Hair transplant surgery for hair loss (alopecia)

Hair loss in men normally starts with a receding hairline and then progresses to thinning hair on the top of the head and finishes by leaving a wreath of hair around the back and sides of the head whilst the rest of the head becomes completely bald. Hair loss in women is usually less severe and often areas like the eyebrows and eyelashes are the focus for surgery but all types can be treated.

Medication

There are a number of solutions to treat hair loss.

Finasteride is a 5-Alpha Reductase inhibitor used to treat hair loss .

Minoxidil is a Vasodilator which is also used to treat hair loss.

The problem with medications is that:

1. Medication doesn’t regrow the hairline
2. There are side effects

Surgery

The only permanent way to fix hair loss in both men and women is modern hair transplant surgery. Our clinic was one of the first hair transplant clinics in the world and we do every type of hair transplant technique. We use the most modern method which is called follicular unit extraction (FUE). This technique leaves no scars, it heals quickly and there are no stitches to remove afterwards.

As well as the techniques below, we specialise in treating Afro-Caribbean hair as well as post-chemo hair transplant and FUT scar repair. With smaller operations we’re able to perform transplants without shaving your head (Unshaven FUE). For full information on all our treatments you can read our detailed guides below or simply contact us for more information.

Hair Transplant Glossary

Before we start researching hair transplants we need to know some of the most common words you’ll see in these guides.

1. Follicle – this is where the root of a hair sits. It’s like a small holder below the surface of the skin which holds the root of a hair like a plant pot holds the root of a plant. More than one hair can grow in a single follicle.

2. Hair graft – a graft is what we call a follicle with the hair or hairs that grow in it. When the surgeon extracts hairs, he always extracts the whole graft which includes the follicle as well as the hair. The follicle plus the hair is called a hair graft.

3. Donor area – the hairs on the back and sides of your head are the ones that we normally use for a hair transplant. This area is called the donor area.

4. Recipient area – before the newly extracted grafts are placed, tiny incisions are made in the place they have to go, whether that’s the top of the head, the eyebrow or the eyelash. This area is called the recipient area.

5. Punch – this is a hollow-tipped needle which is used to extract hair grafts. There are two types of punch – manual punches and automatic punches. Read our article on manual vs motorised punches for more information on this device.

6. Single-hair grafts – these grafts have a root with one single hair growing out of it. These grafts are used to make a new hairline. You can read more about how that works in our article on hairline design.

7. Multi-hair grafts – these grafts have a root with more then one hair growing out of it. These grafts are used to add density behind the hairline.

8. Norwood scale – this is a system that’s used to measure hair loss. The higher the number in the scale, the higher the amount of hair loss. You can see how the Norwood Scale works in the diagram below.

Our treatments in brief

1. Follicular Unit Extraction (FUE)

Follicular unit extraction is a modern technique to move hairs from one part of the head to another.

The operation takes a few hours.

After the operation the transplanted hairs fall out and then start to grow back after a few months following the body’s natural cycles.

Once they grow back, they are permanent.

If you want to read more about how follicular unit extraction surgery works then see our detailed FUE guide below.

2. Follicular unit transplantation (FUT)

Follicular unit transplantation is the original hair transplant technique.

A strip of skin is extracted from the back of the head. The hairs on this strip of skin are separated and then they’re placed onto the top of the head.

The operation leaves a fine scar on the back of the head which is only visible if the hair is cut very short.

If you want to read more about how follicular unit transplantation surgery works then see our brief FUT guide below.

3. Eyelash and eyebrow transplants

Eyelash transplant and eyebrow transplant operations are delicate surgery which rely on the skill of the surgeon.

Hairs are taken from the head and then placed very carefully into the lashes or brows.

You can find out more in our eyelash and eyebrow transplant guide.

4. Body hair transplants

In patients who have enough hair on their chest, it’s possible to move chest hairs to the top of the head.

This is a difficult operation which requires a very skilled surgeon so only a few clinics in the world offer it.

It’s also possible to use beard hairs for a body hair transplant although chest hairs are preferred.

You can read more in our body hair transplant guide.

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In-depth Guides to Hair Transplantation

Table of Contents

Guide to follicular unit extraction

What is follicular unit extraction?
Follicular unit extraction: how it works
Step 1: Harvesting the grafts
Step 2: Making incisions
Step 3: Placing the grafts
Follicular unit extraction: how long does it last?
Follicular unit extraction: what to expect
Phase One: Shedding
Phase Two: Resting
Phase Three: Growth
Follicular unit extraction recovery time
Unshaven follicular unit extraction
Follicular unit extraction post op
Follicular unit extraction risks
Follicular unit extraction scar?

