Do you need a second hair transplant session?

When is one session enough, and when is it not?

Not everyone needs a second hair transplant session. If the thinning area is limited and your donor area (the back and sides of the head, from which the hair follicles are taken) can cover it, one session is often enough. Some people, however, may need more than one session to cover a large area or to reach the density they want. If hair loss progresses over the years, a new need may also arise long after the first transplant.

If it looks as though the grafts you need (groups of one or more hairs, taken and transplanted together with their roots) cannot all be transplanted in one session, we tell you this when we first plan your transplant, and we build the plan in stages. Whether an additional session is really needed, however, is something we decide after an examination, once we have seen the result of the first transplant.

When does a second session come up?

In everyday language, a “second session” can mean several different things. The table below gives a general overview; which one applies to you becomes clear during the examination.

We explain what a corrective transplant covers, and its limits, on the revision hair transplant page.

Spreading a plan that needs many grafts over two consecutive days, on the other hand, does not count as a second session: there is no waiting for a result in between, and for the donor area, the grafts taken over the two days amount to a single harvest.

Why can’t everything be done in one session?

Several factors limit how many grafts can be transplanted at once:

• The donor area’s limit in one session: With the FUE method (in which the grafts are taken one by one), we spread the grafts we take across the whole donor area and leave enough hair in between. If more grafts are taken in one session than the area can spare, it can become noticeably sparse; this is hard to fix afterward.
• Blood supply to the recipient area: Opening the recipient channels (the small openings into which the grafts are placed) very close together can affect the area’s blood supply. That is why we decide how densely to transplant in one session based on the condition of the tissue; sometimes the density you want can only be approached in a second session.
• The length of the procedure: A graft is still living tissue while it is outside the body, and it should not be kept waiting longer than necessary. A very long procedure day is also tiring for you, and the amount of local anesthetic that can be used safely in one day is limited.
• The limit on the total number of grafts: The number of follicles (the roots that produce hair) in the donor area is limited, and a follicle that has been taken is not replaced by a new one. Splitting the work into sessions does not increase this number; it only lets us spread the grafts out over time and see the results as we go. Especially at a young age, when it is not yet clear how far the hair loss will go, using most of the donor area early may not leave enough grafts for areas that may thin later on.

We explain how the number of grafts is determined in our article on how many grafts are needed.

How long is the wait between two sessions?

There is no fixed waiting time that applies to everyone. We plan the second session after an examination, once the result of the first transplant has become clear and the donor area has recovered. We wait for two reasons:

• To see the result of the first transplant: It takes months for transplanted hair to grow; the first hairs to appear are usually fine and sparse, and it takes longer for them to thicken. Shock loss, which may occur in the weeks after the procedure, can also make the area look sparser for a while longer. During this period, it is too early to say which area really needs more grafts. We explain the process in our article on when transplanted hair grows.
• For the donor area to recover: Until we have seen how the points where grafts were taken have healed, and the condition of the hair left in the area, we cannot properly assess how large a second harvest could be. Because the area is sparser after the first harvest, the number of grafts that can be taken in a second session may be more limited.

Transplanting into the same area again before the transplanted hair has grown can waste grafts on an area that would have filled in over time; newly opened channels can also damage grafts that have not yet grown. Shock loss may occur after a new transplant into the same area, and hair transplanted earlier may also be affected. We follow your progress together at follow-up appointments.

Might another transplant be needed years later?

It might. Male pattern hair loss progresses over the years in most people, and in female pattern hair loss the thinning can also continue. A hair transplant does not stop this process. Like the donor area it was taken from, transplanted hair usually stays less sensitive to hair loss; however, your own hair behind and around the recipient area may continue to thin. Over time, a new gap may open up between the transplanted area and the thinning area.

Transplanted hair can also become thinner with age or in some types of hair loss. For these reasons, we do not base the first plan only on how you look today; we take care to keep a reserve in the donor area for grafts that may be needed in the future. We explain how the donor area is assessed from this point of view in our article on the donor area and donor dominance.

Medical treatments aimed at slowing the progression of hair loss can also affect whether a new transplant is needed in the future. These medicines have possible side effects and situations in which they should not be used; whether they are suitable for you can only be determined by your doctor’s assessment. Do not start taking any medicine on your own.

How do we assess a second session during the examination?

We decide together during the examination whether you need a second session and whether one is possible. To do this, we look at:

• The result of the first transplant: which areas have filled in and which have stayed sparse
• The hair left in your donor area and the condition of the area after the first harvest
• How your hair loss has progressed recently, and the hair around the recipient area
• Your expectations, and what your donor area can provide today and in the future

If you had your first transplant elsewhere, bring the date of the procedure, the method used, the procedure report and photos from that time to the examination, if you have them; this information makes planning easier.

Sometimes we do not recommend a second session. If the hair left in the donor area is limited, not thinning the area any further may be a better choice than another transplant. If the thinning is spread across the whole scalp without following a particular pattern, or suggests another scalp problem, the cause first needs to be assessed by a dermatologist. In such cases, we tell you clearly what is possible.

If you notice increasing pain, redness or swelling, discharge or a fever after a transplant, contact us without waiting for your follow-up appointment; in an emergency, or if you cannot reach us, go to the nearest healthcare facility.

Whether you are suitable for a hair transplant or a second session is determined during the examination; results also vary from person to person.