Hair Implantation: A Bit of History

Hair transplantation began in Japan in the 1930s, with techniques focused on treating hair loss and thinning. However, their pioneering discoveries were scientifically ignored due to Japan’s scientific isolation after World War II.

In 1959, Orentreich was the first to demonstrate the effectiveness of hair transplantation in patients with hair loss and thinning. He developed the theory of donor dominance, which remains the cornerstone of hair implantation and a principle of reconstructive dermatologic surgery. Hair follicles taken from the permanent hair-bearing area, regardless of where they are transplanted, retain their original properties—they continue to behave as if they were still in the donor area, meaning they do not miniaturize or shed due to hair loss or the action of androgens.

The widely known history of hair transplantation for treating hair loss truly begins in 1959, with the groundbreaking publication by New York dermatologist Dr. Norman Orentreich. He was the first to establish the theoretical foundations for the clinical application of hair transplantation in combating baldness. However, the real history of hair implantation as a technique is considerably older, and the true “father” of hair transplantation is not Dr. Orentreich—although his recognized contribution will be discussed in detail below.

The First Steps in Hair Follicle Transplantation

The earliest references dealing exclusively with hair transplantation come from Japan, in a publication that first described the treatment of alopecia areata of the scalp, eyebrows, and upper lip with hair implantation. The method used by Okuda in 1939 was the same one later employed by Orentreich in 1959: the removal of small cylindrical grafts (punch grafts) from the donor area using the punch graft technique, and their insertion into slightly smaller cylindrical recipient sites.

Okuda published results from 30 long-term follow-up cases, including eyebrow loss due to alopecia areata, leprosy, cicatricial alopecia, and pubic atrichia. His article was cited two years later, in 1941, in the British Journal of Dermatology and Syphilis, and then ignored. Therefore, the true “intellectual father” of hair transplantation is Okuda, 14 years earlier than Orentreich, with the key difference being that he did not report applying the method to cases of male pattern hair loss. Remarkably, Okuda was a self-taught physician, since no medical school had yet been established in Japan in the 19th century.

The work of Japanese scientists in hair implantation continued in 1943 with Tamura et al., who were the first to transplant single-hair follicular grafts into the pubic area of women with congenital pubic atrichia. Fujita applied hair implantation as early as 1953 to correct various skin defects, most notably for eyebrow reconstruction.

However, the conditions prevailing in Japan during World War II, the country’s isolation afterward, and the fact that none of these scientists applied hair transplantation techniques to cases of baldness prevented their work from being recognized outside Japan. This deprived hair transplantation of many years of progress. Reading Tamura’s publication, in which he describes his technique in detail, it is striking how similar it is to the modern FUT method introduced in 1999—from the strip graft design to the use of single-hair follicular units (FUs) at the hairline and the creation of recipient sites with a needle.

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Evolution in Hair Transplantation and Hair Loss: The Beginning!

Dr. Norman Orentreich (1922–) may not be considered the father of hair transplantation itself, but he rightfully holds the title of the father of hair transplantation for the treatment of hair loss. Orentreich was the first to analyze and prove the effectiveness of hair transplantation in patients with baldness. It is well known that all the later renowned surgeons who further advanced hair transplantation were his students.

As part of his research into vitiligo, Orentreich conducted experiments transplanting normal skin into areas affected by vitiligo to determine whether certain skin diseases were locally “dominant” or “recessive.” His experiment was as follows: after anesthesia and surgical preparation (washing, shaving, antisepsis) of two skin areas—one diseased and one normal—he removed two full-thickness punch grafts. These were transplanted with the following protocol: one normal graft into normal skin, one normal graft into diseased skin, one diseased graft into normal skin, and one diseased graft into diseased skin. The skin samples were photographed and followed for several months.

In the experiment related to hair loss, the results were striking: in all 52 cases (100%) where scalp tissue from the permanent hair zone was transplanted into bald areas, the graft maintained its hair growth exactly as in its original location. Conversely, when balding skin was transplanted into the donor zone, it remained hairless.

This observation led to the development of the theory of donor dominance, the cornerstone of modern hair transplantation and now an axiom of reconstructive dermatologic surgery. Unlike in hair loss, in diseases such as lupus erythematosus and vitiligo, the donor area adopts the characteristics of the recipient area, and thus is “recipient dominant.”

