Hair Transplant on Receding Hairlines

Hair loss manifested as a receding hairline is part of the natural aging process, which can affect individuals of all sexes but is more common in men.

The early signs in men are often noticeable by the mid-twenties and according to some studies, up to 80% of men are affected by the age of 80 years. There are several causes of a receding hairline – androgenetic alopecia or pattern-baldness being the most common.

Treatment options include medications and hair restoration surgeries. Hair transplant for a receding hairline is a common practice in cosmetic surgery and here we present an in-depth overview of the procedure including its cost, risks, and results.

What is a hairline transplant?

Various treatment modalities are available to treat receding hairlines. Medications, like Minoxidil and Finasteride, can halt the recession but the results are often short-lived. Hair transplant for a receding hairline uses techniques similar to those used for other types of hair transplants.

Follicle unit extraction (FUE) is the most common method used, in which hair follicles are extracted from the donor area and implanted into an already marked area of the receding hairline. The back of the head is a common donor area as the hair there is relatively resistant to the actions of dihydrotestosterone (DHT), the hormone responsible for pattern balding and receding hairline. FUT (follicular unit transplant) is another technique in which a strip of scalp containing hair follicles, instead of individual follicles, is harvested from the donor area. This can lead to scarring of the donor area and is less commonly used nowadays.

The modern methods of hair transplant were introduced in the 1950s, the punch hair transplant being the initial surgical technique. Improvement in our understanding of hair anatomy and physiology led to advancements in the field of hair transplant. In the 1990s, FUT became a popular surgical technique which, along with the related and newer technique of FUE, is still in use. Some centers have started using robotics for follicle extraction and implantation to improve precision and speed up the process.

FUE and FUT for hairline hair transplant are specialized cosmetic procedures. A minimum skill set in surgery and cosmetics is required to perform the procedure. Doctors trained to perform FUE or FUT usually have a background in dermatology or plastic surgery.

Characteristics of receding hairlines

A receding hairline is one of the various types of alopecia or hair loss.

A related condition is the maturing hairline, in which the hairline changes after puberty attaining a higher position and exposing more of the forehead and temples. This is a physiologic process and almost universal in men.

A receding hairline, on the other hand, is commonly an early manifestation of male-pattern baldness though that is not always the case. Usually, hairline recession starts at the temples and progresses backward, meeting an area of hair loss on the crown to produce complete baldness. In others, the recession stops after a while without progressing to the typical pattern of androgenetic alopecia, creating what is called a high frontal hairline.

In females, though the most common cause of hair loss, too, is androgenetic alopecia or female-pattern baldness, a receding hairline is not its common feature. Other causes like frontal fibrosing alopecia and traction alopecia are usually the culprits in females with receding hairlines. Androgenetic alopecia occurs as a result of the actions of the hormone, dihydrotestosterone (DHT). Frontal fibrosing alopecia is common in post-menopausal women.

A receding hairline can also be caused by hair loss in traction alopecia. As its name suggests – traction – is consequent to repeated pulling of the hair mostly due to tight hairstyles.

Other factors that might play a role in hair loss include genetic predisposition, smoking, and stress.

The Norwood scale is commonly used to grade the extent of recession and hair loss for patients with patterned-baldness. First introduced in 1975, this classification divides hair loss into seven categories, labeled Type I to VII. In type I there is a minimal hairline recession. On the other extreme, type VII means complete baldness and the most severe hair loss with only a thin horseshoe-shaped strip of hair remaining on the back and sides of the head. (1)

Procedure options

Surgical procedures for a receding hairline are the ones currently in vogue for other types of hair loss, namely FUE, FUT, and DHI.

FUE is the one more commonly used as it offers several advantages over FUT. DHI (Direct hair implantation) is a modified version of FUE. In FUE, individual follicles are harvested from the donor area, placed in a solution to avoid desiccation, and then implanted onto the recipient area. In DHI, harvesting and implantation are done simultaneously, obviating the need to store harvested follicles. DHI requires the use of specialized instruments, is a relatively new procedure and is gaining traction. The disadvantages of DHI include its relative complexity and longer duration of the procedure.

Alternatives to hair transplant include the use of platelet-rich plasma (PRP) and micro-pigmentation. Hairline-lowering surgery is another approach that is discussed in detail in the next section.

 When used alone the results of PRP are inferior to hair transplantation. However, many surgeons use PRP as an adjuvant to hair transplant to expedite the recovery process and promote healing. PRP is derived from the patient’s blood and injected into the scalp after the hair follicles are implanted. Micropigmentation is a non-surgical hair loss solution that involves tattooing dots in the scalp to create an illusion of fuller hair.

Considerations before undergoing a hair transplant procedure include follicle density of the donor area, hair color and texture, the contrast between skin and hair color, and suitability of the recipient area. Patients with hair loss due to an inflammatory condition may not be suitable candidates for hair transplant surgery. Curly or frizzy hair (As the case may be in afro hair transplants) may be difficult to work with during transplant but the results according to some surgeons are better than with straight hair.

Hair transplant procedures are not available on the NHS as they are cosmetic surgeries. For the same reason, they are usually not covered by private insurance firms either.

Transplant VS hairline lowering surgery

Hairline-lowering surgery (HLS), also called forehead-reduction surgery, is an alternative to transplant for patients with a high hairline. The procedure first introduced in 1999, involves surgically removing part of the forehead skin to lower the frontal hairline.

On average, 2 cm lowering is achieved via the procedure, although as much as 5cm is possible. In comparison, covering a comparable area would require implanting 7000 to 9000 follicle grafts. In this regard, it is an effective approach with a high success rate.

