In short, a hair transplant is the only permanent solution for baldness. It involves removing hair follicles not sensitive to androgens (hormones) from one area of the scalp and transplanting them to another. Healthy follicles are taken from the back and sides of the head and transplanted to areas where baldness or hair loss occurs. These transplanted hairs will continue to grow for the patient’s entire life.
The choice of a patient for a hair transplant follows the general rules of hair surgery, essentially involving individuals with realistic expectations, a certain degree of irreversible hair loss, and a stable donor area capable of providing follicular units without risk, sufficient to permanently repopulate the affected areas. Moreover, a good candidate for a hair transplant is someone without significant health issues.
Hair loss tends to accelerate during the fall and winter months, and there is typically an increase in hair transplant surgeries during these periods. This may be influenced by people desiring a more active lifestyle during the warmer months. The timing of your hair transplant is a personal decision and depends on your lifestyle. Some individuals prefer to undergo the procedure when they can have a more secluded recovery period. Others enjoy openly sharing their achieved “dream come true.” There’s also the consideration of when you want to see hair growth. Suppose you desire significant growth for a specific event; in that case, you’ll need to plan your procedure at least 8 months in advance. Therefore, there’s no ideal season, and it’s up to the patient to choose the right time for a hair transplant.
The body’s immune system recognizes hair follicles from another person as a foreign entity and proceeds to eliminate them. Therefore, hair transplantation with hair from another individual is not effective. However, even in advanced cases of baldness, it is usually possible to find the patient’s own donor follicles for transplantation. Dr. Couto will assess the patient’s potential coverage through a restoration surgery.The cloning of hair follicles is expected to be available in the coming years, presenting new opportunities for donor availability through hair multiplication. This breakthrough will address the challenge posed by advanced stages of baldness with limited donor availability, allowing for greater coverage and higher densities in these patients.
We have successfully performed transplants on men ranging from their twenties to nearly eighty years old. The majority of patients are middle-aged, as most men experience some degree of hair loss by the age of 50. Some men choose to address their hair loss earlier, while others prefer to wait before opting for a transplant.Experiencing hair loss before the age of 25 can be particularly challenging for a young man, even if it was expected due to genetic influences from other family members. Premature signs of baldness during this psychologically and emotionally vulnerable stage of life can make individuals feel disfigured, socially less attractive, and may present challenges in certain sectors of the job market.These cases may become easy targets for companies offering ineffective miracle cures with strong advertising in print media, radio, television, and the internet. They may also fall prey to unscrupulous doctors or clinics offering transplants, knowing the potential consequences of such treatment at such an early age. Individuals under the age of 25 should be carefully evaluated, as they are generally not good candidates for surgery for the following reasons:– The pattern and progression of baldness are not well-defined at such an early age. – Designing a transplant procedure that looks natural and appropriate for the patient’s entire life is challenging. – Early-onset baldness often progresses rapidly in the first 10 years. – Hastily performed transplants may require the patient to undergo successive procedures in the short term to maintain aesthetics and naturalness. – Early surgery may complicate the proper management of valuable donor sources that could be crucial in the future. – Very young patients often demand adolescent designs that may not look natural over the years.The most professional recommendation for individuals under 25 with a high genetic risk of rapid hair loss is, first and foremost, appropriate psychological support, followed by treatment with Minoxidil and Finasteride to halt the loss process and improve the thickness of miniaturized hair. This approach aims to plan a successful transplant at a later age.
We recommend refraining from taking aspirin or other anti-inflammatory medications such as ibuprofen, MAOIs, vitamin complexes, and certain infusions for 7 to 14 days before your procedure. These substances could increase bleeding and interfere with the healing process. If you are on Minoxidil treatment, it should also be suspended well in advance of the surgery.More specific instructions will be provided in writing with the surgical plan during the consultation. If you are taking Finasteride, do not discontinue it and continue taking it after the procedure, as it will contribute to the final result. You can continue your regular medications as usual. Patients on anticoagulant therapy will be especially considered and may undergo surgery under specific protocols.
You will feel minimal pain from extremely fine needles, which will be controlled with cooling, vibration, and other pain reduction techniques when starting the application of local anesthesia. The procedure itself is entirely painless. At the beginning of the session, we will administer an oral sedative to minimize anxiety, and you will also sleep during part of the surgery. When you leave, we will provide medication to minimize any discomfort during the first 12 to 18 hours after the intervention.In the case of the FUE procedure, it is generally not necessary to take postoperative pain relievers.
A follicular unit transplant is more labor-intensive than a micrograft. The procedure takes approximately five to eight hours, depending on the size of the area to be transplanted and the characteristics of the hair. During the surgery, breaks are taken for meals or restroom visits.
After the procedure is completed, you will take a short break while receiving final recommendations. Afterward, you will be ready to leave the clinic. Due to the mild sedative administered before the procedure, we recommend coordinating with someone to drive you home or using a taxi. In the case of the FUE technique, sessions are usually more extended, depending on the magnitude of the transplant.
You typically leave the operating room without any bandages. The only trace of the procedure is tiny scabs that form in the grafted area and usually last for 7 to 10 days. Many patients can cover these scabs by combing the adjacent hair over the transplanted area or by wearing a hat. We have topical solutions that can be applied after the transplant session to speed up healing and scab shedding, and specific instructions are given regarding washing in the first few days. The small scabs, when shedding, may be accompanied by some hair; however, this should not be a concern as the follicles remain perfectly housed and will produce new hair.
Many of the transplanted hairs will disappear in the first period after the transplant, even after the scabs have fallen off, only to begin growing again three months after the procedure. In isolated cases, some transplanted hairs may remain without falling out and continue growing immediately after surgery.