Guide to follicular unit transplantation

Guide to eyelash and eyebrow transplants

What is an eyebrow transplant?
What eyebrow shape should I have?
Eyebrow transplant: how it works
Step 1: Harvesting the grafts
Step 2: Making the incisions
Step 3: Placing the grafts
Eyebrow transplant: what to expect
Eyebrow transplant recovery
Phase One: Shedding
Phase Two: Resting
Phase Three: Growth
Eyebrow gel
Eyebrow transplant side effects
Eyebrow trimming
Eyebrow scar: permanent eyebrow restoration
Eyebrow transplant after chemo

Guide to body hair transplantation

Can body hair be used for hair transplant?
Body hair transplant to head
Body hair transplant: what to expect
Step 1: Harvesting the grafts
Step 2: Making the incisions
Step 3: Placing the grafts
Is a body hair transplant permanent?
Can you transplant hair from other parts of the body?
Is there a scar?
Body hair transplant post-op

Guide to follicular unit extraction

In this guide you’ll learn:

• the most important words in follicular unit extraction
• how follicular unit extraction works
• why there’s no follicular unit extraction scar
• what to expect in a follicular unit extraction transplant
• follicular unit extraction post-op instructions
• how follicular unit extraction healing works

What is follicular unit extraction?

Follicular unit extraction is called FUE for short. It’s one of the two main methods that surgeons use to transplant hairs and FUE is the newer method.

Around 70% of hair transplant patients are men suffering from male pattern baldness (MPB). MPB is simply the normal ageing process which causes hair to fall out in most men.

Hairs fall out when they’re affected by a substance in the body which is linked to testosterone. This substance is called Dihydrotestosterone (DHT) and it causes the hair on the top of the head to fall out.

DHT doesn’t affect the hairs on the sides and the back of the head. A hair transplant takes the hairs from the sides and back of the head and places them on the top of the head.

Once hairs from the sides and back are put on the top of the head, they never fall out.

Follicular unit extraction: how it works

Follicular unit extraction hair transplants work by moving grafts one-by-one from the sides and back of the head to the top. There are three steps to the operation.

Step 1: Harvesting the grafts

In the follicular unit extraction technique the surgeon uses a hollow-tipped needle, known as a punch, to loosen and release individual hair follicles. For more information on punches see our article on manual vs motorised punches.

These follicles with hairs still in them are known as grafts. Once released, they’re taken out of the skin one-by-one.

Each of the grafts is then carefully stored in a special nutrient-rich solution where they can be kept safely until they’re needed. To learn more see our article on storing grafts.

Single-hair grafts are extracted as well as multi-hair grafts. Single-hair grafts are used to design the hairline and multi-hair grafts are used to add density. For more on this, see our article on how hairline design works.

Step 2: Making incisions

Once all the grafts have been extracted, the surgeon carefully makes tiny cuts in the recipient area.

This is the most crucial part of the operation for two important reasons:

1. To create each patient’s unique, natural look the surgeon has to design it himself by hand.
2. By making every single incision himself, the surgeon can prevent issues such as shock loss.

Read our article for more information on shock loss.

Please note that shock loss is not serious and it’s always temporary but it can be avoided completely with a skilled surgeon.

The density of grafts in a hair transplant is around 35-40 grafts/cm2. The hairline is made especially dense however and the density in the hairline goes up to around 60 grafts/cm2. For more on density please see our article on dense packing.

Step 3: Placing the grafts

Once the incisions are made, the extracted grafts are carefully placed into the cuts.

Every single hair graft is placed one-by-one. The team assists the doctor during this stage so there are always two people placing grafts at the same time.

By working in a team, grafts don’t stay out of the body too long and this leads to a follicular unit extraction success rate of over 95%.

Follicular unit extraction: how long does it last?

Follicular unit extraction procedures take time. It usually takes between four to six hours depending on how many grafts you need.

Follicular unit extraction results are permanent and the hair will last a lifetime without falling out.

Follicular unit extraction: what to expect

After the operation it takes some time before the new hairs grow.

This is because hair follows a natural growth cycle. You can read more about these cycles in our article on hair growth cycles.

The cycles have three phases:

1. Shedding – hairs fall out
2. Resting – hairs lie dormant
3. Growing – hairs grow

When hairs are transplanted from one place to another, their growth cycles are ‘reset’. So newly transplanted hairs always start off by shedding first.

