Hair Transplant: Techniques, Candidates, and Recovery

What is a hair transplant and how does it work

A hair transplant is an outpatient procedure: healthy follicles are taken from a donor area (usually the back or sides of the head) and implanted into thinning or bald areas. The scientific rationale is 'donor dominance': follicles from the back of the head are genetically resistant to DHT, the hormone that causes androgenetic alopecia. After reimplantation, these follicles continue to grow for life.

The surgeon breaks the procedure down into three main phases. First, they prepare the recipient area: they make micro-incisions in the scalp with thin blades, adjusting depth and angle to mimic the natural direction of the hair. Then they extract the follicular units: in the FUE (Follicular Unit Extraction) technique, each follicle is removed with a rotating punch of 0.7-0.9 mm, leaving pinpoint scars that are not visible to the naked eye. In the FUT (Follicular Unit Transplantation) approach, the surgeon removes a strip of skin from the back of the head, dissects it under a microscope, and sutures the cut: a linear scar remains, but the follicular yield is slightly higher.

The follicular units are implanted one by one with fine forceps or with an 'implanter pen', which protects the bulb and rotates the angle of the hair during insertion. The entire procedure lasts from 4 to 8 hours, depending on the number of grafts (usually between 1,500 and 4,000 per session). The procedure is performed under local anesthesia. The patient remains awake and can communicate with the doctor throughout the process.

An important aspect: the transplant only works if the patient has an adequate donor reserve. If the occipital area is already very sparse, the procedure loses effectiveness. For this reason, evaluating donor density is the first step of any consultation.

Who is the ideal candidate for a hair transplant

Not all patients with thinning hair are suitable candidates. The transplant only works if the donor area has healthy follicles resistant to DHT, the hormone that causes male and female pattern baldness.

The first requirement is that the baldness has been stabilized for at least a year. If the patient is still actively losing hair, the procedure risks creating a patchy effect: the new hairs remain, the original ones fall out. Before the procedure, a serious surgeon requires blood tests (ferritin, TSH, vitamin D) to rule out reversible causes.

Main criteria for being eligible

• Norwood classification (men) or Ludwig (women). The best results are achieved in Norwood stages III-V and Ludwig I-II. Too advanced stages (VI-VII) require an assessment of the amount of available donor hair.
• Recommended age. Most centers prefer candidates between 25 and 65 years old. Under 25, the pattern of hair loss is often unpredictable. Over 65, the quality of the follicles and healing capacity must be verified on a case-by-case basis.
• Sufficient donor density. The surgeon measures the density in the occipital and temporal areas with a trichoscope. At least 50-60 follicular units per cm² are needed to have material to extract without emptying the back of the head.
• Good general health. Uncontrolled diabetes, active autoimmune diseases, anticoagulant therapy, or heavy smoking (more than 10 cigarettes a day) increase the risk of complications and reduce graft survival.
• Realistic expectations. A hair transplant does not recreate the density of a twenty-year-old. It restores a natural appearance, not a thick mane like in adolescence.

Those who have had a previous procedure with unsatisfactory results can still be re-evaluated. An intact donor area and a scar that can be removed or camouflaged are necessary.

Transplant techniques: FUE vs FUT compared

In hair transplantation, the two main techniques are called FUE, follicular unit extraction, and FUT, follicular unit transplantation. The choice between the two depends on various factors, such as the density of the donor area, the level of baldness, and personal preferences.

FUE: point-by-point extraction

With FUE, each follicular unit is individually extracted from the donor area-usually the back of the head-using a micro-punch. The instrument has a diameter between 0.7 and 0.9 mm. There is no linear cut, but small pinpoint incisions. These heal leaving tiny white scars, visible only with very short shaved hair.

Unlike FUT, FUE does not produce a linear scar. This allows you to keep your hair short even after the operation. Recovery is faster than FUT and post-operative pain is less. The procedure takes longer because each graft is extracted individually. An experienced surgeon can extract from 500 to 3000 follicular units in one session. The amount depends on the time available and the degree of baldness.

Extraction requires skill. If the micro-punch is too deep or angled, the follicle can be damaged. This is precisely why FUE is more expensive than FUT: it requires more time and dedicated instruments.

FUT: the strip of scalp

In FUT, the surgeon removes a strip of scalp from the donor area, usually 10-20 cm long and 1-2 cm wide. The wound is closed with sutures. A linear scar remains, which surrounding hair can hide, but it becomes visible if you cut your hair short.

