Hair Transplant

    • Androgenic Alopecia: A progressive, genetically predetermined pattern of hair loss affecting both men and women. It is primarily driven by androgens, specifically dihydrotestosterone (DHT), which is converted from testosterone via the enzyme 5-alpha-reductase. The binding of DHT to androgen receptors on genetically susceptible scalp hair triggers a process known as miniaturisation, where terminal scalp hairs are gradually transformed into fine vellus hairs. This miniaturisation alters the hair cycle, shortening the growth phase (anagen) and weakening the hair shaft with each cycle until the hair eventually disappears.

    • Pattern and Prevalence: In men, androgenic alopecia, also known as male pattern baldness, accounts for 98% of hair loss cases. This affects 30% of men by aged 30 and 50% of men by aged 50. This distinctive pattern is characterised by hair loss in the frontotemporal corners, frontal hairline, midscalp, and crown. The severity of this pattern can be classified using the Norwood-Hamilton scale. Genetic factors, which play a significant role, have been shown to account for about 80% of the predisposition to balding, highlighting the hereditary nature of this condition and suggesting a polygenetic trait.

    • Miniaturisation Process: The miniaturisation process involves complex, androgen-mediated cellular mechanisms, including decreased proliferation of keratinocytes, changes in dermal sheath cell populations, and a reduction in dermal papilla cells through apoptosis or migration. These changes reduce the size of the follicle, directly affecting the size of the hair shaft and leading to finer hairs. Additionally, changes in the hair cycle, such as a reduced anagen phase and an elongated telogen phase, contribute to the progressive shortening and weakening of the hair.

  • Androgenic alopecia is the most common form of hair loss. Its onset and progression are influenced by genetic and hormonal factors, and its prevalence varies widely across different populations. It affects up to 80% of men and 50% of women during their lifetime.

    • Prevalence Across Ethnicities: The prevalence of androgenic alopecia varies across different ethnicities. It has the highest incidence in Caucasian men, followed by Asian, African American, and Native American men. Among Caucasian men, approximately 30% are affected by age 30, which rises to 50% by age 50.

    • Progression and Staging: In men, the progression of hair loss typically follows the stages outlined in the Norwood-Hamilton scale. However, the rate and extent of progression can vary significantly. Some men experience a gradual progression through the stages, while others may find that their hair loss halts at a particular stage. Advanced balding, classified as stage NW5 or higher, occurs in about 35% of balding men, with around 7% progressing to the most severe form, NW7.

    • Protection: Hair loss medications protect your native hair by stopping the hair loss process and thickening existing hair.

    • Correction: Hair transplantation surgery corrects areas of loss, either via FUE (follicular unit excision) or FUT (follicular unit transplantation).

    • Stimulation: Treatments such as PRP (platelet-rich plasma), microneedling or low-level laser therapy.

  • Follicular Unit Excision (FUE) is a modern technique in hair transplantation where individual hair follicle units (small clusters of 1–4 hairs) are harvested from a donor area on the scalp and transplanted to areas with thinning or no hair. Unlike older methods such as FUT, FUE doesn’t involve removing a large strip of skin, making it less invasive and leaving minimal scarring. Here’s how the process works:

    1. Donor Area Preparation: Hair in the donor area (often the back or sides of the head) is trimmed to allow precise extraction and local anaesthetic is used to numb the area.

    2. Extraction: Using a specialised micro-punch tool (usually between 0.8 and 1.0 mm in diameter), each follicular unit is removed one by one. This process preserves the follicle’s integrity and causes minimal trauma to the surrounding tissue.

    3. Implantation: The extracted follicular units are then carefully transplanted to the recipient area, where they’re strategically placed to create a natural-looking hair pattern.

    4. Healing and Recovery: FUE leaves tiny dot-like scars that are usually barely noticeable, even with shorter haircuts. Recovery is generally quicker than with other methods, and patients typically experience minimal discomfort.

    Advantages of FUE:

    • Minimal Scarring: Small, dot-like scars blend into the scalp, allowing for shorter hairstyles.

    • Quick Recovery: The minimally invasive approach reduces recovery time and discomfort.

    • Natural Results: Individual follicular grafts mimic natural hair growth patterns.

    FUE has become popular because it offers natural-looking results with minimal downtime and less visible scarring.

