What is the difference between FUE and FUT?
At The Hairfront we only offer FUE because we believe this method is better for our patients. FUT surgery stands for Follicular Unit Transplant and was the first method of hair transplant surgery to yield natural results as each follicular unit was transplanted one by one into the recipient balding areas. Some doctors still practice this method. The main difference between the two is the method of obtaining the donor hairs: In FUT, a strip of scalp is removed from the back of your head. Patients are left with a linear scar, a tighter head and a painful healing time of at least 4-6 weeks. FUT is easier for doctors to perform as the entire strip can be dissected under a microscope by assistants and this entails minimal time. FUE, or Follicular Unit Extraction differs in the fact that each follicular unit of hair is removed one by one directly from the head (not a dissected strip). The process is much more time consuming and requires much skill from the doctor. Although more time consuming for the doctor, FUE is definitely great for you as the patient as you will have no linear scar and minimal pain and down time.
Am I a suitable candidate for a hair transplant?
Hair transplant surgery uses your own hair that we transplant to balding areas. The hair that we take is from the donor area, which is usually from the back of your head. Your quality and quantity of donor hair will determine whether you are a good candidate for the surgery as well as your age and the progression of your hair loss thus far. Dr Lohlun and her team will be able to give you a consultation in person to discuss your options.
What is the difference between a graft and a hair and how does this influence the cost
Some hair surgeons will charge per graft and others will charge per hair. This is something that all patients need be aware of. A graft or follicular unit can contain anywhere between 1 and 4 hairs. The international standard is to charge per graft and not per hair. If you are being quoted per hair, be aware that the price should be much lower than if you are quoted per graft.
When will I see results?
The transplant procedure takes 12-14 months to yield full results, so be patient! Hair goes through different growth cycles. Approximately 2-6 weeks after the transplant, the transplanted hair shafts will fall out which is completely normal. However, the root will remain. 4 months post surgery these roots will start growing. You will see the first changes after around 6 months and the final result by 1 year.
What about follow up appointments?
No follow up is generally required, however, we would like you to come in the next day for us to redo the dressings and wash your donor area for you. If you require any advice or would like to see the doctor in person for a follow up, you are more than welcome to book an appointment at no extra cost. We also encourage all patients to come in for a free assessment after 12 months for feedback and “after photos”.
How many grafts will I need and what will my hair transplant cost?
The accurate number of required grafts can only be assessed in person. The hair transplant is charged per graft and depends entirely on each individual. We can give you a good estimate if you submit your photos under the "Book a consultation" tab. An online consult as well as an in person consult with Dr Lohlun is R500 and the cost of this will be deducted off any treatments you purchase. Please see pricing tab for more information on pricing.
How will I hide my hair transplant in public?
You may want to wear a loose fitting hat after the procedure for a few days when in public. Avoid tight fitting hats especially within the first 72 hours as the new grafts will not yet have permanently implanted. Covering the transplant is not really necessary, as there will be no evidence after approximately 7-10 days. In the first 7-10 days small scabs will form, avoid picking these off, they will fall off by themselves. After this period, there will be no evidence of the transplant. However, it is recommended to cover the head for the first few weeks when there is sun exposure.
What about scarring?
The benefit of FUE is that there is no big linear surgical scar like in FUT. The results are natural and people won't know that you have had surgery. In a very small population group the donor area may scar and there will be white dots where the hairs were removed. These are hardly visible, especially when the hair has grown to a “number 1 or 2” cut.
When will I be completely healed?
After 7-10 days the scabs of the transplant will fall off and there will be no visible remains of the procedure. The donor area may be sensitive for up to 8 weeks. Numbness and tingling is normal and this generally disappears within a few weeks.
Will I need more hair transplants in the future?
The short answer is “it depends”. However, the need for future transplants is not as a result of a “failed” transplant. Transplanted hair is permanent and will not fall out (in the absence of serious medical conditions). The reason for this, is that the hair is taken from an area of the scalp that is insensitive to the effects of hormones. However, the hair surrounding the transplanted hair may still fall out. The reasons for this usually include continuing balding that would have happened anyway, stress or a medical problem causing hair loss. Continuing balding can be prevented by medication, but this is not without risk and side-effects. As a general rule, if you are under 25 and rapidly balding, your hair loss will probably continue and further treatments would likely be required. If you are over 40 and have a bald patch that has not grown in years, chances are that one transplant will be sufficient. We will assess you during the consultation and advise accordingly.