Phase One: Shedding

The first cycle begins with the shedding phase.

The doctor has moved grafts from one place to another. The grafts are actually like placeholders or ‘seeds’ for the new hairs to come.

Before the new hairs can grow, the old hairs have to make way so in phase one all of the newly transplanted hairs fall out.

In the first week you’ll see scabs or crusts forming across the scalp. This is normal and it’s part of the body’s natural healing process.

After the first two weeks all of the newly transplanted hairs will fall out. This is the end of phase one.

Phase Two: Resting

The second part of the cycle is the resting phase. Once all of the hairs have been shed, only the roots (follicles) remain below the skin.

The follicles lie dormant for many months but during this time a lot of activity takes place below the surface of the skin and you can expect to see patches of redness, pimples and small bumps.

This is due to the fact that new blood supply systems, known as capillaries, are forming below the surface of the skin in order to bring blood to the newly transplanted follicles.

In the rest phase you might see some bumps, pimples and some redness of the skin. To ease any redness we recommend a natural high-strength Aloe Vera based cream. This will ease the distressed skin and the redness; bumps and pimples will all pass in time.

It’s usually around five to six months before you’ll see new hairs starting to grow.

Phase Three: Growth

After five to six months your new hair will start to grow. All new hairs start off thin and wispy at first and they slowly gain in size, strength and density.

The new hairs don’t all grow at the same time. To see full growth you have to wait at least one year for all of the new hairs to complete their cycles.

With hair on the crown, new growth can take as long as eighteen months because most people have less blood supply to the back of the head (the crown) compared to the rest of the head.

Follicular unit extraction recovery time

It’s comfortable to have around one week off after the operation. The grafts ‘set’ in the first three days and after that there is no danger of accidentally knocking them out.

You should wait one week before you wash your hair. You can start light sports after one week and heavy sports or contact sports after two weeks.

You may not wear a hat after the transplant for one week because of the risk of infection.

After one week most of the healing is complete and the shedding phase will start.

Unshaven follicular unit extraction

Almost all patients have to shave their heads before an operation.

In some cases though it’s possible to have the operation without shaving. This is only for cases where the patient has fewer than 2300 grafts.

It’s also possible to conceal an operation if your hair is the right length. Below are some example pictures of a patient who had Unshaven FUE and whose hair was long enough to cover the donor area. Both pictures are postop. For more on this patient take a look at our case study photos.

Image of patient with unshaven FUE at the Villnow Clinic - hair down
Image of patient with unshaven FUE at the Villnow Clinic - hair up

Follicular unit extraction post op

Cardio-vascular exercise promotes blood flow throughout the body – also to the hair.

We’ve noticed very good results in patients who do regular cardiovascular exercise such as running or hot yoga – both of which have shown excellent long-term results in previous patients.

Cardio-vascular exercise seems to help hairs grow after a transplant, especially in cases involving a transplant to the back of the head (crown). Blood supply is often lower to the crown and exercise can promote better graft growth in our experience.

We recommend five to six hours of cardiovascular exercise a week for the best result.

Follicular unit extraction risks

Follicular unit extraction is not a risky medical procedure. It’s a very established and very safe operation as long as it’s carried out by an actual doctor in a sterile operating theatre.

Our clinic houses several state-of-the-art operating theatres and we adhere strictly to German medical law to make sure everything is clean and safe for all of our patients.

One major risk to the success of a follicular unit extraction is smoking.

Smoking can kill grafts outright after a transplant and must be avoided. You should quit smoking before your operation or you risk wasting the operation. Our guarantee does not apply to smokers.

Follicular unit extraction scar?

The advantage of the FUE technique is that there’s no visible scarring at all.

The older technique, which is called FUT or the Strip Method, leaves a thin scar on the back of the head which is visible if your shave your head or keep your hair cropped very short. For more on FUT, see our guide below.

This is the main advantage with FUE hair transplants: there is no follicular unit extraction scarring at all – even if your head is shaved. The patient below had his hair shaved one year after having 5000 grafts extracted by FUE. There is no scarring visible at all. To see more photos of this patient please see our case study photos.


Image of patient with shaved head one year after FUE at the Villnow Clinic - no scarring

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Guide to Follicular unit transplantation

Follicular unit transplantation is called FUT for short. It’s the way hair transplant operations started out.

