African American Hair Transplant Surgeries: What to Expect

Knox Beasley, MD

Reviewed by Knox Beasley, MD

Written by Grace Gallagher

Published 05/27/2024

When it comes to hair transplants for Black men, there are some unique considerations and challenges patients will face. Unlike straight or wavy hair, African American hair often has tighter curls and lower density (the number of individual strands).

This, paired with a higher risk of scarring for darker skin, means African American hair transplants require attention and skill to minimize adverse effects and yield the best results.

But hair restoration for African Americans is absolutely possible. If you’ve ever heard hair transplants for Black men aren’t effective, know that’s a myth. Because of the curl and thickness of African American hair, it actually may require fewer grafts to get it looking full again.

Below, we’ll cover the types of hair transplants available for African American hair, the causes of hair loss in Black men, and alternatives to hair transplants.

Before we get into hair transplant surgeries for African American hair specifically, let’s begin with hair transplant 101.

A hair transplant is a surgical procedure that moves existing hair from areas of the scalp unaffected by male pattern baldness (usually the sides and back) to areas where hair is thinning or nonexistent.

“Donor hair” is the term for hair (from your own head) that relocates, and the “donor site” is the area it’s taken from. The “recipient site” is where it’s moved.

For a deeper dive, check out our guide to hair transplants.

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While a hair transplant for African American hair can certainly be a success, people with curly, coily, or kinky hair should consider some potentially complicating factors.

We’ll outline specific challenges and nuances of a Black hair transplant that set it apart from hair transplants for Caucasian or Asian folks.

Transection

A curly or afro hair transplant poses a greater risk of transection, when the hair transplant surgeon accidentally cuts the hair bulb at the base of the hair follicle. This means new hairs can’t grow properly (it’s like damaging the bulb of a plant).

Coily or very curly hair tends to curl both above and below the skin. Since it’s not a straight line, it can be difficult to know exactly where the hair bulb is.

Imagine how it would look to cut out both a question mark and an exclamation mark from a newspaper. The piece with the question mark would be wider because of its curved top.

The same is true of curved or curly hair — when curly hair is removed during a transplant, each individual donor area needs to be wider.

While this may not seem like a big deal, it can potentially lead to slightly wider scars.

The good news? Hair transplant technology keeps getting better. A relatively new skin-responsive FUE technique uses a device that adjusts for characteristics like hair curliness, skin thickness, and firmness. Research has found that the device is successful in lowering the rate of transection.

Keloid Scars

Black skin is more likely to develop keloid scars. These are raised areas where scar tissue extends beyond the zone of the original trauma, leading to a raised or puffy appearance.

Keloid scars are harmless. Still, it can be disappointing to spend substantial money and time correcting something about yourself only to have another aesthetic condition replace it.

Keloid scars can be difficult to treat (and there’s not a ton of research on them because they don’t seem to occur in animals). But certain steroids or silicone therapy may help.

Ingrown Hairs

Ingrown hairs are when recently removed strands grow back into the skin instead of growing up and away.

Anyone can experience ingrown hair. But due to the spiral and coarseness, thick, curly hair has an easier time growing back toward the skin.

Ingrowns are more common, generally, in Black people with curly hair who shave. They look like small pus-filled bumps and may be painful to the touch.

Your surgeon should go over exactly how to deal with ingrown hairs in case they crop up during the transplant healing process. But treatment is usually pretty simple and may involve hot compresses or topical ointments.

You should always feel empowered to speak frankly with a hair loss surgeon about any concerns you may have. You can also ask about their experience with African American hair or request to see before-and-after photos of other African American men they’ve treated.

A hair transplant procedure is similar regardless of ethnicity or hair type.

Hair transplants keep evolving and getting better and more sophisticated. Currently, there are two leading approaches to hair transplants:

  • Follicular unit extraction (FUE)

  • Follicular unit transplantation (FUT)

These hair restoration procedures produce similar results but with some noticeable differences, especially in terms of scarring. Here’s how each works.

