A hair transplant can absolutely increase hair density. In fact, it was primarily designed to do so. Thinning hair is the most common reason for getting surgical hair restoration. However, the average person can lose up to 50% of their hair before it even becomes noticeably thin [1]. Can hair restoration surgery make up for all that shedding? Find out how much a permanent hair transplant can improve your hair density.
This article will tell you all you need to know about what a natural-looking hair transplant can do to improve your hair density. It explores the methods surgeons use to help your hair grow fuller and presents the risks and benefits of high-density hair transplants. You will also learn the difference between natural and cosmetic hair density and why your hair does not need to be just as full as it was pre-baldness for your surgical hair restoration to yield very good results. Finally, we will provide helpful tips on achieving the best possible hair density through careful hair transplant maintenance.
Key takeaways
In trichological terms, hair density is determined by the average number of hairs that a patient grows on a square centimetre of their scalp. However, many people use this term when talking about how full someone’s hair is. Densely packed hair generally looks thicker and healthier, while hair so thin you can see your scalp is often a sign of balding.
While some types of alopecia lead to temporary hair thinning (e.g. telogen effluvium), others will permanently reduce your hair density if left untreated (e.g. androgenetic alopecia). And sparse hair can lead to a variety of negative psychological and social outcomes (e.g. anxiety, depression, low self-confidence, social marginalisation, etc.).
A hair transplant is the best way to improve your scalp coverage permanently when nothing else works. However, hair restoration surgeons know that graft density is only one of the factors that determine your hair transplant success.
Many factors can affect how close together your hair grows. Some of these are genetic, while others may develop at some point in life. Here are the most important:
Humans tend to have significantly more hair than is needed to adequately cover their scalp. In fact, patients often lose over 50% of their hair mass before they notice the first signs of hair thinning [1][6]. That means you don’t need to reach your pre-alopecia hair density to have a well-covered scalp; you only need to achieve cosmetic hair density.
Cosmetic hair density is achieved when enough coverage is created to prevent having hair so thin you can see your scalp and to provide an illusion of fullness. A person with healthy hair typically has between 124 and 200 hairs/cm² of the scalp, but someone with visible alopecia can have over 50% fewer in the affected area [1][6][7]. Surgical experience shows that, on average, 35-40 hair grafts/cm² are sufficient to provide full coverage [1].
Since a hair follicle typically yields 2-3 hairs, 35-40 grafts would produce around 80 -100 hairs, which is more than half the average natural density. Moreover, in many cases, implanting 25-30 follicular units/cm², which normally yield around 60-75 hairs in total, can provide a high enough cosmetic density to create a significant improvement in patient appearance.
Our experienced surgeon, Dr Peter Barron, explains the difference between natural and cosmetic density in greater detail:
Achieving “natural hair density” is something that I never promise prospective patients, given that they often think this means the density they had when they were twenty years old, which is never possible with a transplant. Trying to reach “natural densities” often risks complications from trying to put too many hairs into too small an area where the scalp and blood vessels can’t withstand the trauma or oxygen demand from the grafts or skin, and the grafts will fail, or the scalp tissue will die.
Numerical density can also be different from visual density. As I’ve alluded to, reducing scalp disability all depends on the overlap of grafts. Crowns are very difficult to get a visual reduction in scalp visibility, sometimes even when using large numbers of grafts or a similar numerical density of incisions as somewhere else in the recipient area, due to the spiral pattern, which causes the hairs to overlap less than if they were going back to front/the same direction.
Again, the number of grafts per cm^2 is very different from the number of hairs per cm^2. You can do the exact same surgery in two different people, but if one has a higher number of hairs per follicle, they’ll have more hairs overall and likely a more dense result.
Hair restoration surgery is one of the most effective ways to permanently increase the hair density in a certain area of your scalp. Here is how this is accomplished:
Getting your hair surgically restored generally involves 2 major steps: harvesting healthy hair follicles from your safe hair transplant donor area and then implanting them into the thinning areas on your scalp.