FUT is done by cutting out a strip of skin from the donor area at the back of the head. This is also why it’s known as the Strip Method. The way the operation works is like this:

1. Once the strip has been taken out, it’s dissected to separate the individual grafts.

2. Once the grafts have been separated the surgeon then makes tiny cuts in the recipient area.

3. Once the cuts are made then the individual grafts are carefully placed into the cuts one by one.

The main advantage of an FUT hair transplant is that it’s quicker to do than the newer FUE method however FUT hair transplants leave a thin scar at the back of the head where the strip was cut out.

This scar is a very fine line and it’s completely invisible if the hair is grown.

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Guide to eyelash and eyebrow transplants

In this guide you’ll learn:

• the most important eyebrow and eyelash terms
• how an eyebrow and eyelash hair transplant works
• what to expect in an eyelash or eyebrow transplant
• eyelash and eyebrow transplant post-op instructions
• about eyelash and eyebrow transplant healing

What is an eyebrow transplant?

An eyelash or eyebrow transplant works in the same way as other hair transplants.

The operation is essentially the same for both eyelash and eyebrow transplantation. In this guide we’ll talk about eyebrows mostly but the procedure is the same for both.

• The doctor removes hairs along with their follicles one-by-one from the back of the head. These are known as grafts.
• Tiny incisions are made in the eyebrow or the eyelash under local anaesthetic.
• The doctor places these grafts one-by-one into the eyebrow or eyelashes

The operation doesn’t take long and it can be done in a single day.

What eyebrow shape should I have?

It’s possible to design your eyelashes and eyebrows any way you like.

Before you have the operation, ask yourself, ‘which eyebrow shape is best for me?’ and then come and talk to us about what you want to have.

Eyebrow transplant: how it works

Grafts are harvested from the head in the same way as in the FUE technique. The advantage of FUE for eyebrow transplantation is that it allows the surgeon to pick the best possible hairs for the eyebrows one-by-one. This is the same for eyelashes.

Step 1: Harvesting the grafts

The doctor uses a small hollow-tipped needle to remove hairs from the back of the head. Once removed, the grafts are placed in a special nutrient-rich storage solution so they are safe.

Step 2: Making the incisions

In the next step the doctor makes tiny incisions in the recipient area.

Step 3: Placing the grafts

And finally, he uses very small forceps to implant the grafts.

The operation doesn’t take long. It’s usually around three hours for the eyebrows and one and a half hours for the eyelashes.

Eyebrow transplant: what to expect

An eyebrow transplant is minor surgery but like any surgery there may be a little discomfort.

An eyebrow transplant is done under local anaesthetic and it will sting a little when the surgeon puts the anaesthetic in at first but after that you won’t feel anything.

Eyebrow transplant healing time is very fast and you can expect any discomfort to be gone within a few days.

Eyebrow transplant recovery

Once the eyebrow transplant surgery is complete then you will need to wait around one year for the new hairs to grow fully.

This is because the hair in the body grows in cycles and when you move hairs they start their cycles from fresh again. Read our article for more on how these cycles work.

Phase One: Shedding

The first cycle begins with the shedding phase.

You can imagine that the hairs that have been transplanted are actually like placeholders or ‘seeds’ for the new hairs to come.

Before the new hairs can grow, the old hairs have to make way so in phase one all of the newly transplanted hairs fall out.

Straight after the operation you’ll see scabs or crusts form on your eybrows or eyelashes.

This is the body’s natural healing mechanism and it’s completely normal.

Since the eyebrow and eyelashes are very delicate it’s important not to pluck or tug at the grafts until the scabs start to fall naturally.

With eyelashes and eyebrows it’s easy to dislodge a graft in the first weeks by pulling on it.

After the first two weeks all of the newly transplanted hairs will fall out.

Phase Two: Resting

The second cycle is the resting phase. Once all of the hairs have been shed, only the follicles remain below the skin.

For several months all the activity takes place below the surface of the skin. New blood vessels form to supply the transplanted follicles with blood.

This phase takes around five to six months and varies from patient to patient.

Phase Three: Growth

After five months you’ll start to see your new eyebrow hairs start to grow.

They don’t all grow at the same time so to see full growth you have to wait around one year for all of the new hairs to complete their cycles.

Once the eyebrow transplant recovery is complete then the new hairs are permanent.

Eyebrow gel

Eyebrow transplant hair sticks out sometimes when the new hairs first start to grow but this is very rare because the doctor is very experienced at placing the new grafts in the right direction.