  • Hair transplantation has evolved significantly over the past century, from rudimentary methods to advanced techniques that provide natural-looking results. Here’s a look at its history:

    Early Beginnings (1930s-1950s)

    • 1930s: The first known attempt at hair transplantation was made in Japan by Dr. Shoji Okuda, a Japanese dermatologist. He developed a technique known as "punch grafting" to treat burn victims by transplanting hair-bearing skin into scarred areas.

    • 1940s: Following Okuda’s work, Dr. Tamura (another Japanese dermatologist) advanced the technique, using smaller grafts of 1–3 hairs to address scalp and eyebrow restoration. However, because of World War II, these innovations remained largely unknown outside of Japan.

    Modern Hair Transplantation Begins (1950s-1970s)

    • 1952: In the United States, Dr. Norman Orentreich is often credited with establishing hair transplantation as a viable solution for male pattern baldness. He conducted pioneering studies demonstrating that hair follicles from the back of the scalp could survive and grow in balding areas (a principle known as "donor dominance").

    • 1960s-1970s: Orentreich’s technique, which involved transplanting large punch grafts of about 4mm in diameter, became popular. However, it often led to an unnatural "pluggy" appearance because of the large graft sizes. The "plug" style was the only option for years despite its limitations in achieving natural results.

    Refinement with Mini/Micro-Grafting (1980s-1990s)

    • 1980s: Surgeons began to refine their techniques by using smaller grafts (mini-grafts of 3-6 hairs and micro-grafts of 1-3 hairs), leading to a more natural look. This period marked a shift toward higher aesthetic standards in hair restoration.

    • 1990s: Dr. Robert Bernstein and Dr. William Rassman popularized Follicular Unit Transplantation (FUT), also known as the "strip" method. This technique involved harvesting a strip of scalp tissue from the donor area and dissecting it into individual follicular units, which provided a more natural distribution of hair.

    Introduction of Follicular Unit Excision (FUE) (2000s)

    • Early 2000s: Follicular Unit Excision (FUE) was introduced as an alternative to FUT. Rather than removing a strip of scalp, individual follicular units were extracted one by one using a small punch tool. This advancement minimised scarring and made the procedure less invasive.

    • Late 2000s: As FUE tools and techniques improved, it gained popularity among patients seeking less noticeable scarring and shorter recovery times.

    Advancements in Technology and Techniques (2010s-Present)

    • Robotic Assistance (2010s): Robotic systems, such as the ARTAS robot, were introduced to assist with the FUE procedure.

    • Refinement of Implantation Techniques: New implantation tools, such as the Choi Implanter Pen, allowed for better control over the direction and angle of the transplanted hairs, producing results that closely mimic natural hair patterns.

    • Stem Cell and Regenerative Medicine: Research on stem cells, PRP (Platelet-Rich Plasma), and hair cloning shows promise for future advancements, potentially making hair restoration even less invasive and more effective.

    Current Trends and Future Directions

    • Minimally Invasive Techniques: With FUE as a gold standard, newer techniques like Direct Hair Implantation (DHI) provide more control and reduce healing time by implanting extracted follicles immediately without the need for slits or channels.

    • Hair Cloning and Bioengineering: Experimental research is focused on developing methods for cloning hair follicles, which could revolutionise hair restoration by providing an unlimited supply of donor hair.

    Today, hair transplantation is considered a refined and effective solution for hair loss, with techniques that provide natural, lasting results and a variety of options to suit individual patient needs.

  • A good candidate for a hair transplant typically meets certain criteria that increase the likelihood of achieving natural, long-lasting results. Ideal qualities include:

    Sufficient Donor Hair

    • The patient should have an adequate amount of healthy hair in the donor area, usually at the back and sides of the scalp. This is essential for providing enough grafts to cover the thinning or bald areas effectively.

    Type and Degree of Hair Loss

    • Hair transplants are most effective for male and female pattern baldness (androgenetic alopecia), which generally follows a predictable pattern. Patients with diffuse hair loss or scarring alopecia may also be candidates, but these cases require careful assessment.

    • Candidates with stable, long-term hair loss are often better suited for transplantation. Young patients or those with rapidly progressive hair loss might need to wait until their hair loss pattern stabilizes.