FUE Hair Transplant

FUE is a newer development in hair restoration surgery. The process involves removing individual hair follicles (sometimes called singular follicular units) and transplanting them in a new area.

The surgeon creates tiny holes (or incisions) in the scalp, known as “micro punches,” to remove hairs with minimal scarring.

FUT Hair Transplant

FUT (sometimes called the strip method) involves removing a strip of existing hair from the back of the head, called the occipital scalp.

Follicles are then extracted from the strip using a microscope and placed into the thinning areas of the scalp.

Is FUE or FUT Better for African American Hair?

Both FUE and FUT have their advantages and disadvantages, but FUE is likely a better choice for African American hair. Your surgeon can help you decide which hair transplant method is best for your hair type and goals.

One thing that sets an FUE hair transplant apart from FUT is that it doesn’t leave a large noticeable scar.

Instead, the process creates hundreds of tiny scars easily covered by thick or dark hair. In many cases, the scars are so tiny that they may not even be noticeable if you wear your hair buzzed.

On the other hand, FUT leaves a linear scar, which could potentially turn into a keloid scar and may be noticeable with shorter hair.

Black hair is often thick and curly, which could cover a scar. Still, if you plan to wear your hair buzzed or close-cropped, FUE for African American hair is probably your best bet.

That said, one benefit of FUT over FUE is that transplanted hairs tend to have a higher survival rate.

In terms of recovery time, there’s not a huge difference between FUE and FUT. With FUT, the donor area heals in two to three weeks, and with FUE, surgical sites generally heal in one to two weeks.

The FUE procedure itself takes longer but can lead to exceptional results, according to some researchers.

For all the possible challenges of African American hair transplants, there are some advantages as well.

  • The low color contrast between the scalp and hair helps transplanted hair blend seamlessly, producing a natural-looking result.

  • While African American hair is technically less dense than Caucasian or Asian hair (meaning there are typically fewer follicles on the head), Black hair transplants often require fewer grafts to restore the look of hair. The curly nature of the hair creates the look of density and covers more of the scalp.

  • Hair transplants are sometimes priced per graft. Needing fewer grafts can save you money.

If you’re here, you’ve probably never had a hair transplant and are wondering what it’s like. Here’s what you can expect before, during, and after a hair transplant.

Before and during:

  • You’ll be asked to wash your hair and scalp with a surgical wash.

  • You’ll get local anesthesia on your scalp. (The procedure shouldn’t be painful, though you may feel some pulling or tugging.)

  • Hair grafts are prepared either by taking hair from the strip (with FUT) or directly from the scalp (with FUE). To save time, more than one healthcare provider may place your hair grafts.

  • The hair transplant process typically takes four to eight hours and will likely require several sessions.

After:

  • You can go home on the day of surgery. Your scalp may or may not be bandaged (some surgeons prefer a bandage, but it needs to be changed extremely carefully).

  • You might notice swelling or pain in the donor sites and the areas where the hair was transplanted.

  • Your surgeon will provide specific instructions on when to change the dressings and how long to wait before washing your hair and exercising. (In general, you should be able to wash your hair within two to three days after the transplant.)

  • Be diligent with aftercare, and avoid scratching or rubbing your scalp to prevent scarring or infection.

  • You’ll need to avoid wearing hats or even pullover clothing for several weeks.

  • Stitches will be removed by a healthcare professional seven to 10 days after surgery.

  • The transplanted hair will fall out two to eight weeks after surgery. Don’t panic — this is normal and expected. You should start to see regrowth within two to three months, with full results in six to 12 months.

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Before the procedure, your surgeon will discuss any possible side effects of hair transplant surgery with you. Common complications may include:

  • Pain and swelling

  • Infection

  • Scarring

  • Cysts

  • Bleeding

  • Anesthesia complications

  • Heart problems during surgery

  • Keloid scars

  • Persistent numbness

  • Folliculitis (inflamed hair follicles)

  • Patient dissatisfaction

Hair transplants can be very successful and, if done well, a permanent solution. But it’s important to have realistic expectations and know about possible complications and side effects beforehand.

