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Questions and Answers

These are some of the questions frequently asked during the consultations.

Will the transplanted hair last all my lifetime, doctor ?
 Yes, you will keep it indefinitely.

What are the risks of an infection, doctor?
 Scalp infection occurs rarely, and “never” if one takes all the necessary precautions. The only cases of serious infections have occurred due to transplanting artificial hair.

Doctor, does laser therapy result in a growth of hair ?
No, laser therapy does not grow nor create new hair. And neither does ultrasound.
The use of laser impairs healing and may create bad scarring.
Therefore it should be avoided if one has just undertaken an operation.

Is it true that the FUE technique does not leave scars?
No, that is not true. This relates to the old method of hair extraction from the donor zone   using a “punch”, which is a cylindrical instrument with a blade of 1 mm  in diameter.
By using this instrument to harvest the grafts,  holes are made and spaced one from another.
Each hole will leave a small white scar: 1000 scars if one was doing 1000 transplants, and so on, so that at the end this will produce a mottled aspect in the donor area filled with dotted like white scars.
Furthermore in this way the follicles are extracted blindly so that up to 40% of their roots could be damaged and therefore not grow into new hair.

Doctor, why do you recommend doing several transplant sessions rather than doing the whole process at one time?
Although the idea of doing the transplantation all in one go appears attractive,  in reality it is risky and often not possible.
Why is it not possible? Simply because one cannot safely transplant in one single session 6000 to 9000 hairs which are necessary to treat a frontal zone.
To harvest such a large number of grafts would require such a large donor zone that the resulting scar would be unacceptably large.
Also we must bear in mind that each time we make an incision in the recipient site to insert a transplant we cut and destroy the capillaries which provide the blood supply for their growth. And the closer the incisions are made to obtain the required density, the more we damage the capillaries.
Therefore by making such a large number of incisions, very close to one another, too many capillaries are destroyed and the result will be a poor growth.
So, in conclusion, after having observed poor results for patients in terms of hair growth and even areas of no hair growth, replaced by scarring tissue, this approach called Megasession is much less practiced today.
To obtain the best results in terms of both hair growth and density it is far better to do the treatment in 2 or 3 sessions.

Doctor, why crown baldness cannot be treated with grafts?
Because baldness is a progressive process.
The hair will continue to fall around the grafts, and after a certain time the patient will find himself with a tuft of grafted hair on the top of his head in the middle of a bald area which continues to grow larger.
The quantity of hair in the donor zone is not sufficient to cover effectively the baldness of the crown.
Only in cases of very small “stabilized” bald spot in men over fifty years of age, crowns may be grafted.

This photo shows a patient whose vertex was transplanted at an early stage of his balding which has progressed with time.

The hair all around has fallen producing this non aesthetic aspect.

For a better understanding, the transplanted hair is attached with an elastic band.

This case can still be repaired.
This photo shows a patient whose baldness at the top and in the back has been treated with a very large number of transplants.

The result is inefficient and non aesthetic.

This case cannot be repaired, as there are too many scars and not enough hair left in the donor zone.

Why scalp reductions are not used anymore for the treatment of baldness?
Since the introduction of the scalp extension technique with the “Frechet extender”®
scalp reduction has become obsolete.
However scalp reductions are still of interest to eliminate a narrow band of scalp , for example to remove a skin cancer or small areas of scarring.

Please would you explain yourself  further, doctor?
For example, the treatment of a baldness which needed 6 procedures while using the scalp reduction performed over a minimum of a time span of a year before, can now be achieved in 3 procedures within a 3 months time period with scalp extension.
Therefore scalp extension being more efficient, quicker, and less expensive has replaced  scalp reduction.
Also patients with a tight scalp who could not be treated by scalp reduction can now benefit from the scalp extension technique.

Doctor, why scalp extension is so much more efficient?
In the case of scalp reduction only a mechanical force was applied for a very short time by
pulling together the two sides of the scalp.
The bald scalp was stretched as well as the hair bearing scalp and a rather narrow ellipse of bald scalp could only be removed.
Whereas with the scalp extension technique the scalp is stretched mainly using biological creep and only the hair bearing scalp is stretched.
The extender placed under the scalp exerts a gentle and permanent linear traction which stimulates the production of collagen and elastic fibres.
As a result  the surface of the hair bearing scalp gradually grows and progressively replaces the bald area at the top and the back of the head which shrinks.
It becomes then easy to bring together the two sides of the hair bearing scalp and remove the remaining bald skin.

Is there any deformity involved when using the extender?
No. The extender is a very thin and flexible sheet of bioelastic of 1mm thick which fits the shape of the head when introduced under the scalp and is totally unnoticeable.

Photo of a patient with a “Frechet Extender” under the scalp.

As you can see, there is no deformity of the head.

And with the balloon or the expander?
This technique was invented by an American surgeon. It consists of  a balloon which is  introduced under the scalp and inflated regularly with saline water.
When the balloon is inflated it will bulge under the scalp and of course  will cause an important deformation of the head for several weeks, until it is removed.
The patient cannot carry on a normal life during this period. This is the reason why this technique is not used for the treatment of baldness.
However this approach is of great interest in reconstructive surgery when the extender cannot be employed.

Doctor, I hesitate to undergo hair transplantation as I have seen some poor results. It was everything except aesthetic   
I understand very well your point of view.
However, you must have come across other treated patients, and you did not notice anything as the result was totally undetectable and natural.
Furthermore, the techniques have progressed very much with time.
The result will depend on the experience and the skill of a competent physician with an aesthetic eye. But also on the motivation of the patient who should understand the different steps of the treatment and not stop half way.
For the success of the treatment it is highly important that a mutual trust is established between the physician and his patient.
And do not hesitate to ask your doctor to put you in touch with a patient who has been treated.
What you will have on your head, you will keep all your life.

What final aesthetic result may I expect?
If you don't expect the moon, nor the mass of hair of your teens, you will be very satisfied.
You must bear in mind that these sugical procedures are aimed to eliminate the maximum of bald skin and create the illusion of natural hair.
The design of the hairline should frame nicely the face. The design of the temporal peaks is essential and so are the orientation and the angle given to the transplanted hair. .

Doctor, what about the “forums” or “blogs” on internet?
Normally, they should have been a good way for patients to exchange ideas and obtain useful information.
Unfortunately it is rarely the case, and often these forums are like arenas for gladiators.
Some people consult them innocently to find a solution to their problem.
Instead they often face individuals ,with mainly a commercial purpose,  hidden behind a pseudonym who try to discredit their colleagues. And others disguised as false patients who try to attract “clients” using unethical methods and giving out wrong and misleading information to achieve their own goal.  

And what about the information on internet ? Is it reliable?
You are asking a very important question.
On internet, one finds all kind of information, true and false.
You can perfectly write on internet that you are the Emperor of Japan and there will always be someone credulous enough to believe you.
Everyone is free to say whatever he wants, there is no control.
It can also be a total abuse.
When someone reads about a subject unknown to him, naturally he will tend to believe what he reads, whether true or not.
In the medical field, one must beware of commercial websites with publicity.
As an example, a surgical procedure without a scalpel does not exist. 
The blade can be straight, cylindrical or pointed. In all cases the object cuts the skin.

A transplant well anchored in the scalp does not fly by magic from the back to the front of the head .

© Dr. Patrick Fréchet 2008