant

A hair transplant is a procedure in which a plastic or dermatological surgeon moves hair to a bald area of the head. The surgeon usually moves hair from the back or side of the head to the front or top of the head.

different types of hair transplants

There are two types of transplant procedures: slit grafts and micrografts.

Slit grafts contain 4 to 10 hairs per graft. Micrografts contain 1 to 2 hairs per graft, depending on the amount of coverage needed.

During a hair transplant

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):

  1. The surgeon will use a scalpel to cut out a strip of scalp skin from the back of the head. The incision is typically several inches long.
  2. This is then closed with stitches.
  3. The surgeon next separates the removed portion of scalp into small sections using a magnifying lens and sharp surgical knife. When implanted, these sections will help achieve natural-looking hair growth.

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.

  1. The surgeon makes tiny holes with a blade or needle in the area of your scalp that’s receiving the hair transplant. They gently place hairs in these holes.
  2. During one treatment session, a surgeon may transplant hundreds or even thousands of hairs.
  3. After, the graft, gauze, or bandages will cover your scalp for a few days.

A hair transplant session can take four hours or more. Your stitches will be removed about 10 days after surgery.

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.

long-term outlook

Typically, people who’ve had a hair transplant will continue to grow hair in the transplanted areas of the scalp.

The new hair may appear more or less dense depending on:

  • scalp laxity, or how loose your scalp skin is
  • density of follicles in the transplanted zone
  • hair caliber or quality
  • hair curl


A full head of hair for women of all ages is the cultural norm. Recent techniques for efficient donor hair harvest and meticulous preparation of hair grafts have allowed many women to be candidates for hair restoration surgery. The artistic creation of grafts of different size and the meticulous handling of these fragile transplants have enabled treatment of some women who might not have been candidates for surgery a few years ago. Still, careful patient selection for hair restoration surgery is essential

Hair Transplantation and Restoration

Surgical Hair Replacement

Hair transplant surgery involves removing small pieces of hair-bearing scalp grafts from a donor site and relocating them to a bald or thinning area

What are the steps of a hair transplant procedure?

Hair transplantation involves removing small punch grafts from the hair bearing scalp or a larger piece of this scalp from a donor area and cutting this into smaller pieces to use as grafts. These grafts are then relocating to a bald or thinning area of the scalp. The grafts created in this manner differ in size and shape. Round-shaped punch grafts usually contain about 10-15 hairs. The much smaller mini-graft contains about two to four hairs; and the micro-graft, one to two hairs. Slit grafts, which are inserted into slits created in the scalp, contain about four to 10 hairs each; strip grafts are long and thin and contain 30-40 hairs.

Generally, several surgical sessions may be needed to achieve satisfactory fullness, and a healing interval of several months is usually recommended between each session. It may take up to two years before you see the final result with a full transplant series. The amount of coverage you’ll need is partly dependent upon the color and texture of your hair. Coarse, gray or light-colored hair affords better coverage than fine, dark-colored hair. The number of large plugs transplanted in the first session varies with each individual, but the average is about 50. For mini-grafts or micro-grafts, the number can be up to 700 per session

Just before surgery, the “donor area” will be trimmed short so that the grafts can be easily accessed and removed. For punch grafts, your doctor may use a special tube-like instrument made of sharp carbon steel that punches the round graft out of the donor site so it can be replaced in the area to be covered—generally the frontal hairline. For other types of grafts, your doctor will use a scalpel to remove small sections of hair-bearing scalp, which will be divided into tiny sections and transplanted into tiny holes or slits within the scalp. When grafts are taken, your doctor may periodically inject small amounts of saline solution into the scalp to maintain proper skin strength. The donor site holes may be closed with stitches—for punch grafts, a single stitch may close each punch site; for other types of grafts, a small, straight-line scar will result. The stitches are usually concealed with the surrounding hair. To maintain healthy circulation in the scalp, the grafts are placed about one-eighth of an inch apart. In later sessions, the spaces between the plugs will be filled in with additional grafts. Your doctor will take great care in removing and placement of grafts to ensure that the transplanted hair will grow in a natural direction and that hair growth at the donor site is not adversely affected.