Dr. Orentreich’s theory was based on the fact that follicles taken from the occipital permanent hair zone, regardless of where they are transplanted (scalp or even another part of the body), retain their original properties. This means that follicles from the donor area, when transplanted to the frontal or temporal regions, will keep the donor’s characteristics and never miniaturize or fall due to androgenic alopecia.

Therefore, transplanted follicles continue to behave as if they remained in the donor zone—provided surgical technique is correct. These principles of donor dominance are now also guidelines for skin grafting in reconstructive plastic surgery, since the transplanted skin must match the donor in texture, thickness, color, and hair-bearing qualities.

Orentreich first tried hair transplantation on an overly insistent patient with frontal baldness who was willing to attempt anything. In 1952, this patient received the first-ever hair transplant: 10 punch grafts, 4 mm in diameter, implanted in the hairline. His case report, submitted to Archives of Dermatology, was rejected as “improbable and impossible.” Enriched by further data and his donor dominance theory, his landmark paper was finally published in 1959 in the Annals of the New York Academy of Sciences.

The rest, as they say, is history! The lasting validity of Orentreich’s theory was proven by his own follow-up 25 years later, when the transplanted follicles were still thriving. Other researchers later confirmed that transplanted follicles also preserve long-term donor characteristics such as hair color and wave pattern.

How does modern hair transplantation differ?

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Hair transplantation is the transfer of hair follicles from the back and sides of the head, which make up the permanent hair zone, to any area showing thinning or hair loss. The strip excision technique was based on removing an elliptical section of scalp, suturing the donor area, and then further dissecting it into smaller grafts—elements that remain a legacy in modern hair transplantation.

The strip excision technique marked the first major step away from the previously irrational and mutilating methods, forcing hair transplant surgeons to rethink and change every aspect of these procedures. For the first time, it became clear that hair implantation is a demanding and detailed surgery which, if performed correctly, can guarantee natural results. From that point on, continuous efforts were made to achieve increasingly better techniques. The use of microscopes, single-blade knives, preparation of smaller grafts, storage solutions, meticulous implantation methods, and minimizing tissue trauma are the other “inheritances” of the strip excision technique, all of which are preserved and continuously improved to this day, raising graft survival rates to nearly 100%.

Patients now have higher expectations, demanding perfectly natural and dense results. As a consequence, techniques, instruments, and ultimately the results of hair transplantation have improved significantly. In modern hair transplantation, both the extraction of grafts and their preparation and placement have been refined to the point where we can now mimic nature in every single transplanted follicle. Today, doctors engaged in hair implantation who genuinely care must stay informed and specialized to deliver what every patient desires: a perfect and dense head of hair.

Older and Newer Hair Transplantation Techniques

The punch graft technique was the first hair transplantation method applied in the West, from 1960 until the mid-1990s. It was a mutilating technique, with obvious disadvantages, unnatural results, and frequent complications, and unfortunately, almost everyone who underwent it eventually regretted it. The promises of doctors were exaggerated and, sadly, matched perfectly with the desperation of hair loss patients, who until then had only wigs as a solution. The technical details of this method made it inherently unsuccessful, and the dogmatism of “authority” figures and the persistence in using this—by today’s standards—unacceptable technique, delayed the evolution of hair transplant procedures for decades.

The scalp reduction technique in hair transplantation arose from the major disadvantages of the punch graft method, which left fertile ground for any alternative technique—no matter how illogical or destructive it was. Although in selected cases scalp reductions could deliver impressive short-term results, the inevitable progression of hair loss in other areas would eventually expose the extensive surgical scars. The disadvantages of follicle wastage and the complications of scalp reduction are enormous, and common sense leaves no room for applying these procedures in modern hair transplantation—except in cases involving the removal of small, scar-related lesions.

The scalp extension technique (scalp stretching technique) was another hair transplantation method that emerged as an alternative to the major disadvantages of the punch graft technique. It was often combined with scalp reduction in order to reduce the number of surgeries and minimize the “stretch back” effect. However, the devices used caused significant discomfort, intense and persistent pain, and made the patient’s appearance unsightly. At the same time, the wastage of hair follicles was enormous, as they were used to cover areas of the scalp with little real aesthetic importance. Common sense leaves no room for such procedures in modern hair transplantation, except in cases of aesthetic reconstruction or removal of extensive scarring lesions of the scalp..