On the flip side, the procedure is suitable for a limited number of patients – namely those with a stable frontal hairline and mobile scalp. This excludes a large number of male patients since their hairline is often unstable due to persistent recession. The ideal candidates for hairline lowering surgery are females with a genetically high frontal hairline. A Hair transplant, on the other hand, is suitable for a wider variety of hair loss patterns.

Both the procedures can be performed under local anesthesia. With HLS, the results are immediately apparent after the procedure, while hair transplant takes 9-12 months for significant hair restoration. Complications of HLS include a visible scar, which is uncommon with a hair transplant with FUE. In addition, HLS may require a follow-up hair implantation to achieve the desired hairline, although the number of grafts required is significantly lower than those for hair-transplantation surgery. In the UK, a hairline-lowering surgery costs on average GBP 7500 . The cost of hair transplantation ranges from GBP 1000 up to 30,000 depending on the extent of hair loss, type of procedure, and the transplant team.

Donor area

An important consideration in hair restoration surgery is the selection of an appropriate donor area.

Plastic surgeons use the term ‘safe donor area’ to refer to an area that is expected to be permanently covered with hair so that the hair follicles harvested from it will remain in the recipient area for a lifetime.

The hair at the back of the head is usually permanent as it is resistant to the effects of DHT. This is the most commonly used donation area for various types of hair transplantation including hairline hair transplant. Hair from other body areas like the beard, chest, and groin can also be used if harvesting from the typical donor area is not feasible for some reason. Implanting body hair to the hairline will require extra care and expertise on behalf of the surgeon to ensure that the hair blends well.

Cost

The cost of a hair transplant can vary greatly from GBP 1000 to 30,000, as mentioned above. The main determinant of cost is the number of grafts required as most clinics charge per graft unit.

Minor adjustments may require as little as 500 grafts while more extensive coverage from temple to temple can take 2000 or more grafts. On average, an early receding hairline (Norwood scale 2) requiring 500-800 grafts will cost £ 1250 to 4000. In comparison, a similar transplant would cost around £800 – 1500 in Turkey. .The average cost per graft is £ 2,5-5 in the UK and half as much in Turkey.

Surgery in the UK vs Turkey

Turkey is a popular destination among health tourists. It can be an attractive option especially for those seeking a hair transplant for a receding hairline as the procedure is not offered by the NHS.

The cost of the procedure in private clinics in the UK can be significantly higher than those offered in Turkey. Things that need to be kept in mind when opting for a surgical procedure, including hair transplant, abroad include the quality of healthcare compared to the UK, the logistics and costs of staying in a foreign country, and visa and flight considerations.

There are clinics in Turkey with qualified surgeons who employ the modern methods of hair transplantation (FUE), with quality of care comparable to other countries including the UK. When the combined costs of travel, hotel stay, and transplant procedure are considered, you can still save up to 70% on your hair restoration treatment in Turkey, compared to the UK.

Health tourism may not be suitable for everyone, however. If you are employed, you will need to take leave from work, and given the cosmetic nature of the surgery, some employers may not count the leave as sick leave. For extensive hair implantation, repeat sessions may be required, which would mean a lengthy stay abroad or repeat visits.

Risks and considerations

Preoperative Considerations:

• Transplant covers the bald area but does not stop the progression of a receding hairline. This means a second procedure may be required after some time if the recession continues and the area towards the vertex thins out.
• Before graft harvesting and implantation, the hairline is mapped out. The hairline design depends on the patient’s ethnicity, face structure, patient preference, and pattern of hair loss. Three patterns are common: flat, flared, and rounded. A rounded contour is relatively easy to draw and is useful for younger patients where there is a risk that the hairline may recede further. Some surgeons prefer the flared contour as it achieves a more natural look.

Risks:

• Infection: With modern hygienic standards the risk of infection is low but like in any surgical procedure it is still a concern and antibiotics are commonly used in the first few days to minimize the risk further.
• Scarring of the donor area is a concern with FUT but is unlikely with FUE.
• Attention to detail is required while mapping out the hairline. Otherwise, the results might not look natural.
• Scalp edema and allergic reaction are relatively common acute complications, which settles promptly with over-the-counter medications.
• Long-term complications include chronic folliculitis, cobble-stoning of the recipient area, and poor hair growth. 

Hairline transplant timeline

Booking an Appointment: On the first visit, the surgeon will assess your hair for suitability for transplant and will guide you regarding the appropriate procedure. Expected outcomes and hairline design will also be part of the discussion.

Surgery: The procedure will take one or more 3–4-hour sessions, depending upon the number of grafts required. It is done under local anesthesia and usually, there is minimal pain during the process.

1-2 postoperative days: Swelling, tightness, and slight pain are common and would settle with pain medications.

First few weeks: Many patients experience itching, scalp dryness, and scabs during the first week. Don’t be alarmed, it is normal. Don’t pick the scabs and avoid scratching. The scabs will fall off spontaneously by the second week.

Recovery: It takes, on average, 9 to 12 months for the implanted to grow significantly. 

Before and after pictures

Results and aftercare

1 Month after surgery: After FUE general recovery is quick and the patient can return to work after a day or two. The implanted hair usually falls off by 3-4 weeks. It is normal and not a cause for concern. You can wash your hair from day 5 onwards but avoid direct application of water from a hose or shower. Massage gently avoiding excessive rinsing.

2-3 months: The implanted hair would have likely shed off by now and your head might look similar to what it was before transplant.

8-9 months: By now sufficient growth is achieved that the new hair can be styled and combed as usual.

1 year: Hair recovery is mostly complete by the end of 1 year. Good results are expected after FUE with up to 80% of the transplanted hair showing growth.