All you need to know about hair transplant

crop4_240x240_15july14What is Hair Transplant?
Hair transplant is borrowing hair roots from the back of the head and implanting them in bald areas to replace the lost roots. It is done on the scientific basis that we are born with two kinds of hair roots, sensitive or temporary and non sensitive or long lasting. Hair roots on the front and top of the head are sensitive. Hair roots within a well defined 11/2 – 2 inch band on the back of the head are non sensitive. This is defined as the permanent hair zone or the safe donor area.

Can we transfer all the hair from the non sensitive area to cover the baldness?
Transferring all the roots from the donor area will create a bald patch on the back. As the international guideline states, 10-12% of the available hair roots can be transferred to the bald area. Usually this amounts to maximum of 6500-7000 grafts in an average bald male.

Adding hair from other areas
We can harvest hair roots from outside the permanent hair zone with an understanding that these are not long lasting and may be lost later. We can add body hair. Beard hair is the closest match in texture, rate of growth.

It is advised to use the shadow area under the chin which is not directly seen. In the event of white spots or scars appearing in this area while harvesting, it is less likely to be seen.  If the healing response is scar free, further beard hair from the neck can be used and if need be from cheek areas as well as a  last option. Next choice is chest hair, but it does not always match the look, texture and rate of growth of scalp hair.

Good quality hair is the basic requirement for a successful Hair Transplant
We easily forget that the quality of hair selected for transplant plays maximum influence on the hair growth and outcome of the procedure. Patients having progressive hair loss for many years, youngsters having severe active hair loss are undergoing hair transplants without preparing the hair for surgery. It is good to have vitamins, antioxidants, iron, calcium, selected hair aminoacids and lotions to bring the hair into a good growing phase and then plan a hair transplant.

How do I choose the right hair transplant surgeon?
Once the hair quality is good, the next important thing you need to look at is the skill and experience of the surgeon. Often decisions are made by comparing rates. Patients end up choosing the center offering the cheapest procedure whereas the aim is to get good results.

Experienced surgeons who are in the field for many years and handle only one case a day will provide personal care and know the value of their work. Membership of learned societies, national international presentations, results and ease of individual consultation can help in selection. Also the team working with the surgeon should be stable without frequent changes and should have good experience.

Who cannot opt for a hair transplant?

Hair Transplant should not be done for people with the following:

1. Poor quality hair roots: Thin weak slow growing hair indicates continued damage from factors causing hair loss. The same factors may continue to affect transplanted hair. Plan 2 months of support program to improve hair growth. Then have a hair transplant and then follow the same care after the transplant. The program usually consists of lotions and low dose vitamins with no enzyme blockers like Finasteride. The program is safe, free of side effects, delivers wellness, good health as well as hair growth.

2. Thinning hair : Hair transplants done for thinning hair are likely to have the most dreaded complication of shock loss. The surrounding natural hair starts falling off after the hair transplant. The patient’s hair would look worse than it looked prior to the transplant. If there has been a pre-conditioning program, the shock loss hair can grow back.

Thinning hair also has the possibility of improving and responding to the best to hair growth program. Vitamins, lotion, low light laser must always be used in thinning hair before deciding for a hair transplant., especially for thinning hair in women. For some reason women have a higher incidence of shock loss. Hair transplant should be avoided for people with early hair loss as the progress and  future hair loss is unpredictable.

The planned replacement of lost hair may not match the future pattern of the progress of hair loss. Some judgment can be made looking at hair loss in the family and close relatives. Early hair loss responds well to vitamins, lotions and laser and does not call for immediate hair transplants.

Adding High Density
Patients look at hair transplant as a way of replacing all their lost hair with new hair. Some mathematics can clear this notion. We are born with 100,000 – 120,000 hair roots on the scalp. Out of which 50-60,000 are on the top of the head and 50-60,000 are on the sides and the back of the head. By the time you reach grade IV – V of hair loss you have lost 30,000 original hair roots. In a hair transplant these will be replaced with 2000- 3000 grafts. You may add another 1000 Body hair. This will never replace all the 30,000 hair that were lost.

The aim in planning a hair transplant is never to replace all the hair. It is to plan a layout to create an illusion of fullness so that you do not look bald. It is good to plan a layout which will reverse the present stage of baldness by two stages.

Hair transplant and Hair Growth Program together add Density: It is possible to grow back 30-40% of your lost hair with a well planned vitamin, lotion and laser program. This will add to the growth and density when combined with a Hair transplant to give better density and thick hair look.

