Hair Implant Surgery

Stephen Barrett, M.D.
May 12, 2002

Hair implantation (also called hair transplantation) is a form of cosmetic surgery in which patches of skin containing healthy hair follicles are transplanted or shifted into areas that are bald or becoming bald. The procedures include punch grafting, strip grafting, scalp reduction, scalp expansion, and various types of flap grafting. Sometimes, two or more techniques are used to achieve the best results. The best candidates for these procedures are people with healthy hair growth at the back and sides of the head that can be used as donor areas [1]. Other factors, such as hair color, texture and waviness or curliness may also affect the cosmetic result.

  • In punch grafting, a punch is used to remove small areas of bald scalp and replace them with plugs of healthy scalp.
  • Minigrafting and micrografting involve transferring only a few hairs at a time [2]. In some cases they are used to make the hairline created by punch grafting look more natural.
  • In strip grafting, strips of bald skin are cut from the top of the head and replaced by strips of healthy scalp.
  • In scalp reduction a portion of bald scalp is removed and the wound is closed by pulling surrounding areas of the scalp toward the bare spot. The remaining bald spot can be filled with transplanted hair plugs.
  • In scalp expansion, a balloon-like device is inserted under part of the scalp and gradually filled with dilute salt water, causing the skin to stretch and grow so that a subsequent scalp reduction can cover a larger area.
  • Flap grafting is done by removing bald areas and replacing them with surrounding areas of hairy skin that have been lifted and swiveled into position. The swiveled portion is left attached to its original location until a new blood supply is established.

These procedures cost thousands of dollars and are often unsuccessful. Sometimes the areas from which the grafts are taken fail to regrow hair properly. Even successful transplants do not last indefinitely, because the transplanted hair lasts only as long as it would have at its original location. A hairpiece, wig, hair weaving, or simply accepting one’s baldness may be a better choice.

The American Society of Plastic Surgeons offers additional information. Consultation with a dermatologist may be helpful in deciding what to do.

  1. Hair replacement surgery. Arlington Heights, IL: American Society of Plastic Surgeons, 1993.
  2. Berland T. Baldness ‘cures’: Does anything really work? Consumers Digest 32(4):68-70, 1993.