What to know about hair transplants for Black men

Lena Weib

Balding is a common issue, and hair transplants can restore a person’s hairline and boost confidence. People with wavy, curly, and kinky hair can experience certain complications, such as ingrown hair and keloid scars, so it is important to find a clinician specializing in textured hair.

Although hair transplantation is a similar process regardless of an individual’s ethnicity, a person’s hair type can affect how the transplant works. Curly and kinky strands can curl both above and beneath the skin, which can make hair grafts take up more space.

A surgeon who specializes in this hair type will know how and where to place incisions.

Read more to learn about how hair transplants work, the different types, and more.

This is a before and after picture of follicular unit extraction, a hair transplant procedure that involves transferring individual follicles from one area of the body to another.

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Umar S, Lohlun B, Ogozuglu T, Carter MJ. A Novel Follicular Unit Excision Device for All-Purpose Hair Graft Harvesting. Clin Cosmet Investig Dermatol. 2021;14:1657-1674. Published 2021 Nov 16. doi:10.2147/CCID.S333353

The procedure itself is similar regardless of hair type. However, the transplant clinic should have experience and understanding of the specific characteristics of the hair.

Kinky and curly hair can curl above and beneath the skin, meaning that hair grafts take up more space. According to Dr. Ingrid Wilson, a trichologist — a hair and scalp specialist — this means “the donor area around the hair groupings needs to be wider to ensure that the coiled hair is removed in one piece.”

Curly hair also presents challenges during grafting due to the ease of transection. A transection is when the surgeon accidentally cuts the hair bulb at the base of the hair follicle. Damage to the hair follicles means the new hairs cannot grow properly, and the transplant is more likely to be unsuccessful.

Robotic hair transplants (ARTAS) are becoming increasingly popular, but they may not be the best choice for people with curly hair. ARTAS has Food and Drug Administration (FDA) approval for use on brown or black straight hair. People with lighter hair or hair that is not straight are not suitable candidates for ARTAS.

People also need to consider how the skin will heal. Dr. Wilson says that because the hair follicles are curly, “the scar takes a longer time to heal, so there is an increased chance of the scar becoming hypertrophic — thickened and raised.”

People with darker skin are more likely to develop keloids, which are large, thick scars that may be lumpy or ridged. “It is important to consider whether the patient has a risk of keloid scarring as surgery would trigger this form of scarring,” says Dr. Wilson. A surgeon familiar with this may be able to take measures to minimize scarring.

According to Dr. Wilson, finding a qualified specialist is crucial for people with textured hair. “Most doctors only have a few hours of training on hair loss,” she says. “There are scarring and non-scarring forms of hair loss, and hair transplants can actually accelerate some forms of hair loss. If you have textured hair, I would recommend that you make sure that your surgeon is familiar with the additional needs of hair transplants in textured hair.”

The two main methods of hair transplant are Follicular Unit Transplant (FUT) and Follicular Unit Excision (FUE).

In FUE, the surgeon does not remove a strip of skin. Instead, they remove individual follicles directly from the scalp. “In most people, the scarring is barely visible, so it is a good option for short or closely shaved hair,” says Dr. Wilson.

For FUT, the surgeon removes a strip of donor skin from the back of the head. They then extract individual hair follicles to transfer to the hair loss area.

“This form of surgery costs less and is quicker to perform, but the disadvantage is that a linear scar is left, and there is discomfort from the healing process,” says Dr. Wilson. “This is better suited for longer and thicker hair from the donor area where the scar is less likely to show.”

The individual and surgeon will discuss the most suitable type of transplant.

Follicular unit transplantation (FUT)

During FUT, the surgeon removes a strip from the back of the head with a scalpel. They close the open wound with stitches.

The surgical team then separates the scalp strip into smaller pieces, called grafts. They make tiny holes in the balding area and insert the grafts. Finally, they bandage or cover the surgical site.

Follicular unit extraction (FUE)

During FUE, the surgical team shaves the back of the head and then extracts individual hair follicles. Next, the surgeon inserts the grafts into small wounds in the balding area. They then bandage the surgical site.

Learn more about different types of hair transplants.

A hair transplant usually takes 4–8 hours. If a person has a large amount of hair transplanted, they may need to return for further sessions. Most people need several treatments a few months apart to achieve their desired fullness.

Before the procedure, a healthcare professional will administer local anesthesia to numb the scalp. Some individuals also use a mild sedative to help them relax throughout the procedure, but generally, people are awake during surgery.

The hair transplant begins with the surgeon removing healthy hair grafts either from a strip of the scalp during FUT or individual grafts for FUE. Surgical technicians will then prepare the grafts while the surgeon readies the scalp for the transplant. Two or three surgical team members may help place the hair grafts into the balding area.

When the team has transplanted all the grafts, they bandage the person’s scalp and provide instructions for at-home care. The individual can return home on the day of the procedure, but they will probably feel pain or discomfort for several days.

Within 6 weeks, the transplanted hair will fall out. This is routine and usually temporary. After several more weeks, the new hair will grow back.

People should not expect immediate results from a hair transplant — most people experience benefits in 6–9 months following surgery.

A hair transplant is typically safe provided a qualified board certified dermatologist or plastic surgeon performs the procedure.

All surgeries, including hair transplants, carry the risk of infection. Additionally, excessive bleeding and scarring are possibilities.

There is also the risk that some of the grafts are unsuccessful and do not establish regrowth in the new location.

According to Dr. Wilson, people with certain hair loss conditions should avoid hair transplant surgery. “There are some more commonly seen in people with textured hair,” she says. “One example of this is central centrifugal cicatricial alopecia (CCCA), which may affect one in 20 women of African descent. Because it presents as thinning at the crown, it can sometimes be misdiagnosed as female pattern hair loss, but a hair transplant should not be done when the disease is active.”

If an individual does not want hair transplant surgery, there are other options to treat hair loss. The first step in the process should be contacting a doctor to determine the cause of the hair loss.

The dermatologist may ask questions, examine the scalp, and test the health of the hair. They may also take a blood test or scalp biopsy if they suspect that disease, vitamin deficiency, hormone imbalance, or infection caused the hair loss.

Once they understand the cause, they can recommend a suitable treatment.

Sometimes, hair loss is temporary. Hair may regrow on its own if a person has:

If the hair does not regrow, treatment options include:

  • Minoxidil (Rogaine): This medication can stimulate hair growth and prevent further hair loss. However, it takes around 3–6 months to give results.
  • Laser treatment: Laser hair combs may help hair regrow.
  • Microneedling: These devices contain hundreds of tiny needles that may stimulate hair growth when applied to the scalp.
  • Platelet Rich Plasma (PRP): This may be a stand-alone treatment or with microneedling or exosomes.

Hair loss is common, and hair transplant procedures provide a solution for thinning or balding hair. Men with curly or kinky hair may want to contact a doctor specializing in their hair texture, as they will be familiar with transplanting their hair type.

During a transplant, a surgeon implants tiny hair grafts from a donor area to the treatment area during the procedure. However, the individual may need to wait 6–9 months for noticeable results, and they may require more than one hair transplant surgery.

Black men should ensure that the surgeon they use for a hair transplant procedure understands the special characteristics of their hair and is board certified.

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