Angie's LIST Guide to
Hair Replacement and Transplants

They say looks aren't everything, but losing your hair can make you feel otherwise. Men and women with thinning or balding hair often feel self-conscious and uncomfortable around others.


balding head
Male-pattern baldness is the most common reason men seek hair replacement treatment. (Photo courtesy of Wikimedia Commons)

How hair replacement works

Hair replacement and transplants are more natural looking than other options—and permanent. Hair replacement, or hair transplantation, is a cosmetic surgical procedure that gives men and women a fuller head of hair.

This procedure involves removing hair from an inconspicuous part of the body and transplanting it to the areas that need more hair. In most cases, the donor hair is taken from the sides or the back of the scalp. These areas are usually not visible, and the hair taken from them looks most natural when transplanted.

Surgeons use a couple of common methods during hair transplantation.

Strip harvesting involves removing small strips of skin with hair from the donor area that are then grafted onto the area that needs more hair. Because this method leaves scars and doesn't look completely natural, it isn't used as often as it once was.

Follicular unit extraction (FUE) is the most common type of hair transplantation procedure used today. It involves removing individual hair follicles and transplanting them onto the area with thinning hair.

This type of procedure leaves smaller scars, if any, and the results generally look more natural.

Best candidates for hair transplants

Nearly everyone facing hair loss is a good candidate for hair transplantation, especially if the thinning hair makes you self-conscious. While a majority of men undergo hair transplantation, women can also benefit from this procedure.

Those looking for skin and cosmetic care have a variety of options and services. From major surgery to small procedures performed at day spas, there are treatment options to suit every preference.

Those looking for skin and cosmetic care have a variety of options and services. From major surgery to small procedures performed at day spas, there are treatment options to suit every preference.

In fact, women may benefit more, because a thick and healthy head of hair is often popularly equated with ideas of beauty.

People suffering from pattern baldness are the most common candidates for this type of procedure. Male-pattern baldness (androgenic alopecia), for instance, can result in patchy bald areas. Some people suffering from this condition may have luck with hair transplantation procedures.

Most people must meet a few other criteria before undergoing hair transplantation. First, you must have a healthy immune system because, just like with any surgery, there is some risk of infection.

Also, your hair-donor area should be full and thick. Depending on the type of procedure you undergo, you may also want to wear your hair long in this area to cover any scars.

Undergoing a hair transplant

Your first meeting with a hair transplantation surgeon will be a consultation. During this appointment, the surgeon will ask you about your general medical history and your family's history of hair loss.

He or she will also evaluate your hair loss and give you a recommendation on the best course of action.

The night before your procedure, your doctor will most likely tell you not to eat or drink anything. You'll be given an anesthesia right before the procedure, which could cause nausea.

After the procedure, you'll likely feel a little groggy, so you should arrange for someone to drive you home. Your scalp will be somewhat sore, and you may need to change dressings and bandages periodically.

Notify your doctor as soon as possible if you notice any signs of infection, such as fever or discharge from your scalp. Any stitches will also be removed between one week to ten days after the procedure.

Your healing time after hair replacement and transplants might last anywhere from a few days to a week, usually determined by the type of procedure your surgeon used and how much hair was transplanted.

Choosing a hair transplant surgeon

Some companies spend a lot of money advertising hair transplants, and some can take advantage of your desire to improve your looks. So, you should investigate any hair replacement center or doctor thoroughly before undergoing this procedure.

A botched operation can cause pain, injury and possible disfigurement.

Check Angie's List to read through members' experiences with the doctors you're considering. Verify their qualifications, education and accepted insurance plans. 

Leave a Comment - 3


Jonathan Ballon, M.D.

Subject: One more addition to hair loss/hair transplantation comments

So sorry, but if you decide to publish my comments, could you add this sentence to the end of Paragraph 4?: (African American women with traction alopecia are a notable exception; in many of these cases, hair transplantation can provide excellent, permanent results.)

Jonathan Ballon, M.D.

Subject: Revision to earlier comments on hair loss/hair transplantation

"It is the artistry of the surgeon in designing the hairline and creating the proper angle and direction of the recipient sites..." should read "..proper angle, direction, and density of the recipient sites."

Thank you.

Jonathan Ballon, M.D.

Subject: Hair loss/hair transplants

I applaud Angie’s List for addressing hair loss and including hair transplantation among the many services reviewed. As the only hair transplant surgeon in the state of Georgia certified by the American Board of Hair Restoration Surgery, one of a few in the world to be recognized both as a Diplomate of the ABHRS and a Fellow of the International Society of Hair Restoration Surgery, and a two-time Chair of the ISHRS Annual Scientific Meeting’s “Basics Course,” I would like to respond to some of the statements made in the “ANGIE'S LIST GUIDE TO Hair replacement and transplants.”

