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Things that can make a hair transplant difficult

Imagine that you’ve booked in for a hair transplant and surgery day has finally arrived! 
You’re excited. You’ve been planning for months, (in some cases maybe a year or more) and you’re prepared. You’ve spent your time researching and know what’s involved. Your expectations are in check, your aftercare plan is ready, and you’re confident in both your decision and surgeon. 
You arrive at the clinic ready for what you know will be a long day…
And that’s where the surprise hits you.  
I mean, you were prepared for a long day of surgery… but this long?
Panic might start to set in as the day drags out and your confidence wavers. 
Is something going wrong? Should you be worried? 
In my experience, patients coming in for a hair transplant surgery (even the highly prepared ones) are often surprised at just how long it can take, even for smaller procedures.


Know how long a hair transplant takes? Patients are often surprised how long a hair transplant takes, even for relatively small areas.
The truth is that there are many different factors that can (and do) contribute to just how difficult your surgery ends up being and it absolutely affects the surgery length. When you want to get the best result possible, you want your surgeon to take their time. 
 If you’re someone considering a hair transplant in the near future, read on for the most common factors that increase the difficulty (and length) of your transplant.
1. Scars

Scars in the transplant area (from previous hair transplants or trauma) increase the difficulty of harvesting and transplanting. 
Previous scarring can definitely increase the difficulty level of a hair transplant surgery. Though FUT is best known for leaving a scar, it’s a myth that FUE will leave none, though they do tend to be less noticeable and more discreet. 
Either way, if there’s scar tissue present, your surgeon needs to work around it. 
Scarring in the transplant area can make hair placement more difficult, as the change in scalp or skin texture can alter the angle of the hair, and this goes for both donor and recipient areas. 
A note about microneedling: Interestingly people who microneedle regularly (once a week) often have a firmness to their scalp. It’s not a big deal in the donor area but – like scarring – it can increase the difficulty for implanting the hair. 
2. Changes in direction

Changes in the direction of hairs (like this whorl) can also increase the difficulty level of your hair transplant and contribute to making your surgery day longer.
Achieving a natural result means respecting the natural direction of hair. Having a whorl (cowlick) at the crown (like in the image above) is pretty typical – most people have one. However, you can have multiple whorls all over the scalp, even at the hairline. Those can be very tricky to replicate but, if they’re not matched with the donor hair, the results just won’t look natural when the hair grows in. Circular patterns, abrupt directional changes – people are unique, and some hair patterns just take more time. 
 3. Density disparity  

When I’m transplanting to a bare area, I’m the one who is deciding how and what kind of density to build. However, if the recipient area is already populated with a lot of hair, then my job becomes one of camouflage and equalization, otherwise the end result won’t be natural. Some cases can be more challenging than others – do I try to double the density in one area, or triple it in another? Are there areas that will look good with more density? Do I avoid regions entirely so I can build up others? All of those decisions take time and you don’t want your surgeon to rush things.

Matching natural variations in density takes time – you don’t want your surgeon rushing things, the end result could suffer. 
4. Bleeding
Avoiding coffee, green tea, alcohol, Motrin, and spicy foods all help minimize the amount of bleeding on the day of surgery – but some people just have thin blood. 
Recipient area, donor area – it doesn’t matter where it is, more bleeding slows a surgery down because I can’t see what I’m doing as easily. If I’m faced with more bleeding during a hair transplant, we have a few tricks – vitamin K, epinephrine, saline solution – but they need to be used safely and in a way that doesn’t put a patient at risk of lidocaine toxicity. All that? It takes time. 

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  5. Popping 
No, we don’t mean the viral TikTok ‘hair popping’ videos, where people pull their scalps until they ‘pop’. Popping during a hair transplant is where implanting a new hair causes the surrounding, freshly implanted hairs to ‘pop out’. It can be a particular problem when your goal is high density. Some patients (and areas of the scalp) are more prone to popping, and you bet it slows a surgery down. Those popped-up hairs need to be replaced. One graft in, two grafts out… You get the picture. 
6. Graft quality
Unfortunately, not all hair grafts are created equal. With the best medical therapy, hairs can still be slippery, covered in a slime like mucus that causes problems (popping) and we can’t really predict. We can (and do!) wash the hairs, but the slippery mucus increases the chance of popping and the time it takes to perform a transplant. 
7. Using non-scalp hair 

Sometimes harvesting hair from the scalp isn’t an option… and that can increase the difficulty (and time) of your transplant. 
Normally we harvest hair for a transplant from the scalp, but sometimes that’s just not possible. Either there’s been depletion from prior surgeries, or the patient really doesn’t want hair removed from their scalp. In those instances, surgeons will take hair from elsewhere on the body. Usually the beard or chest, but some surgeons do use leg hair as well. Anything not standard to hair transplant surgery will add time onto the procedure as well. 
8. Local anesthesia resistance
There is always a subset of patients who metabolize lidocaine differently, and again it’s not something we can always predict. They don’t go numb right away and it typically takes more lidocaine to make sure they’re comfortable during surgery. Scar tissue can complicate the numbing process – it tends to be resistant. 


9. Movement of the patient 
Yes, fidgeting can prolong your surgery. When you move your legs, it means your head shifts and your surgeon may need to pause. Bathroom breaks and stretching your legs frequently can also prolong a surgery. We want to get things done properly and efficiently and have you be comfortable, but if you need to move a lot? It’s going to take longer. 
What does all this mean for your hair transplant? 
This list isn’t exhausted, but hopefully it gives you an idea of the factors that can make your surgery that much longer. At the end of the day many of them are outside of your control, but when you’re deciding on a clinic, it’s important to ask how your surgeon handles these challenges. What’s their plan? How do they adapt when things aren’t ideal? 
Remember, you can’t always predict a complication, but you should always be confident in your surgeon’s plan. 

If you’re experiencing hair loss and want to explore the option of a hair transplant, consider a consultation with City Facial Plastics. You can visit our gallery here.
Written by
Kristi Charish
Edited by
Dr. Gary Linkov
The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.
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