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The scalp lift technique is a sad testament to what a desperate patient with hair loss may endure in order not to be bald. This technique involved detaching the scalp across the entire surface of the skull, lifting it from its original position, and suturing it higher up in order to cover areas previously devoid of hair. Unfortunately, some surgeons—driven by ambition, seeking to stand out from the “crowd” of doctors performing simple hair transplant techniques, and eager to impress both the public and their colleagues—conceived these technically complex but ultimately pointless and mutilating surgeries to treat a benign condition such as hair loss.

The scalp flap technique was an attempt to create a more natural-looking hairline than what the punch graft technique offered. Flaps are categorized as simple, pedicled, or free, depending on whether they are transferred with or without their blood supply. In hair loss surgeries, scalp skin flaps consisted of elongated strips of scalp taken from the temporo-occipital regions and moved to the balding area.

Unfortunately, once again, some surgeons—driven by ambition and the desire to impress, wishing to stand out from the “crowd” performing simple hair transplant techniques—devised these technically difficult operations. While they did indeed provide immediate and “impressive” results, this came at the expense of naturalness and long-term planning, since the donor area was completely depleted. Patients who underwent scalp flap procedures now generally seek hair transplant repairs (repair HT).

The hair transplant technique using Laser was yet another tool of showmanship, advertised as something that could supposedly improve transplant results. Its only application was in creating recipient sites. The Laser was claimed to reduce surgical time, keep the surgical field clean, lessen postoperative pain, facilitate graft insertion, and decrease compression from surrounding tissue. In reality, however, the Laser caused tissue vaporization, micro-burns, and micro-craters. It cauterized blood vessels and nerves, weakened the skin’s elastic support, increased graft rejection and scarring, reduced oxygenation, and delayed healing and revascularization. Thus, unlike the many useful applications of Lasers in Medicine, their use in the field of hair transplantation can only be described as harmful.

The strip excision technique marked the beginning of the end for irrational and destructive hair transplant methods. This technique was based on the removal of an elliptical section of scalp, suturing the donor area, and then further dividing it into smaller grafts — elements that remain as a legacy in modern hair transplantation.

For the first time, it became clear that hair transplantation is a demanding and detailed procedure which, if performed correctly, ensures natural and reliable results. After three decades of dogmatism and “ostrich mentality,” hair transplant surgeons finally revised the “axioms” of the past and, through observation and the sharing of experience, began to establish evidence-based practices with minimal tissue damage and more natural outcomes.

With this healthier mindset, knowledge grew rapidly, surgical ergonomics improved dramatically, and hair transplantation advanced significantly. An important contribution of the strip excision technique was that its many technical demands no longer allowed surgeons with amateur interest in hair restoration to perform the procedure at high standards. As a result, the operation became limited to a few dedicated surgical teams, and the dismal outcomes of the past began to disappear.

The FUT technique (Follicular Unit Transplantation) is now considered the “gold standard” in hair transplantation. By principle, only intact, independent follicular units (FUs) are transplanted. Each FU is not divided into smaller parts, nor are multiple FUs combined into larger grafts. FUT represents the culmination of surgical evolution in hair transplantation with respect to the recipient area. In terms of the naturalness of the final result, it provides the perfect imitation of natural hair growth, the highest survival rate of grafts, and the optimal density.

With FUT:

  • Trauma and micro-deformation in the recipient area are minimized.
  • Healing and graft nourishment are optimized.
  • A completely natural arrangement, direction, and angle of growth is achieved.
  • Even large sessions of >5000 FUs are feasible.

To achieve these ideal outcomes, however, the technical requirements on the surgeon — and especially the assisting team — are substantial. Success demands teamwork, professionalism, and advanced expertise, which only a few highly trained surgical teams can deliver.

The FUE technique (Follicular Unit Excision) differs from the FUT technique mainly in the method of graft harvesting, which is now performed with microscopic punches with a diameter of less than 1 mm.

With FUE, follicular units are extracted one by one directly from the donor area, instead of removing an elliptical strip of scalp as in FUT. However, when the required number of grafts exceeds 1500 FUs, the patient should not undergo FUE as the primary technique.

The Body Hair Transplant FUE (BHT FUE) technique is the latest development in modern hair transplantation. In the BHT FUE technique, FUs are removed from areas outside the scalp and transplanted into the scalp. It has been proven that these follicles gradually acquire a longer anagen phase but do not change in diameter.