1.) With regard to the strip surgery (or “FUT”) method of donor harvesting, it is not the actual strip of scalp, itself, that is transplanted; rather, it is the hundreds or thousands of individual “follicular units” carefully dissected from the strip one by one under microscopes. This technique leaves a single linear scar, typically 1-3 mm wide, that is undetectable through the overlying hair in the vast majority of people; indeed, many patients are able to leave at the end of the day with little or no evidence that anything has been done to the back of their head. The strip technique offers many advantages over the FUE technique, but is generally not advisable for those who wish to wear their hair very short (less than ¼” long). It is simply not true to say that a hair transplant performed using the strip technique “doesn’t look completely natural.” The result achieved by an experienced and skilled surgeon should look completely natural—regardless of the method used to obtain the grafts. It is the artistry of the surgeon in designing the hairline and creating the proper angle and direction of the recipient sites, as well as the experience and skill of his or her assistants, that determines the naturalness of the result. Unfortunately, it seems that many surgeons and their prospective patients these days are paying more attention to the technique used for harvesting donor follicles rather than how they will be used to create a natural and esthetically pleasing hair transplant.

2.) Follicular unit extraction (“FUE”) is not “the most common type of hair transplantation procedure used today,” though it has been gaining in popularity. “FUT” (follicular unit transplantation using microscopic dissection to prepare the grafts) remains the far more common method by about 70% to 30%, at least in the United States. And contrary to the many false claims, FUE surgery is not "scarless." What the FUE method does is simply to substitute hundreds or thousands of small, circular scars for a single linear scar. It may come as a surprise to most people that graft for graft, FUE surgery actually creates more scar tissue than does FUT surgery. Consider the following: the total amount of scar tissue created by a 2000 graft FUE procedure using a 1mm punch is about 16 square centimeters (not counting the number of additional unsuccessful attempts it took to obtain those 2000 grafts, and the additional scar tissue created); however, the total scar tissue resulting from a typical FUT procedure for the same number of grafts is about 4-6 square centimeters. Nor does FUE surgery ensure there will be no alteration in the appearance of the donor area, (especially after large numbers of follicular units have been harvested). The cumulative removal of thousands of follicular units from the back and sides of the head can produce noticeable thinning of the hair, whether worn short or long.

3.) Again, neither method of donor harvesting produces “more natural” results, as explained above.

4.) With regard to selecting suitable patients for surgery, it is simply wrong to say that “nearly everyone facing hair loss is a good candidate for hair transplantation,” regardless of how self-conscious they are about the situation. Certainly, hair restoration surgery can be life-changing for many, but there are great numbers of other people who, for a variety of reasons, are non-candidates for the procedure. Only an experienced and ethical hair transplant surgeon, occasionally with input from a dermatologist, can make this determination. And while some women may be good candidates for surgery, a far greater number are not—partly because of the different nature of female hair loss, partly because of the greater tendency for women to experience “shock loss” (shedding—sometimes permanent—of native hair in the area of the transplant), and partly because many women will not be satisfied with the limited thickness that can be achieved with a hair transplant. Most hair transplant surgeons I know say that that they recommend surgery for only about 20% of the women they see.

5.) Androgenetic alopecia, or male pattern baldness, does not result in “patchy bald areas.” Male pattern baldness is precisely that: hair loss that follows one of several distinctive, characteristic patterns. Patchy hair loss, on the other hand, signifies something other than androgenetic alopecia (alopecia areata; trichotillomania, or hair-pulling; traction alopecia resulting from tight braids or pony tails; one of a number of types of scarring alopecia; etc.) People with patchy bald areas most often do not “have luck with hair transplantation procedures.”

6.) Hair transplant patients are typically not told to “not eat or drink anything the night before the procedure”; indeed, most surgeons encourage their patients to eat a good breakfast on the morning of surgery, since general anesthesia is almost never used. And a full stomach can actually help reduce any nausea from drugs used as well as prevent a drop in blood sugar during the first part of the day.

7.) Arranging for a ride home is never a bad idea; however, by the end of the day, most people feel little or no effects of any drugs used at the beginning of the procedure, and are quite able to drive themselves home.

8.) Most surgeons do not use bandages or dressings.

9.) Many surgeons use absorbable (“dissolvable”) stitches for their strip surgery patients, making removal unnecessary.

10.) While surgical healing takes about 7-10 days, return to normal activities for
FUE patients will also depend upon the time required for the hair in the shaved
donor area to grow back to a length that matches the length of the hair on the
rest of the head. (For most strip surgery patients, there is no visible evidence of
surgery in the donor area from Day 1.)

Thanks for your interest—I hope this was helpful.

Jonathan Ballon, M.D.
Diplomate, American Board of Hair Restoration Surgery
Diplomate, American Board of Neurological Surgery
Fellow, International Society of Hair Restoration Surgery

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