Advancing the hair line or making Widow’s Peak: Hair should be implanted only over the top, flat of the head. Where the forward slope of the forehead starts the hair transplant should stop. Implanting over the slope of the forehead leaves a skin show behind the hair making it look sparse and unnatural. The Da Vinchi’s law of facial proportion id followed to mark the level of the new hair line.

Length of the nose and distance from tip of the nose to the chin must be equal to the forehead. This decides the level of the hair line. Then a man’s hair line runs straight back to meet the temporal angle, while a women’s hair line curves round across the temporal angle. We need to be careful while making a widows peak and avoid coming down over the forehead.

Correction of very youthful temporal angles: Placing new hair in front of the temporal side lines is not a good plan. You will continue to lose hair behind the newly created angle giving an empty unnatural appearance. Temporal angles should be corrected only if they have receded to the level of the side locks or behind the side locks.

crop1_240x240_25july14Hair transplant at a young age
Hair transplant at a young age has numerous disadvantages. If you begin with severe hair loss requiring hair transplant at young age, the chances of continued hair loss and requiring repeated hair transplants are higher. Reconstructing a very forward young looking hair line leaves you a large area to fill up behind. The future progress and expected areas of hair loss are not defined at a young age making it difficult to plan the distribution of grafts.

Thinning eyebrows: Is it possible to make it look thicker with hair transplant? 
Eyebrow hair is of unique quality which does not match with any donor source for replacement. Scalp hair is thick and faster growing than eyebrow. If entire brow is lost it is easy to replace with scalp hair. But scalp hair grafts should not be mixed with the original eyebrow hair to make it look thicker or dense. The eye brow hair has specific pattern and shape which need to be recognized and planned accurately.

Low hair line with empty scalp
Patients in advance stages of hair loss approach with their college photographs to make a hair line like their previous looks. But rest of the face does not match a low hair line. Lower hair line requires more number of grafts to create. The bald area for restoration also increases as the hair line is shifted forward. Low hair line with bald areas on the top of the scalp and mid scalp look unnatural. Always plan to fill up the top of the scalp and mid scalp first to take away the bald look and then lower the hair line in a second sitting.

Hair Transplant and Post care 
People who come for hair transplant are caught up with their busy lifestyle and do not have time for applying lotions, taking vitamins etc. So they assume getting a  hair transplant is a one stop solution and assumes it solves the problem. It is important to know that transplanted hair will not grow unless we take care of the roots with regular vitamins and lotion. Such patients will end up with thin weak slow growth of the transplanted hair as well. A good hair care program is necessary after a hair transplant.

Health conditions and hair transplant: What is prescribed to whom 

Patients on Bodybuilding supplements: Use of body building supplements and whey protein makes the ph of the blood acidic, causing return of calcium back into the blood to buffer the acidity. This calcium is bound in the blood and becomes unavailable for body functions. Excess blood calcium is also excreted through the kidneys. All those using fat burner, creatinine, weight gain supplements, whey protein can lose hair. Some are born with good hair type, different roots and may not be affected. But if you are losing hair you need to discontinue the gym supplements.

Weight watchers on strict diet control: Hair has the lowest priority in the body. The body feels it can live a fit and healthy life even if it loses all the hair. There is no natural repair or restoration program to replace lost hair. Important body functions receive the best nutrition and any remainder reaches the hair. The moment you cut down on calories, food intake, use meal replacements, the first system to suffer is hair growth. Body shuts down the hair. Weight watchers and persons with restricted eating always have hair loss. Same is true for hair loss after high fever, illness, any surgery, stress, emotional event, metabolic disease etc.

Dieting: We are all conscious weight watchers, restricted eating is become a way of life. Our bodies have lower nutrients than required. Iron, Calcium levels are  always low. Vitamins are of two kinds: water soluble and fat soluble. Cutting of fat from the diet results in deficiency of fat soluble vitamins A, D, E, K. Hair has the lowest priority when it comes to distribution of nutrients. The body feels we can survive without growing a single hair on the head. Any nutritional imbalance in the body and your hair is the first to shut down. Whether you lose weight or not by dieting, you lose hair for sure. Just replace the  nutrition your hair requires efficiently and the hair grows back in 2-4 months.

Thyroid Imbalance: Both hyper & hypo thyroid states cause hair loss. Hyper thyroid state increases the metabolic rate leading to higher consumption of nutrients and relative deficiencies. Whereas hypo thyroid state lowers the metabolism leading to poor utilization of the nutrients. Both lead to hair loss and both respond to nutritional correction. Zinc & iodine are essential elements for production of thyroxin. Balance of all nutrients is essential for propagation of hair growth cycles.

