Everything you need to know about hair transplants

It all starts with a couple of hairs found on the pillow or in the shower drain, followed by an increasingly receding hairline and balder temples and head. About 7 men out of 1 can suffer from androgenic alopecia, commonly called baldness. Genetic predispositions are to blame, as well as the environment, nutrition, stress, possible hormonal imbalances or illnesses.

In order to counteract this lottery between nature and nurture, beyond just improving health practices, you could possibly turn to cosmetic medicine. It could help you find a mane worthy of that name thanks to different techniques, explained here by Dr Antoni Calmon of the Dr Dray clinics in Paris and London, and David, a patient who resorted to hair transplants at the parisien clinic Lutétia.

“The first step, when I receive a patient, is pinning down the stage of the baldness” says the doctor. “Generally, men lose hair on top of their skull, because there, the hair bulb has testosterone receptors that cause the shedding of hair.” This is not the case with hair located on the crown, which we could call eternal hair. As a first step, I can prescribe medication such as Minoxidil and Propecia to stop the shedding by slightly modifying testosterone levels.” To sum it up, to counter the natural process of transformation of testosterone into DHT (DiHydroTestosterone) that causes hair loss, this medical treatment inhibits the 5-alpha-reductase that allows this conversion. “On top of the drug therapy, a PRP (Platelet Rich Plasma) will allow an intrinsic stimulation of regrowth”. It is a blood sample that we centrifuge to collect the PRP and growth factors, before mixing it with a cocktails of nutrients and reinject it with mesotherapy (painless picropitting with an airpressure gun) directly on the scalp. “Each treatment will allow an improvement of 5 to 10% of the alopecia. When we combine Minoxidil, Propecia and PRP, we can reach 30%” Dr Antoni Calmon sums up. “Sometimes that is enough: we begin to see results after three months, and after six months, we know what is up. From there we see the patient again to determine wether we can move forward to the next step: transplants.

In terms of transplants, there are two techniques: FUT (Follicular Unit Transplantation) and FUE (Follicular Unit Extraction). “The first one is pretty old school and really surgical; under a local aesthetic, the doctor cuts with a knife a spot of scalp with hair, which leaves a scar. Then he extracts 100% of the grafts (each graft can contain 1 to 4 hairs) to transplant it wherever the patient needs it” describes the doctor, who doesn’t practice FUT himself. This technique, also called “with strips” is practiced less since FUE promises a result without scars. The hair transplant with strips remains particularly interesting for people who have a donor zone (the part of the head that still has hair) that is very small: if you only have a very marked monk’s tonsure, this can be worth it.

Without a surgical knife, therefore without a scar, FUE is endorsed more and more since it turns out to be less invasive and allows a more discreet result. “You can have it done while awake, under a local anaesthetic. My patients can watch tv, listen to music or talk with me during the entire operation” tells the doctor. “Generally, we collect grafts uniformly on the whole crown during the morning, then we have a lunch break before reinjecting in the afternoon”. It is mainly a distribution challenge so that the result looks natural and balanced over the head. Particularly if the forehead line is at stake: “More and more clinic offer to organise everything to have it done abroad for cheaper, but the final result cruelly lacks naturalness. In France, the country of haute couture, we do it much better, we know that an overly straight forehead line looks fake, for example”.

In order to pick the right practitioner, you have to ensure several points: “If he says yes” to all your demands, there’s probably a problem. Before anything, the doctor has to inform you and tell you the truth of what is possible rather than promising impossible miracles. If he’s honest with you from the start, you will find complete satisfaction” says the Dr Antoni Calmon at the Dr Dray clinic. “Then, to judge the quality of work, there’s nothing better than word-of-mouth and a first appointment to see if the doctor and his aesthetic sense inspire confidence because he will have to collect each graft carefully, without damaging hair around it, in the right environment and then transplant them in the best conditions, checking for spikes, hair orientation, forehead line that has to contain grafts with only one hair, etc”.

The prices also constitue a selection criteria: prices that are much lower than in the rest of the market must alert you. Be careful to the terms used: “Generally, clinics charge the number of grafts, a word that shouldn’t be confused with hairs. For example, some charlatans offer to implant 1000 hairs, tricking you with the fact a graft can contain many hairs. On average in Paris today, a graft costs between 4 to 10 euros depending on the clinic”.

In another clinic than Dr Antoni Calmon’s, David had a hair transplant over two years ago, and agreed to tells us his story: “I started to notice I was losing hair when I was about 24. In the beginning, I wasn’t so worried about it, but from the age of 28, it started to become an obsession. I didn’t have advanced baldness, but a strong receding hairline was forming a distinct M-shape”.