The causes of hair loss across ethnic groups are similar. But we’ll highlight some common causes of hair loss in Black men specifically.

Male Pattern Baldness

Androgenetic alopecia (that’s male pattern baldness) is the most common cause of hair loss in all men, affecting around 85 percent of men, according to some estimates.

It’s more common in white men than other races and ethnicities. Still, it’s the most common cause of balding or thinning hair among Black men.

Male pattern baldness is caused by a mixture of hormones and genetics — specifically, a genetic sensitivity to the male hormone known as DHT (dihydrotestosterone), a byproduct of testosterone.

DHT does two things to cause hair loss:

  • It shortens the anagen (growth) phase of the hair growth cycle.

  • DHT-affected hair becomes thinner, shorter, and more fragile, ultimately making hair follicles stop producing new hair.

Typically, male pattern baldness follows a pattern of thinning at the hairline in an M-shape before spreading toward the crown of the head.

Traction Alopecia

Traction alopecia is most common in people of African descent, especially women. But it can affect people of all races and sexes.

This type of hair loss is caused by continuous pulling at the roots, which is often the result of certain tight hairstyles, like braids or dreadlocks.

Over time, it can damage the hair follicle to the extent that new hair stops growing.

Other Potential Causes of Hair Loss in Black Men

We highlighted two common causes of hair loss, but there are actually many reasons you may be losing your hair.

Other potential causes of hair loss include:

A healthcare provider can help you figure out what’s causing your hair loss.

As hair transplant technology continues to evolve, the procedures grow in popularity. But it may not be the right choice for all men, as surgery is invasive and expensive. A 2021 study found that the average total cost of a hair transplant in the U.S. is $13,610.

Fortunately, less invasive and more affordable hair loss treatments are available.

Minoxidil and finasteride are approved by the FDA (U.S. Food and Drug Administration). There are also products and low-risk procedures that can help treat hair loss. Here’s what to know.

Finasteride

Finasteride lessens DHT. Many hair transplant patients are actually prescribed finasteride to slow the loss of surrounding hair.

So it’s always a good idea to get a jumpstart on finasteride, whether you go through with a hair transplant procedure or not.

Minoxidil

Minoxidil is a vasodilator, bringing blood flow and oxygen to the scalp. It also seems to widen the diameter of hair follicles, which can create thicker hair.

We offer minoxidil foam and minoxidil liquid solution.

You can also use minoxidil after a hair transplant — just make sure to get the green light from your surgeon first.

Minoxidil and Finasteride Together

If you don’t want to choose between finasteride and minoxidil, that’s actually a good thing. Research shows the two ingredients are more powerful together than either alone.

You can try our dual-action topical finasteride & minoxidil spray.

Platelet-Rich Plasma Therapy

Platelet-rich plasma (PRP) therapy involves injecting your own blood platelets into your scalp. It may boost the success of an FUE transplant, according to some research.

Of 20 people in a group treated with PRP during their hair transplant procedure, 75 percent saw hair regrowth at six months — whereas only four in the control group saw that level of regrowth.

Hair Products

Hair products can’t restore hair growth quite the same way as medication. But they can definitely make your hair appear fuller, at least temporarily, and for some people, that’s good enough.

Here are a few options to try:

  • Biotin supplements. If you suspect you’re deficient in biotin or a blood test confirms it (rare but possible), biotin gummies can help. Biotin is crucial for the production of keratin, the protein that makes up hair, skin, and nail tissue.

  • Volumizing shampoo. Our volumizing shampoo contains biotin and caffeine, which — quite literally — turn up the volume of hair at the root, making it look fuller and denser.

  • Saw palmetto shampoo. Our thickening shampoo with saw palmetto helps plump up your hair so it seems fuller. Saw palmetto is kind of like nature’s finasteride in that it slows the conversion of testosterone to DHT.

Hair loss treatments, delivered

Hair transplants for Black hair can definitely be successful and are worth considering in certain cases of hair loss.

Here are a few takeaways:

  • There are challenges associated with African American hair transplants, including the potential for transection, keloid scarring, and ingrown hairs.

