Afro hair transplants– here’s all you need to know

Image: Andrey_Popov/

Black women suffer inordinately from hair loss, because of hair styling practices and hereditary factors, yet no one seems to be talking about hair transplant options for them. Until now…

Dr. Serkan Aygin is a member of the International Society of Dermatology, with over 23 years of experience in hair transplantation. Established under his name, his Turkey-based clinic has earned its reputation as a centre of innovation in the hair transplantation industry. In this article he breaks down what hair transplants look like for African Caribbeans with natural afro hair textures.

Dr. Serkan Aygin with staff from the clinic

The lack of articles online covering what hair transplants on afro hair would have you think that African-Caribbeans aren’t suitable candidates for the procedure. This is quite far from the truth; in fact people with afro hair are arguably better candidates for a successful hair transplant, for reasons I shall explain later. Over the years, I have found that hair loss sufferers of black descent particularly are less confident in their eligibility for hair transplantation, so I’m hoping this article will be informative, and help to debunk this myth.

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One of Dr Serkan’s patients shows the results of her successful hair transplant

How hair transplants work
As reported by WebMD, one of the leading causes of hair loss in black women is a condition called central centrifugal cicatricial alopecia (CCCA). In the black community particularly, wigs and hair extensions are ironically the ‘cure’ and the cause of hair loss– traction alopecia is caused by tight hairstyles that eventually cause permanent damage to the hair follicle, and the best way to hide the damage is by covering it with… wigs and hair extensions. 

With alopecia being such a rampant issue for black women, hair transplants are particularly relevant as hair transplantation is the only real permanent solution for hair loss. By nature, hair transplants are permanent because hair follicles are extracted from “safe donor areas”, which refers to areas on the head that are genetically resistant to balding, then implanted back into balding areas. Eventually these hairs grow, and retain their balding-resistant qualities, so they stay intact and essentially restore the patient’s curls to its former glory.

There are two main methods for hair transplants:

FUE (follicular unit extraction) transplantation method
This is the most popular method. The classic FUE method involves a two-step process. First, the surgeon collects the hair follicles from safe donor areas, in a natural pattern that is discrete. The second step is to make the incisions and implant the extracted follicles into the recipient site, again in a natural and homogenous pattern.

DHI (direct hair implantation) transplantation method
This method is similar to the FUE technique, but instead the surgeon uses Choi implanters to perform the procedure. The Choi implanter is a piece of surgical equipment that allows for recipient site creation and follicle implantation to happen simultaneously, as part of a one-step process, i.e. the Choi implanter embeds the extracted hair follicles directly into the targeted areas without any prior preparation. Results using the DHI method tend to look more natural as the surgeon has full control of depth, direction and angle of placement of each graft.

The DHI method is more commonly used for hair transplants for women, eyebrows and beards. Reason being that Choi pens allow for incredible precision, meaning that fewer surrounding hair follicles are damaged during the extraction and implantation process, thus leading to a more dense end result.

You may find many other named methods for hair transplants offered by different surgeons, but usually they are simply a variation of the two methods listed above. Hair transplant surgery has seen much innovation over the years, so many surgeons have introduced their own variations of classic methods. For example at the Dr. Serkan Aygin Clinic, we have introduced the Soft FUE method, a technique that combines traditional methods in order to completely eliminate painduring the procedure using soft sedation before introducing any needles for administration of a smaller quantity of local anaesthesia.

Another variation offered at the Dr. Serkan Aygin clinic is the Sapphire FUE which replaces the usual steel blades used during FUE procedures with blades made from sapphire, which allow for faster healing post-operation. These blades are designed to minimize scab formation and speed up the recovery process as they require much smaller incisions within the recipient’s scalp for transplantation. Sapphire FUE is a great choice for cases of general balding, as these cases tend to be more extreme, and Sapphire FUE allows for filling larger areas much faster than other variations of FUE.

Differences by race and hair texture
In medical literature, while it can vary, human hair is generally classified under three different ethnic groups: African, Asian and Caucasian. Despite the fact that the chemical and protein structure of hair is the same in all three groups, they differ in terms of hair growth pattern, hair density and hair shaft diameter.

A study by L’Oréal on diversity of hair types summarises these differences well:

• African hair is characterized by both slow hair growth and low hair density

• Asian hair also has a low/moderate density but grows very fast

• Caucasian hair grows at an intermediate rate per day and is very dense

African hair tends to have the slowest hair-growth pattern and the lowest hair density of the three groups. The most important criterion that determines the eligibility of a person for hair transplantation is the hair density in the donor area.

African-Caribbeans usually have grafts with triple hair follicles, while Asians have double and Caucasians have grafts with triple and quadruple hair follicles. Afro hair textures also tend to have a thinner hair shafts, which is sometimes surprising because of how voluminous afro hair appears to be– this is because of the kinky/curly texture of afro hair.

Thankfully this means that procedures performed on afro hair textures require fewer hair grafts transplanted to obtain a voluminous appearance. Essentially black people who undergo hair transplant surgery will have fewer scars to heal and overall less trauma to the scalp.

Key things for to consider before opting for a transplant
In addition to hair texture, the strength of the tissue surrounding the hair follicle is a significant factor that can determine how many grafts are damaged during the extraction process— this is referred to as the transection rate. Stronger skin around the hair follicle will require the surgeon to apply more force when extracting, which can sometimes cause rupture and damage to the hair follicle. In African-Caribbeans, the epidermis layer (upper skin) that surrounds the hair follicle externally is thicker and tighter compared to other ethnic groups, so high transection rates are more likely.

There’s also the risk of keloid development on scars during the healing process— this excess of healing tissue produced by the body after wounds are already fully healed, is more common in African-Caribbeans than in other ethnic groups.

It is of course possible to achieve successful hair transplant results for patients with afro hair, and there are endless case studies of success across a number of surgeries and clinics. It is however important for African-Caribbean people in particular to ensure that their surgery is performed by an experienced hair transplantation specialist who is experienced with afro hair, and a professional team with modern equipment, proper technique and care.

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