With the BHT FUE technique, the number of potentially usable FUs for transplantation theoretically increases significantly, but body FUs are generally single-hair, thinner, less “shiny,” and with a shorter anagen phase. Extraction of the grafts is difficult, intraoperative damage during removal is very high, postoperative survival is often disappointing, healing is slow, while complications in the donor area are much more frequent than in scalp FUE.

In general, the BHT FUE technique should not be recommended to the average patient and is indicated only for individuals with a fully depleted scalp donor area, those who need repair FUE, and for cases of hair transplantation in areas where finer hairs are required (eyebrows, eyelashes).

Why do we see bad results from older procedures?

It’s not uncommon to see a young man with a shaved head and a large scar on the back of his head. This is due to two reasons: first, the doctors who performed these transplants did not have the proper specialization, and second, these cases were unsuitable and should never have undergone hair transplantation. A hair transplant performed by a specialized team on appropriate candidates leaves no marks and is never noticeable.

Hair Thinning Coverage Techniques

The use of products that cover thinning by reducing the color contrast between hair and scalp is very popular abroad and recently also in Greece. Candidates are people with thinning hair, not those with completely bald areas. There are 4 categories of camouflage products: powders, pastes, sprays, and microfibers. Each product comes in different shades to match any hair color. With the exception of microfibers, all other categories have significant drawbacks: unnatural scalp appearance, poor application, frequent scalp irritation, unknown long-term safety, difficulty in removal by washing, and they usually remain noticeable.

In contrast, microfiber products have the most advantages. They offer precise application and a natural look, are unaffected by activities, inert, do not cause irritation or interact with medications, and are easily removed by washing. When used correctly, they are never noticeable. The KMax Milano Hair Fibers (natural keratin microfibers) is the officially recommended product by the International Society of Hair Restoration Surgery (ISHRS). It is indicated in most stages of hair loss and also after hair transplantation, both immediately and long-term, to improve naturalness and coverage. In fact, KMax Milano Hair Fibers is an extremely useful and often essential supplement to any hair loss treatment, perfectly complementing even the best hair transplant by offering natural coverage and higher density, even in patients with fine hair.

Another method of covering thinning hair is the use of hair systems (wigs). Modern systems have improved greatly compared to previous decades and can often look indistinguishable from natural hair. Factors such as hair type, knotting technique, base type, and attachment method create a wide variety of products to meet many needs. Wigs are mainly indicated for people with no other options, such as patients with alopecia totalis, extensive alopecia areata, post-traumatic scars, or patients undergoing chemotherapy. For men with hair loss, wigs should only be considered as a last resort—those with a completely depleted donor area, disfiguring scars from older hair transplant methods, or advanced stage VII baldness.

Doctors and patients should understand the limitations of wigs. A wig on display may look impressive and feel natural, but once worn, problems begin. For hair loss patients, doctors must be clear: the financial cost of wigs over time is enormous—many times higher than hair transplantation or medical treatment. The psychological cost is also immense, as patients often adapt their personal and professional lives around their wig.

In general, wig use should be avoided except in stage VII baldness, in patients unsuitable for hair transplantation, those fully determined and wealthy, or those with permanent scars from past procedures that cannot be improved even with Scalp Micropigmentation. Even in such cases, it is better to consider Body Hair Transplant (BHT) or simply wear a hat rather than commit to a wig

Suitable Candidates for Hair Transplantation

Whether a patient with hair loss is a suitable candidate for a hair transplant is a decision that results from specific tests and is always finalized with the advice and experience of the doctor who selects the cases. The diagnosis must be personalized, but there are certain situations where a hair transplant should necessarily be ruled out.

Hair transplantation generally attracts individuals under psychological pressure due to hair loss, those with high expectations (sometimes unrealistic) regarding the results, and even psychiatric patients who require early identification and appropriate management.

The main criteria a hair transplant surgeon considers when deciding if a patient is suitable are:

  • The patient’s age

  • Overall health

  • The goals and expectations from the procedure

  • Mental health

  • Family history of hair loss

  • The donor-to-recipient ratio and suitability

  • The hair characteristics

Other secondary but important criteria include skin thickness, temples and temple hair, medications the patient is taking, skull shape and size, donor and recipient elasticity, and available options for coverage.

