Baldness is the most common hair pathology in France. 12 million French people are affected by androgenetic alopecia, which leads to the progressive balding of the top of the scalp. While there are a number of treatments that can slow down the hair loss process, there are still no therapeutic solutions to permanently cure it. The only way to truly correct baldness is to get a hair transplant. Each month, the four surgeons at the CMCC center in Paris perform more than forty implant surgeries on both French and international patients. Here is a presentation of our approach.
What is the purpose of a hair transplant?
Micrografting is a surgical procedure that is now considered the reference method to correct the effects of this disease.
The principle is simple: the doctor (at the CMCC center in Paris for example) takes healthy follicular units and implants them on the bald areas, which redensifies a thinning head of hair.
The harvesting and anchoring methods of the transplants have progressed so much since the 1980s that the aesthetic results have become absolutely natural and undetectable to the naked eye (provided, of course, that the surgery is performed under good conditions by professional surgeons).
The other advantage of hair transplantation is that it is a relatively non-invasive surgical procedure and its effects are permanent. In fact, the transplanted hair is taken from the temples and the occiput, two areas not affected by the phenomenon of androgenetic alopecia. The introduced hair will therefore grow throughout the patient’s life.
Who can get a hair transplant?
Hair transplantation is suitable for the vast majority of patients suffering from baldness. This is true for men (50% of men in their fifties experience baldness) as well as for women (20% following menopause).
At the CMCC, we generally prescribe a hair transplant when the alopecia reaches a certain stage, when the regrowth can no longer be sufficiently stimulated by treatments and when there is a significant psychological impact on the patient.
For example, we recommend a hair transplant to our patients when their disease reaches stage 2 on the Ludwig scale, i.e. when they start to lose hair at the top of their head.
For men, a hair transplant can be prescribed at stage 1b, when a bald spot appears at the top of the head or when the gulfs become more pronounced.
Since the transplanted hair is the patient’s own, there are very few contraindications to hair transplantation. These include clotting problems, scalp diseases, respiratory and cardiovascular diseases, certain allergies, pregnancy and breastfeeding.
How are the grafts extracted?
Extracting the grafts is the first step in a hair transplant. It involves extracting the follicular units from the crown. There are two main techniques available today for this purpose, both of which are offered at the CMCC center in Paris.
Strip harvesting (FUT technique for long hair)
This is the reference method in hair transplantation.
The doctor removes a very thin strip of scalp from the crown of the hair, from which the transplants are taken. The donor area is immediately closed with sutures or staples. The strip is placed under a microscope and dissected into either micrografts (1 hair) or follicular units (between 2 and 4 hairs). These are then divided according to the number of hairs they contain and their morphological characteristics (thickness, stem shape, color).
The advantages of strip sampling are multiple:
- No need to shave the collection area.
- Up to 2,000 follicular units can be collected in a single session. It is perfectly adapted for advanced alopecia, as well as for female alopecia which is often more diffuse.
- From a medical point of view, the risks of transsections are limited and the hair is visible in its entirety, which facilitates the sorting process.
The main disadvantage of the FUT technique for long hair is that it leaves a fine scar on the occiput. Although this scar is very discreet (no more than one millimeter wide), it is not recommended if the patient want to shave his head.
Follicular Unit Extraction (FUE technique)
The FUE technique involves extracting the grafts one by one with a micro-punch. Once extracted from the scalp, the follicular units are placed under a microscope by the physician to check their integrity and prepare them for their insertion into the receiving area. As with the strip method, they are then sorted according to the size and characteristics of the hair.
Follicular extraction is the most popular method among patients and has a number of advantages:
- FUE increases the potential donor area by 30-50% since it is possible to extract the follicular units not only from the occiput, but also from the patient’s temples.
- There is no linear scarring, as the micropunch only leaves small circles of less than one millimeter in diameter.
- The patient will be able to cut his hair short or even very short.
However, the FUE technique has several disadvantages:
- The donor area must be shaved, partially or completely, except for transplants requiring less than 800 to 1,000 grafts. This can be inconvenient for a woman.
- The number of transplants that can be extracted with FUE during a single session is limited. Several surgeries (spaced at least six months) may be needed for a perfect result and sufficient density.
- The risk of root transection is increased with FUE, since the separation of the follicular unit from its attachments is done at the time of extraction.
How are the grafts implanted in bald areas?
The anchoring of the grafts on the bald areas is an essential step of the transplant. It is done either with micro-needles or with a Choi-type implanter.
In both cases, the implantation requires all the skill and experience of the doctor to create a truly natural effect and to get the transplanted hair to blend harmoniously with the patient’s hair. To achieve this, he will work on three key aspects:
- Hair density: a sufficiently dense head of hair must include 20 hairs per cm².
- The positioning of the grafts: the doctor must take into account the orientation and the angle of anchorage of the existing hair, while implanting the transplants in a random manner to look natural.
- The morphological characteristics of the follicular units: this will depend on the type of hair (light, frizzy, fine, straight, curly) and the area where the grafts are implanted.
How long does it take for the transplanted hair to grow back?
Small scabs will form on the transplants a few days after the procedure. This is part of the healing process and they will fall off five to seven days later.
The roots of the grafts will be in a resting phase for three to four months. The new hairs begin to grow between the third and fourth month. The results are noticeable after the sixth month. The hair thickens, gradually gaining in density and quality. It is not until the twelfth month that the regrowth is considered complete.
To stimulate regrowth, the doctor may prescribe a complementary PRP treatment to promote healing and strengthen the transplants. This is a minimally invasive method that consists of extracting platelets from the blood plasma and injecting them into the scalp. This activates the hair microcirculation and regenerates hair cells.
You can contact the CMCC Paris if you would like more information about hair transplants at 01 84 83 14 00 or make an appointment by clicking here.