  • There are also advantages to African American hair transplants, including the need for fewer grafts.

  • It’s important to speak to your surgeon about their experience performing Black hair transplants and how they account for hair curliness, skin thickness, and firmness, which are essential for achieving natural-looking results.

If you’re considering hair loss treatment options but aren’t sure where to start, check out our guide to dermatologist-recommended hair growth products.

If you’re ready to take the next step (or even just learn more about your options), our free online consultation will connect you with a hair growth specialist who can recommend medications and other treatments.

20 Sources

  1. American Academy of Dermatology (AAD). (n.d.). A hair transplant can give you permanent, natural-looking results. https://www.aad.org/public/skin-hair-nails/hair-care/hair-transplant
  2. Allah KC, et al. (2013). Keloid Scars On Black Skin: Myth or Reality. https://pubmed.ncbi.nlm.nih.gov/22542368/
  3. Birnbaum M, et al. (2018). Evaluation of Hair Density in Different Ethnicities in a Healthy American Population Using Quantitative Trichoscopic Analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219221/
  4. Chen L, et al. (2019). The Efficacy and Safety of Finasteride Combined with Topical Minoxidil for Androgenetic Alopecia: A Systematic Review and Meta-analysis. https://cdn.mednet.co.il/2012/05/the-efficacy-and-safety-of-finasterideminoxidil.pdf
  5. Chike-Obi C, et al. (2009). Keloids: Pathogenesis, Clinical Features, and Management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884925/
  6. Fisher J. (2005). Revision of the Unfavorable Result in Hair Transplantation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884704/
  7. Gentile P, et al. (2015). The Effect of Platelet-Rich Plasma in Hair Regrowth: A Randomized Placebo-Controlled Trial. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622412/
  8. International Society of Hair Restoration Surgery (ISHRS). (2019). Harvesting of donor hair for hair transplants. https://ishrs.org/2003/10/01/harvesting-of-donor-hair-for-hair-transplants/
  9. Kerure A, et al. (2018). Complications in Hair Transplantation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371733/
  10. Khanna, M. (2008). Hair transplantation surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825128/
  11. Kinter K, et al. (2023). Biochemistry, Dihydrotestosterone. https://www.ncbi.nlm.nih.gov/books/NBK557634/
  12. Knoedler L, et al. (2023). Hair Transplantation in the United States: A Population-based Survey of Female and Male Pattern Baldness. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10642908/
  13. Mohmand M, et al. (2018). Effect of Follicular Unit Extraction on the Donor Area. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066700/
  14. Mysore V, et al. (2021). Hair Transplant Practice Guidelines. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611706/
  15. Patel D, et al. (2017). A Review of the Use of Biotin for Hair Loss. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582478/
  16. Sharma R, et al. (2019). Follicular Unit Extraction (FUE) Hair Transplant: Curves Ahead. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795649/
  17. Suchonwanit P, et al. (2019.) Minoxidil and its use in hair disorders: a review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691938/
  18. Tanus A, et al. (2015). Black women's hair: The main scalp dermatoses and aesthetic practices in women of African ethnicity. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560533/
  19. Umar S. et al. (2023). Follicular Unit Excision in Patients of African Descent: A Skin-Responsive Technique. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10521773/
  20. Zito PM, et al. (2021). Hair Transplantation. https://www.ncbi.nlm.nih.gov/books/NBK547740/
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Knox Beasley, MD

Dr. Knox Beasley is a board certified dermatologist specializing in hair loss. He completed his undergraduate studies at the United States Military Academy at West Point, NY, and subsequently attended medical school at Tulane University School of Medicine in New Orleans, LA. 

Dr. Beasley first began doing telemedicine during his dermatology residency in 2013 with the military, helping to diagnose dermatologic conditions in soldiers all over the world. 

Dr. Beasley is board certified by the American Board of Dermatology, and is a Fellow of the American Academy of Dermatology.

Originally from Nashville, TN, Dr. Beasley currently lives in North Carolina and enjoys spending time outdoors (with sunscreen of course) with his wife and two children in his spare time. 

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