Written by the AfroHairClinicTurkey editorial team, drawing on the clinical experience of our medical team · Last updated September 29, 2026 · How we write and check this
Six questions before you book anything
Afro hair restoration — a transplant on coiled, Afro-textured hair — turns on a few things about your own scalp, and most of them are visible before anyone quotes you a number.
This is not a diagnosis and it will not guess a graft count. It asks about what you can see and feel, and gives you back the questions worth putting to a clinic — this one or any other. It runs entirely in your browser; nothing you answer is sent anywhere or recorded.
Which of these is closest to your hair?
Pick the pattern nearest to yours. If you are not sure, that is a normal answer — the pattern assessment walks you through finding it properly.
What best describes what you are seeing?
Describe what you can see, not what you think it is called.
Are you still wearing tight styles regularly?
Braids, cornrows, weaves, locs or tight ponytails.
Do you, or a close relative, form raised (keloid) scars easily?
This rules nobody out. It changes how the donor area is planned. Why it is the first question, and what it does and does not decide: keloids and dark skin.
How does the hair at the back and sides compare to the area you want covered?
Nobody can measure this from a screen. The question is only what you notice.
Have you had a hair transplant before?
What your consultation should cover
A self-check, not a diagnosis. Candidacy is settled by someone examining your scalp, not by six questions. What follows is what your answers suggest is worth raising — and the questions to raise it with.
Timing
Operating on a scalp still under tension treats the result and leaves the cause running. Traction induces inflammation and follicle damage, and the risk rises with styles that hurt — pain from a hairstyle is a warning sign rather than something to tolerate.[1,2] Traction alopecia can progress to permanent hair loss if the styling that causes it continues.[2]
Still unanswered How common traction alopecia is in school-age girls. A widely repeated figure of 22% could not be traced to a primary study: the population studies we read report 17.1% in girls aged 6-21, while 22.6% is the overall adult prevalence in a separate study.
- Should I stop the styling before we plan surgery, and for how long? A clinic that books you straight in has answered a scheduling question, not a clinical one.
- How will you tell what has recovered on its own? Some of it does. Grafting into it wastes donor hair that does not refill.
Worth ruling out first
Patchy loss on top, particularly with tenderness, is the pattern that needs a name before a transplant is discussed at all. central centrifugal cicatricial alopecia is the most common form of scarring alopecia among women of African ancestry.[3] Scarring conditions destroy the follicle rather than shrink it, and transplanting into active disease can lose the grafts as well.
What CCCA is, what treatment can and cannot do, and the transplant question answered honestly.
- Do I need a dermatologist and possibly a biopsy before this conversation continues? The honest answer is sometimes yes, and it delays the sale.
- If it is scarring, is the disease active or burnt out, and how did you decide?
How the donor is closed
Keloid scarring occurs more often in Black patients than in white patients; the reason for the difference is not established.[4] This rules nobody out. It changes punch size, closure and what you should be told to watch for afterwards.
Still unanswered Why keloids form more readily in some people than others is not established. The difference itself is well documented; the mechanism behind it is not. source
- What will you change in the donor area because of this? A specific answer names the punch and the closure. A reassuring one names neither.
- What should I do if a scar starts to raise, and how soon can I reach you?
Donor supply
The donor is the ceiling on everything else, and it is the one number nobody can take from a photograph. hair density in people of African descent has been measured five times: by scalp biopsy in 22 African Americans against 12 white patients, by phototrichogram in 38 African-born adults, in 2,249 adults from 24 ethnic groups, and by trichoscopy in 122 South Africans and in 909 Nigerians. Four of the five found it lower than white or worldwide comparisons; the Nigerian study reported a median of 330 hairs per square centimetre and called it high, and its counting rule could not be verified. None measured a donor area, and none measured what curl adds to how much scalp each hair covers.[5,6,7,8,9,10]
Move a finite supply into a thinning area and watch the trade-off, or work the arithmetic behind any graft count you are quoted.