    Realistic Expectations

    • It’s essential that the candidate has realistic expectations about what a hair transplant can achieve. While it can improve density and create a fuller look, depending on the severity of hair loss and donor capacity, a transplant may not always restore a youthful hairline or thickness. Discussing goals can help establish what’s achievable.

    General Health

    • Good overall health is important for successful healing and recovery. Candidates should be free of chronic health conditions that might impact healing, such as uncontrolled diabetes, autoimmune diseases, or blood clotting disorders.

    • Non-smokers tend to heal better, but those who do smoke are often advised to stop at least a few weeks before and after surgery to optimise blood flow and healing.

    Age and Hair Loss Stability

    • While there’s no specific age limit, younger patients may not be ideal candidates unless their hair loss pattern has stabilized, usually in their late 20s. Performing a hair transplant too early could lead to an unnatural appearance if the hair loss continues to progress.

    Commitment to Post-Care

    • A successful hair transplant requires proper post-surgical care to protect the grafts and promote healing. Candidates should be prepared to follow post-procedure instructions closely, which includes avoiding strenuous activities and keeping the scalp clean.

    Who Might Not Be a Good Candidate?

    • Those with certain types of diffuse hair loss, active scalp infections, or an insufficient donor supply might not be suitable candidates.

    • Individuals experiencing hair loss due to medical conditions like alopecia areata, as it can cause unpredictable hair loss even after a transplant.

  • Grafts are taken from the donor area. This is the back and sides of the head that contains DHT resistant follicles that are not predisposed to hair loss. The number of grafts you need depends on the extent of hair loss, the size of the area you want to cover, and your desired density. It is important to be aware that the donor area has a limited number of grafts that can be extracted in a patient’s lifetime. Below average donors can supply 4000 grafts in total, average donors can supply 6000 grafts and above average donors can supply 8000 grafts. The graft number depends on the following:

    Hair Loss Level

    • Norwood Scale for Men: This scale categorises male pattern baldness into seven stages. The higher the stage, the more grafts are generally needed.

    • Ludwig Scale for Women: This scale classifies female pattern hair loss into stages as well, though the pattern often involves general thinning rather than specific bald spots.

    Area to be Covered

    • Hairline Only: Around 1,000–1,500 grafts are often sufficient for a conservative hairline restoration.

    • Front or Crown: Covering the front or crown areas separately typically requires 1,500–2,500 grafts, depending on the level of thinning.

    • Extensive Hair Loss (Entire Top of Scalp): When hair loss affects most of the top of the scalp, 3,000–4,000+ grafts may be required.

    Desired Density

    • Natural-Looking Density: For a natural appearance, around 30–40 follicular units per square centimeter are often sufficient, though denser coverage might need more grafts.

    • Full Density: Achieving very dense coverage, closer to natural hair density (50+ units per square centimeter), requires significantly more grafts, which may not be feasible in a single session.

    • How dense? It has long been established that there is a reserve capacity within hair loss where if there is less than 50% loss, this does not appear as hair loss to the naked eye. Therefore, hair transplantation should not seek to match the natural density of hair but instead utilise the minimum number of grafts needed to create an illusion of density. This concept is essential since the donor area is a limited resource; therefore, matching natural density is a poor use of grafts that can be utilised in other areas, especially since densities lower than 100% can achieve the illusion of density. From experience, 50-60% density in the recipient area compared with the donor can achieve an average result, 60-70% achieves a decent result, and 80-85% density gives a great result.

    Common Graft Estimates (based on Norwood Scale for Men as a Reference):

    NW Stage 2 – 800-1200

    NW Stage 3 – 1500-2000

    NW Stage 4 – 2000-2500

    NW Stage 5 – 2500-3200

    NW Stage 6 – 3000-4000+

    NW Stage 7 – Often challenging due to donor area limitations, may need 4000+ grafts in multiple sessions  

    To determine an accurate graft number, it’s best to have a consultation to assess your hair loss pattern, goals, and donor area. This way, you’ll get a personalised treatment plan and a realistic estimate of the number of grafts you’ll need.

  • Follicular Unit Excision (FUE) is generally a low-pain procedure, thanks to the use of local anaesthesia and advancements in techniques. Here’s what to expect:

    During the Procedure

    • Anaesthesia: Local anaesthesia is used to numb both the donor and recipient areas, so you shouldn’t feel pain during the extraction or implantation of grafts.