After the grafting session is complete, the scalp will be cleansed and covered with gauze. You may have to wear a pressure bandage for a day or two. Some doctors allow their patients to recover bandage-free.

Tissue Expansion

Another technique used in the treatment of baldness is called tissue expansion. Plastic surgeons are the leaders in tissue expansion, a procedure commonly used in reconstructive surgery to repair burn wounds and injuries with significant skin loss. Its application in hair transplant surgery has yielded dramatic results-significant coverage in a relatively short amount of time.

In this technique, a balloon-like device called a tissue expander is inserted beneath hair-bearing scalp that lies next to a bald area. The device is gradually inflated with salt water over a period of weeks, causing the skin to expand and grow new skin cells. This causes a bulge beneath the hair-bearing scalp, especially after several weeks.

When the skin beneath the hair has stretched enough-usually about two months after the first operation-another procedure is performed to bring the expanded skin over to cover the adjacent bald area. For more information about tissue expansion, ask your plastic surgeon for the American Society of Plastic Surgeons, Inc. brochure entitled, Tissue Expansion: Creating New Skin from Old.

Flap Surgery

Flap surgery on the scalp has been performed successfully for more than 20 years. This procedure is capable of quickly covering large areas of baldness and is customized for each individual patient. The size of the flap and its placement are largely dependent upon the patient’s goals and needs. One flap can do the work of 350 or more punch grafts.

A section of bald scalp is cut out and a flap of hair-bearing skin is lifted off the surface while still attached at one end. The hair-bearing flap is brought into its new position and sewn into place, while remaining “tethered” to its original blood supply. As you heal, you’ll notice that the scar is camouflaged—or at least obscured—by relocated hair, which grows to the very edge of the incision.

In recent years, plastic surgeons have made significant advances in flap techniques, combining flap surgery and scalp reduction for better coverage of the crown; or with tissue expansion, to provide better frontal coverage and a more natural hairline

Scalp Reduction

This technique is sometimes referred to as advancement flap surgery because sections of hair-bearing scalp are pulled forward or “advanced” to fill in a bald crown.

Scalp reduction is for coverage of bald areas at the top and back of the head. It’s not beneficial for coverage of the frontal hairline. After the scalp is injected with a local anesthetic, a segment of bald scalp is removed. The pattern of the section of removed scalp varies widely, depending on the patient’s goals. If a large amount of coverage is needed, doctors commonly remove a segment of scalp in an inverted Y-shape. Excisions may also be shaped like a U, a pointed oval or some other figure.

The skin surrounding the cut-out area is loosened and pulled, so that the sections of hair-bearing scalp can be brought together and closed with stitches. It’s likely that you’ll feel a strong tugging at this point, and occasional pain

Procedure Steps

Before: Hair transplant candidates should have some noticeable hair loss with healthy hair growth at the back and sides of the head to serve as donor areas

Step 1: A tube-like instrument punches round grafts from the donor site to be placed in the area where hair replacement is desired.

Step 2: A tube-like instrument punches round grafts from the donor site to be placed in the area where hair replacement is desired.

Step 3: When the skin beneath the hair has stretched enough, it is surgically placed over the bald area.

Step 4: During flap surgery, a section of bald scalp is cut out and a flap of hair-bearing skin is sewn into its place

Step 5: The patterns used in scalp reduction vary widely, yet all meet the goal of bringing hair and scalp together to cover bald areas

After: The results of hair transplant surgery can enhance your appearance and self-confidence.

