Jul 24 / Skillmed Institute

How to Overcome the Challenges of Hair Restoration Surgery

Hair loss is a common condition affecting more than 80 million men and women in the United States. Luckily, with the advancement of medical technologies, hair restoration surgery can provide a permanent and effective solution to help patients regain their natural hair and build their confidence. While hair restoration physicians can help patients reclaim control over their appearance, the procedures come with their own unique benefits and challenges that doctors should be aware of. 

Common Hair Restoration Procedures and Their Benefits

The two main types of hair restoration surgery are follicular unit extraction (FUE) and FUT (Follicular Unit Transplantation). Both procedures involve a delicate process to ensure the best possible outcome for the patient.

FUE is a minimally invasive procedure that involves individually harvesting and transplanting hair follicles from the donor area to the recipient site. FUT involves removing a strip of skin from the donor area and then dividing it into individual follicular units, which are then transplanted to the recipient site.

Both procedures can be used to successfully restore hair and provide clients with a natural-looking full head of hair, with permanent results and minimal scarring.

Lack of Donor Hair

One challenge hair restoration surgeons face is limited donor hair availability. Hair loss is often progressive, so patients may not have enough healthy and viable donor hair to achieve their desired outcome. Genetic factors, such as loss patterns, density, and texture, and medical conditions, like alopecia, can cause this. A lack of viable donor hair can also be an issue for patients with prior hair transplant surgeries, who may not have enough remaining healthy donor hair left to create a successful restoration result.

To best mitigate this issue, surgeons should be aware of the patient’s donor hair availability before making recommendations. This will ensure that the patient has realistic expectations and will be able to achieve their desired outcome.

Hair Survival

Another challenge of hair restoration surgery is the survival and growth rate of the transplanted hair follicles. The success of a hair transplant procedure depends on how well the transplanted hairs take to their new environment and whether they will continue to grow as expected. Unfortunately, there is no guarantee that all transplanted hairs will survive in their new environment; however, physicians can take steps to ensure the highest rate of survival possible.

Studies have shown that hairs can survive well in chilled solutions for up to 8 hours before exhibiting any signs of decreased survival. With this knowledge, surgeons can increase the survival rate of grafts after harvesting to achieve successful results.

Scar Concealment

Scar concealment is another important factor to consider in hair restoration surgery. FUT can cause linear scarring, while FUE can result in pinpoint scarring. The goal of restoring hair with minimal visible evidence of surgery is paramount.

In most cases, hair restoration incision sites are small and barely noticeable. However, poor surgical decisions, such as taking too much tissue, or a patient's skin characteristics may result in visible scars that may be difficult to conceal.

Additionally, keloid scarring is a rare complication of hair transplantation and is usually associated with strip harvesting. In these occurrences, the skin heals with a visibly raised scar that is apparent and disfiguring if the hair in the donor area is not long enough or thick enough to conceal it.

Surgeons can minimize these risks through proper technique and thorough post-operative care instructions to patients. By assessing scalp laxity and limiting the width of the excision, doctors can help avoid excessive tension upon closure. Additionally, some surgeons employ platelet-rich plasma or extracellular matrix material to aid in the healing process.


Hair restoration surgery can be an effective solution for many patients, but there are various challenges associated with the procedure. Doctors should consider factors such as donor hair availability, hair survival, and incision site healing to ensure successful results for their patients.

With this in mind, it is important to find a hair restoration training center that can provide the most comprehensive and up-to-date education on how to best perform hair restoration procedures and mitigate potential risks.


1. Cleveland Clinic medical. “Hair Loss: Causes, Treatments and Prevention Options.” Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/21753-hair-loss. Accessed 22 Aug. 2023.

2. Rose, Paul T. “Hair Restoration Surgery: Challenges and Solutions.” Clinical, Cosmetic and Investigational Dermatology, U.S. National Library of Medicine, 15 July 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507484/