Hair transplant (autologous hair transplant)

What is hair transplant (autologous hair transplant)?

Hair transplant is a surgical procedure in which hair roots (grafts/units) from the back and side of the scalp, which are less affected by AGA (androgenetic alopecia), are transplanted to areas of concern for hair loss. In essence, it is a "hair relocation," and as the front gains hair, the back loses hair by the same amount. According to guidelines from the Japanese Dermatological Association, hair transplant is rated "B: Recommended" for male-pattern hair loss and "C1: May be considered" for female-pattern hair loss.

Once transplanted hair takes successfully, it inherits the characteristics of hair from the back and side of the scalp and is therefore less affected by AGA, continuing to grow throughout the hair cycle like normal hair. However, since the progression of hair loss in surrounding existing hair does not stop, the basic approach is "transplant for what is lacking, and hair growth treatment for maintaining the current state." Please also consult with us about continuing hair growth treatment (such as finasteride or dutasteride) to maintain existing hair.

Differences between FUE and FUT, with or without shaving

There are two methods for hair root extraction: "FUE (non-incisional method)" in which hair follicles are extracted unit by unit with a punch, and "FUT (strip method)" in which a strip is cut with a scalpel and then subdivided. The current mainstream is FUE, and our clinic primarily performs FUE. The extraction marks from FUE become point-like scars, which become less noticeable as the remaining hair grows.

There are two approaches to handling the extraction area. "With shaving" is a method in which the extraction area is shaved short before extraction, with approximately 3,000 units per session as a guideline. "Without shaving" involves extracting one row at a time while combing, which allows the extraction area to be hidden by surrounding hair, making it less noticeable after surgery, but extraction takes longer with approximately 2,000 units per session as a guideline. Surgery is performed as an outpatient procedure under local anesthesia plus intravenous anesthesia in either case.

For these concerns

We address M-shaped or receding hairline, hair loss in the front to crown area, and transparency in the part line. Transplantation can also be considered for alopecia areata after several years of progression and for scarring from injury or burns. The appropriateness of treatment and the number of units needed will be determined based on examination during consultation.

Unit quantity and coverage guidelines

The required number of units is calculated as "area × density." The hair density in Asian hair is 70–100 follicles/cm², and the maximum density possible in a single transplant is 50 units/cm², usually around 30–50 units/cm². As a guideline, lowering the hairline by 1 cm requires approximately 800 units, and filling in both M-shaped areas requires approximately 800–1,200 units.

Based on a transplant density of 30–40 units/cm², 1,000 units covers approximately 25–31 cm² (M-shaped/hairline area), 2,000 units covers approximately 50–67 cm² (front to crown area), and 3,000 units covers a broader area. Since transplantation is layered over areas with fine or thinning hair, the actual design and number of units will be determined at the examination.

Surgical procedure

① Free consultation (medical history, photo documentation, design consultation) → ② Pre-surgical blood test → ③ Day of surgery (informed consent and design confirmation, followed by surgery under local anesthesia plus intravenous anesthesia; outpatient procedure; surgical time varies depending on the number of units, typically 4–5 hours) → ④ Next day (bandage removal and hair washing) → ⑤ Regular follow-up appointments.

Recommended follow-up visits are: the day after surgery, 1 week later, 2 weeks later, monthly from 1–6 months, at 9 months, and at 12 months. While monitoring progress, we can also discuss adjustments to hair growth treatment as needed.

Post-operative course and downtime

Transplanted hair grows to approximately 5 mm and then sheds within 1–3 weeks (the hair root has taken and enters a resting phase). Around 1–3 months is the peak of temporary shedding (shedding of transplanted hair) and shock loss (shedding of existing hair), and hair may temporarily appear thinner than before surgery. From around 3–4 months, new hair begins to grow, with completion expected in approximately 1 year. Newly growing hair may have strong curl at first, but gradually settles into the original hair texture.

As a guideline by symptom, eyelid swelling peaks around days 2–3 (more likely to occur with higher graft density near the hairline), pain and itching typically last 1–2 weeks, redness persists for several months, folliculitis (acne) is prone to occur until around 6 months, and sensory abnormalities in the transplant area may continue for 3 months to 1 year. The trimmed donor site 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 (and may be lower in scarred areas), provided that grafts are properly selected and handled without damage. Hair that has successfully taken root generally does not fall out and continues to grow according to the hair growth cycle.

However, there are limitations. The maximum transplant density in one procedure is 50 grafts/cm², and because the donor hair is somewhat thicker, the result will be "somewhat thicker hair growing at somewhat lower density," with the limit being approximately 70% of the original volume reproduction (though volume appears greater than density alone would suggest). Multiple procedures are possible, but since the hair in the back and sides of the scalp decreases by the amount harvested, there is a limit to the number of procedures. Some cases may not meet your wishes (non-indicated cases), so confirmation during consultation is important.

Risks and side effects

Temporary shedding of transplanted hair, shock loss of existing hair, eyelid swelling, pain and itching, redness, folliculitis (acne), sensory abnormalities in the transplant area (paresthesia or hyperesthesia), punctate scarring in the donor area (may become noticeable if trimmed extremely short), scar irregularities or hypertrophic scars, and possible persistence of initial growth direction are explained. Effects and recovery vary by individual.

Cases requiring pre-operative consultation

If any of the following apply to you, please inform us during your consultation. Depending on the content, you may not be able to receive surgery, or confirmation from your primary physician may be necessary. Oral anticoagulants (Warfarin, Pradaxa, Xarelto, Eliquis, Lixiana, etc.) / medication for schizophrenia, bipolar disorder, or depression (local anesthesia combination agents may not be usable) / diabetes (HbA1c 7.5 or higher) / glaucoma (closed-angle or narrow-angle) / foreign objects beneath the scalp at the surgical site (plates, shunt tubes, etc.) / history of synthetic hair transplants / infection / recent chemotherapy. Please also inform us of allergies to medications (especially antibiotics), fruits, soybeans, and eggs.

Hair transplant for women

According to guidelines, autologous hair transplantation for female-pattern hair loss is rated as "C1: acceptable." Female hair loss is often diffuse, thinning overall, and is typically performed focusing on specific points such as the M-shaped hairline or part line. As a case example of graft count, approximately 600 grafts total (both sides) are used for M-shaped areas and around 700 grafts for the part line. Because finasteride and dutasteride are contraindicated for women, the primary adjunctive medication treatment is minoxidil topical application. During the shedding phase, changing the part line or covering with a wig are also options.

About the physician

Hair transplants at our clinic are performed by Dr. Yuichiro Kizuka, a non-full-time physician at our Ginza location. He learned surgical fundamentals at Kurume University Department of Plastic Surgery (since 1997), gained experience at the hair transplant specialty clinic Island Tower Clinic (since 2017) and THE CAPSULE CLINIC (since 2023), and joined our clinic in 2026. For detailed background and introduction, please see the physician page (/ja-jp/doctors/yuichiro-kizuka/).