Ultimate Guide To Hair Transplants

If you're dealing with hair loss and looking up hair transplants, you're not alone. An estimated 50% of men have visible thinning/balding before they turn 50. That means in a room of 100 guys half of them are already balding or will begin soon. Dealing with genetic hair loss is all about catching it early. The sooner you treat the condition, the better your odds of preserving your hair. However, there is no stopping the inevitable, eventually the hair will fall, and when it does the only proven method is hair transplantation. In this article, we will be providing the ultimate guide to hair transplant surgery.

Hair Transplant The Procedures How They Work

Surgical hair restoration involves transplantating hair from the back and sides of the scalp-known as the donor area- to the balding areas. Some say hair transplants do not work on a completely bald scalp, we're here to say that is not true. In fact, hair transplantation is the only proven treatment that can regrow hair on a bald scalp. That said, there are limitations associated with surgery, a full restoration of the scalp is unlikely. 

There are two different donor harvesting techniques for eligible candidates: Follicular Unit Extraction (FUE) and Follicular Unit Strip Surgery (FUSS)

How Follicular Unit Strip Surgery (FUSS) Works

For strip, a physician surgically removes a strip of hair-bearing tissue from the donor area, once excised technicians begin to dissect the strip in to follicular unit grafts. Folliuclar unit grafts come in groupings of 1-hair, 2-hair, 3-hair, 4-hair, and even 5-hairs per graft.  The follicular unit grafts are then placed into pre-made micro-incision sites more on that later. 

How Follicular Unit Extraction (FUE) Works

FUE has been coined as the 'modern' technique and has become the most popular harvesting technique, because of the favorable scarring. FUE involves a surgeon extracting follicular unit grafts individually with the use of a surgical punch. The surgical punch ranges from 0.7mm to 1mm in circumference. FUE relies on the entire donor area, as opposed to the strip procedure which focuses on a strip concentrated- in one area. 

Why Do Recipient Sites Matter

Everywhere on the internet you'll hear about why __harvesting technique is better than the other, but rarely are incision sites ever discussed. So what are incision sites? Well, incision sites are where the follicular units are placed in the balding area. These sites are responsible for the angle, depth and density of the overall procedure. 

If an incision site is too large for the graft-the hair will develop what is known as pitting. Conversely, if the incision site is too small for the graft-the hair will develop cobblestoning. It's called cobblestoning because the scar tissue when healed will have a bumpy appearance that resembles cobble stone streets. Another potential problem is the angle and direction of the hair, if angled improperly the hair will appear unnatural and stick out in unnatural direction. 

Hair changes directions all over the scalp, for example in the crown the hair is flat in a clockwise or counter-clockwise direction. Therefore, it is crucial to select a surgeon who understands the nuances of hair direction depending on the location. 

Pros and Cons with FUE and FUSS

Contrary to what you may have read, there are pros and cons to each harvesting technique. The biggest pro for FUE is the favorable scarring. Patients who undergo FUE are able to wear their hair short without scarring becoming visible. Patients who undergo FUSS will have a linear scar on the back of their scalp from ear to ear. This scar can be easily concealed with hair, but the hair must be a certain length.

On average FUE grows slightly less than the strip method, some surgeons claim anywhere from 5% less to 20% less. This depends on the physician. FUE is more labor intensive therefore, less grafts can be extracted in one session. This means patients with extensive hair loss may require 3-4 sessions, as opposed to strip. 

The biggest con with strip is the scarring. There is no getting around the linear scar. Regardless of the closure-the scar will be visible with short hair. Also, there is a chance of developing permanent nerve damage. The recovery time is also longer with strip. 


Both FUE and FUSS have their place in modern hair restoration. When combined both FUE and FUSS produce more hair than either technique would alone. Not all hair restoration physicians are created equal their skill, talent, and experience vary widely, as do their results. It is crucial to choose a pre-screened, certified hair transplant surgeon. The best place to find real-patient reviews, results and photos is on the hair restoration network forum. The forum is over 18 years old, and has over 35,000 members.