Hair Restoration Surgery

Hair restoration is a highly sophisticated subspecialty that offers significant relief to patients with hair loss. An improved understanding of the aesthetics of hair loss and cosmetic hair restoration, hair anatomy and physiology, and the development of microvascular surgical instrumentation has revolutionized the approach to surgical hair restoration since the original description. Additional elements that contribute to the current state of the art in hair restoration include graft size, site creation, packing density, and medical control of hair loss. The results of hair restoration are natural in appearance and are provided with a very high level of patient satisfaction and safety. This aspect of cosmetic surgery is a very welcome addition to a traditional aesthetic practice and serves as a tremendous source for internal cross-referral. The future of hair restoration surgery is centered on minimal-incision surgery as well as cell-based therapies

Hair Restoration

Alopecia, the term for generic hair loss, involves a diminution of visible hair. There are numerous types of alopecia. The most common form of surgically treatable alopecia is androgenic alopecia (AGA). Throughout time, the presence of scalp hair has represented attributes of health, vigor, vitality, and strength. Accordingly, loss of hair in men (MAGA, or male pattern androgenic alopecia) and especially women (FPHL, or female pattern hair loss) can have significant psychosocial effects. The overwhelming majority of procedures for hair restoration are hair transplants, and the advent of microvascular surgical instrumentation as well as an improved understanding of the anatomy and physiology of hair loss has revolutionized the art of surgical hair restoration since the original description and early refinement

Anatomy, Genetics, and Physiology of Hair Loss

Androgenic alopecia is characterized by progressive visible thinning of scalp hair in genetically susceptible men and in some women. The current scientific data support the thesis that AGA is a polygenic trait. Significant associations have been reported with variant regions of the androgen receptor gene, which is located on the X chromosome. Epidemiologic surveys of AGA reveal the highest incidence in Caucasians, followed by Asians and then Africans, with the lowest incidence in Native American For the purpose of hair transplantation, the scalp may be divided into the frontal, midscalp, vertex, and temporal areas Hair thinning and subsequent shedding is due to gradual miniaturization of genetically marked hair follicles and represents shortening of the anagen (growth) phase of the hair follicle with an increase in the telogen/anagen ratio of the affected scalp. An understanding of the normal hair follicle life cycle is critically linked to an appreciation of the physiology of hair loss

In women, there is no consensus on whether hair loss is truly androgen dependent. Most women with FPHL do not have biochemical hyperandrogenism. In fact, some women without detectable circulating androgens may also develop FPHL, suggesting a possible role for non-androgen-dependent mechanisms. Based on this evidence, it seems appropriate to replace the term androgenic alopecia in women with the previously mentioned, more contemporary and scientifically descriptive term female pattern hair loss (FPHL), to include this recognized heterogeneity

Nonsurgical Options for Treating Hair Loss

General Evaluation

Young men and women are particularly distraught by the signs of hair loss. Low self-esteem and vulnerability to a fantasized outcome place this subset of patients at particular risk for quick decision making and unrealistic expectations. Managing these expectations and formulating a realistic surgical plan for patients with hair loss is a critical component to the long-term success of the procedure.

A fundamental concept that physicians and patients are advised to maintain during the evaluation and planning for HRS is that hair loss is progressive. The appearance of hair loss in the office during consultation is merely a snapshot along a continuum that began years earlier and will progress until death. Communication regarding the quality of the patient donor hair is also an additional essential component in managing expectations. The qualities of the hair that should be reviewed include curl, hair shaft diameter, color, texture, follicular unit density, and the telogen/anogen ratio of in situ donor hair. These aspects of the donor hair should be not only reviewed but also documented as a means to predict how well the transplanted hair will camouflage areas of scalp alopecia.

Hair Transplant Technique

As with any surgical procedure, the techniques of the operation will vary based on personal preference and clinical circumstances. Although the fundamental approach described herein is nearly universally applicable, the specific techniques do reflect most closely the methodology preferred by the lead author (JEV).


