We have about 100,000 hairs and lose 100 of them every day. There is thus a complete renewal of hair within 1,000 days.
Hair essentially consists of keratin which is a sulphur-based protein.
The medulla: this is the centre of the hair composed of big cells without nucleus
The cortex: this is the middle layer which represents more than 90% of the hair mass. It looks like a long wire rope.
The cuticle: this is the outer most layer formed by scale-like cells, like the tail of a lizard.
A hair cycle corresponds to the life of hair from birth and life (anagen phase) to death (catagen phase).
Yes, hair cycles happen constantly, which explains why we lose about 100 hairs every day.
The cause is often hereditary. This is actually a hyper sensitivity from some hairs to male hormones, but this is not an excess of male hormones. Moreover, hair loss is the result of a programming whose timing is different according to the place the hair is located.
It is very difficult to plan precisely the evolution of a patient’s hair. We must refer to the family history and observe accurately the bald area and its surroundings. However, we should not forget that this forecast is not certain and absolute.
You said hair transplant?
The theoretical principle is quite simple: micro grafts consist in transferring this resistant hair from the back of the scalp to the bald front area. Furthermore, you should collect the graft as it stands. That is what is called a follicular unit transplant..
25 years ago, hair surgeons were using 3 to 4 mm punches and the results were often not very aesthetic. In the last ten years, the cutting of hair grafts has slowly but surely replaced this technique. Since 1995, in order to avoid the linear scar, follicles are directly extracted from the scalp, using a micro punch of approximately 0.9 to 1.2 mm wide. This latest step forward in hair transplants is the so-called Follicular Unit Extraction technique. The technical difficulty involved is considerable, that is why appropriate instruments had to be developed to achieve these results.
The major difference lies in the way we obtain the follicular graft. The FUT technique consists in isolating a strip which is then cut into slivers under a microscope. The FUE technique, on the other hand, is an extraction technique during which grafts are extracted with a system of micro punch. This is a micro “coring” whose disadvantage is that it is performed without eye control. Damage caused to follicles are more numerous.
You should always get a detailed consultation from a professional before undergoing a hair transplant. The indication must be fully considered, the possibilities must be discussed and the expectations must be reasonable.
It is certain that a transplant on long hair is more difficult. From time to time, especially when density is still high, it can be hard to obtain the same level of quality. That is why shaving the recipient area is often recommended. However, by women or by a patient with very long hair, it is often better to avoid shaving in order to avoid a difficult postoperative period.
No, all seasons are interesting. You will just have to avoid intense sun exposure, but you can wear a cotton sunhat or a cap to protect the transplanted area.
Interested in a consultation?
You can contact us either by phone at the number +32 2 880 70 60, or by email at the address email@example.com. You can also ask for an online consultation on our website. This diagnostic does not replace a personal consultation with Dr Devroye but it gives you an idea regarding the work that has to be done (how many grafts are needed, which is the best strategy to adopt in your case, how is your donor area ...).
During the face-to-face consultation with Dr Devroye, you will be explained the theory and the technique of hair transplant and a detailed analysis of your hair situation will be made. The respective densities of the donor and recipient areas will be measured with a micro camera in the room Dr Devroye uses to take pictures. At the end of the consultation, a detailed diagnostic of your hair situation will be made. The strategy to adopt will be discussed, on which Dr Devroye will base to draw his assessment.
The consultation takes place in Brussels from Monday til Friday. The clinic is located at the Avenue de Tervueren, 36, 1st floor in 1040 Etterbeek.
The first consultation lasts about 40 minutes. As far as a postop consultation is concerned, it last about 15 minutes.
A consultation - either personal or online - is mandatory. You can contact us either by phone at the number +32 2 880 70 60, or by email at the address firstname.lastname@example.org. You can also ask for an online consultation on our website. This diagnostic does not replace a personal consultation with Dr Devroye but it gives you an idea regarding the work that has to be done (how many grafts are needed, which is the best strategy to adopt in your case, how is your donor area ...).
No, several languages are spoken at the clinic, such as English, Italian, Spanish and German.
How to prepare for a hair transplant?
You can contact us either by phone at the number +32 2 880 70 60, or by email at the address email@example.com.
