Do I need another hair transplant? (Photo)

I had had neograft hair transplant one year ago. FUE with 1800 graft. Now I'm not satisfied because it doesn't look natural, also there is lack of density. I was told that it will never look natural because of the direction of my hair grows backwards. Is this true? Do you think another procedure will make it look better( natural)? And if yes, how many grafts? FUT or FUE?

Doctor Answers 20

Does this patient need a second hair transplant?

Dear Beemao,

The short answer is yes, you do need another hair transplant. The lack of density is pretty clear in the picture, and the hairline is a bit linear and unnatural. A second hair transplant would be indicated to fill in the gaps between these areas. Of course your hair can and should look natural. I have performed surgery on many people who's hair grows like yours.

It does not appear as though all the grafts survived the transplant process, as typically more density would be expected from a single hair restoration procedure.  What I have discovered in performing exclusively hair restoration surgery for nearly 15 years is that occasionally hairs can die if outside of the body too long.  This is more a reflection of the talent, experience, and dedication of the technical staff that assists with procedures, especially in FUE/Neograft cases, due to the inherent limitations of speed with any FUE procedure with any FUE device, including Neograft.  The simple fact is that if the surgical hair transplant technicians (the people in the room with the doctor, using the microscopes) are not careful with the follicles, or the surgical team is not proficient and the follicles stay outside the body for more than about 5 hours, or if the technicians allow the grafts to warm up, or if the grafts are allowed to dry out, they can literally die prior to implantation.  In those cases where the grafts are outside the body too long, the grafts warm up, are not handled properly with the proper instruments, or allowed to dry out, the grafts simply die. I have no idea if this happened in your case, but a lack of density usually means a lack of growth, and that is nearly always a function of the experience and dedication and passion of the surgeon and his or her team of surgical technicians. I hope this information is helpful to you.

Kind Regards,

Ken Anderson, MD, FISHRS

Atlanta Hair Restoration Surgeon
5.0 out of 5 stars 153 reviews

Hairline lowering

You may still see more growth after one year.  When it comes to lowering hairlines, it is often difficult to obtain the same density going from a zero-density area below the hairline to a dense hairline, like yours.  With hair pulled back, this discrepancy is obviously more visible. A second session is sometimes needed to improve density and should be rather straightforward.  

Tim Neavin, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 46 reviews

NeoGraft Second Procedure

Thank you for your question and submitting your photos. If you are unhappy with your results from your first procedure, there are a couple of considerations. First, is it merely the density - in which case a second procedure would help to increase the density. Second, is it how the hairline was created and lays? This would best be assessed with photos before your hair began to thin. It would then be a question of how to best recreate that appearance. This would again likely require a second grafting procedure. It is not uncommon to need two procedures to get the density you desire. As to the number of grafts, this can only be determined during a personal consultation. I hope this was helpful - Dr. Moore.

Richard E. Moore, MD
Saint Louis Physician
3.9 out of 5 stars 7 reviews

Additional hair grafts

You could benefit from additional grafts to improve the density of the frontal hairline. The direction of the hair grafts should be matched with your native hair. Either method (FUE/FUT) can give you the results you want. I would advise seeing a surgeon that has advanced training in both so you can get an honest opinion. It looks like 1000-1200 grafts would be adequate, maybe less.

Sumit Bapna, MD
Columbus Facial Plastic Surgeon
5.0 out of 5 stars 49 reviews

Neograft Revision

I would agree with you that a secondary Neograft procedure would benefit you for a more natural looking hairline.  The density in your transplanted region is below what it should be compared to the rest of your scalp.  The benefit of Neograft is that allows for additional harvesting from the donor sites when patients, like yourself, desire a touch up.  The direction in which your hair grows should not be an issue, as a skilled Neograft technician should be able to match the grafts with the direction of your natural growing hair.  Without a "before" picture, to see what the 1800 grafts got you, it is hard to estimate the number you will need at a secondary procedure, but to fill in that area, I would estimate it to be in the 500 graft range. 

Christopher S. Zarella, MD
Portland Plastic Surgeon
5.0 out of 5 stars 8 reviews


Thank you for your question. You would be a candidate for NeoGraft's FUE System. Patients who have already had a hair transplant like yourself can benefit from this process because it can be used as a camouflaging procedure. I suggest that you move forward and consult with a board certified facial plastic surgeon.

Best wishes,

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 120 reviews

Another session could be very helpful

Your frontal hairline can definitely be improved. A skilled hair transplant surgeon can shape the direction of the grafts in such a way to blend them in with the direction of your native hair. They can also blend the frontal hair line in better. Your frontal hair line has an unnatural appearance not so much because of the direction of the hairs but because of the planning, shape, and density of the hairline.

I would recommend another session of 500-1000 grafts (depending on how dense your hair is on physical exam) with a skilled hair transplant surgeon in order to improve the density of the transplanted area and break up the contour of the hairline.

The method used to harvest the grafts is not very critical, but since you've had Neograft before, an FUE method like Neograft would probably be what I would recommend for you for the second session as well.

Matthew Richardson, MD
Frisco Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Do I need another hair transplant?

I would suggest to try  PRP +Vitamin Coctail+StemCells+Microneedling Treatment . Then, please make sure that you get adequate Nutritional support /Supplements( LifePackNano from Pharmanex is THE BEST) +Green Tea(2-3 times a day) for next 6-9 months. 

If you are not still going to be happy with results, then a second session is needed , and I would recommend 1500- 2000 grafts to  improve density to desired appearance. When we are dealing with the lowering hairlines, it is monumentally important to angle the grafts in a certain way  that  it follows the direction of the existing  hair shafts.This requires the highest technical and professional level. NeoGraft is  my preferred method for re-grafting to significantly increase density of the hairline. I recommend consulting with a highly qualified hair transplant specialist.

Svetlana Danovich, MD
New York General Surgeon
5.0 out of 5 stars 5 reviews

Frontal Hairline

In an effort to make frontal hairlines look most natural, it can often times require at least two sessions of grafting.  One session can establish the hair line and the second session will add density.  This should give you the natural look you desire.  Based on the picture presented, you should have enough donor site for a second session of grafting.  I would use another 1500-2000 grafts. 

Regarding the direction of the hair shaft, it is important to angle the grafts in a specific manner that typically follows the direction of the hair shafts already present.  As an example, in the temple region, the grafts should be angled in slightly posterior, lateral and inferior direction. 

Joseph L. Hill Jr., MD
Lexington Plastic Surgeon
5.0 out of 5 stars 5 reviews

Second Neograft Hair Transplant

The shape of the frontal hairline appears natural however the density of the transplanted hair does not appear to match the rest of the hair. If there is still donor hair available it is possible to add density to this area by packing in more follicles. This will provide a thicker more natural look. Another round of FUE with NeoGraft is usually my preferred method for re-grafting for increased density depending on the individual. I recommend consulting with a well qualified hair transplant specialist to see if you are a good candidate for further grafting. 

I hope this helps,

-Dr. Angelos

Tyler Angelos, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.