FAQ

Hair restoration questions

The principle in hair transplantation techniques is to redistribute hair from the donor area (an area extending from the back of the head through to above the ears) to the recipient area of the scalp where the hair is lost. Once moved, the transplanted hair behaves as if it were in its original location (i.e recipient dominance). This is possible because the donor hair is far less commonly effected by the male pattern baldness gene and therefore retains its genetic makeup regardless of location. After roughly three months the new hair begins to grow, often in spurts over the next 12+ months. A full result requires this length of time for the hair to mature and develop in its new environment.

Hair loss is a medical condition that affects some 25% of men in their twenties and an astounding two-thirds of men over sixty. Male-pattern baldness has no medical side effects other than hair loss. Due to this many consider it a purely cosmetic concern, however those who experience hair loss can suffer from very tangible psychological trauma.

Cures for male baldness have been around for thousands of years, from ancient Egyptian pigeon droppings to early-20th-century electroshock treatments for the scalp. Indeed, the search for that elusive cure has been ongoing, but it wasn’t until recently that we actually discovered what causes baldness. It turns out that male-pattern baldness is a result of a gene in the body that converts large quantities of testosterone into DHT (di-hydrotestosterone).

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Hair loss can be a very personal and private issue for many individuals. We have found that very few people discuss their feelings with close friends or family which can cause intense  levels of anxiety. Losing or thinning of hair is something that we generally associate with the older generations and therefore it can be extremely difficult for young men to accept, especially considering the modern day reliance on social media and its constant demand for photographs and selfies.

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Effective treatments for hair loss range from medicinal to surgical. FDA-approved medications such as minoxidil (commonly know by brand names such as  Rogaine/Regain) and finasteride (commonly know by brand name Propecia) can provide an effective treatment against hair loss. Minoxidil was typically a topical solution that helps follicular stabilisation and oftentimes regrowth but is only effective in approximately 60% of patients.

These types of medications are treatments and not solutions, meaning that any results achieved through medication will stop and actually reverse when discontinuing the medication

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Hair loss in the African-Caribbean community is a widespread concern for both men and women. Along with with male pattern baldness, traction alopecia is a common issue for females due to tight braiding and extensions amongst other factors.

 

Afro hair presents unique challenges and therefore requires specific expertise. 

The natural shape and design of the hairline can be vastly different than caucasian and asian patients.

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Gender reassignment surgery is also known as sexual reassignment surgery (SRS) and allows an individual to alter their existing physical appearance to acquire characteristics of the opposite sex. Thanks to facial feminisation, a man can modify his facial appearance to bring it closer in shape and size to typical female facial features.

This type of operation, that is carried out by BHR Clinic, is aimed at transgender candidates. Individuals whose gender, psyche and social identity related to the concepts of men and women are in conflicts with their biological sex.

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The Norwood Scale is a classification of MPB from remedial thinning to progressive hair loss. The scale makes it easier to understand the present grouping and determine the potential for future loss. The scale exists from stages 1 to 7, with 7 being the most aggressive form of hair loss.

A hair transplant is generally used to treat MPB & FPB, but not Alopecia Areata or Trichotillomania cases. Just because people retain hair around the sides and back of their head does not mean they are suitable for a transplant. Extensive research must be done to ensure that the person is aware of what can be achieved and the doctor is clear on realistic goals. After a thorough consultation process, transplants are often a compromise between doctor and patient.

The art of hair transplantation is the illusion of density. Logic tells us that you cannot replace all lost hair as your donor area does not have sufficient resources to provide such a hair count. However with the correct surgical approach and artistic application of the Doctor, hair can be transplanted at the most natural cosmetically beneficial angle, depth and direction to achieve the greatest illusion of density possible. The fact is that most men lose 40% of their hair before realising that they are thinning and therefore before beginning any type of medical intervention. Full restoration is a question of supply and demand and will ultimately depend on your extent if hair loss, and the strength and characteristics of your donor area.

Donor management is vital to the long-term happiness of the patient. We as patients have a finite amount of hair that is available to be extracted and transplanted, so it is essential to use it wisely. The patient must be aware of any and all limitations that are influenced by such factors as their age, future hair loss, future loss, hair characteristics, donor density  and desired goals. 

Some fortunate individuals have very optimal hair density and characteristics that can provide restorations to even the most extensive degrees of hair loss, whereby others are much more limited in terms of how much coverage can be achieved.

Hair characteristics play an influential role in the overall result of a transplant. Some patients have more favourable hair characteristics than others. 