Based on these criteria (and some technical factors), the doctor can judge whether the patient is suitable to proceed. Since hair loss is progressive, the doctor must use sound judgment and also have an artistic sense to deliver a result that satisfies both the patient (aesthetically) and the surgeon (technically). The doctor must also recognize the limitations of the donor and recipient areas and avoid over-promising results.

However, not all patients should undergo hair transplantation. A quick way to assess suitability is whether the procedure will make the patient look aesthetically better than before. If yes, the patient is suitable; if not, alternative treatments should be considered.

In addition to the standard questionnaire and tests, there are also so-called Red Flags that warn the surgeon of possible problems during or after surgery. These are best recognized by experienced hair transplant surgeons and fall into three categories:

  • Medical Red Flags: blood clotting disorders, poor wound healing, diabetes, gastrointestinal issues, joint problems, harmful lifestyle habits, substance abuse, psychiatric or neurological disorders.

  • Objective Red Flags: limited donor supply, very low donor-recipient elasticity, very young or elderly patients with uncertain hair loss progression, extremely low follicular unit (FU) density.

  • Subjective Red Flags: unrealistic expectations, dependence on cosmetic procedures, obsession with hair despite minimal objective hair loss.

An Unpleasant Truth About Hair Transplantation in Greece

In Greece, it is very common to see men either with obviously poorly designed or poorly executed hair transplants, as well as – mostly young – men with a shaved head and a large, wide scar in the donor area. The truth is that whenever you see a man with visible grafts or with a shaved head and at least one obvious scar in the donor zone, you are looking at someone who:

  • should never have undergone a hair transplant in the first place, as they were not a true candidate from a medical, ethical, or aesthetic perspective,

  • was a candidate, but was never clearly informed of the limitations of hair transplantation or was given unrealistic expectations about the final result,

  • was so disappointed by the poor outcome and the subsequent behavior of the doctor or clinic that performed the procedure, that he completely lost faith in ever being helped again and chose to live with an aesthetically unacceptable appearance.

These patients are a living, moving, and very effective advertisement against a branch of surgery that, in reality, can provide excellent benefits to the right candidates. Wherever they go, these patients will blame the doctor or clinic that deceived them, condemn hair transplant surgery as a whole, and deliberately discourage others — who may actually be ideal candidates — from pursuing the procedure.

Hair Transplantation with the FUE Technique

The FUE technique, as mentioned earlier, is one of the two hair transplant methods currently used. In this technique, the entire donor area is first shaved down to 1–2 mm. Partial shaving of the donor zone is generally avoided, unless the surgeon has significant experience with this approach. In the operating room, LED lighting is used (to prevent graft dehydration), and magnification of at least X5 is applied. The donor area is divided into smaller sections, which are gradually anesthetized. Then, the hair follicles are separated from the surrounding tissue using a special tool (punch). Once this process of follicular isolation is completed, the follicular units (FUs) are extracted from the scalp with the help of forceps. Finally, after undergoing partial preparation, they are placed in Petri dishes until they are transplanted into the recipient area.

Hair Transplantation with the FUT Technique

The FUT hair transplant technique is considered quite complex and demanding, as it involves a lengthy process before the hair follicles reach their natural form and are ready to be transplanted.

Therefore, the technicians in each FUT hair transplant procedure must work quickly and precisely, ensuring minimal trauma and maximum graft survival. This is also the reason why FUT requires a large medical team and specialized equipment (microscopes, graft extraction tools, etc.).

In particular, FUT procedures involving more than 3000 FUs (the so-called mega-sessions) are extremely demanding, time-consuming, and exhausting for both the medical staff and the patient.

Instructions before hair transplantation (with FUE and FUT techniques)

Hair transplantation, although a surgical procedure, does not require any special preparation for its smooth conduct. It would be good to keep in mind the following:

Do not cut your hair for at least 3 weeks before the procedure. It is necessary for the hair at the back as well as on the sides to be at least 1 centimeter long in order to cover the stitch after the procedure. If there is any doubt regarding the length, it is preferable to leave your hair long and we will bring it to the preferred length on the day of the procedure.

It is important to inform us about any treatment you may be taking during this period, because it may be necessary, one week before the procedure, to stop or modify it, provided of course that your attending doctor allows it. Also avoid taking multivitamins, aspirin, or any other non-steroidal anti-inflammatory drug for 7 days before the transplant. Abstaining from alcohol for 3 days is also recommended, and 1 day before the procedure avoid drinks that contain caffeine as well as smoking.