Before my Hair Transplant
What do I need to do in preparation for my hair transplant?
Everything will be explained to you on booking. Certain medications may need to be adjusted and we also recommend stopping smoking and alcohol. We do not recommend you drive after the procedure due to the sedation drugs, so you may need to organise someone to pick you up or we can also organise transport for you. You may eat a light meal before your surgery, unless you have specifically requested a conscious sedation. Line up some entertainment at home as it is not recommended that you go out the night of your surgery.
What medications do I need to stop or adjust?
You should stop all blood thinning medications such as warfarin, clavix, ecotrin etc at least 1 week before surgery. However, you need to discuss this with your surgeon first, to ensure that it is in fact safe to stop the medication or if you require different interim treatment. Beta blockers (Propanolol etc) may need to be adjusted before your surgery as this may interfere with your sedation. Vitamin B and E supplements should also be stopped a week before as well as NSAIDS (non steroidal anti inflammatories) such as aspirin, brufen etc.
What if I am a smoker?
You should stop smoking for as long as possible before and after the procedure. Smoking nicotine causes constriction of blood vessels and decreases oxygen carrying capacity especially to the scalp and can significantly affect healing of your newly transplanted hairs. This can also increase your chances of scarring and infection. The effects of nicotine can take time to leave your system and we recommend abstaining from smoking at least 1 week before your operation although longer is better.
What about alcohol?
Try to avoid alcohol for at least 3 days before your procedure. Having alcohol in your system may affect how you react to the sedation drugs.
Do I need to book time off work?
By day 2, most people are back to their normal routine as pain is minimal and healing rapid. The main concern for most patients is discretion. For the transplant to be completely undetectable, it is advised to take about a week off in order for the scabs to fall off completely and you will look like you just shaved your head. If discretion is not a concern, then you will be able to do most activities the next day!
Day of Operation
Special instructions before I come in?
The morning of your procedure, you may eat a light breakfast but avoid caffeine. Have a shower and wash your hair with your usual shampoo, do not use conditioner and do not place any products in your hair. Please wear comfortable clothing and a shirt that does not need to be pulled over your head. Look in the mirror and say goodbye to the old you!
What steps are involved before the transplant?
When you arrive, we will explain the procedure to you again and double check your medical history. Any further questions you may have will be addressed and consent will be taken. We will then map out your new hairline and make sure you and the doctor are both satisfied. You will be given oral medication to calm any nerves and for sedation which will take about 20 minutes to start working. "Before pictures" will then be taken for reference and then your head will be shaved and washed. We will numb your head with local anaesthetic so you won't feel any pain. Your job is then to sleep or relax while we give you your hair back! Every step will be explained and you will be encouraged to ask questions as much as you would like.
Do I get sedated?
Yes, we will give you oral sedation and you will sleep for most of the procedure.
Where will they take donor hair from?
We will usually take donor hair from the hormone immune area on the back of your head or from the sides of the head (the horseshoe). These hairs are insensitive to the effects of androgen and are thus unlikely to ever fall out. If you do not have enough donor hair we can also take hair from your beard or chest, but this will have to be assessed on an individual basis.
Will it be painful?
Patients report of the discomfort ranges from zero pain to minimal discomfort. The procedure is much less painful than getting a tattoo. Bear in mind that the area will be completely anesthetized and you will be given oral sedation. Full sedation with an anaesthetist present can also be arranged if you are extremely anxious or sensitive. This option can be discussed on consultation.
How long will the procedure take?
An average procedure will take up to 8 hours. This depends on the number of grafts and we can give you more accurate information on consultation. Time will go fast for you though as you will sleep through most of it.
After my hair transplant
What happens directly after my surgery?
After surgery, your head will be bandaged and we will help you get dressed. If you have a partner or friend staying with you for the evening, they may come in for the post op consult. You will be given a small pack with medications, shampoo and printed instructions which we will explain in detail. All print outs will also be emailed to you on booking the procedure for easy reference. Your head will be numb and therfore you must be very careful not to bump it for eg. when getting in and out of the car.
What happens when I get home?
