Can all type of hair loss be treated with hair transplant surgery?

Some hair loss conditions can be treated with hair transplant surgery but others cannot. In any situation where someone loses their hair, the first step is to confirm the diagnosis before any treatment can be recommended. Your GP or a specialist dermatologist are the ones who would decide on the best treatment options.

If alopecia areata is diagnosed there are only certain situations where hair surgery is recommended, and this is when there are only 1 or a few discrete patches that have remained unchanged for several years. For most people alopecia areata is a condition that comes and goes and changes location on the scalp or elsewhere on the body. Because it can’t be determined where the permanent hair is going to be, surgery is only an option if the condition is burnt out and is unlikely to come back or extend further. Of course, when someone loses all the hair on their head (alopecia totalis or alopecia universalis) there is no available donor hair as we can’t use hair from another person.

The majority of patients who undergo hair transplantation surgery have androgenetic alopecia, sometimes referred to as male pattern hair loss or female pattern hair loss. Hair transplant surgery can also restore hair in cases of traction alopecia. 

How would a hair transplant work?

Modern hair transplant techniques involve follicular unit grafting. A follicular unit is the natural grouping of hairs with most hairs grouped as 2, 3, or 4 hairs in a close bunch. There will also be a small number of single hairs that grow on their own. Hair transplant surgeons try to keep these natural groupings together and move them surgically by two main techniques. One method involves the removal of a strip of hair bearing scalp from the back of the head then stitching the area. The hair above the surgery site will disguise the stitches or staples until they heal at which point you are left with a scar averaging 1mm in width. The strip of skin and hair is then dissected under microscopes to isolate the follicular units. The other method is called follicular unit extraction (FUE) and is a process of meticulously coring out each grouping with a tiny punch. Usually with this technique the back of the head needs to be shaved. When the scalp heals there are small dot scars that are left behind. Once the follicular unit grafts are prepared these are then inserted into a small incision made in the bald area. The surgeon will normally place 20-40 of these grafts in each square centimetre of bald scalp. The procedure is done as a day case under local anaesthetic.

How successful are hair transplant surgeries?

In a completely bald area with one operation, hair transplant surgeons can achieve about 30% of the original density so some patients may require 2 operations to achieve a thicker look. If hair loss is due to genetics, then the result should be long lasting. In other situations, if hair is lost due to a medical condition such as alopecia areata, then transplantation cannot be guaranteed as the disease process can recur at any time. But for some patients even a temporary return to ‘normal’ hair is acceptable.


Information provided by Dr Nilofer Farjo of the Farjo Hair Institute