Preparations containing Finasteride are allowed to be taken even on the day of the procedure, however if you use preparations containing Minoxidil, stop using them 4 days before the procedure and you can start the treatment again 15 days after the procedure.

Regarding the day of the procedure, after you have slept well the previous night, in the morning wash your hair well but do not use styling products, or thinning coverage products and do not use cologne or perfume. Wear loose, comfortable clothes with a zipper or buttons and do not forget to bring a hat with you for after the procedure.

If the procedure is scheduled in the morning have a light breakfast before you come to the clinic, avoiding the consumption of milk, coffee or any other caffeinated drink. If the procedure is scheduled to begin in the afternoon, eat a normal breakfast but your lunch should be light.

It would be good to have an escort with you, or to leave by taxi because the medication you will receive during the procedure may cause drowsiness, so avoid driving. For people coming from the provinces it is recommended not to travel immediately after the procedure. It is preferable to stay overnight in the city and return to your area the next morning.

Instructions after the FUE procedure

After the transplantation, on the same day the only thing that someone who has undergone a hair transplant has to do is to rest for the rest of the day.
He should be careful not to hit his head, to avoid bending over and not to forget the spraying with saline solution and the medication that was given to him.

In the following days, it is recommended to wear clothes with buttons or with a zipper and gradually one may return to his activities, avoiding however for a few more days alcohol, vitamins and herbs. Proper care of the recipient area and frequent spraying of it with saline solution will minimize the small scabs, the scar will be less visible and will heal faster. During this period the person who has undergone a hair transplant should continue to be consistent with the intake of the medication that was given to him.

As for washing, in the donor (back) area, you can wash the donor area with lukewarm water by doing light massage with the tips of the fingers and according to the doctor’s instructions. After a few days you will be able to wash the entire head. You should avoid at first, styling products and hair dyes. If you were using some treatment before the surgery, the doctor will advise you when you can start it again. There is a small possibility of itching either in the donor or in the recipient area after the surgery, which is not worrisome because it is part of the healing process.

Rarely, swelling may appear in the first days after the surgery. The swelling usually starts from the hairline and reaches the forehead. However, you should not worry, it goes away on its own and does not need special treatment.
There is also the possibility of numbness, tingling or similar symptoms due to the removal of the grafts in the donor area and the transplantation in the recipient area. Usually this feeling disappears after a few days and no unpleasant sensation remains.
The stitches that exist in the donor area are not absorbable and must be removed on the day that your doctor will indicate to you.

Any activity that increases the pressure in the donor area (rubbing, pressure, etc.) and generally the stretching of the back part of the head, team sports, or sports that require the use of a helmet you will be able to start again when your doctor indicates. However, if you wish, you can do exercises such as light walking, lifting light objects and mild leg exercises a few days after the surgery. For the summer months avoid swimming for certain days and do not forget the hat for protection from the sun.

Hairline: The Frame of the Face

The most important area of hair growth is the anterior hairline, which is a zone 1–1.5 cm wide along which the transition occurs from the bare skin of the forehead to the scalp.

The hairline is important because it constitutes the frame of the face. Just as a painting is incomplete without a frame, so in the male face, as soon as the hairline is restored, the frame of the face is immediately restored as well!

The aesthetic importance of the hairline and its proper reconstruction by the hair transplant surgeon are enormous, and the quality of a hair transplant surgeon’s “work” is judged by the hairline he has designed. At this point, the factors of the surgeon’s technical skill and aesthetic perception come into play.

At Anastasakis Hair Clinic, the shape of the hairline is designed individually for each patient, according to his unique characteristics. The high aesthetic perception, the use of the unique Laser-assisted hairline designer tool, as well as our dedication to exceptional detail, allow us to create a youthful, natural-looking result, for life. The design of the hairline depends on many parameters and must fit each patient individually. Thus, we design the hairline that matches your age, preserving the angles of the temples so that they give an image of “masculinity” and can also match your appearance over time, since the results of hair transplantation are permanent.

The height of the hairline is approximately 9.5–11.5 cm higher than the point where the nose joins the forehead, and 7 cm from the eyebrows. The shape of the hairline must be symmetrical and resemble the shape of the person’s face and, accordingly, can be categorized into the four main types: round, oval, triangular, and square. At the hairline, only single-hair FUs are used, and those with the smallest diameter are selected in order to ensure a natural, soft transition from skin to scalp. The grafts are not lined up as if on a straight line but are instead placed in an irregular, broken line. The angle of placement of the grafts is also of utmost importance.

