Will My Hair Look Natural After A Hair Transplant?
Written by Hair Transplant Surgeon Ali Emre Karadeniz
Publish Date: 29.06.2019
We have to distinguish two things, hair looking "good or bad" and hair looking "natural or unnatural". If hair restoration surgery is done in a professional way, even though it may not give you a full head of hair if you have an advanced hair loss pattern, it should still give you a natural appearance.
We frequently get this question from the patients. First, we have to define what is natural, what are we talking about when we talk about the naturalness of our hair.
People who go for a hair transplant are people who have hair loss. First of all hair loss is natural. That means, when we see someone with hair loss we know that's a natural appearance. So, we have to distinguish two things, hair looking "good or bad" and hair looking "natural or unnatural". This is the first question to answer because when we have hair loss our hair doesn't look good of course, we think our hair looks bad and we want to make it better. Obviously hair loss is a bad thing and it causes our hair to look bad. However hair loss is natural. Our hair could look bad but natural at the same time. So, good and bad is different, natural and unnatural is different.
So, hair loss causes our hair to look bad, but it can never make our hair look unnatural except for some very special diseases which may cause an unnatural appearance. If we're talking about male pattern hair loss in general, this is a natural hair loss type which makes our hair look not so good. For our hair to look unnatural there must be either one of the two things: one is it could be a dermatological disease that causes hair loss in an unnatural way, but this is not our topic today. The other way to get unnatural hair is to have a poorly designed and/or executed hair transplant. If we have a bad hair transplant we won't only have a poorly looking hair but also it will look unnatural. So we have to distinguish our hair looking bad in a natural way or our hair looking bad in an unnatural way.
When we have a hair transplant there are some limitations to what we can do, I mean considering a patient who lost 50% or more of his hair, you can't give back that hair back, so there's a limit to the improvement you can give in one surgery. When some people ask "I want my hair to look natural", they are actually using the term mistakenly, they are actually trying to say "I want a full head of hair", but they are using the wrong term. In most advanced hair loss cases, you can't get a full head of hair but you can get a natural looking hair. (Click to get more information about: How many grafts do you need?)
If hair restoration surgery is done in a professional way, even though it may not give you a full head of hair if you have an advanced hair loss pattern, it should still give you a natural appearance. That means your hair may still show signs of hair loss but this should be in a natural way. This is the most important distinction between a poorly executed hair transplant and a good hair transplant. A poorly executed hair transplant is not only going to not give you a head of hair but also going to be looking unnatural whereas a good hair transplant even though if it doesn't give you a full head of hair due to your advanced hair loss and donor hair limitations it should be looking natural. That means within this question the most important thing is to understand the difference between lacking hair (i.e. hair looking not so good) which may still be natural and looking unnatural. These are two different things.
Understanding this is also connected to how the design and planning should be made especially in advanced hair loss cases. If you have advanced hair loss (you lose or expected to lose at least 50% of all your hair volume) obviously you cannot restore the appearance back to its original state simple because that 50% is gone and nobody is going to bring it back. There has to be some design tricks to make this look natural. When we cannot give one a full head of hair (and that's most of the time) the best strategy is to try and design a situation that shows signs of hair loss but it's still natural. For example, let's say you lost all or most of your hair on the top, front to back you have no hair line and you have a balding from front to the lower crown. In most of these cases a full head of hair is impossible especially in just one session. If you think having hair on all the scalp is the most natural, you're going to make a mistake because you're going to distribute a limited number of hairs all over the scalp which is actually going to look unnatural because that appearance doesn't represent any natural hair loss situation. Nobody loses their hair in such a way that they're diffusely thin front to back with scattered hairs all across. There's a pattern that we see hair loss, these patterns may be like receding of the hair line, or may be bald patch in the crown and some hair remaining in the middle, so there are certain patterns of hair loss.
A professional hair transplant design should aim at switching the patient's advanced hair loss into a better hair loss appearance, it's still with hair loss, it still shows signs of hair loss but it's natural and it's much better than how it used to be. So this is a very important philosophy to understand in how natural looking hair could be done via a hair transplant.
If a full head of hair is not possible (and this is the case most of the time) then it's better to switch to a hair loss case where it looks much better, it's natural looking but it still shows signs of hair loss versus evenly spreading the hairs all across the balding region at low density which is obviously unnatural (Click to to get more information about hair transplant density).
A good example is to instead of drawing a line where your hair line used to be when you were 14 and evenly distributing the hairs all across the scalp, it's much better to design a much more receded hair line especially at the temporal regions the front or temporal angle should be more receded, so much higher hair line with receded temples and then perhaps also a thinning crown should be deliberately created so that a more dense appearance in the hair line frontal region and mid-scalp is achievable. So this is a very sophisticated topic which requires a separate blog post but I'm just trying to emphasise the importance of understanding what wanting a natural looking hair actually means and the difference between hair showing signs of hair loss doesn't mean it's unnatural or not covering the whole area doesn't mean it's unnatural, actually frequently the opposite is unnatural. In advanced hair loss it actually gives unnatural results if you spread a limited number of hairs over a too large area at low density. That looks more unnatural than making a receded hair line with balding in the crown deliberately to give a higher density in priority areas which resembles a more natural looking hair.
Written By Dr. Ali Emre Karadeniz, MD, PhD
Ali Emre Karadeniz, MD (Dr. K) is the only American Board of Hair Restoration Surgery Certified Turkish plastic surgeon. He has performed over 2000 hair operations. He is an active member of the International Society of Hair Restoration Surgery (ISHRS).