Hair transplants last permanently at 5 years and beyond. Transplanted follicles maintain a 90% to 95% survival rate at the 5-year mark because they are harvested from the DHT-resistant donor zone. The real challenge at year 5 is not graft loss but the continued progression of native hair thinning in untreated areas, which can create visible contrast between transplanted and non-transplanted zones.
This article is for informational purposes only and does not constitute medical advice.
Are Transplanted Hairs Still Growing at Year 5?
Yes. Transplanted follicles retain the genetic characteristics of the donor area permanently. They do not become susceptible to DHT-driven miniaturization just because they were moved to the recipient zone. This principle, known as donor dominance, is the biological foundation of hair transplantation and has been validated in clinical studies spanning over 30 years.
At 5 years, transplanted hairs have completed roughly 5 to 7 full growth cycles. Each hair goes through anagen (growth), catagen (transition), and telogen (resting) phases lasting 2 to 6 years for the growth phase alone. The hair you see at year 5 is thicker and more established than at year 1 because the follicle has fully adapted to its new location.
5-Year Results by Norwood Stage
| Starting Stage | Grafts Used | Transplanted Zone at 5 Years | Common Native Hair Changes |
|---|---|---|---|
| NW2 | 800 to 1,500 | Stable, excellent density | Minimal change if on finasteride |
| NW3 | 1,500 to 2,200 | Stable, natural hairline | Possible mid-scalp thinning |
| NW4 | 2,500 to 3,500 | Stable, good frontal density | Crown may need attention |
| NW5 | 3,000 to 4,500 | Stable, but native thinning visible | Likely needs maintenance therapy |
| NW6 | 4,000 to 6,000 | Stable, second session often done | Progressive native loss expected |
| NW7 | 5,500 to 7,500 | Stable, maximum coverage achieved | Ongoing loss in remaining areas |
The Contrast Effect
The most common concern at 5 years is not that transplanted hair has failed but that surrounding native hair has continued to thin. This creates a visible contrast where the transplanted zone looks denser than the areas around it.
For patients who started at Norwood 3 and did not use finasteride, the typical progression is to Norwood 4 or 4A by year 5. The transplanted hairline remains intact, but the mid-scalp behind it may show noticeable thinning. This is why virtually every hair transplant surgeon recommends long-term finasteride use to protect native hair.
Patients Who Used Maintenance Therapy
Patients who maintained finasteride (80% to 90% effective at halting loss) and/or minoxidil (40% to 60% effective at promoting regrowth) throughout the 5-year period consistently report better overall results. Their native hair remains stable, the transplanted zone blends naturally, and there is no visible contrast line between treated and untreated areas.
| Maintenance Plan | 5-Year Outcome |
|---|---|
| No treatment | Transplanted zone stable, native hair likely thinner |
| Finasteride only | Transplanted zone stable, native hair mostly preserved |
| Minoxidil only | Transplanted zone stable, some native hair regrowth |
| Finasteride + minoxidil | Transplanted zone stable, best native hair preservation |
| Full stack (fin + min + PRP) | Transplanted zone stable, maximum overall density |
Long-Term Graft Survival: The Data
Published studies on long-term graft survival consistently show that properly transplanted follicles remain viable indefinitely. The 90% to 95% survival rate established at 12 months does not decline at 5, 10, or 20 years because these follicles are genetically programmed to grow regardless of their scalp location.
Factors that can compromise long-term graft survival include trauma to the scalp (injury, burns), certain autoimmune conditions (alopecia areata), and extremely rare cases of surgical technique failure where follicles were damaged during extraction or placement.
For the vast majority of patients, every graft that survived the initial healing period will continue producing hair for life.
Do You Need a Second Transplant at Year 5?
Whether you need additional work at 5 years depends entirely on your starting Norwood stage and whether you have been on maintenance therapy.
Unlikely to need a second session: Norwood 2 to 3 patients who started finasteride. These patients typically have excellent 5-year results with stable native hair and a dense transplanted zone.
May benefit from a touch-up: Norwood 4 to 5 patients who want to add density to the crown or mid-scalp. A second session of 1,000 to 2,000 grafts can address areas that have thinned since the first procedure.
Often plan for additional sessions: Norwood 6 to 7 patients who need progressive coverage. Due to donor area limitations (safe extraction limit is roughly 45% of available follicles), these patients often plan their restoration over 2 to 3 sessions spread across several years.
Cost of 5-Year Maintenance
The total 5-year cost of maintaining your transplant result goes beyond the initial surgery price. Here is a breakdown:
| Expense | Annual Cost | 5-Year Total |
|---|---|---|
| Finasteride (generic) | $60 to $120 | $300 to $600 |
| Minoxidil (OTC) | $120 to $300 | $600 to $1,500 |
| PRP sessions (3x/year) | $1,500 to $6,000 | $7,500 to $30,000 |
| Follow-up consultations | $100 to $300 | $500 to $1,500 |
| Second transplant (if needed) | One-time | $2,500 to $24,000 |
The minimum maintenance cost (finasteride only) totals $300 to $600 over 5 years. The maximum (full stack with PRP and a second transplant) can reach $30,000+. Most patients fall somewhere in between, spending $1,000 to $3,000 over 5 years on finasteride and minoxidil combined.
Protecting Your Investment Long-Term
Your transplant is a permanent investment in your appearance. Protecting that investment requires minimal effort but delivers significant returns in sustained density and natural appearance.
Start or continue finasteride if your doctor approves. It is the single most effective way to preserve native hair around the transplanted zone. Add minoxidil if you want additional growth support, particularly in the crown area where it performs best.
Avoid excessive sun exposure on the scalp, which can damage follicles over time. Use SPF-rated hats or scalp sunscreen during extended outdoor periods.
Maintain a healthy diet rich in protein, iron, and biotin. While nutritional deficiencies rarely cause graft failure, they can affect the quality and growth rate of both transplanted and native hair.
For month-by-month detail from surgery through year 1, see our growth timeline reference. To understand your current stage, check our Norwood classification guide.
Frequently Asked Questions
When will I see my final hair transplant result?
Your final transplant result is fully visible by 15 to 18 months. At 5 years, what you see reflects the permanent graft survival (90% to 95%) plus any changes in your native, non-transplanted hair. Transplanted follicles remain permanent because they are genetically resistant to DHT. Any density changes at the 5-year mark are due to continued thinning of native hair, not graft loss.
What does a successful hair transplant look like?
At 5 years, a successful hair transplant shows stable density in the transplanted zone with no signs of graft loss. The transplanted hair looks natural and has gone through multiple growth cycles. The main visual change at 5 years compared to year 2 is typically in the untreated native hair, which may have continued thinning if not maintained with finasteride or minoxidil.
How do I know if my hair transplant worked?
Compare your 5-year photos to your pre-surgery baseline and your 1-year photos. The transplanted zone should show stable or slightly improved density compared to year 1 and 2. If the transplanted area itself has thinned, consult your surgeon. If thinning appears around the transplanted zone, that is native hair loss requiring medical treatment, not graft failure.
Want to assess your current stage of hair loss? Get a free AI hairline analysis at myhairline.ai/analyze to evaluate your hair loss pattern and see what long-term results look like for your Norwood stage.