Still unanswered Whether curl really does let each follicle cover more scalp, which is the basis of the widely repeated claim that textured hair needs fewer grafts. Three searches returned nothing measuring it.
- What is my donor density, measured how, and at which points on the scalp? Measured in person under magnification, or it is an estimate wearing a number.
- What does this plan leave in the donor for later? The supply does not refill, and a second procedure may be needed.
- Is the number you are quoting what you will extract, or what you will implant? They differ by the grafts lost on the way out.
Repair case
A repair is harder than a first procedure: the donor has already been drawn on, and the previous plan constrains this one. It is also where reading a gallery matters most, because repair results are the ones most often photographed generously.
See how lighting, angle and timing change what the same hair looks like.
- What went wrong the first time, in your reading? A clinic that will not assess the previous work will not avoid repeating it.
- How much donor is left, and does that cap what can be fixed?
- Can I see repair cases at twelve months or later, on hair like mine?
Your hair, not a straight-hair default
In tightly curled hair the follicle sits curved beneath the skin rather than straight, with a bent, golf-club-shaped bulb and an asymmetric root sheath.[11,12] A straight instrument entering a curved follicle has more of it to cut across — and in a retrospective series of 64 patients of African descent, the mean transection rate was 3-6%, and scalp thickness and firmness affected it more than hair curliness did.[13]
Watch a straight punch meet a curved follicle.
Still unanswered How much more often follicles are cut during extraction in tightly coiled hair than in straight hair. The closest study we found measured this in only six coiled-hair patients out of 152, and concluded that scalp thickness and firmness affected the rate more than curl did.
- What punch will you use on my hair, at what diameter, and how did you choose it? A brand name answers a marketing question.
- What transection rate do you measure on hair like mine? A clinic that has never measured it cannot tell you — and that answer is informative on its own.
Nothing here says wait
None of these six questions turned up a reason to pause — but six questions are not an examination, and the things that decide a plan are measured on a scalp. The questions below are worth asking anyway.
Work the arithmetic before anyone quotes you a number.
- What area are you covering, in square centimetres, and at what density? A total without a density is not a plan.
- What do you think caused this, and how did you decide? The answer changes whether surgery helps at all.
- What happens to this result if the loss keeps moving?
Take them to whoever you are considering, including us. A clinic that answers them plainly has told you something; one that changes the subject has told you something too.
What this does not do
- It does not diagnose anything, or name your condition.
- It does not tell you whether you are a candidate.
- It does not estimate a graft count or a price.
- It does not replace an in-person examination, and nothing here was measured about you.
If we are one of the clinics you are asking — you do not have to send this to us, and the list was built to work anywhere. But if we are on your list, send it over and we will answer it in writing. An automatic note confirms it arrived, a person replies within one working day, and you will not get a graft count or a price until somebody has properly looked at your scalp.
One more thing before any of these: if the work would be on your edges or temples, read why Afro hair transplants fail. The tests it describes come before the questions above.
What to send, and what each thing settles
Any clinic is guessing until it has seen certain things, and on coiled hair almost none of them are in the photograph people usually send — the top of the head, taken from the front. That picture shows the part you are unhappy with. It shows none of the things that decide whether the operation is a good idea. Here is what to send instead.
The back of your neck, with the hair lifted
Acne keloidalis nuchae is a chronic inflammatory condition of the hair follicles of the occipital scalp, classified as a primary cicatricial alopecia, that presents as papules, pustules and keloid-like plaques. In a multicentre series of 142 patients it affected men almost exclusively, and three quarters reported previous trauma to the nape; in a separate series of 101 treated patients most responded to treatment but very few had full resolution.[14,15]
Most people know it as razor bumps and think of it as a shaving nuisance. It is a scarring condition, and it sits on the occipital scalp — the exact strip the grafts come from. A photograph taken from behind at head height, in daylight, with the hair lifted clear of the nape, is the only way anyone can see it before you are on a plane. More on it is on our keloids and scarring page.