In case of a FUT procedure, it is very important to begin to massage the donor area as soon as you can (at least 2 weeks before the surgery). It will soften the skin in this area, which will facilitate the removal of the strip and will reduce any tension that you may feel at the level of the scar after your surgery. Massages have to last 5-10 minutes, and you can repeat them several times a day. Moreover, on the day of your surgery, please take a shower or a bath and wash your hair with a normal shampoo.
A blood analysis is requested for Hepatitis B, C + HIV., The results of this analysis should ideally be in our hands at least 2 days prior to the day of the surgery. If you have a copy no older than 4 months, you can send it to us by email, by fax or by post and give it to us on the day of your procedure.
You should not drink alcohol during the three days preceding your surgery, but also during 48 hours following the transplant.
If you are a smoker, it is recommended to stop smoking a week before the surgery and ideally two weeks after the transplant.
You should not take aspirin the week preceding your surgery.
Yes, of course. Our clinic has double rooms and the other person can even come with you in the operating room.
Pour les patients résidant en Belgique, nous leur demandons d’être présents à la clinique un peu avant 8h afin de fixer les derniers détails avec le Dr. Devroye lors d’une consultation préopératoire.
Pour les patients résidant à l’étranger, nous leur demandons d’être présents à la clinique la veille de l’intervention. Une consultation préopératoire sera fixée entre 17 et 18h.
We offer you a double room equipped with a shower for the postoperative night. For the preoperative one, we recommend you to make a booking that you could cancel free in case one of our rooms should be available. Nonetheless, we cannot guarantee you anything for the preoperative night. If you want, we can of course provide you with names of hotels situated around the clinic.
How does the surgery take place?
The procedure normally lasts all day (for a FUT procedure or for a one-day FUE procedure), or two days for a FUE procedure involving a high number of grafts (more than 2,000 grafts).
You will have a 30-minute break around lunchtime, during which you will be served a meal. You will also have several short breaks during the rest of the day.
Yes, a local anaesthetic is administered at the beginning of the procedure.
We graft the hair and the dermal sheath containing the sebaceous gland and most of all the stem cells which will be responsible for the regrowth of a new hair.
Grafts always come from the area where hair is stable, where hair is not affected by the hereditary tendency to fall. They are removed from the crown area, from the back or from the areas situated above the ears.
Grafts are inserted into tiny incisions made in the recipient area. They are transplanted manually thanks to small and thin pliers, or possibly thanks to implanters, which are sort of very thin syringes into which grafts are slipped.
The bulb is 3 to 5 mm deep under the skin.
It is common to transplant 2,000 to 3,000 follicles and sometimes 3,500 to 4,000 grafts, that is to say from 4,000 to 10,000 hairs.
We need a team which is used to handle a large number of grafts. My team consists of a high number of experienced assistants, who are able to place some thousands of grafts every day while reaching the best quality.
What should I expect?
No, it is not mandatory. We put a room at your disposal the night following surgery because this one is long and tiresome. However, if you prefer going home, there is no problem provided that someone picks you up because you are not supposed to drive after the surgery. Moreover, you should know that a postoperative consultation is scheduled the day after the transplant.
The first hours are very important. You must avoid touching the grafts because they could fall out of the incisions. You will receive a spray with physiologic lotion. You will have to spray the lotion on the grafted area every 10 to 15 minutes during the first night following the surgery. When you see that there is no more bleeding and no more liquid secretion on the recipient area, you will be able to space spraying gradually. It often happens that around 2 or 3 am you can stop using the spray.
A postoperative consultation is automatically scheduled for the day after your surgery. The time of the postoperative appointment is arranged directly with Dr Devroye on the day of your procedure. No other postoperative consultation is mandatory, but Dr Devroye is of course happy to welcome his patients for a follow-up consultation. Anyway, we will regularly send you emails to follow the evolution of your hair transplant.
You will be given an antibiotic cream after your surgery.
For the FUT, please start applying this cream to your scar from the morning after surgery for one week, twice a day.
For the FUE, you will also receive a corticoid cream that should be mixed with the first one and applied on the donor area from the morning after surgery for one week, twice a day.
Theses creams favour the healing of the scars and avoid any kind of infection.
You may feel some pain after surgery: this is perfectly normal and the medicines prescribed will help you to relieve the pain. Normally, the pain should not be intense.