Hair transplantation can be performed under local anesthesia alone or with supplemental sedation. The local anesthesia solution is a 40-mL mixture of 0.25% bupivacaine with 1:200 000 epinephrine + 20 mL 1.0% lidocaine with 1:200 000 epinephrine. This solution is used in the donor and recipient sites, and supplementation with additional bupivacaine 0.25% is performed in both regions of the scalp prior to discharge from the operating room. If conscious sedation is included with the procedure, the patient is premedicated with 1 to 2 mg PO aprazolam. In the operating room, an intravenous cocktail of ketamine 5 mg/mL, midazolam 0.5 mg/mL, and fentanyl 10 mcg/mL is titrated to achieve the desired level of sedation. All patients receiving any type of sedation are continuously monitored during the procedure with oximetry and receive supplemental nasal

Donor Site Harvest

In contemporary practice, follicular units can be obtained either through strip excision of the donor scalp with subsequent microscopic tissue dissection or by removal using a technique called follicular unit extraction (FUE)

Strip excision.

In preparation for the strip harvest, the selected area of donor hair is trimmed to 4- to 5-mm length and the patient is positioned in a lateral decubitus position. An ellipse of donor scalp is outlined, and following the administration of local anesthesia, tumescent saline solution is infiltrated. Tumescence in conjunction with precise knife blade angulation parallel to the hair shafts reduces follicle transection. Dissection level of the donor strip should be at the superficial fat to avoid injury to the occipital neurovascular bundle. The wound is closed in 2 layers, with an absorbable suture in the deep layer and a monofilament suture of choice at the level of the skin. Staples or dissolving sutures are also options

Follicular unit extraction.

Follicular unit extraction is an alternative method of donor harvest. This technique is essentially a refined “micropunch grafting” version of the older punch graft technique. Using the current technique of FUE, 1 FU is removed at a time. There are several techniques and instruments to perform FUE. These include manual, power-assisted, and automated methods. No matter which technique is employed, the net result is still the isolation and removal of a single FU  The remaining puncture is left to heal by secondary intention. Some hair transplant surgeons choose to employ FUE on a selective basis for small cases  , whereas others select this donor harvest technique for their larger sessions  The increased popularity of FUE has been linked to the development of power-assisted technology as well as a general trend toward minimally-invasive techniques. The indications, outcomes, and techniques for FUE as a donor harvest option are found elsewhere

Hairline Design and General Recipient Area

The first landmark that needs to be determined is the height of the anterior hairline (AHL) In most instances, the location of the most anterior, midfrontal portion of the hairline is between 7.5 and 9.5 cm above the glabella. The shape of the head, predicted future hair loss, and donor capacity are factors to consider in this creative decision. One must place the hairline in such a location that it will look natural as the patient matures and continues to lose hair.

If the temporal point is expected to recede, a higher hairline should be considered because a low hairline with a lost temporal point suggests a hairpiece. The temple point should be even or slightly posterior to the frontal hairline. Along with the aforementioned principles, a gently curving hairline should be created, with care taken to always maintain a significant frontal-temporal recession. Restoration of the temporal triangle is performed according to the personal preference of patient and surgeon.

The design should begin by ensuring the presence of a lateral hump . If the lateral hump is absent, this should be designed first. The lateral hump is the superior extension of the inferiorly directed hair of the temporoparietal fringe. The superior extent of this important landmark is even with or just medial to a line drawn vertically from the lateral canthus. This landmark is important because it represents the lateral extent of the AHL. The intersection of the lateral AHL and the lateral hump is the apex of the frontotemporal recession and should always be convex in a male AHL design

When a forelock pattern is created, the rear border should be located somewhere along the midscalp. Whether or not there is a plan to graft the vertex, the rear hairline should be constructed with an irregular border of small grafts. The lead author prefers to create a tapered posterior forelock pattern of trailing design that renders the crown less circular and mimics a natural variation on the balding process .A distribution of grafts recreating a natural whorl pattern can be constructed at the posterior aspect of the forelock. The crown area can be further grafted as indicated but should always be considered as an extension of the posterior forelock to maintain a natural distribution of hair

