Hair transplantation (autologous hair transplantation)

What is hair transplantation (autologous hair transplantation)?

Hair transplantation is a surgical procedure in which hair follicles (grafts/units) from the occipital and temporal regions, which are less affected by AGA (androgenetic alopecia), are transplanted to areas of hair loss. It is essentially a "hair relocation"—as hair increases in the front, it decreases in the back. According to the Japanese Dermatological Association guidelines, it is rated as "B: Recommended to perform" for male-pattern hair loss and "C1: May be performed" for female-pattern hair loss.

Once grafted hair takes, it inherits the characteristics of hair from the occipital and temporal regions and is therefore less susceptible to AGA, continuing to grow through normal hair cycles. However, the thinning progression of surrounding existing hair does not stop, so the basic approach is "transplantation for deficient areas, hair growth treatments for maintaining existing hair." Please consult with us about continuing hair growth treatments (such as finasteride or dutasteride) to maintain existing hair.

Differences between FUE and FUT, with or without shaving

There are two methods for harvesting hair follicles: "FUE (non-incisional method)," which extracts hair follicles one unit at a time using a punch, and "FUT (strip method)," which cuts a strip shape with a scalpel and subdivides it. FUE is currently the mainstream approach, and we primarily perform FUE at our clinic. The extraction site from FUE becomes a point-like scar, which becomes less noticeable as the remaining hair grows.

There are two approaches for handling the extraction site. "With shaving" is a method where the extraction site is shaved short before extraction, with approximately 3,000 grafts per session as a guideline. "Without shaving" involves extracting one row at a time while combing the hair, allowing the surrounding hair to conceal the extraction site, making the postoperative appearance less noticeable; however, extraction takes longer, with approximately 2,000 grafts per session as a guideline. Surgery is an outpatient procedure performed under local anesthesia plus intravenous anesthesia in either case.

For these concerns

We address M-shaped/receding hairline, thinning from the frontal to vertex area, and parting transparency. Cases such as alopecia areata that has progressed over several years or hair transplantation to scar tissue from injury or burns may also be considered. Whether the procedure is suitable and the number of grafts needed will be determined based on examination during consultation.

Guidelines for graft count and coverage area

The required number of grafts is calculated as "area × density." Asian hair density is reported at 70–100 hair follicles/cm², with a maximum density of 50 grafts/cm² possible in a single transplantation session, typically 30–50 grafts/cm². As a guideline, lowering the hairline by 1 cm requires approximately 800 grafts, while filling in bilateral M-shaped areas requires approximately 800–1,200 grafts.

At a transplantation density of 30–40 grafts/cm², 1,000 grafts covers approximately 25–31 cm² (M-shaped/hairline), 2,000 grafts covers approximately 50–67 cm² (frontal to vertex), and 3,000 grafts provides coverage of a broader area. Since transplantation is done by overlaying vellus or thinned hair areas, the final design and graft count will be determined at examination.

Surgical procedure

① Free consultation (medical history, photography, design consultation) → ② Pre-operative blood work → ③ Surgery day (informed consent and design confirmation, then surgery under local anesthesia plus intravenous anesthesia; outpatient procedure; surgical time varies by graft count, approximately 4–5 hours) → ④ Next day (bandage removal, hair washing) → ⑤ Regular follow-up appointments.

Follow-up visits are recommended on the day after surgery, at 1 week, 2 weeks, monthly from 1–6 months, at 9 months, and at 12 months. We can monitor progress and consult about adjusting hair growth treatments as needed.

Postoperative course and downtime

Transplanted hair grows to approximately 5 mm and then temporarily sheds within 1–3 weeks (the hair follicles have taken, entering a resting phase). Around 1–3 months, there is a peak in telogen effluvium (shedding of transplanted hair) and shock loss (shedding of existing hair), which may temporarily appear as less hair than before surgery. Growth typically begins around 3–4 months, with completion expected at approximately 1 year. Hair growth in the early stages may have strong curls, but gradually settles into the original hair texture.

As a guideline by symptom, eyelid swelling peaks around days 2-3 (more likely if there are many grafts near the hairline), pain and itching typically last 1-2 weeks, redness lasts several months, folliculitis (acne) is more likely to develop until around 6 months, and sensory discomfort in the transplanted area may persist for 3 months to 1 year. The shaved donor area generally becomes unnoticeable in 2-4 weeks as the remaining hair grows. Individual variation exists in all recovery timelines.

Graft survival rate and limitations

The graft survival rate is approximately 90-95% on average, assuming proper graft selection and careful handling (the rate may be lower in scarred areas). Once grafts take, the hair generally does not fall out and continues to grow through the hair growth cycle.

However, there are limitations. Maximum transplant density per procedure is 50 grafts/cm², and because donor hair is somewhat thicker, the final result is "somewhat thicker hair growing at a somewhat lower density," with the limit of reproduction being approximately 70% of the original volume (though density often produces more volume than expected). Multiple procedures are possible, but because donor hair is reduced in the back and sides of the scalp with each procedure, the number of procedures is limited. Some cases may not meet your expectations or may not be appropriate candidates, so confirmation during consultation is important.

Risks and side effects

The following have been explained: temporary shedding of transplanted hair, shock loss of existing hair, eyelid swelling, pain and itching, redness, folliculitis (acne), sensory discomfort in the transplanted area (hypoesthesia or hyperesthesia), punctate scarring in the donor area (may be noticeable if cut extremely short), uneven or hypertrophic scars, and possible persistence of growth pattern quirks in newly growing hair. Effects and recovery vary by individual.

Cases requiring pre-operative consultation

If you fall into any of the following categories, please inform us during consultation. Depending on the details, you may not be eligible for surgery, or confirmation from your primary care physician may be necessary. Use of anticoagulants (Warfarin, Pradaxa, Xarelto, Eliquis, Lixiana, etc.) / Use of medications for schizophrenia, bipolar disorder, or depression (certain local anesthetic combinations may not be usable) / Diabetes (HbA1c 7.5 or higher) / Glaucoma (closed-angle or narrow-angle) / Foreign objects beneath the scalp in the surgical area (plates, shunt tubes, etc.) / History of synthetic hair transplants / Infection / Recent chemotherapy. Please also inform us of any allergies to medications (especially antibiotics), fruits, soy, or eggs.

Hair transplantation for women

According to guidelines, autologous hair transplantation for female pattern hair loss is rated "C1: may be performed." Female hair loss is often diffuse, affecting the overall scalp, and is typically performed on specific areas such as the M-shaped hairline or part line. As a guideline for graft count in cases, approximately 600 grafts total on both sides of the M-shaped area and approximately 700 grafts for the part line are typical examples. Since finasteride and dutasteride are contraindicated for women, the primary medication treatment used in combination is topical minoxidil. During the shedding phase, alternative methods such as changing the part line or covering with a wig are available.

About the attending physician

Hair transplantation at our clinic is performed by Dr. Yuichiro Kizuka, a part-time physician at our Ginza location. He studied surgical fundamentals at Kurume University Department of Plastic Surgery (from 1997), gained experience at hair transplant specialist clinics including Island Tower Clinic (from 2017) and THE CAPSULE CLINIC (from 2023), and joined our clinic in 2026. For detailed background and introduction, please see the physician page (/ja-jp/doctors/yuichiro-kizuka/).