PCOS / PCOD: Polycystic Overian Syndrome / Disease: The cyst lining produces androgens and androgen precursors leading to hair loss. However, obesity, nutritional imbalance, insulin resistance and metabolic disorder is the underlying cause for PCOD. The replacement of balanced micro nutrients resets the metabolism and supports hair growth as well. Correction of metabolism in PCOD patients results in hair growth, seen clinically on serial pictures taken within 2-4 months.

Rising Androgen levels in Women: Today women are living like men. They work hard, have physical exertion, exercise, stress, sometimes even smoking and drinking. The female body is secreting more male hormone as need of the hour. Many women are presenting with male pattern type of hair loss. We do not believe in changing the hormone levels with medications but we can accelerate the natural hair growth to strengthen the roots and make them stand the damage.

Post Pregnancy Hair loss: The sudden hormonal withdrawal after delivery slows down the hair growth cycles which gradually, corrects itself over next 3 months. But the post pregnancy hair loss is also due to lack of nutrients which were utilized to create another body out of the mothers resources. Rather out of the limited resources of today’s mothers. Post delivery these depleted resources are not replaced adequately from fear of weight gain. In a hurry to get back in shape women practice restricted eating leading to hair loss. The balanced, low dose micro nutrient replacement program helps to re-grow the lost hair showing photographic results within 2-4 months and control of hair loss within 4-6 weeks.

Patients with Hormonal changes: Obesity, insulin resistance, acne, dandruff, oily skin, are considered to be a male variant of PCOS in young boys. The incidence is on the rise due to faulty selection of foods, lack of exercise and stress. . We do not believe in changing the hormone levels with medications but we can accelerate the natural hair growth to strengthen the roots and make them withstand the damage.

Hair transplant should be planned for:

1. Grade IV or more of hair loss: As per our experience and guidelines of the International Society of Hair Restoration Surgery – USA, hair loss of grade IV and beyond requires hair transplant. As per area the planning and layout of grafts should be optimized. Frontal forelock or mid frontal area can support high density. Temporal corners where the curvature of the head begins to slope downwards, gives very poor support to the grafts.

Limited advancement over this area or creating a bell shaped hair line with lateral flare at both the corners is advised for the temporal corners. Mid scalp area has the advantage of being flat. The hair overlap and fall over each other and look fuller even with average density. Crown area has a natural curvature and biologically is a area of low blood flow and reduced oxygenation. The ischemia theory is one of the reasons for hair loss on the crown. Grafts implanted over the crown area do not grow very well.

Many clinics around the world refuse to do a hair transplant for the crown area. The results for crown area are guarded. One can try the best but usually more number of sittings and repeat grafting is required for the crown.

2. Receding hair line: When the  Da’Vinchi’s law of facial proportion is implemented, the hair line can be advanced successfully. Plan to stop where the flat part of the head ends and the downward forehead slope begins. This is the shingling point.  Do not extend the hair line beyond this point. Advancing the hair line can give good results in men and women.

3. Correction of temporal angles: There are three grades of temporal receding namely,

  1. Loss of temporal angle
  2. Receding to the level of the side locks
  3. Receding behind the level of the side locks.

Careful planning and placing the grafts facing downwards and backwards to match the angle is essential.

4. Burns, trauma, scalp disorders: Hair transplant after burns, is the last procedure planned after finishing all other corrective surgeries and having a well settled mature scar. Any scarring alopecia or scalp disorder must be inactive with no fresh lesions for more than one year before a hair transplant is planned.

5. After Face Lift Surgery: Face lift surgery often causes loss of the frontal hair line and scarring just behind the hair line. The lift also makes the forehead look broad. A hair line creation can cover the scar and improve the aesthetics of the forehead.

6. Moustache, Beard: Patients with burns, trauma, scars causing loss of mustache or beard hair can benefit from hair transplant. A thin growing moustache can also be thickened with hair transplant.

7. Trans-sexual or Gender change operations: Patients who are transsexual or have gender change operations can be helped by creating male of female type of hair line to match the character as per the new gender.

8. Odd requests: Chest hair in Korean and Japanese men, pubic hair in oriental women can be restored with hair transplant.


Dr. Rajesh Rajput Hair Restore, M.S., M.Ch.,
Aesthetic & Hair Transplant Surgeon

Dr. Rajesh Rajput, a Trichologist & Hair Transplant Surgeon, has an experience of 25 years in providing focused solutions for hair transplant surgery for women and men. He has performed over 3,500 transplant procedures for patients from all over the world. He has also pioneered Cyclical Hair Treatment which controls hair loss & induces over 30% new hair growth in 2-4 months without side effects.

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