Is there a difference between hair transplantation and hair restoration?

A hair transplant is a surgical procedure whereby permanent hair is taken from the back and/or sides of the head (the “donor area”) and placed in thinning or balding areas (the “recipient area”). Hair restoration is a general term that could include both surgical treatment—i.e., a hair transplant—and non-surgical treatment, such as medication, low level laser therapy (“LLLT”), and some newer experimental treatments.

Am I a good candidate for a hair transplant?

This is undoubtedly the most important question to be asked, and why it is so important to meet with a qualified, experienced and empathetic hair restoration surgeon who will exercise good judgment in advising you at the time of your consultation. The answer will depend on:

The cause of your hair loss

For example, are you one of the 90% of people whose hair loss is genetic (hereditary)? Or do you have one of a number of scalp conditions that would prevent a transplant from growing?

Your age

There is no such thing as too old for a hair transplant, (Dr. Ballon’s oldest patient—and one of his happiest—was 87), but many people who are considering a hair transplant are too young. It depends on the amount of hair you have lost, your family history, your expectations, and your understanding of the progressive nature of genetic hair loss, among other things. It is generally true that the younger you are, the more sense it makes to postpone restoring a minimally receding hairline or early thinning on the top or back of the head. And the younger you are, the more important it is to focus on being proactive medically because of your greater potential for future hair loss.

Supply vs. demand

We will help you get a sense of how much donor hair you have available relative to your present and possible future hair loss, and work with you to formulate the best possible comprehensive strategy. Our approach takes the long view—we want to help you to not only replace as much hair as possible, but also to maintain as much hair as possible.

Your expectations

Dr. Ballon says, “as a happy hair transplant patient myself, I can tell you that getting my hair back has made a huge difference for me! Every single day, I appreciate no longer being bald. When I was losing my hair, I just didn’t feel as old as the guy I saw in the mirror every day. My hair isn’t as thick as it was in high school, but that’s OK: I wasn’t told I’d get that kind of result, and I never expected that kind of result.” Dr. Ballon will listen to your concerns and educate you as to what you can realistically expect to achieve from a hair transplant.

What’s the difference between a graft and a follicular unit?

For all practical purposes, the terms are interchangeable.

What is a follicular unit?

The hair on your scalp grows in “units,” or groupings, of one to four or five follicles. Each follicle grows a single hair, but there can be more than one follicle, and therefore more than one hair, in a follicular unit. The modern era of hair transplant surgery began with the recognition that using naturally occurring follicular units provides more pleasing results than using “plugs,” which consisted of large, random clusters of follicles.

Follicular Units
Follicular Units

What should I look for when choosing a surgeon?

Probably most important is to choose a surgeon whose entire practice is devoted to hair restoration and who performs at least several hair transplants a month, not one or two every six months. Membership in the International Society of Hair Restoration Surgery (ISHRS) and certification by the American Board of Hair Restoration Surgery are indications that your surgeon holds himself to a high standard, is committed to association with his peers, and is involved in continuing medical education.

More on choosing a surgeon

Your surgeon should openly take pride in his work, and offer you an opportunity to see “before” and “after” pictures as well as speak to several patients. When looking at patient photos, it is very important to know that you are looking at the work of the surgeon who would actually be performing your transplant. If you must choose among several surgeons you feel are equally qualified, pick the one with whom you feel most comfortable. Did the doctor spend sufficient time listening to you and answering questions to your satisfaction? Or did you feel rushed and pressured? Did you feel the doctor was honest and candid? Did you sense confidence, but not arrogance? Do you trust this person?

From the ISHRS website (www.ISHRS.org):

“The ISHRS is the leading authority on hair loss treatment and restoration with more than 1,200 members throughout 60 countries worldwide. We are dedicated to promoting the highest standards of medical practice and medical ethics. The ISHRS also provides continuing education to hair transplant doctors specializing in hair restoration surgery and is committed to providing the latest information on medical and surgical treatments for hair loss to the general public. The ISHRS was founded in 1993 as the first international society to promote continuing quality improvement and education for professionals in the field of medical hair restoration surgery. The mission of the International Society of Hair Restoration Surgery is to achieve excellence in medical and surgical outcomes by promoting member education, international collegiality, research, ethics, and public awareness. The vision is to establish the ISHRS as a leading unbiased authority in medical and surgical hair restoration.”

From the ABHRS website (www.abhrs.com):

The mission of the ABHRS to “establish specialty standards and to examine surgeons’ skill, knowledge and aesthetic judgment in the field of hair restoration.” The  ABHRS grants certification “to candidates who meet the highest standards of the medical profession in the field of hair restoration surgery.” Dr. Ballon is the only hair transplant surgeon in the state of Georgia who is certified as a Diplomate of the American Board of Hair Restoration Surgery.

Am I just being vain?

