• Each hair strand goes through specific phases of growth, development, and shedding. After this cycle, the hair follicle produces a new hair strand. On average, this cycle repeats about 20 times in a person's lifetime. Shedding 100–200 hairs daily is considered normal, with an adult typically having around 100,000–200,000 hair strands.

  • Growth Phase: Lasts approximately 3 years. During this period, the hair remains vibrant and continues to grow.
  • Regression Phase: Lasts about 3 weeks. During this phase, the hair weakens, stops growing, and is pushed out by a new hair strand.
  • Resting Phase: Lasts around 3 months. In this phase, the hair follicle rests before new hair cells divide to produce a new strand.

• Hair: A collection of strands made of a protein called keratin that covers the scalp.
• Follicle: The structure from which each hair strand grows. Each follicle may contain one or more hair strands.
  Hair grows about 0.3–0.4 mm per day, equating to approximately 9 mm per month. Hair quality and growth rate are affected by factors such as genetics, hormonal changes, nutrition, geographical location, stress, and chemical treatments.

The main causes of hair shedding include:

• Genetic predisposition
• Radiation and chemotherapy
• Thyroid disorders and hormonal factors
• Nutritional deficiencies and anemia
• Connective tissue diseases, skin disorders
• Androgenetic alopecia (male pattern baldness) due to DHT hormone in men
• Digestive issues, vitamin deficiencies, rapid weight fluctuations
• Medication, general anesthesia, stress, unhealthy diets
• Chemical and thermal treatments applied to hair
• Tight hats, helmets, or hairstyles that pull the hair

Before deciding on a hair transplant, the scalp should be examined, and the causes of hair loss should be investigated. It is recommended to address any underlying factors contributing to hair loss before proceeding with transplantation. Common diagnostic methods include:

• Pull Test: 25–50 hairs are gently pulled to assess excessive shedding, which may indicate an abnormal condition.
• Phototrichogram: A method where hair is clipped and photographed to observe growth patterns.
• Scalp Biopsy: In rare cases, this is necessary for diagnosing diseases involving hair follicle loss.
• Hair Analysis: Performed to detect hair loss causes due to biochemical composition, genetic factors, or heavy metal accumulation.

In men, hair loss tends to increase with age. In genetically predisposed individuals, hair loss stages are categorized using the Norwood Classification.

Stage 1 (Minimal Hair Loss): There is no significant hair loss or notable recession in the hairline. Hair loss is minimal, and no surgical intervention is needed.

Stage 2 (Receding Hairline): There is a mild recession of about 1–2 cm around the temples. This stage is also referred to as mild hair loss. Surgical intervention is not necessary unless it causes discomfort.

Stage 3 (Deep Receding Hairline): The hairline recedes deeply on both temples, forming an M, U, or V-shaped pattern. The recessed areas are either bald or sparsely covered. According to the Norwood classification, this is the first stage at which hair transplantation may be considered.

Stage 3 Vertex (Receding Hairline with Crown Thinning): The hairline remains at Stage 2, but significant hair loss occurs on the top of the scalp (crown area).

Stage 4 (Frontal and Crown Thinning): The hairline recession is more pronounced than in Stage 2, with sparse or no hair on the crown. The two areas of hair loss are separated by a band of hair that connects hair on the sides of the scalp.

Stage 5 (Advanced Frontal and Crown Thinning): The two hair loss areas are larger than in Stage 4. Although they are still separate, the hair band between them is narrower and thinner.

Stage 6 (Severe Hair Loss): The bald areas on the temples merge with the bald area on the crown. The hair band across the top of the head is gone or significantly thinned.

Stage 7 (Extensive Hair Loss): This is the most severe stage of hair loss, where the scalp is almost entirely bald, with only a thin strip of hair remaining at the back of the head.

The most common type of genetic hair loss in women is evaluated according to the Ludwig Classification.

• Type 1: Mild hair loss, can be camouflaged and does not require surgical intervention.

• Type 2: Moderate hair loss, hair transplantation may be considered.

• Type 3: Severe hair loss, hair transplantation is recommended.

• Blood thinners such as warfarin and heparin
• Epilepsy medications, especially dilantin
• Gout medications, such as allopurinol and colchicine
• Antihypertensives, diuretics, beta-blockers
• Anti-inflammatories, particularly prednisone
• Cholesterol and lipid-lowering drugs
• Mood-altering drugs like Prozac, lithium, and tricyclic antidepressants
• Chemotherapy
• Thyroid medications
• Oral contraceptives, especially those high in progestin
• Diet pills, street drugs like cocaine, and high doses of vitamin A

Transplanted hair is permanent because it is taken from genetically resistant follicles. When taken from the right donor area, the hair will last a lifetime without shedding.

In hair transplantation, each transplanted unit is referred to as a graft, which can contain 1 to 5 hair strands. For example, if 3000 grafts are transplanted, this amounts to approximately 8000–10,000 hair strands.

