Hair transplant explained: Step-by-step guide to how it really works

India Today

14-06-2025

Hair loss can be emotionally taxing. Whether it's a receding hairline, thinning crown, or patchy beard, the impact on self-confidence is real. Fortunately, modern hair transplant techniques have made it possible to restore hair naturally and permanently. In 2022, the hair transplant market will be valued at USD 195.25 million and is projected to grow at a CAGR of 17.12% by 2029. However, ever wondered what exactly happens during a hair transplant? In this article, Dr Mayank Singh (MCh Plastic Surgery, ABHRS, FISHRS), Founder, CROWN, New Delhi, and President of the Association of Hair Restoration Surgeons of India (AHRS), breaks down the process step by step so you know exactly what to expect before going under the needle.advertisementWHAT IS A HAIR TRANSPLANT?A hair transplant is a minimally invasive surgical procedure in which hair follicles are relocated from a 'donor area' (typically the back or sides of the scalp) to a 'recipient area' experiencing baldness or thinning.
There are two primary techniques:FUT (Follicular Unit Transplantation) – Involves removing a strip of scalp and dissecting it into grafts under a microscope. FUE (Follicular Unit Excision) – Involves individually excising hair follicles using a micro-punch tool.Each method uses your natural hair, which continues to grow even after transplantation.STEP-BY-STEP HAIR TRANSPLANT PROCEDURELet's walk through each phase of a typical hair transplant, from consultation to recovery.1. INITIAL CONSULTATION AND SCALP ANALYSISThis is where your hair restoration journey begins.The surgeon evaluates your hair loss pattern and scalp health. A trichoscopy test may be done to assess follicular density. Donor area strength is analysed to determine the best-suited technique (FUE or FUT). Photos are taken for planning and progress tracking. Expectations, risks, pricing, and post-operative care are discussed in detail.advertisementThis is also the right time to ask questions and set realistic expectations.2. HAIRLINE DESIGN AND SURGICAL PLANNINGA successful transplant is as much about art as it is science.The surgeon designs a custom hairline to suit your facial features and age. The required number of grafts is estimated to achieve the desired density. Future hair loss is considered to ensure long-lasting, natural-looking results. 3. PREPARATION AND LOCAL ANAESTHESIAOn the day of the procedure:Hair is trimmed short in both donor and recipient areas, unless an unshaven or long-hair transplant is planned (especially common for female patients who prefer not to shave). A test dose is given first to rule out any allergy to the local anaesthetic. Once cleared, local anaesthesia is administered to numb the scalp. There may be minor discomfort during the injection, but the procedure itself is painless. You remain awake and relaxed throughout. 4. HARVESTING HAIR FOLLICLES (FUE OR FUT)This is the core of the procedure.FUE (Follicular Unit Excision): Individual follicles are excised using a micro-punch (0.6–1 mm), creating dot-like scars scattered across the donor zone. Each graft has 1–4 hairs and is preserved carefully. FUT (Follicular Unit Transplantation): A strip of scalp is surgically removed from the donor zone and dissected into follicular units. FUT typically yields more grafts from the central core area, where the best-quality follicles reside, and preserves more donor area for future sessions.advertisementEach technique has its pros and cons. It is advisable to let the surgeon decide the most suitable method based on your hair loss pattern, donor reserve, and long-term planning.5. GRAFT SORTING AND PRESERVATIONOnce harvested:Grafts are examined under magnification to ensure their integrity. They are sorted based on size—single, double, or multiple hair grafts. All grafts are stored in an isotonic solution to maintain hydration and viability before implantation.Proper handling here is key to graft survival and natural growth.6. MAKING RECIPIENT SITE INCISIONSTiny slits are made in the recipient area using fine needles or blades.Factors considered:Angle and direction for natural-looking hair growth. Proper spacing to avoid overcrowding and to maintain blood supply. Density planning based on graft availability.Think of this step as planting seeds—precision defines the outcome.7. IMPLANTING THE HAIR GRAFTSThis step involves placing each graft into the recipient sites:advertisementSingle-hair grafts are used at the hairline for a soft, natural look. Multi-hair grafts add density to the area behind the hairline.The process can take several hours, depending on the graft count, usually ranging from 1,000 to 4,000.Hair transplants have evolved significantly, offering lasting and natural results for those dealing with hair loss. But the success of the procedure depends on key factors:Choosing a qualified and experienced hair transplant surgeon (preferably a board-certified plastic surgeon or dermatologist). Ensuring that all excisional and incisional steps are performed by the surgeon. Careful surgical planning tailored to your unique hair pattern. Diligent post-procedure care for long-term results.It's not just about looking better—it's about feeling like yourself again. Take your time, research thoroughly, and step into your transformation informed and empowered.