It takes 3-4 months after the transplant before the hair starts to grow except when the grafts do not fall out (5-10% of patients do not experiment graft loss). Sometimes growth is slower, it can take 6 months!
The result is only considered as definitive after 12 months.
A priori, there is no difference between the density obtained with both techniques, provided that the number of grafts reached is equal. A FUE hair transplant often provides a smaller quantity of grafts because the extraction is limited to 2,000 grafts per day. In two days, it is then possible to reach the same number of grafts as the one reached with a FUT in a single day.
Hair from the donor area do not grow back there anymore, but they will grow back where they have been transplanted. We should then be very careful regarding the management of the hair in the donor area. However, baldness might appear in the donor area only once some thousands of grafts have been extracted.
They are very few risks. The risks of infection are almost null. An oedema might often appear in the frontal area, within 1 or 3 days after the surgery. That is the reason why corticoids and ice are used during the first days of the postoperative period.
There is a possibility - due to operation stress - that a number of hairs will fall out in the post-operation phase. This generally temporary occurrence is known as "shock loss". Don’t worry; hair lost will grow back once the grafts begin to grow. This is difficult to say how long it will take for the hair to grow back, as it is different for each patient.
Only very trained eyes can see the difference. This one lies in a light strengthening of the space between each hair within the follicles. The structure of the grafted hair might also be slightly different, straighter or curlier. These differences fade with time.
Theoretically, there is no risk. Grafted hairs remain forever, at least for the time they would have remained in the donor area, which is often a whole lifetime.
Some swelling may occur on the front area, around your eyes or even your nose in the first days following surgery. That is the reason why we advise to take Medrol from the day before the surgery until a few days afterwards.
The micro bleeding that may appear generally disappears quickly after the surgery. A more important bleeding is almost always the result of an accidental movement responsible of the removal of a graft from its incision.
This is absolutely normal during the healing process. Once you start washing your hair normally, the crusts will fall off: gently massaging your scalp with your fingertips (not with your nails) while shampooing will speed up removal. DO NOT pick at them. You can also apply sweet almond oil during 30 minutes. This will soften the crusts and help remove them more easily.
You may feel decreased sensitivity in the recipient area: do not worry. Over the next 4 to 12 months sensitivity will be restored.
You can use shampoo 48 hours after surgery and, then, every day during at least one week. Use a ph-balanced shampoo (shampoo for baby): put some water and shampoo in a plastic recipient and start to massage your hair, the grafted area and the scar with your fingers and thumb. To rinse your hair, during the first days, pour some water over your head using a receptacle. You have to avoid the direct contact with the shower jet (because of the pressure) until the seventh day after surgery. After a week, you can resume your habits (rhythm, shampoo and water temperature).
As long as your skin is red, you cannot stay out in the sun (or go to the tanning bed) in order to avoid any bleaching of the skin (in the grafted area).
You may not drink any alcohol at all for 48 hours after the surgery.
Yes, there is no problem.
After the surgery, you can resume a normal rhythm of life and/or work 3 days after a FUT and 10 days after a FUE.
Please avoid all physical efforts in the first week after surgery: avoid leaning forward, avoid blowing your nose too strongly… Please limit your physical activities at least during 1 week after surgery (no sexual activity for 7 days). Avoid going to the swimming pool and the sea until full healing of your donor area (+/- 2 weeks).
You can harmonize your hair cut the very next day after the surgery and dye your hair two weeks after the procedure.
You said FUT?
It is very important to begin to massage the donor area as soon as you can (at least 2 weeks before the surgery). It will soften the skin in this area, which will facilitate the removal of the strip and will reduce any tension that you may feel at the level of the scar after your surgery.
The stitches in the donor zone must be removed at the earliest 10 days after surgery. If there is no redness or discomfort, it is possible to continue during a few days and remove the stitches only the 14th day after the surgery.
No, but it is possible to correct the FUT scar by transplanting hairs into it.
You said FUE?
The FUE is a technique which enables extract the follicles directly from the scalp, using a micro punch of approximately 0.9 to 1.2 mm wide.
First of all, this technique leaves few if any scars (in the shape of minute white spots covered by hair) and the scarring process is quite fast: the strip of skin removed with the grafts will in fact grow back without any trace of the intervention. Second of all, the zone in which hair can be removed is larger than with the classic techniques. Third of all, body hairs can also be used, for example hairs removed from the torso or the thighs by men. Finally, we can also transplant grafts in a former scar linked very often to a previous transplant.
