What is a Beard Transplant?
There are two meanings of the term “beard transplant”, either moving hairs into the beard to make the beard look fuller or more extensive or moving hairs from the beard to other parts of the head and body.
The first scenario is transplanting hairs into the beard to make a beard look fuller. It can involve either using beard hairs as a source (usually from under the chin where the beard is not as cosmetically important) or using scalp hairs transplanted into the beard.
The second scenario when someone refers to a beard transplant involves using beard hairs (again taken from usually under the chin area) to be transplanted to other areas besides the beard like in the scalp, etc.
Who needs a Beard Transplant?
For a candidate who simply wants a fuller beard in appearance, then the procedure would need to be defined as how much beard fullness he would want, for example, a full “lumberjack” beard or simply a “low strap” beard where the hairs just extend above the jawline a short distance.
Another reason someone may want a beard transplant is that he has lost hair due to scarring or trauma and wants beard hairs placed into a zone that is deficient or devoid of hairs.
A person would use beard hairs as a source to transplant, for example, the scalp when the donor supply of the scalp has been depleted from multiple prior transplants and the beard is used as a salvage source.
Also, for a candidate, age shouldn’t be a big concern for a bread-to-beard transplant since beard hairs are resistant to the effects of DHT.
Image Context: This 40-year-old gentleman is shown before and after a beard-to-beard FUE hair transplant to fix a patch of hair loss caused by an inappropriate chin implant performed elsewhere. He also had beard hairs placed to thicken his beard and mustache. A beard transplant using beard hairs is a very sophisticated and technically challenging procedure that spares shaving the scalp as well as risk of donor depletion from the scalp. It also allows matching exact proper hair caliber and curl, as beard hairs are a perfect match for beard hair loss, also leaving behind minimal risk of changes of skin color even in darker skin types unlike scalp FUE harvesting.
What is the Procedure for a Beard Transplant?
If beard hairs are used as the source for transplantation, then the only safe way to harvest beard hairs is through follicular unit excision (FUE), which involves harvesting hairs through punch excision rather than a strip procedure. If hairs are transplanted into the beard, then hairs can be harvested from the scalp via either a strip procedure, formerly known as FUT (follicular unit transplant), or today more correctly referred to as linear strip excision (LSE), or via FUE.
Preoperative Evaluation
If beard hairs are to be used as donor hairs, it is important to try to determine if the beard hairs have a proper match to their site of destination. For example, if the beard hairs are curly, dark, and reddish and the scalp hairs where the hairs are intended to be transplanted are fine, straight, and blonde, the result will not look correct. If there is some mismatch between the donor and the recipient areas, then the result still may look natural if the beard hairs are only used as a filler between other transplanted hairs. Another concern would be to determine if there are sufficient beard hairs to be used as a donor to transplant into other areas where the intended recipient sites will be.
If a fuller beard is desired, then other considerations are involved. If beard hairs are to be used, the color and caliber match will be perfect since a beard-to-beard transplant offers unparalleled match in donor-to-recipient areas since they are one and the same. The greatest limitation is whether there are sufficient donor hairs from the beard to be used to be transplanted into the beard. If scalp hairs are to be used to fill in the beard, then the aforementioned match of donor-to-recipient hairs must be determined to be close enough to result in a natural-looking transplant. In addition, a patient’s scalp hair must be deemed safe and effective for transplantation. For example, if someone is undergoing male pattern baldness, taking hairs from the scalp has two major problems if not more: 1) removing hairs from the scalp is not scar-less, meaning that it will leave punctate white dots if the patient decides to shave his head 2) taking precious scalp hairs away that may be needed for scalp transplantation may be unwise.
Harvesting Follicles
In general, you’ll have to shave the donor area before harvesting follicles but not the recipient area. If beard hairs are harvested, the only way to perform the procedure is via FUE where hairs are taken using a rotary punch device, whether manual or mechanized, but always handheld. Mechanized machines rotate by themselves to facilitate ease of tissue entry but still must be guided through the skin by the skilled hand of a surgeon. Many surgeons do not offer beard harvesting due to the increased technical difficulty in the beard as opposed to the scalp since beard hairs change directions almost constantly throughout the entire beard region making harvesting more challenging to perform.
FUE vs FUT
If beard hairs are harvested, only the FUE method is acceptable. If scalp hairs are harvested to be transplanted into the beard, then FUE or FUT are acceptable. As mentioned, linear strip excision (LSE) is a more semantically accurate way of describing the procedure. The decision between performing either FUE or FUT/LSE from the scalp is based on surgeon preference, experience, and judgment and lies beyond the scope of this overview.
How many procedures will I need?
