Hair Transplant Information

Lets be clear on two things. One, the hair that are lost will never grow back and second, no new hair can be implanted. What actually happens is redistribution of the existing hair. We know that the hair at the back of the head are not affected by hair-loss and are the so called 'permanent hair zone'. All transplantation techniques in one way or another harvest hair from this permanent zone and put them in areas of baldness.

Currently there are two techniques of harvesting the hair from the permanent zone. One, Follicular unit transplant (FUT or "strip" technique) and other is Follicular unit extraction (FUE or "punch" technique).

FUT / Strip Technique

FUT/strip technique is the most commonly performed technique in the world and is considered as the gold standard. A strip of scalp skin along with hair follicles is harvested from the permanent zone and the remaining gap is sutured using 'trichophytic' closure technique to result in a thin imperceptible scar. The scar line gets covered by rest of the hair at the back of the head and so it is not visible. This strip is dissected under magnification using microscope and loupes and numerous follicular units are obtained.

The harvested strip is thin so that the scalp can be closed easily with sutures. Along with the size of the strip, the variability of the hair density among different people determines the number of follicles that are actually obtained. Once this number is known the surgeon creates appropriately placed very tiny incisions in the bald area and implants these follicles one by one.

FUE / Punch Technique

In FUE/punch technique the hair is harvested using a punch either by hand or by a machine. The punch is a small hollow needle like thing which cuts a small circle around the follicular unit. The surgeon then plucks out the hair along with its root. No suturing is required. This is mainly useful in patients of low grade baldness who require lesser number of grafts.

Which one is better?  Which one is for me?

Well, Both are equally good, both give good results in trained hands. But each is meant for a different purpose. In the strip technique once the strip has been harvested the team of assistants dissect the follicular units under magnification looking directly at each hair follicle and its root. So that the transaction rate is very low (< 1%), the work is faster and there is very little wastage. But to do that more staff is required, additional infrastructure and costly microscopes are needed.

In FUE technique the surgeon can not see below the skin. A calculated guess is made about the direction of the hair as it exits the skin. The punch is driven in the same direction as the hair along the hair shaft. If there is even a slight error in this angle the hair gets cut.This  results in higher transection rates, between 10% to 20%. The surgeon is a single person taking out hair follicles one by one, hence the process is slow.

In strip technique, at a time around 1cm wide strip is harvested and the remaining donor areas may be used in further sessions. Around 3-4 sessions can be performed in a person depending upon the requirement. Although a six months interval is required between each session.

In FUE at least two follicular units have to left in between the harvested sites, the complete donor area can not be harvested, otherwise the donor area will appear bald. So comparatively the yield in FUE is low and to obtain sufficient number of grafts often the entire donor area is utilized in a single session. This makes future sessions very difficult if not impossible. It has also been seen that in some cases due to partial injury to the follicle at the time of FUE punch harvest, which is not visible at that time, the injured implanted hair grow weak and thin and may fall off in a few years.

Both FUT and FUE produce scars, all the advertisements about scar-less surgery are false. Both are painless because both are performed under local anesthesia. In strip technique there is a single line like scar at the back of the head. It may be 1 to 2 mm wide and is not appreciable even when some one runs a comb through the hair because the hair grow through the scar by the trichophytic closure technique. In FUE there are many many small scar dots from the punch harvest. If a person keeps normal length hair that is 2-4 cm or long hair then both the scars are not visible. If a person shaves the head then both are visible. If some one wants to keep the hair very small ("buzz cut") the visibility of FUE scar is much less than the visibility of a clearly defined line like scar running across the back of the head.


Often in people of darker colored skin there may be colour changes in the FUE scars, so that they may be visible if the hair are kept too short. Strip technique can only be used for harvesting the scalp hair. To harvest other body hair FUE technique is used. Other body region hair such as beard hair are used to increase the density by placing them in between transplanted scalp hair.

To summarize, the strip technique is relatively quicker, cheaper and gives much more hair follicles so anybody with moderate to severe baldness should pick strip technique. If the grade of baldness is low and the baldness is not increasing then FUE is equally good although strip is still the prefered choice because MPB may progress at any time and more hair grafts may be required in the future.