When you arrive home, you are likely to be sleepy and/or hungry. We advise you to have a light meal and rest. You may shower but avoid wetting your head directly under the stream. You can go about your regular activities, but no exercising or going outside where there could be pollution and sunlight. Please don't touch your head as this could introduce infection. If you have any concerns, we are just a phone call away and please do not hesitate to contact the doctor.
What medications will I be given?
Unless you are allergic, you will be given three types of medications. Medication for pain, medication for swelling and inflammation and antibiotics. You are unlikely to need any pain killers for most of the first evening because your head will still be numb for some hours.
How should I sleep on the first night?
You can sleep on your side or back with your head raised at a slight angle. If possible, avoid pressure over the new hairs in the transplanted area. Lying on the donor area is no problem.
What about washing my hair?
You will be given full detailed instructions with your post op pack. You do not wet or wash your hair on the day/evening of your procedure. If you can, you are encouraged to come in the next day so we can do the first wash and show you what to do for future washes. We will also remove your old bandages and give you clean ones. You should not wash your hair for day 2 and 3 and only start the washing procedure on Day 4 for the next 10 days.
What about bleeding?
There is usually little or no bleeding after the procedure. The scalp is very vascular though and sometimes you may have an area that bleeds. The best is to apply some pressure by putting a piece of gauze over the bleeding area and then holding it in place with the head band we give you. If you have any persistent bleeding, please contact Dr. Lohlun for further advice.
When can I exercise?
You can resume light exercise after 1 week such as walking and stretch classes. We recommend resuming intense weight lifting or heavy cardio only after 1 month.
When can I go outside?
You can go outside the next day, provided your head is covered with some form of sun protection, such as a hat. This should be worn for at least the first month if you are out in the sun for prolonged periods of time.
Sauna sessions, steam room and swimming?
Sauna and steam room sessions should be avoided for at least 3 months as the intense heat may impede the growth of your new hair. Swimming in pools or the ocean should be avoided for at least 2 weeks.
How much pain will I be in?
As stated before, the pain during and after the procedure is minimal. You will be given pain killers and anti inflammatories if necessary. The donor area may be sensitive for a period of approximately 8 weeks.
When can I have sex?
While there are no precise studies available for guidance, the general recommendation is to wait for 7-10 days after the procedure.
When can I get a haircut?
Although the grafts are stable after around 72 hours, it is recommended to wait at least 3 weeks for a haircut using a scissors. Electric shavers over the newly transplanted hairs should not be used for the first 6 months. You may shave the rest of your head and donar area after one week.
When can I dye my hair?
There is no precise studies or evidence regarding this question but due to harsh chemicals and risk of allergies or burns, we recommend to stay away from dyeing your hair for at least 1 year.
What is PRP?
PRP also known as Protein Rich Plasma therapy is a relatively new area of medicine. Your own blood is drawn and then spun down in a centrifuge to concentrate the healing proteins and growth factors into a serum, the serum is then injected back into areas of your scalp with the purpose of accelerating healing and improving hair growth. PRP therapy has many uses ranging from dental surgery to orthopaedic medicine and now recently hair restoration.
What drugs are available for hair loss?
This topic is a minefield, as there are countless websites dedicated to selling products that assist in hair growth. Some of these have no medical basis and their evidence is anecdotal at best. The only 2 products that have proven benefits are Propecia (Finasteride) and Minoxidil. The Hairfront neither recommends or discourages the use of these drugs. They both have proven to be effective in reducing hair loss and Propecia can even lead to increase hair growth. However, they are not without side-effects. We are happy to discuss all your concerns in person and come up with a decision together.
What are the benefits and risks?
This is a very abbreviated summary. Benefits of Propecia include reduced hair loss, even increased growth in some patients. Side-effects include reduced libido, reduced semen quality and erectile disturbances (although these are reported to be low) Benefits of Minoxidol include reduced hair loss and side-effects include allergic reactions, temporary hair loss and unwanted hair growth in other areas.
When can I take these drugs?
Propecia is an oral drug, requiring a doctor's script. Once you understand the risks and benefits, we can give you a script for this drug. You will need to take it life long, as the benefits are reversed within approximately a year after stopping the drug. Minoxidil is usually administered topically, Rogaine being the most popular product. This is available online without a script. As mentioned previously, if you are interested in these medications, we will give you detailed information during the consultation, so that you can make an informed decision.