Hair transplantation may not be suitable for every patient. Certain health conditions and skin disorders can prevent or complicate the procedure. For a successful and safe hair transplant, the patient should not have the following conditions:

1. Chronic Conditions: Uncontrolled chronic conditions such as diabetes, heart disease, kidney failure, liver disease, and hypertension are contraindications for hair transplantation. Patients with these conditions need a comprehensive evaluation before surgery.
2. Acute Organ Failures: Serious organ conditions like liver, kidney, and heart failure increase the risk of complications during hair transplant. Such patients are not suitable candidates for the procedure.
3. Thyroid Disorders: If thyroid hormones are imbalanced, hair loss may continue, and transplantation may not be effective. Thyroid patients should stabilize their hormone levels and be under medical supervision.
4. Intensive Medication Use: Patients taking strong medications, such as blood thinners, immunosuppressants, or chemotherapy drugs, should avoid hair transplantation. These medications increase bleeding risk and may negatively impact recovery.
5. Hair and Scalp Diseases: Conditions like psoriasis, fungal infections, or active skin diseases may pose risks for hair transplantation. Individuals with these conditions should seek treatment for their skin issues before considering a transplant.
6. Infections or Immune System Disorders: Infections or immune system disorders can hinder the healing process after transplantation. Individuals with compromised immune systems are at higher risk of infection.
7. Severe Hair Loss and Insufficient Donor Area: In some cases, the donor area may not have enough hair follicles for transplantation, particularly if hair loss is extensive. The procedure may be less successful if the recipient area lacks sufficient donor grafts.

In these situations, a thorough evaluation with a dermatologist or hair transplant specialist is essential, and alternative treatment options should be considered.

• The central point of the hairline should be properly aligned with the tip of the nose.
• The distance between the tip of the nose and the midpoint of the eyebrows should equal the distance between the eyebrows and the hairline.
• The distance from each temple corner to the respective eyebrow should also be symmetrical, ensuring that the distance between the right corner and the right eyebrow matches that of the left.
• For older patients, the starting point of the hairline can be set slightly further back to account for age.
• The hairline should not be a straight line; it should have slight irregularities to achieve a more natural look.

• Photos are taken.
• The hair is trimmed, and the area is disinfected.
• Local anesthesia is administered.
• Grafts are collected and stored in a cool environment.
• Channels are created with sapphire-tipped pens, and grafts are placed.
• In the DHI technique, grafts are implanted without channels using special pens.
• Dressing is applied after the transplant.

For a successful and smooth hair transplant process, certain important steps should be followed before the procedure. Here are the essential pre-surgery guidelines:

1. Inform About Existing Health Conditions
   Notify your doctor of any chronic illnesses, contagious diseases, medications, or previous surgeries. This information is vital for preventing potential risks and ensuring the safety of the procedure.
2. Avoid Alcohol, Caffeine, and Smoking
   Avoid substances like alcohol, coffee, cola, energy drinks, and tobacco at least a week before surgery, as these can affect blood circulation and impede healing.
3. Pause Strenuous Activities
   Suspend activities that require physical exertion, such as swimming, running, long walks, fitness, and weightlifting, at least a week before surgery. Physical activities can raise blood pressure and increase the risk of complications during surgery.
4. Stop Blood-Thinning Medications
   Discontinue aspirin or other blood-thinning medications at least a week before surgery, as these can increase the risk of bleeding.
5. Avoid Hair and Scalp Products
   If you are using special shampoos, lotions, or medications affecting the scalp, stop these at least a week before surgery. Hair and scalp cleanliness directly impacts the success of the procedure.
6. Shower Before Surgery
   Since the transplant area should not come into contact with water for the first three days post-op, it’s recommended to shower before arriving for the surgery.
7. Wear Comfortable Clothing
   On the day of surgery, wear comfortable clothes, preferably with a front zipper or buttons, to avoid pulling anything over your head after the procedure.
8. Arrive on a Full Stomach
   Be sure to eat before the surgery to avoid discomfort during the procedure.
9. Treat Any Skin Conditions
   Individuals with dermatitis, fungal infections, or severe acne should complete their treatments for these conditions before considering hair transplantation, as skin disorders can affect the transplant process and delay recovery.

Following these steps can help ensure a smoother and more successful hair transplant experience.

1. Medication Use
   Follow your doctor’s instructions for post-operative medications.
2. Removing the Bandage
   Remove the bandage from the donor area (where the hair follicles were taken) after 24–48 hours.
3. Protect Your Head
   Be mindful to avoid bumping your head, especially when getting in and out of vehicles.
4. Head Position and Swelling
   Keep your head elevated for three days to reduce the likelihood of swelling. Eat protein-rich foods and drink plenty of water.
5. Sleeping Position
   For the first 10 days, sleep on your back and avoid lying on either side to prevent contact with the transplanted area. A U-shaped travel pillow can provide head support while sleeping.
6. Refrain from Sexual Activity
   Avoid sexual activity for the first week following surgery.
7. Avoid Water, Heat, and Sun Exposure
   For the first month, avoid swimming pools, the sea, baths, saunas, and prolonged sun exposure.
8. Avoid Touching or Scratching
   Frequent touching or scratching of the transplanted or donor areas can cause acne and infections.
9. Hair Dryer Use
   After day 15, you may use a hair dryer on a low setting with cool air.
10. Exercise and Physical Activity
    Refrain from sports for the first month. Avoid contact sports like soccer, boxing, and kickboxing that may cause head impact for 45 days.
11. Protect the Transplanted Area
    Avoid scratching, bumping, or hitting the transplanted area.
12. Limit Alcohol and Smoking
    Avoid alcohol while on medications and limit smoking, especially for the first 15 days.
13. Hat Use
    You may start wearing a hat after at least three days, though waiting a full week is recommended.
14. First Haircut
    After three months, trim the hair in the transplant and donor areas with scissors only. From the sixth month, clippers or razors may be used.
15. Hair Dye and Styling Products
    You can dye your hair or use styling products like sprays or gels six months after surgery.

Following these instructions can help accelerate recovery and support the longevity of your hair transplant results.