How Does a Hair Transplant Work? A Step-by-Step Guide
A hair transplant works by moving hair follicles from a donor area, usually the back and sides of the scalp where hair resists pattern hair loss, into small incisions in thinning or bald areas, under local anaesthetic, usually in a single day; the moved follicles keep their resistance, shed their hairs in the first weeks, then start growing new hair from around month three.
| Step | What happens | Typical timing |
|---|---|---|
| 1. Assessment | Diagnosis of hair loss, donor check, plan and price | Weeks before surgery |
| 2. Preparation | Pre-op instructions, medication review, hairline design on the day | Day of surgery, morning |
| 3. Local anaesthetic | Donor and recipient areas numbed | 20–30 minutes |
| 4. Extraction | Grafts removed by FUE or a strip removed by FUT | 2–4 hours |
| 5. Recipient sites | Tiny incisions made at the right angle and density | 1–2 hours (or combined with implantation in DHI) |
| 6. Implantation | Grafts placed into the sites | 2–4 hours |
| 7. Aftercare | Dressings, instructions, first wash often next day | Same evening and next day |
| 8. Growth | Shedding, then new growth; final result | Months 3 to 18 |
At Hair Transplants London your plan, technique and graft count are set at a doctor-led assessment, with the total price in writing before you book.
What happens at the hair transplant assessment?
The assessment decides whether a transplant is right for you. A doctor asks about your hair loss history, family history, health, medication and goals, then examines the thinning areas and your donor area, often with a magnifying scope called a dermatoscope. They may suggest blood tests through your GP if a medical cause is possible.
You should leave knowing the likely cause of your hair loss, whether surgery is suitable now or later, the recommended technique, an estimated graft count, the risks and the total price. Assessments can begin by video for an initial view.
Estimate your own graft count and typical London price with our hair graft calculator.
How is the donor area chosen?
The donor area is the band of hair at the back and sides of the head that usually stays even in advanced pattern hair loss. Follicles there are generally resistant to DHT, the hormone that drives pattern hair loss. The surgeon harvests from this "safe zone" and spreads extraction evenly so the area does not look thin afterwards. In some cases, beard or body hair can supplement scalp hair.
How are grafts removed?
There are two main methods:
- FUE (follicular unit extraction). Individual follicular units of one to four hairs are removed one by one with a punch, usually under 1mm wide. The donor area is usually trimmed short. It leaves small dot scars.
- FUT (follicular unit transplantation). A thin strip of scalp is removed from the back of the head, the wound is closed, and the strip is divided into grafts under microscopes. It leaves a fine linear scar, usually hidden by hair.
Grafts are kept in a chilled holding solution until they are implanted, because keeping them moist and cool helps them survive. Our comparison of FUE vs FUT vs DHI covers the pros and cons of each.
How are grafts implanted?
In standard FUE and FUT, the surgeon first makes tiny incisions, called recipient sites, in the thinning area with fine blades or needles. The angle, direction and depth of each site set how the hair will grow, so this step largely determines how natural the result looks. Grafts are then placed into the sites with fine forceps.
In DHI, grafts are loaded into a pen-like implanter that creates the channel and places the graft in one movement. This gives precise control and can be done between existing hairs without shaving the recipient area.
How is the hairline designed?
On the morning of surgery, the surgeon draws the planned hairline with you. A good hairline suits your face, your age and how your hair is likely to change. It is usually slightly irregular, with single-hair grafts at the very front and denser multi-hair grafts behind, because natural hairlines are not straight lines. A mature hairline, set a little higher, tends to look better as you age than a low, juvenile one.
Does a hair transplant hurt?
The procedure is done under local anaesthetic, so most people feel pressure rather than pain during surgery. The injections sting briefly. Afterwards, the scalp is usually tender for a few days and swelling across the forehead is common, both managed with simple pain relief and sleeping semi-upright.
Next step
Find out what a transplant could do for you
Send us a few details and we will be in touch to arrange a hair assessment. There is no obligation to go ahead.
Request a hair assessmentHow long does a hair transplant take?
Most procedures take most of a day, roughly 6 to 9 hours including breaks, depending on the number of grafts and the technique. Very large sessions can be split over two consecutive days. You go home the same evening.
How many grafts are moved?
A typical session moves 1,500 to 3,500 grafts. A hairline often needs 1,500 to 2,500. Larger areas can need 4,000 or more, sometimes over two sessions. Our guide to how many grafts you need explains how surgeons estimate this by Norwood stage.
What happens after a hair transplant?
| Time | What happens |
|---|---|
| First night | Sleep semi-upright; dressing on the donor area |
| Day 1 | Many clinics do the first wash and a check |
| Days 1–5 | Swelling and tenderness, tiny crusts around grafts |
| Days 7–14 | Crusts fall away; most desk workers back at work |
| Weeks 2–8 | Transplanted hairs shed; follicles stay |
| Months 3–4 | New growth begins |
| Month 6 | Noticeable change for many |
| Months 12–18 | Most of the final result |
The shedding phase surprises many people, but it is expected. The follicle stays in place and grows a new hair a few months later. Our recovery timeline and our guide to shock loss explain each stage.
Why does transplanted hair keep growing?
Because of donor dominance: follicles keep the characteristics of the area they came from. Hair taken from the DHT-resistant donor zone continues to resist pattern hair loss after it is moved, so it usually grows for life. Your untransplanted hair may still thin, which is why surgeons plan for the long term.
Who performs each step?
In England, hair transplant surgery must take place in a clinic registered with the Care Quality Commission, and doctors must be registered with the General Medical Council. In many clinics, trained technicians assist with parts of the procedure under a surgeon's supervision, such as sorting grafts and placing them. Ask which steps the surgeon performs personally, especially the hairline design and recipient incisions. Our guide to choosing a hair transplant clinic lists the questions to ask.
How much does a hair transplant cost?
In London, typical per-graft prices run from about £3,500 for 500 grafts to £11,900 for 4,500 to 6,000 grafts, with fixed packages from around £3,199. See our hair transplant cost guide for a breakdown.
Start with an assessment
A doctor will examine your scalp and donor area, explain the technique that suits you and give you a written graft estimate and price. Request a hair assessment through our online form, in person or starting by video.
Frequently asked questions
How does a hair transplant work?
Is a hair transplant done under general anaesthetic?
How long does the procedure take?
When does transplanted hair start to grow?
Does a hair transplant create new hair?
Related guides
Next step
Find out what a transplant could do for you
Send us a few details and we will be in touch to arrange a hair assessment. There is no obligation to go ahead.
Request a hair assessment