Is One Hair Transplant Surgery Enough?

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When men and women are losing their hair they tend to gravitate toward the more common points of interest regarding prevention and restoration. They usually will investigate natural remedies first but when they realize that these are largely useless, they will visit their family doctor to find out more about their condition and how to deal with it. This usually leads to two differing directions. The first is toward medical therapy, and possibly a referral to a dermatologist. The second may be a referral to a surgical specialist.

Once a man or woman wishing for hair restoration begins their search for surgical information they’ll be inundated with hundreds of before and after images depicting the skill and expertise of countless clinics vying for their attention. It is a fairly standard presentation with little variation. A clinic will show a photo of a patient and their previous state of hair loss, followed by an image showing their current state after surgical hair transplant surgery.

Websites featuring such images are also filled with information about the clinic, the staff, the doctor (or doctors) and usually a blog section. You’ll also be informed of the wonderful amenities you might experience if you choose that clinic and you’ll learn about the stellar reputation of the clinic in general. This will influence people to the point of engagement and the consultation process begins.

It starts with Education

When patients have a hair transplant consultation they will meet with either the physician in charge of the clinic or with a sales consultant. Either way, a standard presentation will usually be given that is designed to provide a basic level of education about the clinic and the procedure or procedures  they have as options. Usually, after consideration, the patient will decide to have a procedure and the date is set. Then surgery is performed and the patient goes home to recover and wait for the eventual result. But once the final result manifests, will it be the end of that patient’s journey with hair transplant surgery? The answer is often “no”.

What you Need to Know

One of the facts about hair restoration surgery is that one surgery is often not the only surgery that a patient will have in their lifetime. However, just as often this may not be discussed with  patients during their consultation. There are several reasons why a hair transplant patient may want more than one procedure.

Continued Hair Loss

The number one reason why a future surgery may be necessary is the risk of continued hair loss from AGA (androgenetic alopecia) and this  should be a consideration discussed with every affected patient. Hair restoration surgery does not stop the patient’s native hair from continuing to be susceptible to the causes of hair loss. This is why non-surgical treatments should be considered first or in conjunction with surgery, in an effort to stabilize one’s pattern of hair loss. If this is not achieved then the great result achieved from even the best hair transplant surgery may require surgery in the future to maintain its optimal aesthetic appearance.

Poor Growth

All clinics have a few cases of poor growth as it is simply unavoidable, even by clinics that have been performing the procedure for a number of years. This is not necessarily due to bad technique but rather the law of averages will present a patient where the grafts placed just do not grow as well as the clinic expected. In cases like this, a review of the possible causes of poor growth is necessary as this may be due to an unexpected or unrecognized dermatologic or medical condition which must be dealt with before pursuing another procedure.  If the scalp or medical condition is treated, or a precise cause is not identified and the scalp appears healthy, a second procedure will usually be offered in order to achieve the expected coverage and/or density.


The clinic has a responsibility to the patient with regard to education and setting appropriate expectations but this isn’t always how the consultation turns out. For example, hair restoration surgeons rarely strive or can achieve the same level of density that nature once provided—because the more hair loss there is, the less permanent donor hair there is to redistribute to areas of lost hair. The latter fact means even if you were willing to pay for the same level of density—there is insufficient hair in the donor area to accomplish this. 

The good news is, it is not necessary to achieve the same level of density in order to achieve excellent cosmetic results.  Nevertheless, clinics should strive to insure complete patient awareness of the procedure and educate you on the limits for density based on the available donor hair and your pattern of hair loss when considering how to achieve a particular outcome. If this is not done accurately it predisposes the patient to be disappointed and finding themselves returning to their clinic, or another clinic, to seek out how to achieve the original result they hoped for.

Unrealistic Expectations

Just like the clinic, the patient has a responsibility to be realistic as well. Patients shouldn’t necessarily expect the ideal result they may see on the best hair transplant advertisements. Every clinic will post their best results and while certainly achievable in many situations, factors involving pattern of hairloss (area of coverage),  hair characteristics, such as color or curl, or hair caliber, as well as budget considerations for graft numbers etc may mean you won’t see the same result in every patient. Each patient is unique and presents a different set of variables. This should also be remembered even if the clinic you choose isn’t being entirely clear or thorough about what to expect, so educate your self and keep your own expectations reasonable or else you’ll be chasing your ideal result until your donor hair is depleted.

Hair transplant surgery can be a fantastic and very rewarding experience, and has been for thousands of people around the world. However, as with any treatment, there are trade-offs and considerations to keep in mind, and one of those is  there are many variables that determine whether one surgery will be enough.  Especially in younger patients your doctor can’t know if your pattern will be stable, and may actually recommend fewer grafts than the maximum possible in order to preserve your donor hair in case medication does not hold your pattern stable.  In general, with the risk of progressive hair loss you should never expect one surgery to  be enough to keep you covered for a lifetime. If you do, then that need for a second surgery may come as an unwelcome surprise!

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