What NPs and PAs Should Know About Hair Transplantation

August marks Hair Loss Awareness Month, providing an opportunity for dermatology nurse practitioners (NPs) and physician assistants (PAs) to revisit how they counsel patients experiencing hair loss and discuss the growing range of restoration options.¹

Hair transplantation is no longer limited to traditional treatment of male-pattern hair loss. Patients are increasingly seeking eyebrow and beard restoration, while interest is also growing among women and patients pursuing gender-affirming hair procedures.²

In an interview with Dermatology Times, Paul Rose, MD, JD, a board-certified dermatologist at Golden State Dermatology, discussed how hair transplantation is evolving and highlighted several considerations that can help clinicians identify appropriate candidates, set realistic expectations, and prepare patients for the treatment and recovery process.

Hair Transplantation Is Expanding Beyond the Scalp

The 2 primary surgical approaches remain follicular unit transplantation (FUT), also known as the strip method, and follicular unit extraction (FUE). Although FUE has continued to increase in popularity, Rose stressed that both approaches have advantages and disadvantages and that FUT continues to have a role in hair restoration.

At the same time, the areas being treated are expanding.

Rose has seen a marked increase in requests for eyebrow enhancement and beard restoration or alteration. Patients may also seek transplantation in less common areas, including the chest and pubic region.

For NPs and PAs, this means conversations about hair restoration may increasingly arise even when a patient's primary concern is not scalp hair loss.

Before Referral, Consider Why the Patient Is Losing Hair

Not every patient experiencing hair loss is an appropriate candidate for transplantation.

Rose emphasized the importance of obtaining a thorough medical history, including previous medical and surgical conditions and current medications. Depending on the clinical presentation, laboratory testing or a scalp biopsy may be warranted to investigate the underlying cause of hair loss.

The scalp and donor area also require careful evaluation. Hair caliber and density, scalp health, the available safe harvesting zone, and scalp laxity can all influence treatment planning.

Of particular importance are scarring and inflammatory forms of alopecia, which may contraindicate surgery.

For example, Rose cautioned that patients seeking eyebrow transplantation should be evaluated for frontal fibrosing alopecia and associated ulerythema ophryogenes. Even when scarring hair loss appears inactive, transplantation may reactivate the disease and result in loss of implanted hairs.

Clinical Takeaway

When a patient asks about hair transplantation, the first question should not necessarily be which procedure? Establishing the cause and stability of the hair loss can help determine whether surgical restoration should be considered at all.

Set Expectations Before Patients Reach the Surgeon

One of the most important roles NPs and PAs can play is helping patients develop realistic expectations.

According to Rose, patients may request a hairline that is too youthful or expect to regain the density they had earlier in life. However, donor hair is limited, and androgenetic hair loss is progressive.

That makes long-term planning essential.

Using too much donor hair to maximize density in one area may leave fewer options if hair loss progresses. Rose said the goal should be to use the fewest grafts necessary to achieve an attractive result while preserving donor hair for future needs.

Patients should also understand that transplantation does not necessarily eliminate the need for medical management of ongoing hair loss. Rose noted that patients may continue treatments such as minoxidil, finasteride, dutasteride, supplements, or adjunctive approaches such as platelet-rich plasma (PRP) to maintain results and limit additional loss.

FUE Is Not “Scarless”

Another misconception clinicians may encounter is that FUE does not produce scars.

Both FUE and FUT result in donor-site scarring. Rose explained that FUE typically produces small, round, dot-like scars, whereas FUT produces a linear scar.

Undergoing one procedure also does not necessarily eliminate the possibility of undergoing the other later. Depending on the patient's needs and donor area, someone who initially undergoes FUE may later undergo FUT, and vice versa.

This distinction can be useful when counseling patients who arrive with expectations shaped by marketing or information they have encountered online.

Eyebrow Transplantation Requires Different Planning

Eyebrow restoration presents considerations that differ from scalp transplantation.

Scalp hair does not perfectly replicate natural eyebrow hair because the hairs differ in caliber, growth cycle, and growth pattern. Grafts must also be placed at a very acute angle to reproduce the natural direction of eyebrow growth.

Eyebrow and beard restoration generally rely primarily on single- and 2-hair grafts, with density and placement tailored to the treatment area.

Patients should also know that achieving the desired eyebrow density may require a second procedure. In some cases, micropigmentation or microblading may complement transplantation.

Help Patients Understand the Recovery Timeline

Hair transplantation requires patience, and setting expectations about the timeline can prevent patients from assuming the procedure has failed during the early postoperative period.

Rose outlined the general timeline:

• Mild discomfort may occur for 1 to 2 days.
• Forehead swelling may persist for approximately 4 to 5 days.
• Strenuous exercise should generally be avoided for 10 to 14 days.
• Direct sun exposure to the implanted area should be avoided for a couple of months.
• Implanted hairs commonly shed within the first several weeks.
• New growth generally becomes noticeable after 3 to 4 months.
• Substantial growth can be expected around 6 to 9 months.
• Results typically reach their end point at approximately 12 to 14 months.

At the 12- to 14-month point, patients may assess whether they want additional density or treatment of other areas as hair loss progresses.

What Could Be Next for Hair Restoration?

Rose expects hair restoration to continue evolving through a combination of surgical refinement, medications, biologic approaches, robotics, and artificial intelligence (AI).

Potential applications of AI include more precise assessment of hair loss, quantification of hair characteristics and donor-hair availability, and more personalized surgical planning.

Interest is also growing around PRP, exosomes, peptides, compounded scalp formulations, and molecular approaches. However, Rose cautioned against getting ahead of the evidence when discussing some futuristic options with patients.

Despite patient interest in stem cells and hair cloning, current technology cannot produce new hairs from stem cells or truly clone hair.

For NPs and PAs, advances in hair restoration may make familiarity with both surgical and nonsurgical options increasingly important. As patients encounter a growing range of procedures and emerging technologies, clinicians can play an important role in identifying underlying disease, correcting misconceptions, setting expectations, and guiding appropriate referrals.

References

1. American Academy of Dermatology. Hair Loss Awareness Month. AAD Impact. Accessed August 25, 2026. https://www.aad.org/member/publications/impact/2024-issue-3/hair-loss-awareness-month
2. American Society for Dermatologic Surgery. Hair transplants. Accessed August 25, 2026. https://www.asds.net/skin-experts/skin-treatments/hair-transplants