The follicles of the hairline always have a forward direction, creating an acute angle of about 60° and at the hairline even 90°. The density with which the hairline is transplanted depends on the characteristics of the hairs. When conditions permit, in a single session densities of up to 40 FUs/mm² can be achieved in the hairline. These and many other technical details and secrets make up a perfect hairline.

Density Increase with Hair Follicle Transplantation

The goal of density increase in the scalp is greater coverage of the thinning that the patient presents. Usually, patients interested in hair transplantation are individuals with extensive hair loss or thinning. However, there are also those who simply want to add more hairs in between their existing ones to give the impression of “full coverage.” Indeed, FUs can be transplanted in between pre-existing follicles in the recipient area, provided that the technique is excellent and every effort is made not to damage even a single viable follicle in the recipient area.

Beyond the effort for a technique that is as minimally traumatic as possible, the hair transplant surgeon must be able to discern whether there is truly the necessary “vital space” for the transplantation of additional FUs or whether, in the end, such damage will be caused to the pre-existing follicles that the final result will appear aesthetically “thinner” than before. This technique requires enormous experience and should not be attempted by inexperienced surgeons.

Repair Hair Transplant (repair HT) and Trichophytic Closure

By applying the most modern hair transplantation techniques, any imperfections and almost any problems from older hair transplants in which outdated implantation techniques were used can be corrected. Unfortunately, even today we see old transplants that have left large unsightly scars. However, there are now techniques that give patients the possibility to reduce the width of a scar without the need to transfer follicles into the scar tissue, which cannot ensure their viability. Nowadays, follicles are transplanted into the scar only when there is no other option.

With the method of trichophytic invisible closure, it is possible to close the donor area for all No-Scalpel Strip cases without exception. In this way, we achieve hair growth through the incision, making the scar undetectable, even by ourselves, after 2 weeks.
Additionally, with Trichophytic Invisible Closure™ a slight change in the growth direction of the neighboring follicles is achieved – about 10° more vertical – resulting in better coverage of the area.

Use of Hair Follicles from Other Areas of the Body in Hair Transplantation (Body Hair – BHT FUE)

The growth of hair follicles in other areas of the body, beyond the scalp, is completely different from that of the scalp and presents different anatomical characteristics. Follicles extracted from these areas require a completely different extraction technique than the usual one, and the physician who attempts it must have extensive experience in the FUE method. The extraction of grafts is particularly painful and tiring both for the patient and the physician. The extraction rate of follicles does not exceed 50 per hour in the best of cases. It is reported that, unlike classical hair transplantation where the grafts retain their original properties, it is assumed that grafts taken from other areas and transplanted to the scalp may acquire the properties of scalp follicles.

There is still no scientific proof – only indications – that the hairs in the area where they are placed will follow the growth rate of the recipient area (about 1.2 cm/month for the scalp) and not that of the area from which they were taken.

The likelihood of inflammation and scarring in the donor area when an area outside the scalp is used is particularly high, resulting in the need for several days of antibiotic administration, and eventually visible scars remain in the area from which the follicles were taken – neck, chest, back, lower limbs. In contrast, inflammation of any form never occurs on the scalp due to its rich blood supply, and the use of antibiotics is either not required or done only for preventive reasons.

Hair growth in the rest of the body occurs mainly in the form of single-hair follicles and rarely as two-hair follicles. The thickness and diameter of the hairs emerging from single-hair follicles on the body are noticeably thinner even than the corresponding single-hair follicles of the scalp. It is not possible to rely on single-hair follicles for a cosmetically satisfactory result in hair transplantation. Normally, only about 10% of scalp follicles are single-hair, compared to 90–95% of body and limb follicles.

Success Rates

Hair transplantation can be a surgical procedure with a 100% natural result. Nature itself ensures the permanence of the result. The transplanted hairs last for a lifetime, since the area from which the follicles are extracted, the zone of permanent hair growth, is not affected by hair loss. As for the density and naturalness of the result, here the responsibility lies with the doctor, who must, with interest and professionalism, having experience and complete specialization, and by using the most modern techniques, provide a completely satisfactory result to the patient.