Hair follicles can be harvested through 2 major methods: follicular unit transplantation (FUT) and follicular unit extraction (FUE). FUT involves surgically removing an entire strip of skin from the back of your head, then slicing it up into individual grafts. This will leave a fine scar on your donor area and can make hair transplant recovery longer and more difficult. FUE is performed by individually extracting each hair follicle using a special tool. While the process takes longer to complete, it leaves virtually no scarring and promotes faster healing. Here is how our experienced surgeon, Dr Ahmad Moussa, explains this difference between FUE and FUT:
There’s two ways we can do it. We can do strip surgery, which is a strip of skin that gets taken out and cut into individual follicles. Or, more commonly these days, men tend to go for FUE, where we take individual roots out.
The reason men tend to go for it is it allows them to wear the hair a lot shorter at the back without noticing too much of a change. The strip, although a very, very good procedure that has its place in certain situations, will leave a long, thin surgical scar. So men need to be a little bit more careful with how they cut their hair at the back and how they style it if they go for that. Ladies, for example, with long hair will always go for a strip.
Once your hair grafts have been harvested, the surgeon makes small punctures in the recipient area. A graft is carefully inserted into each slit, at the right depth, angle and distance from the surrounding hair. With each transplanted graft, the hair density in your recipient area becomes greater.
It takes about 7-10 days after your hair transplant for your grafts to become securely attached inside your scalp. Then, they undergo a dormant period, known as hair transplant shock loss, where the hair sheds and the follicles heal from the trauma of surgery. 3-4 months later, they start producing new hair and will continue to do so for the rest of your life.
There is no fixed proportion by which surgical hair restoration will improve a patient’s hair density. Nor does the quality of the outcome always correlate with density improvements. Here are some of the factors which affect the change in hair density you can expect to see after a surgical hair restoration:
Your donor area hair density should be completely safe if you choose an experienced surgeon who works for a reputable hair transplant clinic. Upon examining you, they will make an expert assessment of how many grafts can be safely harvested without compromising your donor area appearance. This varies with the extent of your hair loss, the size of your donor area, your hair texture and more.
However, inexperienced technicians who perform black market hair transplants will often harvest too many hair follicles, as they are only concerned with providing sufficient hair density in your transplant area. This is a known complication called hair transplant overharvesting, a practice that leaves your donor area looking sparse or patchy. Some patients need a body hair transplant to fix the damage caused by the first intervention.
Since hair transplants involve manually inserting more hair follicles in a scalp area where there are too few left, many patients expect to see an immediate increase in hair density. However, the hair transplant recovery timeline is lengthy and not always linear.
Patients first need to wait through their hair transplant shedding period, where they will see their newly implanted hair suddenly falling out. 3-4 months later, when it finally starts to grow back, it will initially be thin and sparse and will only grow fuller over time. In most people, it takes about 1 year after their hair transplant before they achieve peak hair density (it can even take as long as 18 months for some). Here is Dr Moussa’s realistic estimation of how you can expect your hair density to evolve after your surgery:
It’ll take two, three, sometimes four months for hair to start coming back. Initially, it might look a little bit sparse, might look a little bit spiky and wiry. And it’s just a waiting game at that point for it all to come through and for the hair to soften and settle and look more natural. I always say, being in the industry, we can spot a transplant fairly easily in the first year. But usually, after a year, it’s more difficult for us to tell. And patients are usually very happy. Some patients look amazing after just seven or eight months, and people can’t tell. But we tend to stay a little bit more on the safe side and say, aim for a year. Anything sooner than that is a bonus.
You can expect some gradual decrease in transplanted hair fullness over the years, as even native hair tends to thin out with age. One small 2020 study [8] also reveals some hair density reduction 4 years after surgical hair restoration, though more data is needed to confirm this.
However, most successful hair transplants last a lifetime. This means that while some degree of thinning may occur over time, they should still provide adequate coverage. Find out more about what results you can expect from your hair transplant after 10 years.
There are strict rules to follow regarding how densely surgeons should implant hair grafts. That is because while your native hair follows its biological growth patterns, grafts are manually implanted according to cosmetic criteria. And research has shown that when packed too tightly, their survival rate normally plummets [6]. That is because there may not be sufficient blood supply to nourish all of them. Moreover, the grafts need to be trimmed significantly to fit into a very tight space, which increases the risk of damaging them.
In the earlier days of hair restoration surgery, researchers compared the survival rates of hair follicles transplanted at different densities [6]. When only 10 grafts were implanted per cm², their survival rate was 97.5%. This dropped to 92.5% when 20 hair follicles were used, respectively, to 72.5% for 30 follicles. They then determined that no more than 30 hair grafts can be implanted per cm² without risking hair transplant failure.