Conclusion of Procedure, Postoperative Care, and Emergence of Results

Hair transplants are lengthy procedures. A typical session of 1500 to 2500 grafts utilizing 4 assistants will last approximately 6 to 7 hours. The procedure is conducted using a clean technique with sterilized or disposable instruments. Postoperatively, the recipient sites and donor area are typically not bandaged, and perioperative antibiotics are not prescribed on a routine basis. Patient instructions include head elevation and icing of the forehead and donor area, along with analgesics. Aloe ointment administration to the grafted area and gentle shampooing in the shower should commence on postoperative day 2. Most of the recipient site eschars are gone by day 10, and donor sutures are removed on day 14. Although there are exceptions to the rule, most grafts enter a telogen phase for the first 3 months prior to entering their anagen phase. Full growth and evaluation of transplant results cannot reliably be assessed for 8 to 12 months following the procedure.

Whitening injection:

Whitening injection:

Injectable skin whitening products are marked for injection into vein or muscle or under the skin. They are sold online and in some retail outlets and health spas. They often to lighten the skin, correct uneven skin tone, and reduce blemishes.

Skin whitening injections is a well-known and most demanding procedure that is also known as Glutathione injections.


Glutathione is a naturally occurring substance produced by our liver. This naturally present antioxidant is useful for performing a number of activities in our body such as building and repairing of body tissues, neutralizing free radicals, helping in immunity, acting as an anti-cancer agent, delaying the process of aging, etc. Over the years, the level of glutathione decreases in our body and when this happens, it accelerates the process of aging in our body. Because of this, people tend to turn to glutathione injections which help in maintaining their youthful look along with skin whitening. This external agent helps to increase the level of glutathione in our body.

Based on various studies and research, the general consensus is that glutathione injection’s results are mostly positive for skin whitening. Though taking this injection will provide results for a longer time, you will have to get booster shots in between in order to maintain the effects. These booster shots can either be in the form of injections or glutathione pills. The results of this procedure will be more effective if they are combined with other cosmetic treatment such as laser skin lightening.

Glutathione injection dosage:

The exact glutathione injection dosage that you should take will vary from person to person, depending on various factors, including your height, weight, metabolic rate and why you’re taking the glutathione injection. It is essential to find the right dosage to experience the full beneficial effects of glutathione injections. Glutathione injections required a prescription. You should always consult with a healthcare professional to determine the right glutathione injection dosage and determine if you should take other vitamins on the side, such as vitamin C, to boost or maintain the effects.

The absorption of the glutathione by your body may be affected by factors such as alcohol consumption, smoking, and exercise, which may result in slower visible effects or required higher dosages.

Skin whitening injection benefits:

  • Fight free radicals.
  • Defy sign of aging
  • Protect against UV rays.
  • Detoxify the body.
  • Reduce melanin pigments.
  • Convert dark melanin pigments into lighter pigments.
  • Promote fairer and brighter skin.

 Common Side Effects of glutathione injection:

Like every other cosmetic treatment out there, getting a shot of glutathione injection can also result in various side effects. If in case the dosage administered is much higher than what is required, a patient can suffer serious side effects such as kidney failure or blood poisoning. Apart from this some of the other glutathione injection side effects that can occur, if in case, the dosage given is more than 5grams or more include:

  • Pain and redness at injection site.
  • Nausea.
  • Skin rashes, hives or allergic reactions.
  • Diarrhea or other forms of stomach upset.
  • Loss of hair.
  • Breathing problem.
  • Gain in weight.
  • Toxic epidermal necrosis.
  • Numbness.
  • Aggravate symptoms of asthma.

How much does glutathione cost?