The salesman and musician saw his life change because of his hair loss: “Every morning, I felt forced to mask my bald head by styling my hair in a certain way, and all day long I would watch for the wind, the rain and where I’d lay my head so it stays in place. I was looking after it a lot, and I was spending more time hiding it rather than actually styling it. It was beginning to be unbearable for people close to me and myself so I started researching online about the possibilities of a transplant, different methods, etc. I’ve let the idea mature for about six months before going for it, calling a selection of Parisian clinic and booking a Skype appointment since I live in Angers with the one I trusted the most : the Lutétia clinic.

The man who is now 31 insists on the bond of trust he was able to build with his doctor: “It really is an appointment of information, to clarify everything, understand what is going to happen, how the operation works, etc. For the doctor to establish a diagnostic, he has studied the pictures of my hair I sent him, asked questions about my family background, my habits to be able to assess and anticipate my hair evolution and understand the objective of the transplant. It’s not so much balding as a very high hair transplant. I had looked up a lot of information, on forums in particular and I knew pretty well what I wanted, so I told them my expectations: I wanted 1000 grafts but we decided on 700. The operation cost me 3000 euros in total”. A price that is within the market average.

The day of the operation needs to be calculated according to the professional obligations: “We have agreed on a day for the operation two months later, a Thursday in the November of 2015, and I planned a leave of absence the next day to be OK for the first three days of recovery when you have to be the most careful, and start work again comfortably on Monday."

The big day arrives: “I arrived at the clinic at 4pm. The doctor obviously checked whether what he had observed via Skype matched the reality. In a room with him and an assistant, I was laid on the stomach, face to the ground and had a local anaesthetic with a first injection. Once the back part of my head, the donor zone, was shaved, the doctor started to extract the 700 grafts one by one, which took about 1 hour and a half when you can’t do anything apart from sleeping which I couldn’t. I couldn’t feel anything but when I felt I was getting sensitive, I was telling the doctor who was giving me another injection of the anaesthetic. I really felt like I could hear the sound of every hair coming out of my skull and that was funny. At the end of the extraction, I was allowed to have a 30 minute break before moving on to the transplant. Sat down during the entire process, I could watch TV calmly during the hour and a half it lasted. During the extraction and transplant, I must have received 7 injections of the anaesthetic in total, and then I had no scar since they don’t use a surgical knife or stitches."

Since it is an outpatient operation, we can go home right after: I left at 8.30pm, without feeling any pain but the sensation of having a really heavy head. At mine, I followed the treatment they had explained to me at the clinic, a spray with saline solution to favor hydratation, scarring and prevent infections, to spray every 30 minutes on the transplanted zone for the first two days. For the donor area, I could use aloe vera to soothe it. They gave me a pillow like the neck support one on planes to sleep while sitting down lightly so my head doesn’t touch the mattress. The next day of the operation, I could wash the donor area with the ultra mild product recommended by the clinic. Same for the receiving area from the fourth day. I was meant to use this product for at least a month but I used it for three since it is nice and efficient. I applied all the gestures that were explained to me by the clinic and didn’t feel any pain over the weekend."

David doesn’t see any point in feeling insecure because he resorted to hair transplants and that’s exactly what has allowed it to start a normal life again quick. “Since I didn’t try to hide my transplants to friends or colleagues, I started work again on Monday. During the first month I wasn’t allowed to use a styling product but I disobeyed slightly with a bit of styling paste (laughs). I couldn’t come to the meeting that was set after the regulatory three months, but after six months, I asked to lower my forehead line by 1mm, 300 grafts, which they did for free”. Indeed, it’s better to undergo a second, or even a third operation with a few months apart to better appreciate the result of the first graft rather than transplanting too much hair the first time.

““From there, I was fully satisfied, which I could confirm at the 12th month appointment” tells David enthusiastically. Moreover, the hair transplanted beforehand had really grown and I could finally style my hair like I wanted to at the time, meaning a little like Robert Downey Jr in Iron Man. Today, two years on from the operation, I style happily the undercut I have now (short on the sides, long on top, with a marked parting). Paradoxically, now I have a lot more hair, I take a lot less time to style my hair in the morning, I barely think about it since I obtain what I want more easily and I have no insecurities, nothing to hide, I no longer fear the wind or the rain, etc.”

The operation helped him feel better about himself: “It really helped me stabilise my confidence and keep things in perspective: for example, all the frustrations can’t be soothed, we can live with a bald head, but if it seems unbearable, we can act upon it to move on, because there’s much worse in life. If I had advice to give to those to would like to do it, it would be not to do it before the age of 25 because the crown can still evolve a lot with age and so it is best to wait until the baldness stabilises. Not doing the operation on a whim, obviously, and especially pick a doctor you can trust."

Finally, concludes David, one shouldn’t believe hair transplants on their own will change your life. It is certain that having more confidence can’t hurt, but believing they could make you more productive at work, that is far-fetched.

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