Hair implants: how to choose the right surgeon? The 10 questions to ask yourself before a transplant.

Le Dr Eric Bouhanna réalise une greffe de cheveux au CMCC Paris
More and more patients suffering from baldness – both men and women – end up resorting to surgery to conceal their balding hair permanently. However, in recent years, hair implant surgery has become very popular and there are many conflicting opinions on the Internet.
In these conditions, how can you find the right surgeon for a hair transplant? And how can you make an informed decision from all the advice you are given?
The surgeon’s know-how and experience in hair transplants are crucial criteria to choose the right surgeon. There are other factors to take into account, such as the chosen therapeutic protocol, communication and the quality of the surgeon’s facilities. All of these points are important, because your health is at stake.
Here are the ten most important questions you should ask yourself before getting a hair transplant.

1. What is your surgeon’s actual expertise in hair transplants?

Hair transplants are a medical procedure and, as such, it’s important to have the proper training to perform this type of surgery. In France, dermatologists, plastic surgeons or doctors who have already performed such procedures are qualified to offer this type of treatment.
Hair transplants are a delicate aesthetic procedure that requires great dexterity. This dexterity is, of course, related to the surgeon’s skills, but experience cannot be overlooked. A novice or a surgeon who only performs a few hair transplants per year will necessarily be less skilled than a scalp specialist who performs one transplant per day.
Here are some questions you can ask to make sure your selected doctor has the expertise you need.

What kind of training has the surgeon had?

Hair transplantation is a complex discipline, which requires a precise understanding of the hair’s life cycle, a thorough knowledge of hair topology, knowledge of hair follicle extraction and implantation techniques and, of course, a mastery of the principles of cosmetic and plastic surgery.

What is the surgeon’s professional experience?

As mentioned above, the surgeon’s skill is intrinsically linked to his or her practice of hair transplantation.
A surgeon who performs one or two hair transplant procedures per year will not have the same dexterity as a surgeon who performs them every day.
This is why the doctors at CMCC Paris have chosen to specialize in hair surgery. They have been performing an average of one transplant (hair, beard, eyebrows) per day for more than ten years and offer FUE and long hair FUT to meet the needs of the men and women who request them. They can also provide sound clinical advice on the best treatment to improve the health of your follicles and help you slow down your hair loss.

Is the surgeon recognized by his peers?

In France, hair surgery is strongly regulated (this concerns hair, beard and eyebrow transplants) and this is a good thing for public health.
A surgeon is only allowed to operate if he is registered with the Order of Physicians. Simply contact the National Council of the Order of Physicians and they will easily provide you with all the information you need.
If the surgeon is a member of the ISHRS, that’s also a good thing, because this international hair restoration surgery organization only recommends quality practitioners who follow certified clinical and aesthetic protocols, perform the most effective techniques, and always prescribe a treatment that has been scientifically demonstrated to work.
Finally, if you want independent advice, talk to your dermatologist rather than looking online. Your dermatologist will have access to resources to give you an informed, yet objective opinion about the expertise of a particular practitioner.

2. Will he or she show you before and after pictures?

A good surgeon will be as transparent as possible and will be happy to share pictures of patients – both male and female – who have undergone a hair transplant.

Résultat avant/après d'une greffe de cheveux chez une patiente du CMCC Paris

Nowadays, it is quite common for hair transplant specialists to publish before-and-after pictures on their website. These pictures usually include:
  • the patient’s age;
  • the type of the alopecia
  • the number of grafts implanted;
  • the area(s) where the grafts were implanted;
  • the used extraction method;
  • and the number of sessions required to achieve this result.
The advantage for you is that you can see the results of your surgeon’s interventions on both men and women. When you go to a consultation, don’t hesitate to ask for pictures of patients suffering from hair loss similar to yours to get a better idea of their expertise!

3. Does the surgeon do a clinical examination before the procedure?

This step is crucial to the success of your transplant. Your health is at stake and it will help you avoid problems that can be irreversible, such as a low hairline, overuse of the donor line, a scar that is too large or disappointment with the final result.
The preoperative consultation is generally conducted as follows:
  • Questioning of the patient: the doctor will ask you a number of questions to understand your type of alopecia. For example: when did you realize that you were starting to lose your hair? Are you still losing hair or has it stabilized? Does anyone else in your family suffer from alopecia? Are there any factors that aggravate hair loss (smoking, stress)? Have you ever tried a hair loss treatment? Are you currently taking a treatment? Which areas are most affected by hair loss and which ones would you like to correct first? Do you have any specific wishes regarding the hairline? What is your level of knowledge regarding existing clinical techniques (follicular or strip extraction)?
  • Clinical examination of baldness: after the questioning, the surgeon proceeds to the actual examination of your scalp. To do this, he uses magnifying glasses and examines not only the bald or receding areas, but also the donor area. This examination allows a precise diagnosis of your hair loss. It also allows to calculate the number of grafts needed, to evaluate the number of usable follicular units – micro or mini -, to have a precise idea of your type of hair and to measure the flexibility of your scalp and hair density, two key parameters to determine the surgical technique best suited to your scalp (FUE hair transplant, FUE hair transplant without shaving or FUT transplant with long hair also called “strip technique”)
  • Scalp exploration: sometimes, the clinical examination does not allow for a precise diagnosis. When this happens, your doctor will prescribe an additional exploration of the scalp, usually a trichoscopy or a hair biopsy.