However, recent advancements in surgical technique, as well as graft harvesting and preparation practices, have allowed for higher-density transplants to be safely performed. But it should be kept in mind that it takes an exceptionally skilled and experienced surgeon to achieve good results in such surgeries.
A high-density hair transplant is any surgical hair restoration that involves implanting more than 30 hair grafts per cm². In recent years, some surgeons have published case studies reporting very good results despite transplanting twice or even 3 times the number of recommended follicular units. However, the number of patients involved in these studies was very small – often 1-2 people. This means much more ample research is needed to determine whether the techniques used on them would work as well for other patients.
The highest number of follicular units successfully transplanted, as recorded in relevant literature, is 100/cm². However, this procedure was only performed on 2 patients, who achieved a 96% and 92% graft survival rate, respectively [9].
A different surgeon managed to obtain a 98.6% survival rate after implanting 72 grafts/cm² in a single patient’s scalp [10].
However, these cases are not the rule, but rather fortunate exceptions for surgical hair restoration. The studies had a very small population, and much larger trials are required to determine the safety of this procedure.
In practice, skilled and experienced surgeons, with excellent technique, may reach up to 40-60 grafts/cm², but that also depends on patient eligibility for a high-density hair transplant.
Not everyone is eligible for a high-density surgical hair restoration. Here are some criteria that need to be met for the benefits to theoretically outweigh the risks:
However, only an experienced surgeon can say for sure whether you make a good candidate for a high-density hair transplant. Book a free, no-strings-attached consultation with one of our world-class specialists and find out if this procedure is the best choice for treating your hair loss.
When considering a high-density hair transplant, it is good to be aware of its advantages and disadvantages, so you can make an informed decision. Here are some of the pros and cons of getting this procedure [6]:
If you had a hair transplant and fail to see any improvements in hair density, here are some questions you should ask yourself before you start to worry:
If it’s been fewer than 3 months since your hair transplant, you may not see any results yet. In fact, your hair may even be sparser than it was before, due to shock loss. After that, you can expect hair growth to resume gradually in your transplant area. However, your hair density will likely be lower at first and slowly increase over time. You will only see your final hair fullness around 1 year after your hair transplant (for some, it can even take 18 months).
Proper hair transplant aftercare is vital in increasing your grafts’ survival chances. And this doesn’t only involve protecting your transplant area from excessive sunlight, mechanical damage or infection. It also means respecting the temporary activity restrictions, such as how long to wait before you can exercise after a hair transplant or how long to pause smoking before and after your procedure (yes, smoking can negatively impact your hair transplant results!).
Working out too soon after surgery can cause fluctuations in your blood pressure, which can affect your grafts’ ability to become securely attached to your scalp. And inflammation caused by smoking can interfere with healing and make your white cells attack your hair follicles, damaging your grafts. And all other activity restrictions are thought out in a similar way, to ensure you get the greatest hair density from your hair transplant with the smallest risks.
Most surgeons recommend that you use treatments such as Minoxidil and/or Finasteride to help your transplanted hair grow faster and to prevent further native hair thinning. If you decide against using these medications, your alopecia may progress around your transplanted grafts, making your native hair fall out. So your transplanted hair may be growing as expected, but since the already existing hair in the area got sparser and finer, the overall hair density may still appear unchanged.
Even the best high-density hair transplant can often only provide cosmetic coverage. That means you will no longer be bald, but your hair won’t be as full as it used to be in the pre-alopecia days either. Ethical surgeons are usually transparent about the transplanted hair density and appearance you can expect after your procedure, and the personal limitations you may be facing. For example, if you don’t have enough healthy hair follicles in your donor area, you are unlikely to achieve extremely full hair.
Sometimes, all you can hope for is an improvement in your scalp appearance, not a complete cure for baldness. However, it’s normal for some patients to still hope for a miracle and be disappointed when the results don’t line up with their expectations. This can make them feel underwhelmed even if they achieved an objectively good outcome.
While most hair transplants are successful, in rare cases, they can also go wrong. Here are some red flags to look out for:
Worsening pain – not controlled with simple analgesia (paracetamol, ibuprofen), may indicate infection or other problem that the clinic would need to assess.