Of course, an important factor in the high success rates is the patient – as mentioned above. Whether someone is a suitable candidate for hair transplantation depends on many factors, such as their age, the extent of thinning, as well as whether they face health problems. From these we conclude that hair implantation for each candidate must be approached in a completely individualized way, both in whether they should undergo hair transplantation and in which technique should be applied. Taking all this into account, it is clear that the doctor is the only one responsible who can reliably guide you on whether you can undergo a hair transplant or not. He is the one who will suggest that you proceed with a hair transplant only if he is certain that the aesthetic result will be long-lasting, or to follow some other alternative if he judges that you are not a suitable candidate for hair implantation.

How to Choose the Right Doctor for Your Own Hair Transplant

A very important decision is also the choice of doctor for the hair transplant, considering that the result will be permanent, so it must be absolutely natural and fitting with the individual’s characteristics, not only now but also in the future. For this very reason, you must have three basic criteria in your choice: the doctor’s experience, his technical knowledge, and his specialization. Equally important is the doctor’s aesthetic perception, because this is what will make the difference in terms of the aesthetic result.

Taking all of the above into account, one understands that the choice of doctor should be made calmly and not under the influence of anxiety, panic, or distress. You could ask the doctor – and he is obliged – to show you cases similar to your own and perhaps even get in touch with some of them. Above all, you should not be concerned only with a doctor’s popularity, his frequent appearances on television, or how many celebrities he has operated on. Do not forget that hair transplantation is a purely individualized surgery, so your main concern should be what the doctor can do specifically for your own case.

And always remember that doctors who are specialized in hair transplantation are members of some international organization of surgeons such as the I.S.H.R.S (International Society of Hair Restoration Surgery) or the A.B.H.R.S (American Board of Hair Restoration Surgery).

Why Choose Our Clinic?

The main goal of our clinic is for our patients to achieve the best possible aesthetic result, not only now but especially in the future. We accomplish this firstly by having a surgical team with complete specialization in hair transplantation that works collectively, with speed and flawless coordination, and secondly by using the most advanced hair transplantation techniques as well as the most modern machines and tools.

We use the most specialized stereoscopes worldwide, the Mantis, which with their precision guarantee us a 100% survival rate of the grafts during their preparation. This, combined with flawless and responsible teamwork, can ensure you a successful result – and at the most affordable prices.

PRP and Hair Transplantation

Although the PRP technique is applied by many in Greece, it does not yet have valid published scientific results, therefore we should still be cautious regarding the effectiveness of this technique. In the PRP technique, blood is drawn from the patient, this blood is centrifuged in a special machine, and a super-concentrated solution with certain growth factors is produced.

This solution is then injected with a syringe into the scalp, either in combination with a hair transplant for faster hair growth, or even without a hair transplant, in the hope of hair regrowth.

Cost of Hair Transplantation

The cost of hair transplantation depends on the number of follicular units that need to be transplanted in order to achieve the desired aesthetic result and on the technique that will be followed. As is well known, in hair implantation we transplant follicular units and not hairs.

The hairs grow out of the follicular units. Each follicular unit may consist of one to four hairs. As for the hair transplantation techniques, the doctor may choose either the FUT technique or the FUE technique. The FUT technique can give us in a single session as many grafts as the FUE technique would give us in two or three sessions. Therefore, it is understood that the cost of hair transplantation depends on the number of follicular units, the method that will be followed, as well as the number of sessions required.

Safety and Perfect Result in Your Hair Transplant

For a hair transplant to be a safe procedure, since it is a purely surgical act, it requires that the place where it will be performed is appropriate and fully equipped for such a procedure, and that the doctor and staff have the proper training, experience, and specialization for this surgery. When the above conditions are met, it is ensured that the hair implantation will be safe, will have absolutely no complications or side effects, and the chances of technical error are eliminated, and thus the result will be perfect.

As far as the result is concerned, the perfect outcome can be guaranteed when the hair transplant is performed in a specially equipped clinic, by a specialized doctor and with the help of specialized nursing staff. All the steps of hair implantation must be executed flawlessly, regarding the design, the technique, and the strategy that the doctor will follow, because any mistake during the procedure of hair implantation is multiplied by the number of follicular units that are transplanted. In conclusion, for you to have a perfect and natural result, the prerequisite is that all steps during the hair transplant are performed perfectly.

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