Who should not have a hair transplant? When it may not be suitable

When is a hair transplant not recommended?

We do not perform a hair transplant unless two basic requirements are met: there must be enough healthy hair in the donor area (the back and sides of the head, where we take the grafts from; grafts are the natural groups of hairs removed for transplanting), and the skin in the thinning area must be able to nourish the transplanted grafts. Even when these requirements are met, we may postpone the transplant or suggest a different approach if the cause of the hair loss is not yet clear, if a serious health problem is not under control, or if there is a large gap between your expectations and the result that is possible.

This is because a hair transplant does not create new hair follicles. It moves follicles from an area that is more resistant to hair loss to the thinning area, so both the source they come from and the skin they are placed in need to be suitable. For some of the situations below, the answer is not a definite “no” but “not for now.”

If there is not enough donor hair

The hair we can use in a transplant is limited to the hair in the donor area; a follicle taken from there is not replaced by a new one. If the donor area is not enough to cover the thinning area at a reasonable density, the transplant may not make the difference you expect. Taking more than the area can spare, on the other hand, can make the donor area itself look sparse.

The donor area may fall short especially in the following situations:

• Diffuse thinning: If the thinning does not follow a particular pattern and spreads across the whole scalp, including the back and sides, the hair in the donor area may not be a reliable source; in this case, a transplant is usually not recommended. We explain how this picture is assessed in women on the hair transplant for women page.
• A large bald area together with a sparse donor area: It may not be possible to cover the whole bald area densely; we may discuss a more limited plan that puts the grafts into the areas that matter most for your appearance, or a transplant may not be suitable.
• Previous procedures: If many grafts were taken from the donor area in earlier transplants, the amount that can be taken again may be smaller.

If the cause of the hair loss is not clear, or the scalp is not ready

Hair transplants are mostly used for permanently thinned areas in hair loss linked to inherited predisposition and hormones (androgenetic alopecia). Not all hair loss is of this kind; in some cases a transplant is unnecessary, and in others it is not suitable for now:

• Telogen effluvium: Widespread shedding that can start a few months after severe stress, an illness with fever, giving birth or nutritional problems. Because the hair follicles stay in place, the hair often grows back on its own; we recommend postponing a transplant until the shedding settles down.
• Alopecia areata: A transplant is not suitable while this condition, in which the immune system targets the hair follicles, is active, and even in a quiet phase it is often not the right option. Transplanted hair can also be affected, while hair that has fallen out may grow back on its own or with treatment. We explain the details in our article on alopecia areata.
• Scarring hair loss (cicatricial alopecia): We do not plan a transplant while these conditions, in which inflammation permanently damages the hair follicles, are active; transplanted hair can also be affected by the same process. If the condition has stayed inactive for a long time, we can discuss a transplant with input from your dermatologist; even so, it may become active again later.
• A treatable cause: If a condition such as a thyroid problem or iron deficiency comes with the hair loss, it needs to be corrected first; the hair may recover after that.
• An ongoing cause: In thinning caused by wearing the hair pulled back tightly for a long time (traction alopecia), transplanted hair can also be affected if the habit continues. If there is an urge to pull out your own hair (trichotillomania), this first needs to be addressed with a doctor.

If your hair is falling out in patches or heavily within a short time, or if the hair loss comes with itching, redness, scaling or pain, see a dermatologist first. We do not diagnose from photos; if we suspect such a condition during the examination, we put the transplant plan on hold.

Is the skin in the thinning area ready for a transplant?

Transplanted grafts are nourished by the blood supply of the skin they are placed in. If there is inflammation, infection or a flare-up of a skin condition on the scalp, we recommend treating it first. A transplant can also be done into tissue with a weaker blood supply, such as a scar; because hair growth there is less predictable, however, we discuss the plan and what to expect separately.

If a serious health problem is not under control

A hair transplant is a surgical procedure performed under local anesthesia. Your general health needs to allow for the procedure and the healing that follows. The following situations may mean the procedure has to be postponed or needs an additional assessment:

• Uncontrolled diabetes or high blood pressure
• Uncontrolled heart, kidney or liver disease
• Bleeding or clotting disorders
• An illness with fever or an ongoing infection
• Ongoing treatment that suppresses the immune system, such as cancer treatment
• Pregnancy and breastfeeding

Once your health has stabilized, we reconsider the transplant; in some serious conditions, however, a transplant may not be suitable. A chronic condition that is under control is not, in itself, an obstacle. Be sure to tell us during the examination about the medicines you take, especially blood thinners, any known allergies and any wounds that have left raised scars (keloids) in the past. If necessary, we ask for the opinion of the doctor who treats you. Do not stop any medicine on your own. For details, see our article on chronic conditions and hair transplants.

If there is a large gap between your expectations and what is possible

Because the hair in the donor area is limited, getting back your former hair density with a transplant is often not realistic. A transplant also does not stop hair loss from progressing; your own hair around the recipient area may continue to thin over time.

Some examples of expectations that do not fit into a plan: wanting a very low hairline at a young age, when it is not yet clear how far the hair loss will go, or expecting a large area to be covered densely in a single session. We explain how age affects the plan in our article on age and hair transplants.

If the gap is large, we tell you so clearly before the procedure. Sometimes it may be better to monitor things for a while, or to try medical treatments aimed at slowing hair loss first; whether these treatments are suitable for you can only be determined by your doctor’s assessment. If worry about your hair is noticeably affecting your daily life, we talk about that too; sometimes it may be better to get support from a mental health professional before a transplant.

How do we decide during the examination?

The decision on suitability does not rest on a single criterion; during the examination, we look at the course of your hair loss, the density and thickness of the hair in your donor area, your scalp, your general health, your medicines and your expectations together. If necessary, we ask for a blood test or a dermatologist’s opinion.

During the initial call, we answer your questions; whether you are suitable for a hair transplant is determined during the examination. Results also vary from person to person.