Excessive bleeding, discharging pus content or excessive weeping discharge could indicate infection, poor healing or FUT wound dehiscence, which would need to be examined in the clinic.
Skin changes, like spreading redness or black areas, could be an infection or damage to tissue that would need to be examined.
General malaise, fevers, vomiting – systemic upset can indicate infection and if the patient is unwell, may need a quick assessment by the clinic/NHS service.
Head injury or rubbing to the recipient area may mean dislodged/lost grafts, so it would need examination.
If you already obtained the final results of your hair transplant and feel unhappy with your hair density, there are some things you can do:
I recall a rare case involving a young patient in his mid-20s who was on hair loss prevention medications. Despite this, by 18 months, the area of hair loss had expanded beyond what was observed at the initial consultation, and the density in the transplanted region appeared patchy. By that point, he had also tried adjunctive therapies such as minoxidil, red light therapy, and PRP, with minimal improvement.
Given the progression, we felt further investigation was warranted to assess whether an alternative form of hair loss was contributing. We recommended a scalp biopsy—both from the transplanted region and from an area of newly affected native hair—as well as blood tests to identify any underlying markers that could impact hair growth. The biopsy revealed an autoimmune pathology, consistent with a type of scarring alopecia. As a result, the patient was referred to a dermatologist for medical therapy aimed at stabilising his condition.
At this stage, retreatment via hair transplant was not considered appropriate, though it may become an option after several years of stable disease. This case underscores the importance of considering alternative diagnoses in patients with suboptimal post-transplant results, and the need to manage such patients holistically—referring to appropriate specialists based on the underlying type of hair loss.
The success of a hair transplant depends on many factors, most of which you can influence in one way or another. Here is what you can do to increase your chances of achieving optimal hair density after your hair restoration surgery:
Do some online research and find a well-reputed hair transplant clinic with positive patient reviews on independent websites such as Trustpilot. Contact them and ask about their surgeon’s experience and credentials, and cross-reference the information with patient reviews. Once you have found a good option, schedule a hair transplant consultation with the surgeon of your choice.
Make sure to prepare a list of questions and concerns to address to the specialist during the consultation. Listen to their answers carefully and get a feel of their transparency, patience and concern for your well-being. Don’t forget to ask to see their hair transplant portfolio, so you can get a better idea of their skill and the results they can provide. Only go through with the surgery when you are fully satisfied that you have chosen the right surgeon for you.
Once you have determined that you can trust your surgeon, make sure you take their advice to heart. This means following all their pre- and post-surgery instructions. These generally refer to:
Most surgeons recommend that their patients use hair growth treatments, such as Minoxidil and/or Finasteride, in the long term after their procedure. Minoxidil improves blood flow to your hair follicles, improving chances of graft survival and increasing hair density.
Finasteride is normally prescribed to men with male pattern baldness, as it reduces the dihydrotestosterone (DHT) levels in their blood. Since their alopecia is caused by DHT binding to androgen receptors in their hair follicles, using this medication protects their native hair from further thinning. While this treatment is also likely effective in treating female pattern baldness as well, premenopausal women can’t normally use Finasteride, as it can lead to hormonal imbalances and birth defects.
Our talented surgeon, Dr Chirag Gadhia, explains the benefits of using these hair growth medications after your hair transplant:
Minoxidil can help expedite hair growth by increasing blood flow to the scalp. Finasteride plays an important role in protecting native hairs and has been shown to increase the number of hairs in the growth (anagen) phase. As a result, it may create the visual impression that the transplanted hairs are growing in sooner, although it has no direct effect on the transplanted grafts themselves.
Using Minoxidil combined with Finasteride is even more effective than either stand-alone medication [12]. They help stimulate hair growth, curb native hair loss and help your hair grow faster after your shock loss period.
Be sure to get your doctor’s recommendation for any hair growth medication you plan to use. This ensures that they won’t interfere with other treatments you may be taking or worsen any preexisting conditions.
Once your scalp has healed and it has been at least one month since your hair transplant, you can try some of these evidence-backed therapies to stimulate your hair follicles for growth:
Reducing unhealthy habits, such as frequently consuming alcohol or smoking, can have a significantly positive impact on your post-transplant hair density. As can eating a healthy, well-balanced diet for hair, which offers your follicles all the essential nutrients they need to produce full, thick hair. Finally, getting enough sleep and reducing your overall stress levels can reduce the likelihood of developing anxiety-induced hair loss. This form of telogen effluvium would temporarily thin out your hair, reducing its overall density.