4. Does he carry out the procedure from start to finish?

Greffe de cheveux par le Dr Pierre Bouhanna au CMCC Paris

This is a very important consideration.
For example, the doctors at CMCC perform hair transplants from start to finish. They extract and implant the hair follicles themselves, regardless of the technique used. Of course, they are supported in their work by assistants whose mission is to accompany them during the transplant.
Why can this have an impact on the final result? Because the extraction of grafts and their implantation on bald areas are two delicate operations that must be performed by an experienced specialist.
In addition, the graft has a strong aesthetic dimension: a graft must integrate harmoniously with the original hair. To achieve this, a number of criteria must be met:
create sufficient hair density;
implant micro-grafts and mini-grafts in a random manner;
placing each implant in an appropriate manner according to their size and location on the scalp;
and finally, implanting the grafts at a specific angle.

5. Do you know what harvesting technique he will use during the procedure?

Before you enter the operating room, it’s important to know the extraction method your surgeon will use to correct your alopecia. The surgeon must give you precise details during the pre-operative consultation!
Here are a few questions you can ask to find out more (note that you can also ask these questions if you want a beard or eyebrow transplant):
  • What technique does he recommend to address your hair issue? For what reason?
  • Are these methods done by hand or with a machine? If he uses a machine, can he tell you why he does it and which machine he uses?
  • Will the method (long hair FUT or FUE) leave a scar? Will it be visible?
  • If he recommends an FUT graft, what size strip will he take? How will he close the wound left by the strip so that the scar is as discreet as possible?
  • If the baldness progresses, will it be possible to do a new hair transplant? In fact, a proper management of the donor area is essential to correct alopecia throughout the patient’s life, because the available hair stock is not inexhaustible…

6. Does he provide you practical information on the advantages and disadvantages of each technique?

This is the corollary of the previous question, but it is crucial that you make an informed decision.
This is a question of ethics, of course, but it is also required by law so that you can give your consent in an informed manner, after at least two weeks of reflection.
Your doctor must therefore provide you with exhaustive, fair and clear information that is adapted to your level of understanding. This information is given after the pre-operative consultation.
It must cover the details of the procedure, but also the “foreseeable” risks and the consequences of such an operation.
This information must be given to you orally, but you must also receive written documentation that includes the various elements explained during the consultation. He must provide you with :
  • a precise treatment plan, specifying the anterior hairline and the areas to treat, the number of implants needed per area treated, the number of sessions to expect and the chosen extraction method;
  • an information sheet describing the procedure step by step, the postoperative follow-up and possible complications (these are rare, but it is important to know them).

7. Is your doctor transparent about his fees?

Once again, this is part of your doctor’s ethical and legal obligations.
In order for you to make a truly informed decision, you must receive a detailed quote for the procedure (excluding pre-operative examinations).
The quote must include the following information
  • the date it was written ;
  • the name and registration number of the departmental council of the Order of Physicians;
  • the type of procedure planned and the required anaesthesia;
  • a detailed account, in quantity and price, of each service and product needed for the planned procedure, with the exception of preoperative examinations;
  • the duration of the post-operative care;
  • the total amount to be paid;
  • the validity period of the offer;
An important point to keep in mind: your quote must reflect the price you will have to pay in the end. There is no question of paying extra after the session.

8. Do you feel comfortable with him?

A decisive aspect is that you trust the doctor who will perform your hair transplant.
This is often a matter of intuition, but a good way to know if he is a trusted practitioner is to ask yourself the following questions:
  • Did he answer your questions clearly and straightforwardly?
  • Was he thoughtful?
  • Did he make excessive promises, such as curing your alopecia?
  • Do you feel comfortable having him perform the procedure?
  • Do you find him competent?
  • Do you feel that he is giving you good advice?
  • 9. What is the quality of the clinic where your transplant will take place?
A hair transplant is a surgical procedure.

Echange d'instruments chirurgicaux

In practice, this means two things:
  • The transplant must be performed by a single person, but you must still make sure that your doctor is supported during the surgery by experienced assistants. Their role is key to ensure the procedure goes as smoothly as possible. They are usually responsible for handing over the instruments to the doctor, checking the integrity of the micro-grafts and mini-grafts, sorting them according to the number of hairs contained in each follicular unit (your follicles may contain one or more hairs) and placing them in an optimized preservation bath. They will then transfer each implant to the doctor so that he can insert them in the treated areas. Naturally, they must be able to perform all these steps without damaging the grafts, which requires considerable expertise.
  • The transplant must take place in a fully equipped and secure environment.

10. Is he aware of the latest innovations in hair transplants?

Hair transplantation is a discipline that is constantly evolving. There have been many innovations in the last two decades, whether it be surgical, instrumental or diagnostic.
It is of course important for your doctor to be aware of these innovations, as some of them have considerably improved the results of hair transplants for both men and women.
Do not hesitate to contact the CMCC at 01 84 83 14 00 for any questions or to make an appointment.