Is a hair transplant permanent? Can transplanted hair fall out?

The short answer: transplanted hair usually stays, but your own hair may fall out

Transplanted hair usually keeps growing in its new place for years; however, a hair transplant does not stop your hair loss. That is why the answer to “Is it permanent?” has two parts: the transplanted hair and your own hair in the areas that were not transplanted need to be considered separately.

A hair transplant does not create new hair follicles; it moves existing follicles from an area that is more resistant to hair loss to the thinning area. The tendency of your own hair around and behind the recipient area to fall out does not change.

That is why your appearance may change over the years. How much it changes differs from person to person and depends largely on how your hair loss progresses from here on.

Why is transplanted hair more resistant to hair loss?

In male pattern hair loss (androgenetic alopecia), hair follicles with an inherited sensitivity gradually shrink under the effect of DHT, a hormone derived from testosterone, and produce finer and finer hairs. This sensitivity is seen most at the front, in the mid-scalp and at the crown. At the back of the head and on the sides, above and behind the ears, the follicles are less sensitive to this effect in most people.

Hair transplantation is based on this observation: follicles taken from these areas usually remain less sensitive to hair loss even after they are moved to a thinning area. This is called donor dominance (the characteristics of the area the hair came from remain dominant). We explain the details in our article on the donor area and donor dominance.

Not every part of the donor area is equally resistant, and its boundaries are not in the same place for everyone; in female pattern hair loss, the thinning sometimes extends to the back and sides of the head as well. Follicles taken from a part that is prone to hair loss may also thin over time in their new place. That is why we make a point of taking the grafts from the part expected to be least affected by hair loss; we assess where this part is in your case during the examination.

Can transplanted hair fall out again?

In some cases, yes. Donor dominance describes a tendency; transplanted hair can also fall out or thin. The main reasons are:

Shedding in the first few weeks is an expected part of the process. During the same period, some of your own hair in the surrounding area may also fall out temporarily, while some of the hair that had already thinned may not grow back. We explain this in our article on shock loss.

What happens to your own hair that was not transplanted?

When your appearance changes over the years, the main reason is often not the transplanted hair but your own hair that was not transplanted. A hair transplant does not prevent this hair from falling out. Male pattern hair loss often progresses over years, at a rate that varies from person to person; in female pattern hair loss, too, the thinning can continue. We explain how hair loss progresses in our article on male pattern hair loss.

If the hair loss progresses, the following may happen:

• The transplanted hair at the front stays in place while your own hair behind it thins, leaving a sparse strip between the recipient area and the crown.
• The crown, where no transplant was done, thins out over time.
• Your own hair between the transplanted hairs becomes sparser, and the area looks less full than in the first years after the procedure.

We cannot know for certain in advance how fast and how far your hair loss will progress. Your age, your family history and the examination findings give us an idea; at a young age, it is even harder to predict.

How do we take the future into account when we plan?

We base the hair transplant plan not only on how you look today but also on how your hair loss may progress in the future. During the examination, we look at the following together:

• The pattern of your hair loss, what stage it has reached today and how fast it has progressed in recent years
• Your age and the history of hair loss in your family
• The hair density in your donor area and whether there are signs of thinning there
• How much your own hair around the recipient area has already thinned

We take care to design the hairline at a height and in a shape that can still suit your face as you get older. The number of follicles in the donor area is limited, and a follicle that has been taken is not replaced by a new one. That is why, especially at a young age, we take care to keep a reserve in the donor area for needs that may arise in the future.

Some medicines used for male and female pattern hair loss may help slow the thinning of your own hair. These medicines have possible side effects and situations in which they should not be used, and the effect they achieve is gradually lost once the medicine is stopped. Whether they are suitable for you can only be determined by your doctor’s assessment. Do not decide on your own to start a medicine or to stop one you are taking; make these decisions together with your doctor. As for supporting treatments such as PRP (plasma prepared from a person’s own blood), the evidence on their long-term effect on hair loss is limited.

What should you do if you notice thinning over the years?

Because it takes months for new hair to grow, it is too early to judge the result in the first months. Even after the result has become clear, we review the overall condition of your hair at follow-up appointments; we plan the timing of these appointments with you.

If you notice thinning around the recipient area or in another area over the years, contact us. We discuss the options together during the examination: medical treatment may be an option, based on your doctor’s assessment, or a new transplant if your donor area allows it. We explain when a new transplant is suitable in our article on whether a second session is needed. You can find out how thinning that appears behind the transplanted area, or the appearance of an earlier transplant, is addressed on our revision hair transplant page.

If you notice any of the following, see a doctor or a dermatologist:

• Hair loss that starts suddenly, is heavy or spreads over the whole head
• Round bald patches with clear edges
• Itching, redness, scaling, burning or pain on the scalp
• Other symptoms that come with the hair loss, such as tiredness or changes in weight

These signs may point to a different type of hair loss. A diagnosis can only be made through an examination by a doctor; we do not diagnose online. Whether you are suitable for a hair transplant is determined during the examination, and results vary from person to person.