Important note - Realistic Expectations

The number of grafts available as compared to the requirements is always low. On an average a person has 100,000 hair follicles. 25% of these lie in the permanent hair zone but remember that all of them can not be harvested. Usually in a normal person the natural density is so high that any visible decrease in hair density is noticeable only when 50% of the hair have already fallen. Till then the hair look normal. There are 60,000 hair follicles in a normal person from the hairline to the crown. So at least half of it, i.e 30,000 will be required to provide an imperceptible coverage( in a person who has high grade of baldness). There is a limit to the amount of hair that can be harvested in each session as well as in total, without causing any visible damage in the donor region. In reality the maximum hair that can be harvested from the donor site is approximately between 2500 to 7000 hair follicles depending upon the existing hair density of the person, even if multiple sessions are used and the dissection is done without loosing a single hair. So in moderate to extensive bald people hair density achieved after the transplant surgery can never be like the original. The surgeon, like an artist trying to paint with limited amount of color, tries to transplant the available hair follicle in the areas that require maximum focus, usually these are the hairline and the area immediately behind it. The illusion of a head full of hair that the surgeon creates is bound to break on a very close inspection. It is important to understand that realistic expectations should be placed and one should discuss this at length with their treating surgeon.

Every person has a different grade of baldness and since it is progressive, multiple sessions may be required to keep up with the balding process. Over enthusiastic and aggressive surgeries deplete the future reserves. It is pointless to aim for the hairline of a 25 year old at the age of 45 because since these permanent hair will never fall and the baldness will be progressive in the regions behind it, it will look very awkward in the future plus there will be no donor hair left to cover rest of the balding regions. A real practical approach is to be conservative in planning and always keep an eye on the future requirements that may arise.

 What happens in a hair transplant procedure, before, during and afterwards?

Hair transplant is a very safe and a relatively minor surgical procedure.

Before the procedure, you are asked to come to the Hair Transplant clinic in the morning after having your breakfast. You should scrub/shampoo your hair the night before and in the morning before coming to the clinic.

Hair transplant surgery is performed under local anesthesia and you will remain awake throughout the procedure. There is no pain. It usually takes 6-8 hours to perform the entire surgery. During this period you will be fully awake and have multiple breaks for snacks and lunch. You may enjoy soothing music and television. 

Hair are harvested from the backside of the head. The surgeon makes tiny holes in the bald areas and the surgical assistants transplant one hair follicle at a time in these small gaps. The surgery is over once all the grafts have been placed. Light dressing is applied at the donor site and the transplanted site is left open. Once the surgery is complete you are allowed to go home.

There is usually no pain or discomfort in the grafted area. There may be some tightness in the donor region for the first 2 to 3 days. Any pain is treated with pain medication. You will have to sleep upright with two pillows under the head for a few days. 

Normally small crusts are formed at the graft site. You will be asked to come to the clinic on 3rd day for shampoo and cleansing of the grafted site for the first time. After that you may do it daily yourself. 

Sutures that are placed during the strip harvest are removed after 10th day of surgery. If non-absorbing sutures are placed they will require removal and for that you may have to visit he clinic or you may get them removed by any surgeon nearby. If self-absorbing sutures have been placed they will dissolve by around two weeks. Still it is a good idea to visit the surgeon at least once after 10 days to access the health of the suture line.

Normal hair have a growth cycle of three phases. During the first phase they grow for 3 to 7 years it is called Anagen phase, during the second phase they gradually thin out and fall this is the Catagen phase and lasts for around 3 weeks. After that They go into resting or sleeping phase which is called the Telogen phase and lasts for 3 months and then the cycle is repeated. After surgery the transplanted hair go into sleeping phase. The small grafts are shed by the 3rd week but the roots remain inside. These roots start growing from the third month onwards and grow at a rate of around 1 cm per month. The final result is appreciable after the hair achieve sufficient length that is after 7 to 9 months.