The time in surgery is already quite long, but the skin quality will also facilitate or complicate the work. You should know that the average amount of grafts is limited to 1,800 and 2,000 FU per day in function of the degree of difficulty of the job and the surgeon’s dexterity. Patients must thus foresee several days of surgery to obtain the same result as a classic long session of 3,000 grafts in one day. Generally speaking, the donor area must be shaved, which can sometimes be an issue for certain patients.
No, this is a received wisdom. The total surface of the FUE micro scars is even larger than a FUT scar. However, it is certain that these various micro scars are less detectable than the FUT linear scar.
The scar surface varies between 1.76 mm² and 3.14 mm². If we increase the diameter by 33%, the surface increases by 77%. It is indeed interesting to choose a priori the smallest punch. However, this underlies a reduction of the average number of hairs in every graft. A slight increase in the diameter by 0.05 o 0.1 mm often allows to win 10% of hairs. We must then always consider pros and cons of using very small punches. The patient should be precisely informed about the consequences of using them. He also has to decide which priority he is giving to scars. If the patient does not want to wear his hair short (less than 5 mm), it is often better to choose slightly wider punches as they will deliver a better extraction and a better result.
I think it is often inadequate to perform a FUE by women. Unfortunately, more and more women have an operation with this technique and must bear shaving their donor area. This is linked to the increasing number of doctors who exclusively perform FUE and are not able anymore to perform a FUT. The indication is often bad because the donor area is often poor and hair is thin and fragile. It is then widely better to perform a meticulous work under a microscope with the FUT technique.
We must absolutely respect a minimum distance between extractions. This is even more necessary when the punch diameter increases. Many companies tend to increase the number of extracted grafts as much as possible in order to increase the price of a surgery. Indeed, the price of a hair transplant is often low and multiplying the number increases the final budget. Unfortunately, it turns out that to reach such quantities, it is required to use punches with a smaller diameter: 0.7 mm or sometimes less. The grafts obtained are often very poor in hairs: one or two hairs at most. The transection rate (hair which is severed and stay inside the donor area) is important. It then turns out that the patient becomes a number of hairs that is not really higher than what could have been reached with a good-quality transplant consisting of less grafts. The consequences of an over-harvesting might be extremely severe: it is not rare to see patients whose donor area is completely ruined, unusable for a second hair transplant after only one session. Your donor area is precious, so it is important to preserve it.
When we count the number of grafts punched (dissected) and we compare it to the number of grafts really extracted, there is always a difference. This corresponds, for example, to a graft for which only the upper part comes off. It can also be a graft that would be entirely buried under the skin. In this case, disadvantages are double-folded: the risk of a micro cyst (ingrown hair) but also a destruction or a full loss of such hair. Ideally, this number should not exceed 1 to 5%.
There is only one completely automated system of transplant: the ARTAS robot. I will describe this system in details later, but I will sum up here what I think about it. Currently, this robot is considerably less efficient than the best surgeons. However, it can equalize or be more efficient than less-experienced surgeons. It uses a technique that, I think, will never be as efficient as that used manually. Major faults are: use of punches with a way too wide diameter and a number of transections paradoxically too high. Indeed, as I already said in another question, wide punches usually allow to reduce this rate. Unfortunately, the robot is unable to do it. Moreover, the number of missing grafts is huge, between 10 and 15%. I was one of the first ones to attract attention of doctors on this phenomenon. The ARTAS company announced a particularly low transection rate, without mentioning this problem of missing grafts. The missing grafts created by the ARTAS system are even more annoying since they are almost always buried grafts. Currently and with some exceptions, many experienced surgeons have already sold or given up on using this robot. Others use it as a consumer appeal: they receive patients sent by the company, but rush to use a traditional technique. The ARTAS robot has become the way for many unexperienced doctors to perform hair transplants. Unfortunately for patients, you need to know that a FUE does not only come down to grafts extraction. The distribution of the graft must comply with a precise strategy and then requires some experience. The placement of the grafts is also essential.
The time spent by the doctor and his team is essential. A FUE hair transplant long by definition, the best teams around the world are able to reach a quantity of grafts ranging from 1000 to 2000 grafts a day in 8 to 12 hours. If the number of grafts extracted exceeds 2500, the quality of the surgery might be at risk. Some Turkish clinics extract up to 5000 grafts in one day, which definitely leads to a huge over-harvesting of the donor area and to a way too fast extraction.