You can return to work and resume your daily routine within 48 hours. During the first two days, you should avoid strenuous physical activities. We recommend that our patients refrain from all types of exercise and sports in the first week. We also suggest avoiding contact sports for 15 days.
The most significant precautions will take place in the first week after surgery, during which you should avoid contact or rubbing to prevent dislodging the grafts. After 10 days, once scabs have disappeared, you can treat the transplanted area normally. Direct sun exposure should be avoided for the first four weeks, saunas for three weeks, and chlorinated pool baths for two weeks. Baths in the sea are not contraindicated if you protect yourself from the sun with a hat. It is crucial to strictly follow the doctor’s recommendations for the best evolution of your transplant. We can also provide highly personalized post-operative instructions for each patient, depending on the development of the procedure or the technique used. The recovery time is significantly reduced with the FUE method.
Generally, almost all the hair from the transplanted follicles is lost during the first eight weeks after surgery because these units enter a resting phase (Telogen), lasting approximately three months. A new generation of hair begins to grow on the scalp 12 weeks after the transplant when the implanted follicles have revascularized and entered the active growth phase (Anagen). In some patients, new growth may occur a little earlier or up to eight weeks after the usual 12-week period. It is essential to know that not all hair emerges at once. As a general rule, results become visible after six months when you should have 50% of the growth. The new hair grows at the same rate it used to in its original place, typically 1 cm per month. Initially, it may be thinner and will increase in thickness after the first centimeter.
The final result will be evaluated one year after the transplant. Some delayed follicles may produce hair even up to 18 months after the graft. Your new hair can be treated and styled like the original hair and will last a lifetime.
We specialize in the most advanced hair restoration surgery techniques. Thanks to this, you will have a completely natural-looking head of hair, including the frontal hairline. This natural appearance is achieved by designing a soft and regular anterior hairline in harmony with your facial proportions, reflecting the growth patterns you had when you were younger, restoring the temporal projection point if necessary.
We seek the perfect harmony between the transplanted hair and the existing hair. We use only the appropriate combination of grafts from Follicular Units (not micrografts), transplanted at the correct angle and direction, to achieve undetectable results. The use of appropriate tools creates tiny incisions that match the size of each graft, allowing for increased densities. The safety and naturalness of the procedure for our patients are our most important goals.
Candidates for a hair transplant must have healthy hair growth in the donor area. Diffuse alopecias where the hair in the posterior and lateral regions may also be affected, with the risk of future loss, are not suitable for transplantation due to donor instability. This condition often occurs in women but can occasionally be seen in some men and must be accurately diagnosed before deciding on a transplant.
The density of the donor region is undoubtedly proportional to the results due to the greater availability of grafts.
Other factors, such as the color, thickness, and degree of curliness of your hair, can also influence the results. We will evaluate all these details during the initial consultation.
The transplant of Follicular Units (FUT) is a procedure where hair is transplanted exclusively in its natural groups of 1-4 hairs. “It is the logical endpoint of over 30 years of evolution in hair transplant surgery.”
Follicular Units are small families of hair separated by approximately 1 mm, visible under the microscope. Each unit contains 1, 2, 3, and sometimes 4 hairs. The transplant of follicular units involves taking 1000 to 4000 follicular units from a donor strip at the back and side of the head and inserting them into the area where the patient has hair loss. Under the microscope, we carefully section the donor strip into slivers of 1 to 3 follicular units wide, carefully separate each unit, removing the excess tissue around it, and implant them in the recipient area, one by one. To insert each unit, we make tiny holes that match the size of each one.
In the case of extraction by the FUE technique, each Follicular Unit is individually isolated through cuts made with millimeter-sized micro-punches (0.75 – 0.9 mm), leaving no visible scars.
The transplant by follicular units allows for surprising and much more natural results, ensuring better healing. For this reason, it is our preferred method of transplant, and we practice it in all our patients. Its excellent results allow for a denser and completely natural-looking head of hair. In simple terms, the hair is transplanted in the same way it is originally distributed. Other procedures, such as micro-grafting (mini-micro), involve breaking and dividing these natural families of follicles or creating larger grafts (3 to 8 follicles), without respecting their natural grouping. Micrografting was the generation that followed the Punch Grafts of the 1980s; it is undoubtedly an easier, faster, less technical, and more profitable procedure for the professional or clinic. Unfortunately, there are still many centers that perform micrografts and not Follicular Unit Transplants.
When the Follicular Unit Transplant is performed by an expert surgical team, it achieves a completely natural result, with better use of the donor area and the best cosmetic result in one or at most two sessions, depending on the extent of baldness. The Follicular Unit Transplant requires much more time and effort to separate the grafts, the use of stereoscopic microscopes, and a better-trained team. Be cautious because if you choose a traditionally trained surgeon with little experience or perhaps seek a very low price per graft, you are most likely to end up with a Microimplant or Micrograft and not a Follicular Unit Transplant (FUT).
The FUE technique is, by itself, a true Follicular Unit Transplant.
No, it’s not the same. When planning a hair transplant, the focus is often on the number of hairs to be implanted, not the Follicular Units. This is undoubtedly a marketing strategy to emphasize the procedure medically. It probably sounds better to say, “I’m going to implant 5000 hairs” than to say you will receive 2000 Follicular Units. As is known, a Follicular Unit can contain 1 to 4 hairs. In a Follicular Unit transplant, the approximate number of hairs to be implanted is calculated by multiplying the total number of FUs by 2.4. So:
3000 Follicular Units x 2.4 = 7200 hairs 3000 hairs / 2.4 = 1250 Follicular Units
In skilled hands and with a good team, a strip in a patient with average density can yield an average of 3000 to 3500 FUs, which, when well administered and placed in correct patterns, can cover an area of 70 cm² with a full appearance. Generally, 3000 hairs would only be able to cover 25 cm².