    • Mild Sensations: You may feel some mild pressure or pulling, but it should be minimal and not painful.

    After the Procedure

    • Tenderness and Discomfort: It’s normal to feel some tenderness or mild discomfort in both the donor and recipient areas once the anaesthesia wears off. Most patients describe it as a feeling similar to a mild sunburn.

    • Medication: You will be given pain killers to help with any post-procedure discomfort, which typically subsides within a few days.

    Recovery Phase

    • Swelling and Itching: Minor swelling, redness, and itching are common in the days following the procedure. This is a normal part of the healing process and can be managed with prescribed medications and aftercare instructions.

    Overall, most patients find the pain to be very manageable, with only minor discomfort during the initial recovery period. Following aftercare instructions helps ensure comfort and minimises any post-procedural pain.

  • While Follicular Unit Excision (FUE) is a safe and minimally invasive procedure, like any surgical intervention, it comes with some potential risks and side effects. Most common risks associated with FUE hair transplants include:

    Infection

    Any time the skin is broken, there is a risk of infection. However, with FUE, this risk is minimal and can usually be prevented by following proper hygiene and aftercare instructions. Antibiotics may be prescribed to prevent or treat infections.

    Scarring

    FUE leaves tiny, dot-like scars where each follicular unit was extracted. While these scars are generally small and spread out, they may be visible if the hair is worn very short. Hairstyles of grade 2 length or longer typically provide sufficient coverage of any scarring. However, shorter styles, such as high skin fades, may result in increased visibility of the scars. In rare cases, people prone to keloids or hypertrophic scars may experience raised scarring.

    Pain and Discomfort

    Some patients experience mild pain, tenderness, or discomfort in the donor and recipient areas for a few days following the procedure. This is usually temporary and can be managed with over-the-counter pain relievers.

    Swelling and Redness

    Temporary swelling and redness can occur in the treated areas, particularly on the forehead and around the eyes. This typically resolves within a few days to a week and is managed by following post-procedure guidelines.

    Shock Loss

    Some patients experience "shock loss," where transplanted or nearby hairs fall out temporarily. This is a normal response to the trauma of the procedure, and the hair typically regrows in a few months.

    Itching

    Itching is common as the scalp heals but should be avoided to prevent damage to grafts.

    Folliculitis

    Folliculitis (inflammation of hair follicles) can occur in the donor or recipient areas. It usually resolves on its own but, in some cases, may require treatment with antibiotics or anti-inflammatory medication.

    Numbness or Sensitivity Changes

    Some patients experience numbness, tingling, or changes in sensitivity in the donor or recipient areas. This is usually temporary and fades within a few weeks or months.

    Unnatural Results

    If the hair grafts are not implanted at the correct angle, direction, or density, the result can look unnatural. Choosing a skilled and experienced surgeon helps minimise this risk.

    Poor Hair Growth

    In some cases, not all grafts survive, leading to patchy or incomplete coverage. This can happen due to poor blood supply, underlying medical conditions, or improper aftercare.

    Most FUE risks are minor and can be effectively managed with proper care. Selecting an experienced, qualified surgeon and adhering to aftercare guidelines are key steps in reducing these risks and achieving successful, natural-looking results.

  • The aftercare period lasts two weeks, during which time you should plan to take 7–10 days off work for optimal recovery. Following the procedure, you’ll complete a prescribed course of antibiotics, begin washing your scalp as instructed by your surgeon, and apply a saline solution to the grafts regularly to support healing.

    For best results:

    • Exercise: Avoid all exercise for two weeks to prevent any strain or sweating around the grafted area.

    • Sun Exposure: Refrain from direct sun exposure on the scalp for two months. After two weeks, you can wear a baseball cap to protect the area when outdoors.

    • Swimming: Avoid swimming for one month, as chlorinated and saltwater can interfere with healing.

    By carefully following these guidelines, you’ll promote a smooth recovery and optimise the success of your transplant.

  • We have an open-door policy, and you are welcome to attend as many check-ups as needed.

    Typically, we recommend a follow-up within the first two weeks, another at 6–9 months to assess growth, and a final review at 12 months when results are fully visible.

Book Consultation