A: When the scalp is tight, it can be useful for either the first or the second hair transplant.

Keep in mind, however, that the scalp will naturally stretch between hair transplant procedures, so that if exercises were not needed for the first procedure, they will generally not be needed for the second.

In our practice, we generally wait one year between hair restoration sessions so that we can see the full cosmetic impact of the first procedure and give the scalp laxity a chance to return to normal on its own.

In addition, there is a risk that active massage after the first procedure may widen the donor scar. Therefore, before considering massage before a second hair transplant, make sure that enough time has elapsed between procedures so that stretching of the scar will not be a be a problem.

In general, since the scalp will normally continue to relax for up to a year after a procedure, it makes sense that when there is a tight scalp, one should wait at least a year before considering the next hair transplant session. If massage is contemplated, it should be started one year after the prior procedure. This will give the scalp a chance to loosen naturally and will ensure that the massage will not stretch the donor scar.

In my opinion, it is a mistake to plan hair restorations sessions too close together in patients where scalp laxity is a constraint.

A: For the majority of patients, scalp exercises are not necessary.

The scalp in the donor area has a fair amount of redundancy. With a properly planned hair transplant, the donor area will close relatively easily.

If a patient’s scalp is particularly tight, or if a very large session is planned (even in the face of an average scalp), vigorous scalp exercises are useful in increasing laxity.

The advantage of stretching one’s scalp prior to surgery is that it allows the doctor to remove a slightly wider strip and it decreases tension on the closure so the person will heal with a potentially finer scar.

A: The scalp is very resilient to stretching, particularly in those with a loose scalp to begin with. After removing a strip, the laxity often returns to normal or very close to it within 6 months to a year.

The problem with multiple hair transplant procedures is not only that scalp laxity may decrease, but that the donor density decreases as well. If too much hair is harvested, the donor area may eventually appear too thin. This may happen with either Follicular Unit Transplantation (FUT) or Follicular Unit Extraction (FUE).

Therefore, it is important the doctor not only assess the scalp laxity, but the residual donor density.