We searched PubMed on 19 September 2026 for anything published on harvesting follicular units from, around or through acne keloidalis nuchae, or on the condition reducing the usable donor area. We found nothing. The clinics that state it reduces the donor zone cite nothing for it.[16]
Your edges, with the style taken down
In the series that named the fringe sign, 35 of 41 women with traction alopecia had a retained strip of hairs along the frontal or temporal rim, and every woman whose traction involved the marginal hairline had one. A later review describes the preservation of that fringe as a clue that distinguishes traction alopecia from frontal fibrosing alopecia, where it is lost.[17,18]
Which means the diagnosis lives in the half-inch that laid edges, a wig line, a closure or a fresh braid sit directly on top of. One photograph with the style down — front, then both temples, in daylight, nothing smoothed — carries more information than every other picture in the set. What that finding then changes is set out on our traction alopecia page.
The donor area — and no graft number from you
Scalp biopsies from 22 African American and 12 white patients found total hair density significantly lower in the African American group.[5]
People arrive having read a figure and asking for it by name. The figure was almost always derived from scalps that count differently from theirs. Send the back and sides — combed flat, not freshly faded — and let whoever is quoting you work from what is there. You can see how much the published measurements disagree with each other in our donor density explorer.
Your styling history as dates, not as labels
The same survey did find a strong association between CCCA and sewn-in weaves, and between CCCA and cornrows or braids using artificial extensions. Women with CCCA were also more likely to report pulling and tenderness from those styles.[19]
And the part most people expect to be asked about turned out not to be the part that mattered. In a case-control survey of 101 African American women, no correlation was found between the use of hot combs or chemical relaxers and the development of CCCA, contrary to what had long been assumed.[19]
So the history worth writing down is not whether you relaxed. It is what was pulling, how tight it was, how long it stayed in each time, and across how many years — roughly is fine, and roughly is still better than a label. Where that leads is our CCCA page.
Any raised scar you have, anywhere on your body
A review of cosmetic surgery in Black patients states that the myth that all Black patients develop keloids or pigment changes after surgery should be dispelled, but that in patients with a history of keloid formation or hypertrophic scarring, elective cosmetic procedures should be either withheld or performed with extreme caution.[20]
Earlobes from piercings, a chest or shoulder scar, a surgical line that kept growing or one that settled flat. None of it is on your scalp and all of it is relevant. Say where, after what, whether it spread past the original wound, and whether it ever calmed down.
Any biopsy report you already have
A review of traction alopecia states that histopathology can distinguish traction alopecia from alopecia areata, frontal fibrosing alopecia and patchy central centrifugal cicatricial alopecia, and that dermoscopy can detect ongoing traction through the presence of hair casts.[18,21]
If a dermatologist has already taken one, the report answers in a paragraph a question that photographs can only circle around. Send it even if it is years old and even if you were told it was inconclusive — what it ruled out is worth knowing. If nobody has taken one, that is not a reason to get one before you write; it is a reason to say so. Why the distinction decides outcomes is on our page on why these operations fail.
This next part is our practice, not a citation
Send the same set to everyone you are talking to, and read the replies against each other. A reply worth trusting names what it could see and what it could not, says which of the six items changed the estimate and in which direction, and separates what it is confident about from what it wants to look at in person.
A graft number and a price coming back within the hour is not fast service. Nothing above can be assessed that quickly, and a quote that did not need any of it did not use any of it. We do not give a graft count or a price before an examination, and we would rather lose the enquiry than open it with a number we cannot stand behind.
