Hair Replacement Guide

The Hair Transplantation Procedure

In hair transplantation, pieces of hair-bearing scalp are taken from the sides and back of the head and re-planted in holes in the bald area.
In hair transplantation, pieces of hair-bearing scalp are taken from the sides and back of the head and re-planted in holes in the bald area.

As we mentioned earlier, hair transplantation involves removing small pieces of hair-bearing scalp from a donor site and relocating them to holes or slits in a bald or thinning area, usually on the top of the scalp. Modern techniques in hair grafting (the most recently performed method of transplantation) is performed by many physicians and in many clinics throughout the world. No new hair is added during this procedure -- hair and skin are simply relocated. Grafts vary in size and shape:

  • Punch grafts - Round grafts that usually contain about 10 to 15 hairs
  • Mini-grafts - Much smaller grafts containing 2 to 4 hairs
  • Micro-graft - Tiny grafts containing 1 to 2 hairs
  • Slit grafts - Thin grafts that contain about 4 to 10 hairs each
  • Strip grafts - Long, thin grafts containing 30 to 40 hairs

Several surgical sessions may be needed to achieve more fullness, and a healing interval of several months is usually recommended between sessions. It may take up to two years before you see the final results of the transplant series.

The amount of coverage you need is partly dependent on the color and texture of your hair. Coarse, gray or light-colored hair offers 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 (more about the new megasessions later).

Just before surgery, the donor area will be trimmed short so that the grafts can be easily removed. The graft donor and recipient areas are treated with a local anesthetic similar to that used by dentists. If your surgeon is making punch grafts, he or she may use a special tube-like instrument made of sharp carbon steel for punching the round graft out of the donor site. (The doctor will be very careful in removing and placing grafts to ensure that the transplanted hair will grow in a natural direction and that hair growth at the donor site is not negatively affected.)

For other types of grafts, your doctor will use a scalpel to remove small sections of hairy 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 (a single stitch may close each punch site). When other types of grafts are used, 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 (3 mm) apart. In later sessions, the spaces between the plugs will be filled in with additional grafts.

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