Hair Transplant Surgery: All Your Questions, Answered

For anyone struggling with alopecia (AKA hair loss), finding solutions that are actually proven to work can be both costly and extremely stressful. Lotions, potions, lasers, injections… the options on the market for hair loss can seem endless.

Yet, there is one option that is routinely considered the most tried and true, albeit invasive and expensive, for those looking to regrow actual hair. Enter: the hair transplant.

According to the American Society of Plastic Surgeons, in 2018, there were 23,658 hair transplant surgeries performed across the US, which is a steep incline from the 19,979 performed in 2017. And while those numbers aren't nearly as staggering as say, the 313,735 breast augmentations performed (which has been the number one cosmetic procedure two years in a row), it's still worthy of an in-depth discussion, especially for those considering the treatment for themselves.

To learn more, we spoke with Dr. Robin Unger, a New York City-based specialist in the field of hair transplants and diplomate of the American Board of Hair Restoration Surgery (she's also one of the few female surgeons who perform this surgery on both men and women with hair loss) for answers to all our questions.

Read on for everything you need to know about hair transplants.

What is a Hair Transplant?

Hair transplant surgery is a procedure where hair is taken from the back and/or sides of the scalp (otherwise known as the the “donor area”) and transplanted into areas that are thinning or bald (the “recipient area”). Once inserted, it will continue to grow throughout the patient's lifetime.

One of the most groundbreaking methods of hair transplant surgery was founded by Robert Bernstein, MD, FIHSRS, who discovered that when naturally-occurring bundles of one to four hairs called follicular units are transplanted instead of the traditional method of using larger grafts of skin and hair, the results are more natural. In this procedure, the patient’s scalp is numbed using local anesthesia, and a strip of skin is removed from the donor area. It is then microscopically dissected into hundreds or thousands of grafts, each of which contains an individual follicular unit. Then, hundreds to thousands of tiny holes are punctured into the balding area so that a follicular unit graft can be inserted.

How Much Does a Hair Transplant Cost? 

According to Unger, "A hair transplant can cost anywhere from $2500 to $50,000. The average in the US is approximately $10,000 to $15,000." She explains that the ultimate final cost will largely depend on the city where the transplant will be taking place, the surgeons level of experience, reputation and overhead, the amount of "hands-on" time the surgeon is involved in, the number of grafts required for the specific patient, and the ancillary treatments that may be included.

Because of these variables, the price can vary greatly across the globe. "A clinic in Turkey, paying their staff $50 per day, doing 60 patients a day, with no real involvement from the surgeon can cost as little as $2500," Unger says. While on the other end of the spectrum, "The highest-end doctors treat one patient daily, do all parts of surgery themselves, can use multiple modalities and ancillary treatments, and have a highly trained team of assistants."

Who Is and Is Not a Candidate? 

As with nearly all plastic surgeries, not everyone is a candidate for hair transplant surgery. In order to be a successful candidate, Unger says that the patient, both men and women, should have androgenetic alopecia (in other words, female or male pattern hair loss that is genetic), and will need sufficient donor hair to achieve both their short and long term hair goals.

Hair transplants can also be used for stable forms of scarring alopecia (also known as cicatricial alopecia, or when hair loss is accompanied by scarring) including those that are radiation or trauma-induced.

As far as who is not a candidate, Unger first stressed the importance of realistic expectations. She explains, "Those expecting a full head of hair but don’t have enough donor hair to achieve that [are not candidates as] there are limits as to what can be achieved, due to donor hair supply."

For example, those with diffuse hair loss (also known as Telogen effluvium, or when hair falls out due to stress), involving the entire head, would not have any safe donor areas.

And finally, "Patients with unstable scarring alopecias (like frontal fibrosing alopecia or FFA, and lichen planopilaris or LPP) should ideally not be treated surgically unless the disease has been completely quiet for at least two years," says Unger. Even then, the patient needs to understand that the disease can recur.

The Recovery Process

As with most surgeries and procedures, a certain level of discomfort during the recovery period is to be expected. Unger says that the recovery is actually similar to that from a major dental procedure and that the level of pain or discomfort is manageable with some postoperative pain medication. However, it's important to note that every patient is different and will have a different experience, as well as tolerance to associated discomfort.

As far as a patient's appearance following the surgery, Unger describes, "The area is red and then small crusts form. If the grafts are in a totally bald area, this can be visible for about seven days, if the area has even thin hair to camouflage, it may be difficult to detect by day three."

There can also be swelling in the forehead and temple regions. Because of this, Unger has her patients ice the area frequently in the first two days and advises them not to tilt their head forward.

Side Effects

Hair transplant surgery is, according to Unger, "a very safe procedure."

Most commonly, patients can experience swelling, changes in sensitivity on their scalps, and possible temporary shedding of hair in the treatment area.

As with all surgeries, an infection is always possible, but Unger explains, "the scalp's excellent blood supply makes this very unlikely."

Hair Transplant Alternatives

Before pursuing surgery, there are alternatives to hair transplants that are important to consider and are worth giving a try. These include:

• Medical treatment with a hormone modulator like finasteride, dutasteride, or spirinolactone.
• Platelet Rich Plasma (PRP) treatment. Unger says, "The results vary significantly depending on the provider and the technique used." In her experience, the results have been so impressive that sometimes the need for surgery is eliminated. Though it's important to note, "not all patients are responders and some present with later stage hair loss."
• Exosome Therapy: "This is the newest modality in the arena, and is extremely promising," says Unger.
• SMP: A temporary micro pigmentation (think cosmetic tattoo) to camouflage the whiteness of the scalp and mimic hair stubble

And the least invasive, of course, is a quality hair prosthetic or wig.

Final Thoughts

Prior to pursuing a hair transplant, if the above alternatives have proven to be unsuccessful or are undesired, Unger stresses the importance of a patient doing thorough research before choosing a surgeon.

She warns that hair transplant "centers" are "being opened by individuals with little or no training in the art or science of hair restoration," and adds, "there are even 'respectable' plastic surgeons and dermatologists adding on hair transplant [services], but [are] having a technician do the entire surgery," so be wary and ensure you are in qualified hands of a well-trained physician throughout the process.

As with all plastic surgeries, it's so important to be fully informed about all aspects of the procedure—before, during, and after—and to of course select a board-certified physician.