Any type of hair transplant involves planting grafts that must have a blood supply to grow, so there is no guarantee for 100% growth after a session no matter which surgeon you choose. The number of grafts required can vary from a few hundred to 2,000 plus for grafts needed to complete the task at hand. Also, limitations of donor hair may reduce the extent of a result in terms of density. A qualified surgeon will discuss with you the limitations and perhaps the projected number of sessions needed to accomplish your aesthetic goals.
Implantation
After hairs have been harvested via either FUE or FUT/LSE, or a combination of both methods, the surgeon usually makes recipient sites, which are the holes into which the grafts will ultimately be placed later that day. These are known as pre-made sites. Some surgeons favor a simultaneous graft implantation and site creation using so-called sharp implanters. This is known as stick-and-place. There are two major methods for graft implantation: traditional forceps placement and implanters. There are pros and cons to each of the methods and it is best to discuss with your surgeon which method he or she prefers and why that method would be applicable for you.
From Lam SM. Hair Transplant 101. St. Louis: Quality Medical Publishing, 2023
Rest and Recovery
Typically, most hair transplant procedures do not involve much pain, bruising, swelling, or downtime. However, every patient is different and recoveries differ between different practicing surgeons as well. The surgeon will instruct you when you can shave the donor area and when you can shave the recipient area and those instructions will vary among surgeons. Whether bandages, ointments, or other treatments are necessary again depends on surgeon preferences. There are typically scabs that are present from the areas harvested on the scalp and beard where hairs were taken. There will also be visible scabs in the recipient area, where the hairs were transplanted. You should have a conversation with your surgeon to discuss when your surgeon believes it would be ideal to start rubbing away (never picking) existing scabs without compromising the transplanted grafts.
But the good news is that once you have fully recovered after the transplant these beard hairs will be permanent and can last a lifetime.
What is the Cost of Beard Transplant?
The costs for beard transplant are extensively variable and are dependent on many factors including but not limited to the surgeon who is performing the procedure, the number of grafts to be transplanted, the type of procedure performed (FUE vs. FUT/LSE, where the hairs are harvested, or combination procedures of both FUE and FUT/LSE), and many other factors.
What are the Side Effects of Beard Transplants?
Beard transplants that involve hairs transplanted to the beard area risk grafts that have poor growth, abnormal exit angles, or abnormal “hairline”, that is the border is too straight or inappropriately designed.
There can also be poor judgment of matching scalp hair to beard hair either when scalp hair is transplanted into the beard or vice versa. Rarely, infection, ingrown cysts, or other temporary issues may occur and typically resolve over time with or without intervention. Donor-site problems may also be an issue such as overharvesting of the scalp or scarring, which, as mentioned, are less of an issue if the beard is used as the donor source. Most of these issues involve technical problems and that is why choosing an experienced beard hair transplant surgeon is important.
How to find the Right Physician?
A consultation with a qualified hair surgeon is very important to determine the experience level and comfort you may have with that particular individual who will be taking care of you.
You should ask if that surgeon will be performing the surgery or whether he or she will delegate the procedure to unlicensed individuals who do not have the experience or qualifications to perform the procedure.
Being a member in good standing with the International Society of Hair Restoration Surgery (ISHRS) may be an indicator that a physician commits to ethical guidelines and has attended an ongoing curriculum of education to better oneself in his or her career. Although not absolute, being a diplomate of the American Board of Hair Restoration Surgery (ABHRS) is also an indicator that the surgeon has completed and passed rigorous oral and written exams and has years of experience in the field of hair surgery.
Ultimately, the patient must make a decision based on comfort with a surgeon’s personality, qualifications, before and after results, and experience level.
For a consultation with a hair restoration surgeon, access our Find A Doctor tool where you can search for an ISHRS member by location.
Alternatives
In order to grow more hair in the beard region, the only medication that can help improve beard fullness is minoxidil, marketed by the brand name Rogaine. A 5% formulation can be used or a higher concentration can be tried as well. The problem with minoxidil is that the results are unpredictable, usually not as favorable as a transplant, and must be maintained, or the result with dissipate and ultimately recede back to baseline. Oral minoxidil can also be used for beard hair growth.
Expert Opinion
Beard hairs are an excellent, robust source of hairs for transplantation since they usually have high survival and fast growth. Their coarseness can provide good visual density but the fact that they usually only grow in single hairs total density may still be less than ideal if the goal is to use them for scalp transplantation. One distinct advantage of beard hairs is that the donor area rarely reveals noticeable scarring or hypopigmentation (loss of skin color) even in darker-skinned individuals, which is unlike the scalp area that can show hypopigmentation in all races.
A beard-to-beard transplant offers an unparalleled match in caliber, etc., since the donor and destination are one and the same. However, the major limitation of a beard-to-beard transplant is the limited donor supply of beard hairs that many men may have in the donor area, that is, under the chin. Scalp to beard transplants suffer from depleting scalp hairs and from other limitations stated above including ensuring that the caliber and color match the beard area well.
Expert opinion provided by Dr. Samuel Lam.