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Dermatology. #Hair Transplants

* What works and what doesn’t work against baldness.


* Hair transplants using the FUE technique (“Follicular Unit Extraction”) is at the head of the advances that hair surgery has undergone in recent years.


FOLICULO-PILOSOThe medication that gave back his hair to Donald Trump, hair transplant tourism in Turkey and anti-hair loss shampoos, are just some of the lifelines that half of all the men in the world and up to 10% of women cling on to. They suffer from androgenetic alopecia.


A study published in the journal Jama Facial Plast in 2016 suggested what for many is an obvious truth: that men are more attractive (and appear younger) when they have hair. If we add to this the fact that androgenetic alopecia, the most common form of baldness, affects almost half of men and up to 10 % of women, it is easy to understand the enormous quantity of remedies, with and without scientific evidence, that we find today.


When the skin of the scalp starts to be visible and the density of the hair diminishes, the time has come to take action.


Androgenetic alopecia is caused by the action of male hormones, but it affects young men and women at any age after adolescence, though it more commonly begins in females after the menopause.


Medical treatment.


Amongst the most scientifically-proved medical treatments against baldness we find finasteride and dutasteride, which block an enzyme that makes the hormone testosterone transform into another metabolite which activates baldness. These drugs have an excellent safety profile, but they must be taken perpetually. Minoxidil is also a very popular treatment, in the form of a lotion. As with the others, it must be used continuously, in this case, rubbing it into the scalp twice a day.


Hair transplants.


There is a third method to combat baldness effectively: a hair transplant. The FUE technique (“Follicular Unit Extraction”) is at the head of the advances that hair surgery has undergone in recent years. Dr. Alcaide, a specialist in hair transplants at HC Marbella sums up the process: “It is minimally invasive, and consists in extracting micro-grafts hair by hair from an area that does not suffer alopecia, such as the nape of the neck, and they are implanted under local anaesthesia”.


The operation is very laborious, and requires many members of staff to assist. Rejection does not occur as the cells are the patient’s own and only one operation is necessary but the expert has the following warning: “The hair that is implanted does not have the defect and will remain in place, but if you do not control the rest of your hair, what you have left will continue to disappear and in a few years the balance will be negative”. The solution is simple: either wait until your own hair stabilises, or treat it with one of the drugs mentioned in this article. “Many young patients are sold the implant, but either through negligence or lack of time, they do not apply the follow-up treatment and continue to lose their hair even though the implant has been well done”, adds Dr. Alcaide.


Dr. Meyer, also a specialist at HC Marbella believes that the FUE technique has proved to be a very good option for those patients who have small alopecias, or even those who have had previous operations and the area from which the implants have come is deteriorated, for the FUE technique allows the area that donates implants to be larger. Patients with advanced alopecia can be treated by the FUE technique, but they should have a donating area with an above-average density and the hair should show good characteristics, opening up at the same time more options for the future.


When carrying out an operation according to the FUE technique, the donating area must be completely shaved. When it has been shaved, the surgeon is able to see the direction and angle of the follicular units (FUs) on the scalp; this is a very important aspect when reducing the number of transections of the follicles. Once the “punch” technique has been applied, the FUs are extracted one by one with tweezers.


Hair transplant operations have been associated in recent years with Turkey, where the government attempted to encourage medical tourism by offering more accessible prices than in Europe. Dr. Alcaide confesses that it makes “his hair stand on end” when he sees images of what looks like a “wartime field hospital”, with “enormous halls where patients lying on mattresses on the floor are attended in groups of ten by technicians supervised by just one doctor”. In Spain, that way of doing transplants would be simply unacceptable, adds Dr. Meyer.


Stem cells, plasma and lasers.


The remedies named so far are the ones that are applied most because of their results, but in recent years other more novel treatments have been used of which we have been getting more experience, sometimes positive, other times not so much.


One of these alternatives is plasma rich in platelets (PRP). Dr. Alcaide explains its scientific base: “It is extracted from the patient’s blood, it is processed to concentrate the growth factors, then it is injected into the scalp”. Its application on the tissue encourages the formation of collagen and the appearance of new blood vessels, which are vital in the stimulation of the growth of new hair. The infiltration of PRP is to be recommended for those who still have their hair follicles, in order to promote a capillary revitalisation, so the sooner it is applied, the better the results obtained.


The injection of stem cells is an alternative with less experience. It consists in extracting tissue from an area that is not affected, such as the nape of the neck, to inject stem cells into it. Another option is the treatment with lasers, about which we know relatively little: “It seems that they help to stabilise the process if they are used continuously, but it is a tedious process because it has to be performed three times a week”.


Vitamins, shampoos and other quack medicine.


According to the experts, there is a long list of miraculous solutions that neither halt the alopecia nor improve the density of the hair. Vitamins have a cosmetic effect, but not a medical one. Anti-hair loss shampoos do not exist, because the shampoo is a product that cleans your scalp and hair, but does not penetrate to the root, which is 3 millimetres under the skin.


Carboxytherapy, ozone therapy, massage, capillary botox, brewer’s yeast… Dr. Alcaide laments that many patients spend 20,000 euros in treatments “with a lot of advertising but with no logical or scientific evidence”.


It should not be forgotten that androgenetic alopecia is genetic in origin and so it has no cure. As soon as testosterone starts to be generated during adolescence, the process is activated. It is like diabetes, familial hypercholesterolaemia or essential arterial hypertension: as long as we are unable to modify the genes involved, the treatment merely slows down the problem.


This means that the drugs mentioned in this text, as we said before, should be taken indefinitely, or, as Dr. Meyer says: “as long as it bothers the patient”. The important thing is that if it is treated, it should be done “the earlier the better” and she assures us that if you stop taking them, you lose “50 % of what was gained”. “There is no point in doing it for three months, the minimum is a couple of years”, and she adds that “many people start to use minoxidil, which has no noticeable effect for six months, and they stop after a couple of months because they think that it is not working”.


Another option: to be bald.


The two doctors insist that androgenetic alopecia is an aesthetic matter and does not affect one’s health. You can apply a conservative treatment or not. Some people assume that they are going to go bald, just like their father, though in women it is more difficult to accept. Perhaps the key lies in accepting yourself as you are with humour, just as the Roman philosopher Seneca is said to have pronounced: “I do not consider myself bald, it is just that I am taller than my hair”.


Let us study your case. Our specialists in hair transplant at HC Marbella will evaluate your case and will tell you if you can benefit from any of our treatments, with or without a hair transplant.


Sources: Dr. Alcaide / Dra. Meyer.
Hunt, Nigel & McHale, Sue. (2005). The psychological impact of alopecia. BMJ (Clinical research ed.) / JAMA Facial Plast Surg. 2016;18(6):413-418. Perception of Hair Transplant for Androgenetic Alopecia.



March 7, 2019





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