Recipient Site Design in FUE Hair Transplant
Recipient site design is the step that separates natural-looking results from obvious transplant work. The surgeon creates tiny incisions in the balding area, and every decision about angle, direction, depth, and spacing at this stage determines how your hair will grow for the rest of your life. Even with perfect graft extraction and a 90 to 95% survival rate, poor site design produces disappointing outcomes.
What Are Recipient Sites?
Recipient sites are the small incisions (also called slits or channels) made in the scalp where extracted grafts are placed. Each incision is created with a fine blade or needle, typically 0.6mm to 1.5mm in size depending on the graft type.
The surgeon makes hundreds to thousands of these sites before the implantation team places grafts into them. In a 2,500-graft procedure, that means 2,500 individual incisions, each requiring precise control over four variables.
The Four Variables of Site Design
1. Angle
Natural hair does not grow straight up from the scalp. It exits at an angle, and that angle changes across different zones of the head.
| Scalp Zone | Natural Growth Angle |
|---|---|
| Hairline | 10 to 15 degrees (nearly flat) |
| Mid-scalp | 30 to 45 degrees |
| Crown/vertex | Spiral pattern, 45 to 60 degrees |
| Temples | 10 to 20 degrees, pointing forward and down |
If sites are created at the wrong angle, the transplanted hair grows in an unnatural direction. Hair that sticks straight up at the hairline is one of the most visible signs of a poor transplant.
2. Direction
Direction refers to the compass orientation of hair growth. On the top of the head, hair generally points forward. At the crown, it grows in a whorl or spiral pattern. Along the temples, it points downward and slightly forward.
A skilled surgeon maps the patient's existing hair direction in surrounding areas and replicates that pattern in the recipient sites. This requires constant adjustment as the surgeon moves across different zones.
3. Depth
Each incision must reach the correct depth in the dermis. Too shallow, and the graft sits high, producing a "cobblestoned" surface or grafts that fall out. Too deep, and the graft sinks below the surface, leading to buried hairs or cyst formation.
The ideal depth matches the natural position of surrounding follicles, typically 3 to 5mm depending on scalp thickness.
4. Density and Distribution
Density refers to how many sites are created per square centimeter. Natural hair density varies by ethnicity:
| Ethnicity | Natural Density (FU/cm2) |
|---|---|
| Caucasian | 170 to 230 |
| Asian | 140 to 200 |
| African | 120 to 180 |
| Hispanic | 145 to 195 |
| Middle Eastern | 150 to 210 |
A transplant cannot always match native density in a single session, especially for patients at higher Norwood scale classification stages where large areas need coverage. Surgeons typically aim for 30 to 50 FU/cm2 in the first session, which creates the appearance of meaningful coverage when combined with proper angle and direction.
Strategic distribution matters too. Placing more grafts along the hairline and gradually reducing density toward the crown creates a natural gradient effect.
Hairline Design: The Most Visible Decision
The hairline is where recipient site design is most critical. A natural hairline has these characteristics:
- Irregularity: Natural hairlines are slightly jagged, not ruler-straight
- Single-hair border: The front row uses only single-hair follicular units
- Gradual densification: Density increases as you move 1 to 2cm behind the leading edge
- Age-appropriate placement: The hairline should match your age, not recreate your teenage hairline
Most surgeons draw the hairline design before surgery and review it with the patient. This is your opportunity to provide input. Ask to see the design from multiple angles and while sitting upright (not just lying down).
Crown and Vertex Considerations
Crown work requires special attention to the whorl pattern. Every person has a natural spiral at the crown, and the recipient sites must replicate this pattern. Multi-hair grafts (2 to 4 hairs per unit) are typically used in the crown for maximum density.
The crown is also the hardest area to achieve full coverage because:
- The viewing angle makes thinning more visible
- The spiral pattern requires site direction changes every few millimeters
- Hair grows away from the center in all directions
What Can Go Wrong
Common recipient site design errors include:
- Straight-line hairline: Looks artificial, especially as surrounding hair continues to thin
- Wrong angle at temples: Hair sticking outward instead of lying flat
- Uniform density: Same spacing everywhere looks unnatural
- Ignoring the whorl: Crown grafts that grow in parallel lines instead of a spiral
These errors are permanent. Unlike extraction issues that heal over time, site design flaws show in the final result and often require corrective surgery.
Assess Your Stage Before Consulting
The amount of area requiring recipient sites depends entirely on your current hair loss stage. Getting an objective assessment before your consultation means the surgeon can spend more time discussing design specifics and less time on basic classification.
Use the free AI-based hair loss assessment at myhairline.ai/analyze to get your Norwood stage from photos. That data helps you and your surgeon plan the most effective site design strategy.
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult a board-certified dermatologist or hair restoration surgeon before making treatment decisions.