For example - a patient with coarse, wavy hair, with more follicles containing 3 -4 hairs, will achieve more with less grafts than a patient with thinner, fine and straight hair, with lower haired follicular groupings.
It is important to remember this when viewing patient results with a similar loss pattern to yourself. Whilst it can be helpful to appreciate what can be achieved, each patient has their own hair characteristics. Therefore they may require a different graft count to achieve a similar result.
Each and every patient offers a unique situation, there is no direct comparison between one patient and another. 

Hair transplants are not just about technical ability but also a talent for artistic design. This is especially important when designing the hairline. A Doctor with a gift for design will create the most natural looking head of hair, virtually indecipherable from original hair. This will be the difference between a good transplant and a great one.



Male-pattern baldness does not generally affect the hair on the sides and back of your head (donor area). This allows the extraction of grafts from your donor area, to an area of thinning while maintaining its natural characteristics.

This depends on the procedure and the number of grafts placed. This will be decided on a case by case basis, but as a general rule FUE procedures can achieve 3000 grafts harvested in one surgical day. 

In comparison, FUT procedures of up to 5,000 grafts where appropriate and possible can be completed in one surgical day.

Hair transplants are considered minor surgical procedures performed with just a mild sedative under a local anaesthetic. Many say the administrative element is the most painful part of the procedure. Pain is quite personal to each individual and whilst some patients experience almost zero pain, others may report a little more discomfort. 

Strip procedures can be more uncomfortable - particularly -  post-op, with tightness around the suture, and this may last for a few days. Post-op is less dramatic with the FUE procedure than a FUT/Strip, although in general, a mild painkiller will relieve any discomfort.

There is no simple answer to this question. Each technique has its positives. That is why a consultation is vital in deciding which procedure is best suited for each individual's personal case, their goals and their long-term happiness

Unfortunately not. The genetic properties of the follicle must match those of the recipient patient, and while research on donor transfer has begun, it is still in its very early stag

The use of body hair FUE should only really be considered as a last resort for patients whose scalp donor area has reached its limit or has suffered so much trauma that there is limited hair available to harvest. Beard hair is the most common type of body hair used in restoration surgery and is an extremely reliable source of donor hair. Body hair can also be taken from the back, chest, arms and legs, but its important to understand that all types of body hair have their own characteristics that make them different from scalp hair, and the patient must be aware of this before considering to proceed with any transplantation using body hair. It is BHR policy to utilise the option of body hair in the most appropriate way to achieve the best results long term. The goal is not to rush into extensive body-hair procedures simply to be able to avoid larger graft counts.

This term is common in the industry and generally refers to either a FUE or FUT procedure of over 3,000 grafts placed in one session to give maximum density and coverage without the need for multiple procedures. As tools and techniques have evolved, larger graft counts have become more common-place, but often to an unethical extent that does not represent an educated and sustainable approach, especially when not performed to the high standards that such mega sessions require.

This is the art of placing follicular units close enough together to ensure a natural result/density in one pass. For example, the initial rows of the hairline design require a higher transplanted density. This is because single hairs must be used to achieve a natural and undetectable result and to frame the face ensuring the best aesthetic outcome. 

Placing density must be appropriately planned in relation to the follicular groupings (how many hairs in the follicle) of the patient. The goal isn’t to achieve the highest density possible. The goal is to reach the most appropriate density considering all surgical and donor factors to achieve the most refined and impressive result possible.

The number of follicular units placed (density reached) will be unique to each patient depending on hair characteristics, amount of loss, follicular groupings amongst many other considerations. The skill here is to place grafts close together without compromising the growth of each hair.

Transection is the damaging if existing follicles when they are punched in the donor area. 

An acceptable rate of transection is approximately 5 – 7%.

The growth rate is the percent of follicular units that grow after placement in the recipient area. Growth can be compromised if the grafts are not placed correctly, stored effectively or damaged during placement. An acceptable growth rate is approximately 94 – 98%.

Shockloss is a term that is used that explains the normally temporary loss of native hair due to surgery. It is something that can occur in both the recipient area if implanting within native hair, and the donor area around extraction sites.
Shockloss generally occurs when the native hair is in a weakened condition and isn't strong enough to resist the “trauma” of your procedure. In the majority of cases, the native hair will grow back in approximately 3/4 months time.
If some hair was in the latter stages of the miniaturisation process, it is possible that this hair will not grow back. 

This is more important for FUT procedures but is also plays a role in FUE. 