Subsequently, a team of technicians dissects the strip under a microscope into individual follicular units. With FUT, more grafts can be extracted in a single session, often up to 4000-5000 units. This technique is indicated for patients with advanced baldness (Norwood 5-7) or with a low-density donor area.

Recovery times are longer. The pain is more intense, and the suture can cause a feeling of tightness in the back of the head for several weeks. The linear scar is permanent, but with careful closure and proper management, it tends to fade over time.

Direct comparison

FactorFUEFUT

How the procedure is carried out step by step

The preoperative phase: preparation and local anesthesia

On the day of the procedure, the patient arrives at the clinic having fasted for about four hours. The patient wears a disposable gown, and the donor area (back and sides of the head) is shaved. With the patient seated, the surgeon uses a surgical marker to outline the area to be treated and the contour of the areas to be filled. Local anesthesia is then administered: a series of micro-injections along the donor strip and the recipient area. In the first few seconds, a tingling sensation is felt, then the area becomes completely numb. After about ten minutes, the patient is ready. They remain awake throughout the procedure and can watch a movie or listen to music.

Extraction of follicular units (FUE)

With the FUE technique, now the most common, the surgeon uses a rotating micro-punch with a diameter of 0.8-1.0 mm to extract each individual follicular unit. The work is done in parallel strips on the donor area, extracting an average of 500-600 units per hour. For a transplant of 2,500 grafts, extraction takes about four hours. The extraction is precise: the micro-instrument only incises the skin around the follicle, without damaging the bulb. Each unit is immediately placed in a saline solution at 4 °C, where it remains until implantation.

Preparation and preservation of grafts

Under the microscope, technicians separate the grafts based on the number of hairs: from 1 to 4 follicles per unit. Single-hair units are reserved for the frontal hairline, while larger ones are used for the crown. The grafts are washed and preserved in a nutrient solution at 4 °C. Preparation takes about 30-45 minutes and overlaps with extraction, so as not to lengthen the overall time.

Creation of recipient sites

Using a thin blade or micro-needle, the surgeon makes tiny incisions in the bald area, following the predetermined design. The angle and depth of each incision determine the final growth direction. For a natural result, different angles are alternated: on the forehead, lower angles (about 30°) are used, increasing to 45° toward the crown. An experienced surgeon can make up to 500 incisions per hour. For 2,500 grafts, this phase takes about 2 hours.

Implantation of grafts

Technicians insert each follicular unit into the newly created holes using delicate forceps or micro-implanters. The operation requires precision: the graft must be placed at the correct depth, without bending the bulb. The process proceeds sequentially, starting from the front and moving toward the crown. Each graft is visually checked to ensure proper alignment. Implanting 2,500 units takes on average 2-3 hours.

Recovery and healing times after the transplant

The first 2-3 days after the procedure are the most delicate. Both in the donor area (back of the head) and the recipient area, small scabs, redness, and slight swelling that tends to move down toward the forehead and eyelids are observed. There is nothing alarming: it resolves on its own within 48-72 hours.

From the third day, a gentle wash of the scalp with the shampoo recommended by the surgeon is possible. The scabs fall off spontaneously between the fifth and tenth day. Forced maneuvers should not be performed: pulling them off can damage the transplanted follicles.

The real work, however, is subcutaneous. After the scabs fall off, the transplanted hairs enter a shock phase: around the third week, they begin to fall out. This is not a failure of the transplant. It is exactly what should happen. The follicles remain alive under the skin, and around the third or fourth month, the first new shafts emerge.

What can and cannot be done in the first weeks

• Avoid intense physical activity for at least 15 days. Sweat and increased blood pressure do not favor graft retention.
• Do not expose the scalp to direct sunlight. The scalp is vulnerable. A sunburn in the first 4-6 weeks can compromise results.
• Do not wear tight hats. Only wear loose, breathable head coverings after the first 7 days.
• Do not smoke in the first 2 weeks: smoking reduces oxygen supply to the follicles, slowing down engraftment.
• Do not consume alcohol for at least 7 days: it dilates blood vessels and increases the risk of bleeding and swelling.
• Do not scratch or rub the area: even after the scabs fall off, the scalp remains sensitive for about 3-4 weeks.

Factors influencing recovery times

Age matters. The technique also has an impact: with FUE (follicular unit extraction), recovery is generally 2-3 days faster than with the FUT strip technique. A finding from the Dott. Clinic.

They are not an optional extra: they reduce the risk of infection and accelerate the falling off of scabs.

What to expect month by month

In the first month, almost all transplanted hairs fall out. This is normal and expected.