Hair Transplant Mistakes - What Patients Should Know
A good hair transplant starts before the day of surgery. During consultations, I often see patients who have researched hair transplantation alot. However, some of the most important points can easily be missed. Ideas and perceptions can be influenced by social media, online forums and marketing.
Most of these hair transplant mistakes are avoidable. Understanding them early can help your outcome whether it’s a consultation or the hair transplant procedure.
Dr Peter Thomas
MBBS MRCGP FUE Hair Transplant Surgeon
UK-trained doctor and specialist FUE hair transplant surgeon with postgraduate qualifications including MRCGP and specialist training to CCT level. Bringing refined FUE hair restoration techniques and renowned for natural results.
1. Thinking about today's hair loss but not tomorrow's
This is probably the most important mistake I see. A hair transplant moves permanent or more resistant donor hair into an area affected by hair loss. It does not stop the surrounding native hair from continuing to thin. Therefore, we should not plan a transplant simply around the current bald area. It is important to consider age, family history, current miniaturisation of hair, donor area supply and the likely pattern of future loss.
This matters particularly in younger patients. A very aggressive transplant can look impressive initially but leave fewer grafts available if the hair behind it continues to recede. Longterm donor planning is an established principle of hair restoration surgery (Mysore et al., 2021).
2. Assuming stronger finasteride or minoxidil must work better
Finasteride and minoxidil are commonly used to help slow further hair loss and protect native hair. I meet patients in clinic taking stronger doses of these medications but it does not necessarily mean better.
Finasteride already produces most of its DHT lowering effect at standard doses, with little extra benefit from increasing the dose (Drake et al., 1999; Kaufman et al., 1998).
Similarly, one study found that 5% topical minoxidil performed better than 10%, with the stronger preparation also causing more irritation (Ghonemy et al., 2021).
3. Shaving your hair before a consultation or surgery
Patients sometimes shave their head before a hair transplant consultation because they think this will make assessment easier. But the opposite is true. Seeing the hair with some length can help me understand how it naturally sits and where coverage is being lost. I see exactly how much existing hair remains within areas that appear thin. Also, longer length can help assess the miniaturisation of the hair easier.
The same applies before surgery. Do not assume you should shave the recipient or donor area yourself. Dr Thomas and team will do this on the day again for reasons mentioned above.
Read more about the hair transplant process and what happens on the day of surgery.
4. Reading hair transplant scare stories until you expect the worst
Search for hair transplant pain online and you will quickly find some experiences that patients have had. We should not dismiss these as pain thresholds vary and we can’t promise completely painless surgery.
However, online discussions can give a distorted impression of what most patients experience. People are naturally more likely to post about an unusually difficult experience than an uneventful one. In FUE surgery, the main discomfort is usually associated with administering local anaesthetic. Once the scalp is anaesthetised the procedure should be considerably more comfortable.
Feeling anxious before surgery is completely understandable. Myself and the team take time to explain what to expect, answer concerns clearly and make the day feel as calm and predictable as possible.
Discover more: how painful is hair transplant surgery?
5. Wanting a hairline that is too low or too straight
The hairline design has a huge influence on whether a result looks natural. Commonly I hear patients ask “can you just bring it a little lower?”. Sometimes this is fine but sometimes it is not.
A very low hairline requires substantially more grafts to fill the additional area. This does not support longterm donor management. It also needs to remain appropriate as the patient ages.
Straight hairlines can cause similar problems. Natural male hairlines generally contain curvature and irregularity rather than resembling a flat line.
Hair transplant guidelines specifically emphasise age, facial characteristics, future hair loss and long-term appearance when determining hairline position (Mysore et al., 2021). My aim is to design one that suits patients now and continues to make sense later.
See Dr Thomas’s approach to natural hair transplants here.
6. Expecting transplanted density to equal natural density
Patients understandably want the maximum hair transplant density. However, transplantation is not about replacing every hair that has disappeared.
A naturally dense scalp contains far more follicles than we can safely move from the donor area. Fortunately we do not need to recreate the original density to produce a good cosmetic effect. Hair shaft thickness, colour contrast, curl and the direction of graft placement all influence how dense a result appears. This is sometimes described as cosmetic density. Strategic placement allows a smaller number of transplanted follicles to create the visual impression of substantially greater coverage (Venkataram and Mysore, 2019).
The goal is not to pack in as many grafts as possible but to use a limited donor supply sensibly.
7. Judging a transplant by the graft number
“How many grafts will I get?” is a reasonable question. But the mistake is assuming that more hair transplant grafts means a better result.
Grafts contain different amounts of hair, typically contain 1-3 hairs. Also hair calibre, the thickness of the hair strand, varies. So does donor density and the size of the area being treated. Where those grafts are placed also matters enormously. For example, I generally want finer single hairs around the leading edge of a hairline. Larger follicular units can then provide greater visual density further behind.
Consequently, comparing clinics purely because one has quoted 2500 grafts and the other 3000 tells you little about the quality of the proposed result.
8. Trying to copy somebody else's hairline
Patients frequently show me photographs of celebrities or hair-transplant results they have seen online. This can help me establish their ideas and expectations. The problem comes when a patient is trying to specify the same result.
Two people can have completely different forehead proportions, facial shapes, hair shaft thickness, donor capacity and patterns of hair loss. A hairline that looks excellent on one person may look unnatural on another. Therefore we shouldn’t use these photographs as a template.
9. Planning to drive yourself home after surgery
This is surprisingly common and something we should be careful with. Hair transplant procedures can be lengthy and sedative medication is often used. If sedation is taken you will need to follow the clinic’s instructions about driving as it may not be safe.
See the Visiting Dr Thomas page for further practical advice and travel planning.
10. Assuming one transplant must achieve the final result
A second hair transplant does not automatically mean that the first procedure has failed. Hair restoration often needs to be viewed as a long-term process.
Some patients later choose another procedure to enhance density. Others want to address the crown after initially concentrating grafts at the front. Native hair may also continue to thin if preventative measures aren’t taken which creates a new area that requires treatment.
The donor supply is finite. Using large amounts of graft to chase maximum coverage in one surgery can leave fewer options later on. Recommendations suggest the possibility of future sessions as part of donor planning (Mysore et al., 2021).
A final word from Dr Thomas...
Many of the hair transplant mistakes I see are not really caused by patients doing anything wrong. They usually come from understandably focusing on the immediate result. Hair transplantation requires a longer view.
That is why I believe a good hair transplant consultation should involve more than simply drawing a hairline and providing a graft quote.
Speak with Dr Thomas and the team by booking a consultation today. You can also find more information about hair transplants on Dr Thomas’s Instagram.
DrThomas
References
Drake, L. et al. (1999) ‘The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia’, Journal of the American Academy of Dermatology, 41(4), pp. 550–554.
Ghonemy, S., Alarawi, A. and Bessar, H. (2021) ‘Efficacy and safety of a new 10% topical minoxidil versus 5% topical minoxidil and placebo in the treatment of male androgenetic alopecia: a trichoscopic evaluation’, Journal of Dermatological Treatment, 32(2), pp. 236–241.
Kaufman, K.D. et al. (1998) ‘Finasteride in the treatment of men with androgenetic alopecia’, Journal of the American Academy of Dermatology, 39(4), pp. 578–589.
Mysore, V. et al. (2021) ‘Hair Transplant Practice Guidelines’, Journal of Cutaneous and Aesthetic Surgery, 14(3), pp. 265–284.
Venkataram, A. and Mysore, V. (2019) ‘Logic of Hair Transplantation’, Journal of Cutaneous and Aesthetic Surgery, 11(4), pp. 169–172.