The cost of glutathione ranges greatly depending on dosage and location. Generally, a treatment of 1500 to 4000mg once or twice a week will cost anywhere from $150 to $400. It may be a less expensive treatment if you learn to self-administer after consulting with your health care provider and getting a prescription.

Evolution of Hair Transplantation


Hair transplantation has gone through a big revolution with the pioneers in this field[15]. To achieve a good cosmetic result in hair transplantation, a natural-looking hairline with adequate density shall be established. There are numerous modifications of defined techniques with each one explaining and suggesting verified solutions.

This note describes the available options in hair loss surgery and the concepts of non-surgical approaches, and an experience is shared with a few patients grafted via direct hair implantation (DHI) method. Moreover, to us, this is the only study demonstrating the opening of the nests with sliced razor blade just before the implantation of the hair follicles. Thus, the evolution with the future of hair transplantation is summarized as well. Moreover, this article focuses on the surgical techniques. The medical management of hair loss is out-of-scope


Between January and December 2014, hair transplantation was carried out in 207 patients. The patients with beard and/or moustache transplantation, multisession transplantations and female patients were excluded. The harvested grafts out of the scalp were also not evaluated.

All the procedures were carried out under local anesthesia. The hair was cut 1-2 mm in length. Micromotor system was used in the harvesting of the hair follicles This system consists of punches attached to the hand-piece of the micromotor system (1500-3000 rpm). Punches were chosen according to the diameter of the follicles ranging between 0.8 and 1.2 mm. Harvesting of the follicles was handled in supine position. With the aid of the sharp punch attached to the motorized system, the follicle was detached from the surrounding tissue (approximately 3-4 mm in depth=deep dermis layer). Later on, it is released manually with fine-curved microforceps produced for this purpose. Temporooccipital region was used as donor site.

The harvested grafts were aligned in Petri dishes with cooled saline (4 °C). A dressing is made with sterile saline coated gauze to the donor area and the patient was turned to the supine position.

In follicular unit extraction (FUE) technique, razor blade that was cut into pieces was used to open the nests in vertically-oriented fashion that are to be grafted . With this, we aimed to diminish the incarceration of the implanted follicles. However, in DHI technique, the grafts were loaded to the DHI pens with one charged staff for this purpose  . The implantation of the follicles was carried out in accordance with the natural hair angles by the author under loupe magnification

Hair transplantation is comprised of consecutive steps: planning, preparation, anesthesia, graft harvesting, secure of the harvested grafts, graft transplantation, and dre


While several surgical treatment options (plug grafts, scalp reductions, transposition flaps) have been used historically to treat androgenic alopecia, we outline the two most common techniques of HT based on the follicular unit-principle, namely the follicular unit transplantation (FUT) and the follicular unit excision (FUE)

FUT Donor Site Harvest 

  • The patient placement is in a prone position.
  • If not done already, the donor site hair is trimmed to 2 mm.
  • The calculated strip length is marked, and a local anesthetic is injected superficially into the dermis. A tumescent solution may be injected as well to increase anesthesia, hemostasis, and dermal turgor.
  • A beveled incision is made parallel to the exiting follicles, into but not beyond the subcutaneous tissue (about 4 to 5 mm in depth).
  • With lateral retraction around the periphery using sharp skin hooks, the donor strip gets dissected off the galea aponeurosis and occipital fascia which minimizes bleeding and sensory nerve damage. NOTE: cauterization should be used sparingly to decrease the risk of permanent FU damage.
  • The donor strip gets prepared by removing excess subcutaneous tissue, with care to leave 2 mm of fat beneath the FU to avoid damage to the follicle.
  • The strip is then dissected (usually by a technician) under magnification into vertical segments one FU thick.
  • Individual FUs are then isolated with further sharp strip dissection and placed immediately into a holding medium of chilled saline. NOTE: the FU is susceptible to desiccation in just a few minutes, which renders the graft unusable.
  • The donor strip is then closed either primarily or with a two-layer closure using sutures and/or staples per surgeon preference.
  • The patient transitions to a sitting position for recipient site preparation and graft implantation.