At the award-winning Wimpole Clinic, we have over 50 years of experience providing state-of-the-art hair transplants with 97-100% success rates. We’ve worked with thousands of patients to create full, thick hair that restored their confidence.
See more of our results in these hair transplant before and after photos, and read our hair transplant clinic reviews to find out how our patients feel about their experience with us. Then book a free consultation with one of our experienced surgeons to find out what we can do to improve your hair density.
Find out more about the impact of hair transplants on your hair density by reading the answers to these frequently asked questions:
It is not recommended to get a hair transplant if you are not experiencing significant hair loss. Any surgery has risks and causes some stress to your body, and ethical medical professionals will carefully weigh these risks against the benefits of the cosmetic procedure. Many other non-surgical hair restoration treatments can increase your hair density (e.g. Minoxidil).
It is, however, important to understand the reason you find your current hair density unsatisfactory so you can get the right treatment. If you are experiencing temporary hair shedding caused by telogen effluvium, it may resolve itself in 3-4 months, or it may require some lifestyle changes before you see an improvement. However, if your hair density simply got slightly lower with age, it may be a natural phenomenon and not necessarily something that can or needs to be surgically corrected.
Only highly skilled and experienced surgeons should perform high-density hair transplants. That’s because they are technically challenging and can easily result in poor graft survival rates if not performed to the highest standards.
Some black market clinics – especially in countries known for plastic surgery tourism, such as Turkey – will offer you any hair density you want for a low price. But the low hair transplant costs in Turkey are often not worth the risk. So many surgeons have reported having to correct black-market hair transplants gone wrong that the International Society of Hair Restoration Surgery has launched a campaign to warn patients against them [13].
Keep in mind that a hair transplant is a permanent investment in your appearance, and its results will be with you forever. So if you are looking for a hair restoration surgery with a higher degree of complexity and risk, always choose a well-reputed, experienced surgeon.
It is not common for a hair transplant to completely restore your hair to its pre-thinning density. However, in most cases, it is not necessary to do so either. Cosmetic hair density is significantly lower than natural.
This means that your hair can still look great and you can get a hair transplant without anyone knowing, even if your hair is not packed as tightly as it used to be. Skilled surgeons use a variety of techniques to make your hair look fuller. Moreover, most people can lose half their hair mass before the thinning even becomes visible. So you can have hair grafts transplanted at a much lower density than your natural one without anyone noticing the difference.
They often do this to maintain a good profit margin while still keeping a low cost per graft, for marketing purposes. If they cannot charge more for each hair graft, they will simply pack in more grafts to increase total procedure costs.
While not all Turkish hair transplant clinics use unsafe, unethical practices, many of them do, especially unauthorised ones. And packing hair grafts more densely than necessary is just one of these practices, which can lead to poor procedure results and donor area overharvesting. Here are some other Turkish hair transplant clinic red flags to look out for.
Yes, in general, people with curly hair require fewer grafts to achieve the same coverage as those with straight hair. That is because the coily texture covers a greater surface and creates an illusion of volume and fullness. However, hair transplants for curly hair can be more difficult to perform, as it is more challenging to find the right implantation angle.
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Dr Ahmad Moussa is an experienced surgeon. His qualifications include a Master of Science degree in General Surgery, Membership of the Royal College of Surgeons of England, Doctorate degree in Neurosurgery and Fellowship of the Royal College of Surgeons in Neurosurgery. He is a member of the British Medical Association and the Society of British Neurological Surgeons. Dr Moussa has over 15 years’ experience working in neurosurgery and is a GMC and Royal College of Surgeons certified Neurosurgeon.
His training and subsequent work as a consultant neurosurgeon in the NHS has included performing intricate brain surgery while patients are fully awake to be able to safely resect complex brain tumours. This level of skill, expertise and familiarity with the scalp has allowed Dr Moussa to successfully step into the rewarding world of hair transplant surgery.
Dr Moussa is trained in FUT and FUE hair transplant techniques including combining the two techniques together when required to achieve the appropriate number of grafts without overharvesting. He successfully carries out hair transplant surgery for both scalp and beard hair loss. Registered Number: 6065705
