Chapter 1: Cases when hair transplantation is not recommended

For many people suffering from hair loss, hair transplantation is considered one of the most reliable and effective solutions. In fact, it is clear that a sophisticated hair transplant is an excellent treatment for regaining confidence. However, I carefully consider the condition of the patient's scalp and hair, as well as the overall plan for hair loss treatment, and sometimes tell them that hair transplantation should not be recommended or the timing should be adjusted. This is my treatment philosophy to provide the best results to all patients, and the following cases apply.

1. If there is an inflammatory disease in the scalp

Hair transplant is like planting a seed in healthy soil. If the soil where the seed is to be planted, i.e. the scalp, is not healthy, it is difficult for the seed (hair follicle) to take root and sprout properly, no matter how good it is. This is the case if you have inflammatory skin diseases on the scalp, such as seborrheic dermatitis, eczema, psoriasis, and folliculitis.

If transplantation is performed while the collection site (occipital region) and the transplantation site are inflamed, the transplantation process itself may worsen the existing inflammation. During the process of collecting and planting hair follicles, microscopic wounds and a natural inflammatory response occur on the scalp. If you have a pre-existing inflammatory disease, this response may be excessively amplified.

As a result, if recovery at the harvest site is slow or severe, a small scar may remain, and more importantly, at the transplant site. In a scalp environment full of inflammation, it is difficult for transplanted hair follicles to settle down properly and receive nutrients. This is called ‘low engraftment rate’. This can lead to the unfortunate result that hair that was planted with great difficulty may not grow properly and fall out.

Therefore, I emphasize to patients who are considering hair transplantation with scalp disease that they must plan the transplant after sufficiently treating dermatitis to bring the scalp into a healthy and stable state.

2. If hair loss has progressed excessively beyond the middle stage

Hair transplantation is not a procedure to ‘create new hair that is missing’, but rather a procedure to ‘rearrange existing hair’. In other words, the principle is to transplant healthy hair from the back of the head, which is relatively less affected by hair loss, to the hair loss area.

However, if hair loss has already progressed beyond the middle stage and the hair in the back of the head has started to become thin and weak, the effectiveness of the transplant is greatly reduced. Transplanting weakened hair is like expecting weak hair to eventually grow back. Even if engraftment is successful, it is difficult to grow thick and strong, and there is a high probability that it will fall out again in the long term.

Additionally, if hair loss continues for a long time, the scalp itself often becomes thin and hard, resulting in 'fibrosis'. This means that the space for new hair follicles to take root and live has become narrow and barren. If you force a transplant into this type of scalp, not only will the engraftment rate drop, but it may also lead to unnatural results.

Therefore, in these cases, priority should be given to protecting remaining hair and improving the scalp environment through drug treatment or scalp care rather than transplantation.

3. If you are indifferent to hair loss treatment and rely only on transplantation

There are people who come to the clinic thinking, “If I just get a transplant, everything will be solved.” But I tell you this firmly. Hair transplantation is not the end of hair loss treatment, but only a new beginning or part of the process.

Hair transplantation is very effective in improving hair loss in specific areas, such as the M-shaped hairline or parting correction. However, what you must remember is that hair loss in other areas that have not been transplanted will continue to occur. If hair loss treatment and management are completely discontinued after transplantation, the transplanted area may remain, but the surrounding hair may continue to fall out, ultimately resulting in an unnatural and awkward appearance.

Also, the belief that “transplanted hair will never fall out” is only half true. Although it is true that hair in the back of the head is less affected by hair loss genes, this is not absolute. Especially for people whose hair loss began at a young age or progresses very quickly, even transplanted hair may slowly thin and fall out over time.

Therefore, in order to maintain successful hair transplant results for a long time, efforts must be made to manage the root cause of hair loss, such as consistent medication use, scalp care, and lifestyle improvement after transplantation. A transplant may be a short-term solution, but long-term hair health depends on the patient's consistent efforts.