FUE Donor Site Harvest

  • The donor site is shaved to 2 mm to visualize the angle of the follicles.
  • The patient placement is in a prone position for ease of harvesting.
  • Local and tumescent anesthesia gets injected into the donor site.
  • If manual FUE is being performed, a sharp punch (diameter 0.8 to 1.2 mm) is oriented within the center of the hair follicle at the same angle and advanced in an oscillating motion to a depth of 4 mm or less to prevent transection.
  • The FU is removed using delicate forceps in an atraumatic fashion and placed either directly into the recipient site (after inspection of FU integrity) or a holding medium of chilled sterile saline.
  • The patient then gets transitioned to a sitting position in preparation for recipient site implantation.
  • NOTE: Modifications of the manual sharp FUE technique include the manual dull punch technique, the use of powered devices with oscillatory or rotating punches, or employing a vacuum apparatus to facilitate atraumatic extraction. Regardless of the technique used, a 5% transection rate is generally acceptable.

Recipient Site Creation and Implantation

  • No matter the harvest technique used (FUE or FUT), the implantation process must also take place in an atraumatic and meticulous fashion. For instance, grafts should only be manipulated using the perifollicular tissue. Furthermore, grafting should be done expeditiously, since prolonged exposure of the FU will cause graft desiccation.
  • Attention to the recipient’s hair pattern is important to promote a natural-looking result. For example, hair along the frontal scalp hairline points anteriorly at an angle of 15 to 20 degrees, while hair follicles in the temporal region are oriented inferiorly. Also, the surgeon should strive to recreate a sharp temporal recess in males and a rounded temporal recess in females. Lastly, the angles and spiraled orientation of the crown should be followed to create a natural result.
  • The recipient sites for the FUs are then created in a random and irregular pattern under magnification using either flat-edged blades or a combination of needles (19 or 21 gauge), with care not to transect the native follicles.
  • The graft is gently placed into the recipient site, with light pressure applied for several seconds with a wet cotton-tip applicator to promote hemostasis and to avoid graft extrusion or “popping.”
  • An emollient or antibiotic ointment and a non-adhesive bandage are placed gently across the donor and recipient sites.


  • ROBOT Follicular Unit Extraction: More recently, robotic devices have been developed with potential advantages including more accurate and faster graft harvesting, decreased FU transection rate, and increased implantation accuracy at the recipient site, though comparative studies are lacking. Regardless, the robot offers a promising technique to maximize HT outcomes.
  • Facial Hair Restoration: While the focus of this article was to discuss the nuances of HT for the scalp, facial HT techniques may also be applied to obtain dramatic results when restoring facial hair such as eyebrows, beards, and sideburn

Hair Transplant

Hair transplantation aims to restore a more youthful appearance for those distressed by hair loss, particularly androgenetic alopecia. This activity reviews the evaluation and management of patients undergoing hair transplantation and explains the role of the inter professional team in improving care for patients who undergo this procedure


  • Identify the anatomical structures, indications, and contraindications of hair transplantation.
  • Describe the equipment, personnel, preparation, and technique in regards to hair transplantation.
  • Review the appropriate evaluation of the potential complications and clinical significance of hair transplantation.
  • Summarize interprofessional team strategies for improving care coordination and communication to advance hair transplantation and improve outcomes.

