Surgical Restoration

Mustaches and beards can be restored or thickened by transplanting the grafts from the scalp. The only difference is that the recipient area is not in the scalp, but in the face. However, the procedure is somewhat more sophisticated and laborious than in the case of the normal hair transplant and it requires more time as well. After the initial period, when the transplanted hair is lost and the follicles start to produce the new hairs (this whole procedure takes about 3 months) the mustache and the beard can be cut, shaved and generally handled in the same way as a natural mustache or beard.

Beard and mustache hair transplants:

There are a variety of reasons patients choose this type of transplant, and many suffer from the following: Scars due to trauma, burns, or surgery, traction alopecia (especially in Indian Sikh population), congenital hypotrichia/atrichia, post-folliculitis scarring, long-standing alopecia areata. In addition, many men simply want to improve the density in certain areas of their beard or mustache depending on certain styles they would like.

How does it differ to scalp hair transplants: It is slightly different from scalp hair transplantation. But before going into the details of the procedure, it is imperative to review the anatomy of the beard and the difference between the characteristics of the scalp and beard hair. Beard and moustache hairs consist of mainly single-hair follicular units. The beard growth starts during puberty, under the influence of androgens, and increases in density until the mid- 30s. This is in contrast to the scalp, where the increased action of androgens causes hair loss.

There are differences among different ethnic groups. Indian and Middle Eastern men have denser beards. Caucasians and Africans also have good density; they have more hair in the beard compared to Orientals.

Is the planning of a case of facial hair transplant different from that of scalp?

The basic principles of hair transplantation are the same but need to be planned in a different way. The surgeon needs to examine the whole face in detail when figuring out how many grafts will be required for every area of the beard and mustache that needs reconstruction.

We can harvest donor follicles using strip harvest (FUT) for facial hair reconstruction or follicular unit extraction (FUE). Beard- to-beard is done if small scars are to be reconstructed requiring less than 100 grafts or for moustache reconstruction and the patient is willing to take grafts from the area under the chin. For the rest of the cases, scalp-to-beard is preferred.

Pre-operative planning

Treatment goals in beard restoration are often set by the patient. Patients typically present with a rather specific understanding of how they want their facial hair to appear. A patient’s goals may vary from increasing the density of an existing beard or mustache while maintaining the same shape, to transplanting full beards/mustache where very few hairs exist. The design and density of the beard may be limited by the quality and quantity of the donor area. Transplantation of full beards requires large amount of grafts and patients are always made aware of the possibility of undergoing secondary procedures after around one year if further density is desired. These grafts, it must be made clear, once transplanted will no longer be available for use in the scalp in the future if male pattern hair loss is to develop. Regardless of the donor technique used, patients are made aware of the potential limitations of the donor hair quantity and therefore “size” and density of the beard which can be achieved through solely one procedure. It is our experience that the scalp hair transplants to the face have a very high regrowth percentage and if properly performed patients can achieve a very natural outcome. Patients who desire facial hair restorations, in general, express a very specific desire for how they want their beard designed.

The Procedure:

Like for eyebrows the donor follicles can be harvested using a strip technique or follicular unit exraction technique. In order to perform large sessions of FUE, the entire donor area must be shaved. However for most mustache and partial beard restorations limited shaving is sufficient. Only in cases of full beard restoration does one need to shave the entire donor area. In contrast, with FUT using strip harvesting, the donor incision can be covered with hair – even with very large sessions.

Normal events associated with the procedure

  1. Scabs – On the first day following your procedure, small scabs the size of a pinhead surrounding the transplanted hair follicles will likely be visible. They may look like little grains of sand. Scabs protect the grafts from shifting upwards and protect against infection. Every patient is different, but in general the scabs and the transplanted facial area redness or pinkness goes away anywhere between a few days to around 2 weeks. When the scabs fall off, the short hairs that were implanted will generally fall out too. This is to be expected. The follicles are alive and healthy under the skin and new hairs will begin to grow in about 3-4 months. Any follicles that did not fall off with the scabs will grow for 3-6 weeks and generally shed. If crusts are not going away by day 7-10, place a warm, wet compress over the transplanted facial area for 10 minutes prior to showering. Repeat this until crusts are gone. You may notice that your scabs turn white and/or swell. This is because they have 4 become waterlogged. This is not a cause of concern. Do not pick or scratch the scabs, as doing so can cause infection and endanger the survival of the grafts. If scabbing persists beyond 14 days, you may not be shampooing vigorously enough. It is important to note that the transplanted hair will be fully embedded after 7-10 days
  2. Pinkness or Redness – In most patients, mild pinkness or redness over the donor scar and transplanted facial area fades in a few days to 2 weeks; however, on rare occasions there have been some patients that will hold redness in the recipient area for up to 8 weeks or more, especially if they have fair skin.
  3. Mild Pain – Generally, most of the discomfort that you will feel will arise from the tightness in your scalp if you underwent an FUT procedure (the strip method). The tightness and/or tenderness will be present both in the transplanted area as well as in the area where the donor grafts were taken. Your symptoms will gradually improve over a few days to weeks. Patients who have undergone the FUE procedure will have some soreness and discomfort along the donor area for a few days. You have been provided with prescription pain medication. Please take as directed.
  4. Bleeding – It is normal to slightly ooze (red “spotting”) either from the recipient sites or donor area for the first 24 hours. If slight bleeding occurs along the donor area, apply firm pressure with the palm of your hand using gauze moistened with tap water, for 15-20 minutes. If bleeding does not stop with firm pressure for 20 minutes, please call our office.