Clinical references
- Mirmirani P, Khumalo NP. Traction alopecia: how to translate study data for public education—closing the KAP gap? Dermatol Clin. 2014;32(2):153-61. view source →
- Haskin A, Aguh C. All hairstyles are not created equal: What the dermatologist needs to know about black hairstyling practices and the risk of traction alopecia (TA). Journal of the American Academy of Dermatology. 2016;75(3):606-611. view source →
- Malki L, Sarig O, Romano MT, Méchin MC, Peled A, Pavlovsky M, et al. Variant PADI3 in Central Centrifugal Cicatricial Alopecia. The New England journal of medicine. 2019;380(9):833-841. view source →
- Kelly AP. Keloids. Dermatol Clin. 1988;6(3):413-24. view source →
- Sperling LC. Hair density in African Americans. Archives of dermatology. 1999;135(6):656-8. view source →
- Loussouarn G. African hair growth parameters. Br J Dermatol. 2001;145(2):294-297. view source →
- Loussouarn G, Lozano I, Panhard S, Collaudin C, El Rawadi C, Genain G. Diversity in human hair growth, diameter, colour and shape. European Journal of Dermatology. 2016. doi:10.1684/ejd.2015.2726 view source →
- Anaba EL, Sani H, Magaji D, et al. Trichoscopic Evaluation of Normative Values of Scalp Hair Density in an African Population from Nigeria: A Cross-Sectional Study. West Afr J Med. 2024;41(11):1105-1112. view source →
- Dlova NC, Enechukwu NA, Suleman MH, Maseko JZ, Rudnicka L. Baseline trichoscopic values for afro-textured hair in indigenous South Africans. International Journal of Dermatology. 2025. doi:10.1111/ijd.17633 view source →
- AHC Afro Hair Clinic. Literature search record: measured hair density, shaft diameter and coverage per follicle in patients of African descent or with Afro-textured hair. PubMed, run 20 September 2026.
- Thibaut S, Gaillard O, Bouhanna P, Cannell DW, Bernard BA. Human hair shape is programmed from the bulb. Br J Dermatol. 2005;152(4):632-8. view source →
- Thibaut S, Barbarat P, Leroy F, Bernard BA. Human hair keratin network and curvature. Int J Dermatol. 2007;46 Suppl 1:7-10. view source →
- Umar S, Khanna R, Lohlun B, Maldonado JC, Zollinger M, Osei-Tutu A, et al. Follicular Unit Excision in Patients of African Descent: A Skin-Responsive Technique. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]. 2023;49(10):949-955. view source →
- Sánchez-Dueñas LE, Ungson-García MG, Ramírez-Sánchez JA, et al. Acne Keloidalis Nuchae: A Multicenter Retrospective Study of 142 Hispanic Patients. Dermatol Pract Concept. 2024;14(3). view source →
- Smart K, Rodriguez I, Worswick S. Treatment of Acne Keloidalis Nuchae in a Southern California Population. Cutis. 2026;117(2):60-64. view source →
- AHC Afro Hair Clinic. Literature search record: acne keloidalis nuchae and follicular unit harvesting. PubMed, run 19 September 2026.
- Samrao A, Price VH, Zedek D, Mirmirani P. The "Fringe Sign" - A useful clinical finding in traction alopecia of the marginal hair line. Dermatol Online J. 2011;17(11):1. view source →
- Billero V, Miteva M. Traction alopecia: the root of the problem. Clin Cosmet Investig Dermatol. 2018;11:149-159. view source →
- Gathers RC, Jankowski M, Eide M, Lim HW. Hair grooming practices and central centrifugal cicatricial alopecia. Journal of the American Academy of Dermatology. 2009;60(4):574-8. view source →
- Grimes PE, Hunt SG. Considerations for cosmetic surgery in the black population. Clin Plast Surg. 1993;20(1):27-34. view source →
- Goldberg LJ. Cicatricial marginal alopecia: is it all traction? Br J Dermatol. 2009;160(1):62-68. view source →
References are checked on the dates recorded in our evidence library. If a source has been superseded, tell us and we will update it.