Most people simply want to look their best. If you are not happy with your appearance due to hair loss, having a hair transplant could be one of the best things you’ve ever done for yourself.

Are hair transplants painful?

A properly performed hair transplant should be virtually painless. Through the use of sedation techniques, even the few minutes it takes to administer local anesthesia should cause minimal or no discomfort. Once your scalp is numb, you should feel nothing during the procedure. Likewise, you should have only minimal discomfort during the days after the procedure, whether your grafts were obtained via the FUT (strip) or the FUE method.

How long is the healing and recovery period?

There will be some redness and crusting where the grafts were placed that gradually resolves over the first few days and generally is undetectable by 8 or 10 days after the procedure. With FUT (strip) surgery, the donor area usually looks normal immediately after surgery. It takes about a week for the donor area scabs to heal after FUE surgery; also, unless you wear your hair at #2 length or shorter, it will be awhile before the hair in the donor area catches up to the hair elsewhere on your head.

When will I see any results?

After a dormant period of 3-4 months, you will begin to see some light growth. The transplanted follicles do not all start growing new hairs at the same time, so growth is very gradual. It takes a year or longer to get the final result, but by 6-8 months there is usually enough hair to make a cosmetic difference.

What can I expect my hair transplant to look like once it has grown in?

A hair transplant performed by a skilled and experienced surgeon should look like you were born with it, and should blend imperceptibly with any surrounding hair. It should be undetectable even close-up.

Is the transplanted hair permanent?

In all but very rare cases, yes. The follicles carefully chosen to be used for your hair transplant are genetically programmed to continue growing for life. These follicles are resistant to the hormone (“DHT,” or dihydrotestosterone) that causes other follicles to gradually stop growing.

More on hair transplant permanency

It is important to understand that while a hair transplant can replace some of the hair you have already lost, it will not stop you from losing more hair if you are genetically predisposed to do so. This is why various preventive measures are strongly encouraged for most patients.

Will I need to do this again?

Patients are very often happy with the results of a single procedure, though two or more surgeries may be necessary to achieve the desired result. Your surgeon should discuss your particular situation with you candidly.

How long will the surgery take?

This will depend on the number of grafts to be obtained and transplanted, and the method (FUT or FUE). Small sessions (several hundred grafts) typically can be done in about 4 hours; larger sessions (2500-3000+ grafts) can take all day (or two days with the FUE technique). You will be able to take breaks during the day, and you can sleep, listen to music, watch TV or a movie, or chat with our friendly staff.

What does a hair transplant cost?

Like any cosmetic surgery procedure, the cost varies depending upon the extent of the surgery performed. Expect to spend several thousand dollars or more for a quality hair transplant, depending on the size of the area. It is important that you choose your surgeon based on his or her qualifications, and not on price. Your best chance for a good result is your first one; shopping for a “bargain” may lead to disappointment, regret, and further expense.

Are hair transplants covered by insurance?

No, even (in most cases) when performed for “medical” reasons, such as hair loss due to scars, burns, trauma, radiation treatment, etc.

Is financing available?

Yes, for qualified applicants. Our staff will be happy to discuss options with you at the time of the consulation.

Is corrective surgery possible?

A patient who is unhappy with the results from a previous hair transplant should not assume that nothing can be done to improve the situation. Dr. Ballon has performed many corrective surgeries, and they can be some of the most gratifying transplants for patient and surgeon alike.

Should I have “FUT” surgery or “FUE”?

This is the subject of enormous discussion, confusion, misinformation, misunderstanding, and controversy, largely because of aggressive and frequently misleading advertising. Myths abound, making it very difficult for the prospective hair transplant patient to truly understand his or her options.

Very briefly, there are two different methods for obtaining the follicles to be used as grafts for your hair transplant, “FUT” (follicular unit transplant) and “FUE” (follicular unit extraction).

The FUT method involves removing a narrow strip of tissue from the back and/or sides of the head and dissecting it into individual follicular units by means of precise stereomicroscopic dissection. Typically, the scalp heals in a fine line which is undetectable through the overlying hair in the vast majority of people. In the FUE method, grafts are removed by drilling small holes in the scalp and extracting the follicular units one at a time. Rather than a single linear scar, this technique leaves many small circular scars which can be less noticeable through extremely short hair (contrary to the many advertising claims, FUE surgery is not “scarless”).

The terms “FUT” and “FUE” are unnecessarily confusing and create a false distinction: both are techniques for extracting follicular units from the donor area, and both involve transplantation. Sadly, many surgeons and prospective patients seem to be paying more attention these days to the method by which donor follicles are harvested rather than how they will be used to create a natural and esthetically pleasing hair transplant.

Both FUE and FUT have their advantages and disadvantages depending upon the individual. Dr. Ballon is an expert when it comes to evaluating patients on a case-by-case basis and explaining the pros and cons of the different methods. He will spend as much time as you need during your consultation making sure that you understand your options and answering any questions you might have.