If you think your eyebrow transplant hair is growing in the wrong direction at first then you should not be disappointed.

You can use eyebrow gel to ‘train’ the hair to grow in the right direction by styling it.

You should wait around a month after the operation before you use eyebrow gel to start styling your hair.

Once the new hairs arrive then you can start to use small amounts of eyebrow gel.

Be careful with your new hairs because they are very delicate.

Use the eyebrow gel to make sure all of the hairs are pointing in the right direction.

After two or three months the new hairs will grow in the right direction on their own.

Eyebrow transplant side effects

The only thing you need to watch out for if you have an eyelash or eyebrow transplant is the length of the new hairs.

Take a look at our section on eyebrow trimming for more on this.

Eyebrow trimming

After an eyelash or eyebrow transplant, the new hairs have to be taken care of.

The transplanted hairs grow like they would normally so, for the best result, patients need to trim their new brows or lashes from time to time or the new hairs will grow long.

You can expect to trim your new hairs once a week or so.

Eyebrow scar: permanent eyebrow restoration

An eyebrow hair transplant is a great way to cover a scar in your eyebrow.

Grafts can be placed within a scar to cover over it.

Eyebrow transplant after chemo

There are also other medical reasons for this type of surgery, such as after chemotherapy (chemo). Hair loss is one of the chemotherapy side effects.

Hair growth after chemo changes from person to person and it’s not always certain that lashes or eyebrows grow back after chemo although normally everything does grow back.

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Guide to body hair transplantation

In this guide you’ll learn:

• the most important body hair transplant terms
• how a body hair transplant works
• what to expect in a body hair transplant
• body hair transplant post-op instructions
• about body hair transplant healing

Can body hair be used for hair transplants?

Body hair transplantation is the same as a normal scalp hair transplant except that it’s a hair transplant from other parts of the body.

The best body hair transplant results are with patients who have a lot of hair naturally.

The number of grafts you can get depends on how many hairs a patient has on his chest or beard but as a rough guide a chest with a strong amount of hair can yield up to around 1000 body hair grafts.

Body hair transplant to head

This technique normally involves a hair transplant from body to head since the hair of the body is not well suited for eyebrows or eyelashes.

This is because of body hair’s unique texture which can be a little curlier than other hairs.

Body hair is also unsuitable for building hairlines.

Hairline reconstruction is fine and detailed work involving carefully-placed rows of single-hair grafts which are always taken from the donor areas on the head. You can read our article here for more on hairline design.

Body hair is an excellent way to add density in large balding areas behind the hairline – especially if the patient’s donor area in the scalp is limited.

Body hair transplant: what to expect

A body hair transplant is done in the same way as an FUE hair transplant: by using a punch to remove individual grafts from the patient’s donor area. You can read more in our FUE guide here.

The process has three stages.

Step 1: Harvesting the grafts

First the chest or beard is shaved. Then grafts are removed one by one using a hollow-tipped needle called a punch.

Step 2: Making the incisions

The rest of the process is the same as a normal scalp hair transplant. In the second step the doctor carefully makes incisions in the scalp.

Step 3: Placing the grafts

In the final stage, the body hair transplants are carefully placed into the incisions.

Is a body hair transplant permanent?

A hair transplant using body hair is permanent and our body hair transplant success rate is very high – we expect a graft survival rate of over 90%.

Can you transplant hair from other parts of the body?

When performing a hair transplant from body hair the best results come from hair that’s on the chest in our experience however Dr Villnow can use both chest hair and beard hair. For beard and body hair results take a look at our case study photos.

Is there a scar?

Even though the hairs are extracted from the chest there is no body hair transplant scar formation in the chest after the operation.

This is because the grafts are extracted with a small punch which does not leave a scar.

The picture below shows a patient who has just had a body hair transplant at the clinic.

This next picture shows the same patient six months after the operation – the donor area has healed completely and there is no scarring at all.

Body hair transplant post-op

Like all transplanted hairs, body hairs follow a natural growth cycle.

After the operation, the newly-transplanted hairs fall out after a couple of weeks.

After five to six months the new hairs start to grow again.

You’ll see the full result after twelve to eighteen months.

You can read more about these cycles in our article on hair growth cycles.

Body hairs grow in a different way to scalp hair and are always used to add density rather than for delicate work such as creating a hairline.

Placing body hairs in the crown is the best way to use them effectively.

A body hair operation is always more time-consuming and exhausting than a regular scalp hair transplant so this option costs more.

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