# Hair Transplant: Basics

> Hair transplant basics for NEET-PG Dermatology: donor dominance, FUT vs FUE, graft numbers, shock loss and continued medical therapy.

- Canonical URL: https://prepelephant.com/topics/neet-pg/dermatology/hair-transplant-basics
- Exam / course: NEET-PG · Subject: Dermatology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Hair Transplant: Basics", PrepElephant, https://prepelephant.com/topics/neet-pg/dermatology/hair-transplant-basics

## Direct answer

Donor dominance — Norman Orentreich's principle that transplanted follicles retain their original androgen-resistant behaviour wherever they land — is the entire scientific basis of hair transplantation: occipital hair moved into a bald frontal scalp keeps growing as occipital hair. The surgery redistributes, never creates, hair. Two harvest methods define modern practice: follicular unit transplantation (FUT), excising a strip of donor scalp and slivering it into follicular units of one to four hairs, and follicular unit extraction (FUE), punching individual units (0.8-1 mm) without a linear scar. Planning runs on the Norwood stage, donor density and hairline design; regrowth begins at three to four months after the expected shock-loss shedding, maturing fully by twelve to eighteen months. Medical therapy with finasteride and minoxidil continues lifelong, because native hair keeps miniaturising.

## What you must remember

- **Core principle:** donor dominance — the occipital "permanent" fringe resists dihydrotestosterone, so its follicles survive and grow wherever they are relocated.
- **FUT versus FUE:** FUT gives high graft yield per session at the cost of a linear occipital scar; FUE avoids the scar, permits very short hairstyles and body-hair harvesting, but is slower with higher transection risk in unskilled hands.
- **Graft vocabulary and numbers:** a follicular unit holds one to four terminal hairs with its sebaceous lobule; native density approximates one unit per square millimetre, transplantation achieves 30-50 units per square centimetre per session, and a stage III-VI male with good reserves commonly receives 1500-4000+ grafts across one or more sessions.
- **Timeline to recite:** shedding of transplanted shafts at three to six weeks (shock loss, including temporary native hair loss), regrowth from months three to four, cosmetic maturity at twelve to eighteen months.
- **Medical therapy forever:** finasteride 1 mg daily (DHT reduction; sexual adverse effects in a minority, post-finasteride syndrome remaining debated) plus topical minoxidil 5 per cent preserve the native fringe that frames the transplant.
- **Contraindications and cautions:** active scarring alopecia (quiesce disease first), poor donor density or diffuse unpatterned alopecia, unstable very-young pattern loss, unrealistic expectations and body dysmorphic disorder; keloidal tendency needs counselling in Indian skin.
- **Complications list:** folliculitis, transient shock loss, forehead oedema, hypoaesthesia from great occipital nerve injury (mainly FUT), wide or hypertrophic donor scarring, and an unnatural hairline from bad design rather than bad surgery.
- **Indian context:** India is a major global hub for hair restoration, priced per graft — financing access and tempting over-harvesting; vivas increasingly ask how you would counsel a medical tourist.

## Counselling a candidate: the consultation that decides everything

A 28-year-old software engineer, Norwood III vertex, arrives transplant-minded with photographs of a film star. First, age and stability: his loss is early, so the plan pairs frontal hairline design with finasteride and minoxidil to defend the mid-scalp — operating without medical therapy creates an island of hair in a receding sea within five years. Second, FUE is selected because he crops his hair and refuses a linear scar; roughly 1800 grafts map to the frontal third. Third, the calendar: shafts shed in month one, regrowth begins at month four, and judgement waits until month twelve. He leaves with photographs, a written plan and the single most protective sentence in hair-transplant medicine: surgery moves hair, medicine keeps the rest.

## Where candidates slip

The principle question looks easy and is answered badly: candidates mumble "hairs grow" instead of naming donor dominance — the specific phrase exams want. The second slip is timing: judging or abandoning a result at month two (when everything has shed and nothing regrown) or promising density at month three; the expected answer walks shedding at three to six weeks, regrowth at three to four months, maturity at twelve to eighteen. Third, the medical-therapy omission: a transplant plan without finasteride-minoxidil in a young Norwood III is the planted management error. Fourth, FUT-FUE trade-offs reduced to "FUE is better" — the mature answer weighs linear scar versus transection, yield and session size. Finally, the scarring-alopecia trap: operating on active lichen planopilaris transplants follicles into a battlefield, and the correct sequence is biopsy, quiescence, then surgery.

## Frequently asked questions

### What principle explains the survival of transplanted occipital hair?
Donor dominance — follicles keep their dihydrotestosterone-resistant behaviour at the recipient site, as established by Orentreich.

### How do FUT and FUE differ fundamentally?
FUT harvests a strip yielding many follicular units with a linear scar; FUE extracts individual units with tiny punches, avoiding the scar at the cost of time and transection risk.

### What is shock loss after transplantation?
Temporary shedding of transplanted shafts and some adjacent native hair at three to six weeks, with regrowth beginning by months three to four.

### Why must finasteride and minoxidil continue after surgery?
The transplanted follicles resist dihydrotestosterone but native miniaturising hairs do not, so medical therapy preserves the surrounding hair that frames the result.

### When is hair transplantation contraindicated in scarring alopecia?
While the scarring process is active — lichen planopilaris or discoid lupus must be diagnosed and quiesced before grafting, or the disease destroys the transplant.