One common misconception about a hair transplant is that it’s a one-and-done procedure. However, the need for additional procedures is very possible as time and hair loss progresses. A conscientious, ethical hair restoration surgeon – such as Dr. Marco Barusco – Founder and Chief Medical Officer at Tempus Hair Restoration – will discuss long-term as well as immediate plans for follow-up surgeries during the initial patient consultation.

“When I counsel my patients, I always discuss the possibility or the likelihood of more transplants in the future because hair loss is progressive,” says Dr. Barusco. “What you see today on your scalp is not going to be the same in 10, 20 or 30 years. It’s safe to assume that if you are experiencing hair loss and facing a transplant, you’re probably going to be needing more as you get older.”

Why You May Need a Second Hair Transplant

For a variety of reasons, patients often have more than one hair transplantation procedure over their lifetime. Hair loss is dynamic, and an individual’s trajectory continues to evolve over time based on numerous environmental factors, genetics, overall health and age. Age-related changes include decrease in hair density, pigmentation and mass.

However, the most common cause of hair loss is androgenetic alopecia (male and female pattern hair loss). This is an inherited, progressive condition. As the International Society of Hair Restoration Surgery (ISHRS) reports, it is also an unpredictably progressive condition. Early hair loss due to androgenetic alopecia can be an indication that hair loss will progress rapidly and will continue until most hair is lost. A hair restoration surgeon may recommend a program that conserves existing hair with a hair restoration drug approved by the FDA, such as minoxidil (brand name Rogaine) or finasteride (brand name Propecia – which is recommended for men only).

While a hair restoration surgeon assesses a patient’s donor area to determine the number of hair grafts available for the transplant procedure being planned, the surgeon should also be calculating how many can be harvested for a subsequent surgery. The donor area is the region at the back of the head where hair grafts are harvested for transplantation into areas experiencing hair loss. This area serves as the primary source of healthy hair follicles for the transplant procedure.

Predicting the progression of androgenetic alopecia is not easy. According to the ISHRS, “An experienced hair restoration doctor is able to anticipate future hair loss, and place transplanted hair into those areas to create a reserve against future hair loss. On the other hand, surgical hair restoration procedures may be required after the original procedure due to progressive and unpredictable hair loss. A potential problem over the years of treatment is the possibility that androgenetic alopecia will outpace efforts to restore hair, and at some point there might not be enough donor hair available for transplantation. The surgeon will be able to anticipate the patients’ need for subsequent procedures, and custom design the long-term treatment plan accordingly.

This is a critical issue that should be discussed by the patient with the physician hair restoration specialist in planning a comprehensive approach to long-term hair restoration.”

The Difference That a Skilled Hair Transplant Surgeon Makes

The key to planning hair restoration surgery to address future hair loss depends upon the surgeon’s skill, experience and eye for achieving the best aesthetic outcome in planning the initial surgery. This includes educating patients and ensuring they have realistic expectations of what can be achieved.

For example, men who start losing hair in their 20s may want a hair transplant – which is understandable, as hair loss has an aging effect. However, Dr. Barusco advises against hair transplant surgery for those under the age of 25. The reason is – as mentioned earlier – a hair transplant relies on using donor hair from the back of the head. If performed too early, the donor hair may be distributed too heavily in one area, leaving too little to be transplanted later, when needed on another area of the scalp as hair loss progresses.

Moreover, as our blog post – “When Should You Have a Hair Transplant Procedure?” – covers, the male hairline continues to form up to approximately age 29. Younger men may believe their hairline is receding, when in fact it’s evolving into what is known as a mature hairline. This occurs when the hairline moves back about a half inch to one inch from where it used to be. A mature hairline forms the “M” shape that distinguishes the male hairline from the female oval hairline shape.

For this and other reasons, Dr. Barusco advises his potential patients to wait until their hair loss has stabilized. Doing so not only allows him an accurate determination of the best procedure to perform to address current hair loss, but predict how the pattern will progress over time and plan accordingly for the second procedure.

One sign of a botched hair transplant is one in which the surgeon – or unlicensed technician who actually performed the procedure – created an aggressive, forward hairline and/or placed too many grafts to fill in bald or balding areas – thus overharvesting grafts from the donor area, not leaving enough for a future procedure. Our blog post – “Don’t Let a Technician Perform Your Hair Transplant Surgery” – covers this important topic in detail. We strongly recommend you take the time to read it.

Will Your Second Hair Transplant Procedure be the Same as Your First?

This depends upon the experience and skill of your surgeon. Each patient’s situation is unique, requiring the ability to accurately forecast the pattern of progressive hair loss and accessing the amount of grafts that will remain in the donor area. The main procedures are as follows.

Follicular Unit Excision (FUE) – In this procedure, follicular units (hair grafts) in groupings of one, two or three hairs are individually extracted from the back of the head (donor area) using small circular punch blades instead of a scalpel. The grafts are then transplanted to the thinning or balding areas of the scalp. Once the desired number of grafts are obtained, the donor sites are left to heal without suturing. The resulting scars are not readily visible and are easily concealed even by very short hair.

No-Shave FUE – Developed by Dr. Barusco, the no-shave FUE completely conceals harvested donor sites immediately, allowing you to resume your regular activities with virtually no evidence of the procedure.

Follicular Unit Transplantation (FUT) – Also known as the “strip” method, the FUT procedure has undergone refinements over the years so that the only evidence is a pencil-line linear scar easily concealed by hair – even at a shorter length. Although many hair transplant practices encourage patients toward the FUE, there are circumstances in which the FUT will produce the more successful outcome.

Combination FUE and FUT – This technique covers large areas of baldness in a single surgery. Patients with advanced hair loss are typically required to undergo multiple hair transplant procedures to obtain coverage of their entire bald scalp – having to wait one year or more between procedures. This allows patients to achieve their ultimate goal sooner, with one procedure versus many.

This decision should be based on a thorough consultation with a qualified surgeon. Each patient’s individual circumstances, preferences and long-term hair restoration goals must be carefully considered. Engaging in open and honest discussions with your surgeon is crucial to plan for the future. Understanding how many grafts you might need over time can help you decide whether FUT, FUE or a combination of both techniques aligns with your hair restoration journey while maximizing the potential of your donor area.

Plan Wisely for the Future by Choosing Your Surgeon Wisely

Being aware of the possibility that you will need more than one hair transplant procedure in your lifetime gives you all the more reason to make sure you choose your surgeon wisely. Ultimately, choose your surgeon based on experience, results and integrity. Dr. Barusco’s long list of accomplishments, his notable artistic ability and his successful surgical team make Tempus Hair Restoration a renowned practice.

We understand that the main concern you may have is cost, which is why we offer financing options that can place this goal within reach.

Contact us to schedule your free virtual consultation. Dr. Barusco conducts every consultation himself, giving you the opportunity to learn your options in the comfort of your home – or any location, on any internet-enabled device. 

Dr. Barusco conducts consultations in English, Spanish and Portuguese. For your greater convenience, Tempus Hair Restoration offers a two-night complimentary hotel stay to out-of-town clients who travel 100 miles or more to our Port Orange, Florida, surgical center. No matter how far the distance, we welcome the opportunity to help you on your hair restoration journey!


Author: Tempus Hair Restoration