Recommendations regarding medication?
Minoxidil can indeed speed up hair loss during the first months you use it. However, you should not stop the treatment because hair loss will stabilize and this stabilization will last on the long term.
There are no documented studies about women and the influence of Minoxidil on their foetus during pregnancy (by animals, there is no teratogen effect). However, as a small part of Minoxidil goes through the skin when it is applied on it, it is recommended to stop using Minoxidil during pregnancy. Moreover, hormonal changes caused by the pregnancy will help reduce hair loss and will balance possible losses when stopping the treatment.
Nothing proves that Minoxidil might cause any trouble to the baby feeding from his mother’s milk. However, it was demonstrated that Minoxidil ends up in the mother’s milk. As a precaution, some doctors advise against the use of Minoxidil while breastfeeding, and others authorize it. If you are in favour of the zero risk, you will not recommend it during this period. Nonetheless, the postpartum period is a time where hair loss is very likely again because hair is not protected by the pregnancy hormones anymore; so Minoxidil is often very useful at this time.
Minoxidil has to be applied twice a day, in the morning and evening. Try to humidify the skin only, not the hair. It is better to use a 4-5% concentration than a 2% one because the results obtained are better. You do not need to massage because, when doing so, you diffuse the product in the hair, which tends to leave your hair greasy.
It is very important to be patient when you use Finasteride. Indeed, its action is often delayed in time and, moreover, it is often discreet. You generally have to wait a few weeks before observing a slowdown in hair loss (between 5 and 6 months). The action is all the more difficult to observe as the average hair loss amounts to one hundred hairs per day. Very often, the action of Finasteride is observed a contrario, that is to say when the patient stops using it: at that moment, a larger hair loss than the initial one occurs.
By medical prescription, Propecia or Proscar form. Or online, but please take into account that there is no guarantee regarding the product’s quality. In fact, they are often copies from Asia or from Eastern European countries. Finasteride is not a substance which, like Minoxidil, is easily available in the public domain.
- Pain in the chest which is sometimes accompanied by swelling (gynaecomastia)
- Reduction of the sperm volume (1.2%)
- Changes in sperm consistence
- Less frequently, erection troubles (1.3%) or loss of libido (1.8%)
When they appear, side effects are premature. At this time, the treatment has not produced any negative side effects and thus, stopping the treatment will not cause hair loss.
What about hair transplant in women?
As is the case with men, androgenetic alopecia is the main cause of hair loss in women. It is a hereditary condition which affects 2/3 of women who lose their hair. It can be transmitted by the father or the mother or even by both parents. There is no general rule, hereditary transmission is complex. Moreover, this affliction can also affect siblings unequally and can also jump an entire generation. As is the case with men, secondary circumstances can be at the origin of hair loss or can contribute to the effects of the hereditary pathology.
What about body hairs?
BHT (or body hair transplant) is a variant of the FUE hair transplant. These body hairs are extracted from the chest, legs or beard through the FUE technique.
BHT is an excellent technique to use when no other solution is conceivable or when we want for example to treat a FUT scar without using classic hair grafts. We can also use BHT to soften a hair line thanks to these thin body hairs.
However, I am not keen on favouring BHT when the patient still has classic FUE grafts. BHT indeed has three major disadvantages in terms of cover: compared to head hair, body hairs are thinner, grow smaller and often contain only one hair per graft. For all these reasons, the “transferred mass” is often 3 to 5 times smaller if we compare a BHT graft to a classic FUE graft. Finally, the harvest of body hairs is often slow and difficult, and regrowth is harder than with classic FUE grafts.
This is why I recommend my patients to use BHT only when the indication is excellent.
What about eyebrow transplants?
Excessive and repeated tweezing is often responsible for the eventual disappearance of eyebrow hair. Hiding a scar is a good indication. An eyebrow transplant is also an interesting alternative to permanent tattoos, as it looks natural and it is hard to detect the fact that it is a transplant.
Generally, hair is used, but if possible we can also use armpit or chest hair extracted with the FUE (follicular extraction ) method, or we can remove a strip from the armpit. The use of grafts with one single hair is essential.