Graft Survival and Growth Phases in Hair Transplant Surgery

Biological Foundations of Graft Survival

Hair transplant surgery, particularly using the Follicular Unit Extraction (FUE) method, relies on precise handling of hair follicles during extraction and implantation. Once a graft is removed from the donor area, it immediately begins a critical period of ischaemia, where it lacks blood supply. The ability of the graft to survive this phase and integrate into the recipient area depends on multiple biological and procedural factors.

Revascularisation—the process where new blood vessels grow around the graft—begins within the first 72 hours after implantation. During this period, the follicle must maintain cellular integrity despite the lack of oxygen and nutrients. Excessive trauma during handling, dehydration, or extended time outside the body can all reduce survival rates. In an article published by Beehner in Hair Transplant Forum International (2017), it was noted that graft survival dropped significantly when follicles remained ex vivo beyond six hours, particularly without proper hydration and temperature control.

Various holding solutions such as chilled saline, Lactated Ringer’s solution, and ATP-enriched media have been studied. While all provide temporary preservation, there is still no consensus on the optimal solution. A review by Vowels and Dawber in the British Journal of Dermatology (2005) suggested that hypothermic conditions improve graft longevity by reducing metabolic demand, but timing and technique remain paramount.

Phases of Hair Regrowth After Transplantation

Patients often become concerned when the implanted hairs begin to shed shortly after surgery. This is part of the expected post-operative cycle. The initial shedding phase, usually occurring within two to three weeks, is caused by surgical trauma triggering telogen effluvium. This is not a loss of the follicle itself—only the hair shaft is shed while the follicle enters a resting phase beneath the skin.

Following this, most grafts enter a telogen phase lasting around 10 to 14 weeks. During this time, the follicle begins cellular repair and prepares for re-entry into the anagen, or growth, phase. New hair shafts begin to emerge slowly, usually starting around month three or four. By six months, visible coverage improves, although final results often require 12 to 18 months.

Variations in regrowth between grafts are normal. Each follicle has its own intrinsic cycle and may respond differently depending on scalp blood flow, inflammation, and the body’s healing response. A clinical analysis by Uebel and colleagues in Plastic and Reconstructive Surgery (2007) observed a regrowth rate of over 90% in patients with optimal technique and postoperative care.

Regional Pricing and Patient Considerations

Hair transplant prices in the UK vary depending on clinic reputation, surgeon experience, and location. In Manchester, clinic prices range from £2,899 for 1,000 grafts to £4,899 for 3,500 grafts. This pricing reflects the detailed nature of FUE surgery and the importance of careful graft preservation and implantation.

Patients should view the transplant as a staged biological process. Understanding each phase helps align expectations and supports better outcomes through adherence to post-operative instructions.

References

• Beehner, M.L. "Graft Dehydration and Survival: Practical Considerations." Hair Transplant Forum International, 2017.

• Vowels, B.R., Dawber, R.P.R. "Hair transplantation: techniques and mechanisms of graft survival." British Journal of Dermatology, 2005.

• Uebel, C.O., et al. "Follicular survival rates after hair transplantation with autologous platelet-rich plasma." Plastic and Reconstructive Surgery, 2007.

FAQ

How much does a hair transplant cost in Manchester?
At My Hair UK, prices begin at £2,899 for up to 1,000 grafts. For 3,500 grafts, the cost is £4,899. All procedures use the FUE method.