Beyond the Hair Plug: The Evolution of Natural-Looking Hair Transplants (2024)

We all know what fake hair looks like. A rug, a mop, a piece, a plug. These all describe attempts at hair restoration or covering that don’t pass the sniff test. While wigs and toupees have come a long way in their realism (thank you, human hair wigs), hair plugs, or hair transplants, are often thought of as an obvious, unnatural looking sign of hair-restoration treatment. The good news, though, is that doesn’t have to be the case anymore.

New Jersey facial plastic surgeon Jeffery B Wise, MD explains that the process of hair restoration and hair-loss treatment has vastly improved over the years, leading to natural-looking and reliable results.

The Journey from Hair Plugs to Follicular Unit Extraction (FUE)

“Hair transplantation has come a long way in the last several decades,” Dr. Wise says. “Gone are the days where people got macro transplants. This is when they would take multiple hairs at one time and line them up like a doll’s hair on someone’s head and give them a very artificial appearance.”

The term hair plug comes from this outdated practice.

“It didn’t look good,” Dr. Wise says. “And it gave hair transplantation a bad name because they were considered very pluggy.”

The method that surgeons use today involves getting to a much more micro level. “Today, we do something called Follicular Unit Extraction,” Dr. Wise explains. “We take single follicular units at a time.”

Those follicular units in our scalps look like dozens of little holes all over the head, from which a few hairs sprout naturally. A unit typically has a two to three hairs growing from these microscopic holes, which is why our natural hair doesn’t look like clumps of plugs.

“We take those exact units out and then transfer them to the top of the head, creating a very natural look,” Dr. Wise says. “So, if follicular unit extraction performed correctly, it should be very challenging to recognize someone who has had it done.”

Unveiling the Science Behind Natural-Looking Hair Restoration

If you want a hair transplant to look natural, you need to carefully punch those hairs into the scalp. The smaller entry you’re able to make into the scalp to do that, the more realistic it looks.

“The old device, which is still in use in many facilities, that accomplishes hair transplants punches are as big as 1 millimeter, 1.2 millimeters and up to 1.4 millimeters,” Dr. Wise explains. “Over time, the punch size has gotten significantly smaller. The device we use has a current punch size of 0.5 or 0.6 millimeters, which is almost the diameter of a needle. This allows for no scarring on the back of the head. You’ll be able to wear your hair short and no one will ever know.”

Additionally, hair transplants are now frequently combined with other treatments like platelet-rich plasma (PRP) therapy to enhance results. “It’s also used as a holding solution for the grafts themselves to give them nourishment while they’re outside the body, which has been fantastic for us,” Dr. Wise says.

Risks and Realities: The Pitfalls of Overseas Transplants

Like many cosmetic procedures, it can be cheaper to attain this procedure outside of the United States. That, though, comes with a lot of risks.

“There’s been a trend in recent years that a lot of hair transplantation patients, in an effort to save money, go on what we call medical tourism,” Dr. Wise explains. “This is when patients go out of the country to get a hair transplant. Frequently, things turn out fine, but I do think it’s important to be aware that there are risks.”

“When you go to another country you don’t know who’s doing it,” Dr. Wise points out. “You don’t know how it’s being done, you don’t know the standard as far as sterile technique and there’s even a risk for potential infections and diseases.”

We do know what it takes to safely operate in the United States and patients should use that knowledge to choose a reliable and trusted surgeon. You may also encounter less-than-stellar results if you choose to pursue a hair transplant overseas.

“One thing I have seen when people go out of the country to receive a hair transplant is they have something called over-harvesting,” Dr. Wise says. “Over-harvesting essentially means that instead of taking a few thousand grafts or an allowable number of grafts, so people don’t see anything in the back, they take so many grafts that they basically denude or devitalize the back of the head. And that means patients have significant thinning or balding problems in the back of the head where they take the grafts. So, it’s very important to understand the nuance of this procedure and the risks involved and to weigh the risks and benefits of traveling elsewhere to get potential cost savings.”

Navigating Recovery: What to Expect After an FUE Procedure

“Today’s hair transplant technology, especially in our hands, allows for fairly minimal downtime,” Dr. Wise explains. “People are fine to do any sort of work within 24 hours. However, if you’re looking to keep the hair transplant completely private before going back to work, you can wear a hat within 2 to 3 days.”

Hair placed via follicular unit extraction hair transplants will look normal within a few days, according to Dr. Wise.

“There is some very mild crusting on the top of the head or the recipient site where the hair is placed, but it is usually short-lived,” he says. “Most patients look relatively normal within 10 days and no one would even be able to tell they got anything done.”

Patients may also be interested in combining this procedure with other hair-restoration techniques to preserve the rest of their natural hair.

“When a hair transplant is performed, those transplanted hairs essentially never fall out and should last the course of a lifetime,” Dr. Wise explains. “With that said, it doesn’t preserve the patient’s natural hair and we have to do something to preserve it.”

Beyond Transplants: Complementary Treatments for Optimal Results

In conjunction with FUE transplants, patients may explore adjunctive therapies to maintain overall hair health. Dr. Wise recommends a comprehensive regimen comprising oral minoxidil, DHT blockers and nutritional supplements to complement the longevity of transplanted hair.

Moreover, low-light therapy devices offer added solutions for stimulating hair growth and preventing further loss. These noninvasive modalities augment the efficacy of FUE transplants, fostering a holistic approach to hair restoration. “We recommend two devices here at our practice,” says Dr. Wise says. “One is the LaserCap and one is the iGrow system and what we like about these products is that they’re FDA-approved and used for medical use.”

In essence, the evolution of hair transplantation heralds a new era of natural-looking results and enhanced patient satisfaction. By embracing advanced techniques and prioritizing safety, individuals can embark on their journey to restored confidence and a fuller head of hair.