Rare events following your procedure

  1. Dislodged Grafts – Please make sure to not bump your face, donor area or cause any friction to the grafts. If a graft is actually dislodged (something that may occur the first few days following the procedure) there will be bleeding at the site of the lost graft. If you have excessive bleeding – DO NOT PANIC. Apply steady pressure to the area for 15 minutes with a slightly damp towel or gauze without rubbing the area. If the hair graft is clean, put it in normal saline solution (purchased at any pharmacy) or in a wet gauze and call for an appointment (within 1-3 days) for reinsertion. If you see scabs falling off with hair attached and you are NOT bleeding, this is NOT the graft.
  2. Ingrown Hairs – Ingrown hairs are pimple-like lesions that can occur within the two weeks to the first few months following hair transplantation. Occasionally, a patient may develop this as the new hair is beginning to grow through the surface. If this happens, apply a warm, moist cloth to the area for 10 minutes, three times a day to bring them to a head. You may safely “pop” them like pimples, but do NOT pick or scratch the area. You can also apply over-the-counter benzoyl peroxide preparation to the area two times each day for 3-5 days to help clear these up quickly. If after 3-5 days there is no relief please contact the office, as you may need to be seen to have the ingrown hair removed by our staff. In addition, if at any point the area becomes reddened, swollen, tender, or you notice multiple red or puss-filled pimples, contact the office.
  3. Infections – Infections are extremely rare. To avoid infection, avoid exposure to dirt and debris for several days after the procedure. If you do develop inflammation and/or infection of the hair follicles of the skin, please notify our office immediately. Most common symptoms include multiple red or white head-like pimples associated with surrounding redness, severe itching, mild pain, tenderness, and possible discharge. If you develop these symptoms, please call our office as you may require topical and/or oral antibiotics.
  4. Hair Shedding (“Shock” Shedding) – Shock shedding is a normal physiological process in which there is temporary or uncommonly permanent shedding of hair around the donor area (back of the scalp) in response to the stress of the surgical procedure itself. It usually begins within the first 3 months after the procedure. Please don’t be alarmed. More often than not the hair that has gone into shock will grow back after 3-4 months (rarely after 6-12 months).
  5. Changes in Hair Texture – Infrequently, there is some textural change in the transplanted hair. It may become curlier than it was, or even somewhat wiry; often the luster of the hair is also diminished if this altered texture occurs. This phenomenon is temporary, and resolves with the normal growth cycles of the hair often in 12 to 18 months.

Average recovery and hair growth timeline after hair transplantation

Saline sprays are advised for the first 48 hours and a restriction of washing face for this time following surgery. The first wash is done under supervision and after this you may begin washing your face as directed. Begin using the normal saline spray as directed. Expect some soreness, tightness and possibly some numbness. There will be some oozing in the donor area.

Moderate redness and scabs will form on the recipient area in the first two days. Some swelling may appear on the face. Soreness begins to improve by the third to fourth day. Some swelling may appear at this time.

By the end of the week the swelling would have usually subsided. Anywhere between 7-10 days scabs begin to flake off and the patients may begin normal face washing. Soreness is generally gone. FUE: The donor area is usually healed.

After 10 days the grafts are held well and now any residual crusting may be gently scrubbed off. The recipient area appears pinkish lighter than earlier and patients who have undergone strip harvest will have their sutures removed at 10-14 days.

In the next 3-4 weeks most of the transplanted hair would be shed. After this period the patient would be allowed haircuts or hair color.

After this period the transplanted area appears as it was before the surgery and by the end of 3-4 month small hairs will be seen growing.Most of the hair would be growing by 9-12 months.