Anatomy and Physiology

t is essential to understand the relevant anatomy and physiology of hair, and the hair cycle, in order to maximize the outcomes of hair transplantation. Key elements in hair restoration include[5]:

  • Hair follicle – composed of a hair shaft, two surrounding sheaths (inner and outer), and a germinative bulb. The follicle divides into three sections: infundibulum (from the skin surface to the sebaceous gland duct), the isthmus (from the sebaceous duct to the arrector pili muscle insertion), and the inferior segment (from the muscle insertion to the base of the matrix) 
  • Bulb – the deepest segment of the hair follicle which contains the hair matrix (creates the hair shaft), dermal papilla (regulates growth), and melanocytes (produce color).
  • Terminal hair – thick, pigmented hairs at the top of the scalp, beard, axillary, and pubic regions, all of which are androgen-sensitive. The hair elsewhere on the body, including the parietal and occipital scalp, are androgen-independent.
  • Vellus hair – this is fine, short, non-pigmented hairs (“peach fuzz”) found on the adult that covers much of the body.
  • Follicular Unit (FU) – a naturally occurring group of hair(s) seen on the scalp consisting of several terminal hairs (usually 1 to 4), a sebaceous gland and duct, and an arrector pili muscle. The collagen band which surrounds the FU is called the perifolliculum

Clinical Significance

Hair transplantation represents a powerful tool that can restore a more youthful appearance to those affected by androgenic alopecia. When performing hair transplantation, proper patient evaluation and execution of a comprehensive treatment plan can produce safe, reliable, and satisfactory outcome

Nursing, Allied Health, and Interprofessional Team Monitoring

Close follow-up during the initial post-operative period, either by a wound care nurse and/or clinician experienced in the post-operative care of HT, should monitor the patient for possible complications including infection and ingrown hair formation. The patient should receive counsel that loss of the implanted hairs normally occurs after several days and may take several months to grow. There may also be surrounding native hair loss at the donor or recipient site, though the patient should understand that this “shock loss” is normally transient and to expect a full recovery after a few months

5000 grafts Hair Transplant

5000 grafts Hair Transplant:

5000 grafts hair transplant operation is also known as the mega session. Since this operation is much more complex than the average hair transplant procedure which only involves the transplantation of 3000-4000 grafts, not every patient is eligible for it.

Eligibility for 5000 grafts hair transplant:

First of all, the number of healthy hair grafts must be sufficient for extracting 5000 grafts from the donor area. The density of the donor area must be high and the patient must be in good health to be eligible for 5000 grafts hair transplant.


The procedure starts with a consultation to decide on the desired target area, hair density, and suitable hair transplant technique. Commonly FUE technique is used for 5000 grafts hair transplant.

  1. The donor area is shaved and local anesthesia is applied in preparation for the procedure.
  2. Hair grafts are extracted manually or with a punch tool by an expert team of surgeons. The extracted grafts are then collected in a suitable environment to ensure graft viability and successful hair transplant results.
  3. Micro channels are opened on the desired area.
  4. Hair grafts are implanted into the recipient area. Your expert hair transplant team will implant the hair grafts carefully by paying attention to the angle and placement for the most natural result.

Once your 5000 hair grafts are transplanted from the donor area to the target area and the necessary areas are bandaged up for protection, the surgical hair transplant operation is complete. For better results and maximum comfort after the hair transplant, you are required to follow the aftercare instructions given by your surgeon.   

Can 5000 grafts be transplanted in a single session?

Yes, it is possible to transplant 5000 grafts in a single session. However, you should not forget that a single session operation is much more complex. That’s why single session operations are only performed under special circumstances by experienced surgeon that can be ensure a safe operation and successful results.

How many hours do 5000 grafts hair transplant operations take?

The length of hair transplant operation is one of the most important factors for patients. Because it is a complex process, 5000 grafts hair transplant operation takes longer than standard hair transplant operations and can be completed in 7-9hours on average.

What is the cost of 5000 grafts hair transplant?

The cost is another important factor to consider when deciding to get a hair transplant operation. According to our clinic, the average 5000 grafts hair transplant cost in Pakistan ranges from 150,000 PKR to 250,000 PKR. The cost will be calculated as per grafts and it is necessary to understand that cost can vary from person to person. It is a delicate surgery that cannot be performed at cheap prices.