Skin is amazingly pliable, and a strip can be removed without dramatically compromising tissue or even cosmetic appearance. Scalp laxity plays an essential role in influencing what size strip can be safely excised, which will directly influence the amount of grafts that are available to be transplanted. A person with better laxity can expect potentially a larger surgery in terms of graft count and/or more transplants. Naturally, the more procedures that are performed on a patient results in a decline in scalp laxity. The more taut the scalp becomes, the more it can compromise the scar post surgery due to potential stretching.

All patients are completely unique in this aspect and this is dependent on the donor density of each individual. 

Average patients will normally be able to achieve between 3000 - 3500 grafts via FUE in their first procedure if appropriate. Additional procedures can be carried out at a later date to harvest further grafts if the patient loses more existing hair or desires more coverage. Careful donor management protocols allow for the maximum amount of grafts to be harvested safely without obvious signs of extraction. This is essential in all cases, especially individuals who have experienced more extensive loss and require higher graft counts.

Factors such as age, Norwood classification and future progression of hair loss will influence this answer. In many cases, a patient will very likely undergo more than one procedure, even if there are many years between each one performed.

Regardless of the technique or how well it is performed, if skin tissue has been cut or punched there will be scarring to some degree. With the FUT technique, closure methods have made linear scars nearly undetectable even with short hair. The FUE technique is much less invasive and scarring much less dramatic. Sometimes scarring is invisible to the naked eye even if the head is shaved with patients who have opted for FUE surgery.

The transplanted hair in the recipient area takes about one week to become secure within the skin tissue and cardiovascular system. Transplanted hair will shed in the first weeks post surgery, returning you to your pre surgery condition. It is common for 80% of the placed grafts to shed. The follicle then rests for three to four months before growth starts, but this is unique with each patient. In virgin scalps, on average between 40 - 60% of growth can be seen at six months with further growth, thickening and maturation in the subsequent months. It will take a year to see full maturity and real results.

There are very few health risks associated with hair transplant, but we still take all necessary medical precautions with surgical procedures. Risks are typically related to the healing process, and even post-op infection is very unlikely if you follow the instructions and take the medications provided.

Generally there are no medical conditions that would deter you from undergoing a hair transplant. Having said that, blood test results are requested before any procedure, and it is your responsibility to declare any conditions that you may have or any medications that you are taking.

Certain precautions can be taken before and after your operation to aid healing and encourage the best possible result. These mostly have to do with your cardiovascular system. We advise that you do not smoke or drink alcohol before and after the procedure (see the pre- and post-op instructions).

This can depend on the procedure. Recipient sites heal at the same speed for either procedure, but donor healing may vary. In the recipient area, there will be short shafts of hair surrounded by a small scab. You begin to wash your hair the day after the procedure. The scabs are washed away gradually, and the shafts of hair will shed. This typically takes 10-12 days until there is very little to see.

Donor healing FUE is generally quite quick as punch sites are hidden by your natural hair growth around the site. Even after seven days, it is hard to see any signs of the transplant one your donor whilst they continue to heal.

With the strip in the donor area, the suture can be hidden if your hair is kept long. The suture can be removed 10 days post-op, but the area will remain a little red for a month while the skin tissue relaxes.

Swelling can occur on the forehead, especially in extensive procedures that involve hairline restoration. This is normal and starts the day after the procedure and typically last three days. There is no danger to your health or the success of the procedure. A gentle massage and an ice pack will help to keep this to a minimum.

Post-op care helps stop the infection and speeds up the healing process. Products include anti-bacterial cleansers and shampoos, which are generally used for the first two weeks before returning to your regular regimen.



Although the procedure is classed as minor, it is still surgery, so a couple of days rest is advised. The cosmetic signs of your hair transplant will last for a couple of weeks, so depending on your lifestyle and/or job, you may wish to wait until there are no visible signs. Medically speaking, it is entirely feasible to return to work within a couple of days.

Physical activity is not advised for several weeks after the procedure. There are many reasons for this. The cardiovascular system should not be tested while the grafts are still embedding themselves into the recipient area.

Especially with FUT, any labour intensive activity should be avoided in the first two weeks as such activity could put pressure or create pulling on your scar which may cause it to stretch.

BHR Clinic believes in transparency and the highest level of patient care. We always endeavour to ensure that you feel like you are in safe and professional environment from the moment of first contact, until long after your procedure.

Pricing will be explained to you based on your own personal requirements and will be clearly detailed in your treatment plan.

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About BHR Clinic

BHR performs hair restoration surgery using advanced technology and Dr. Bisanga’s unique artistry and design.

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