Topics of the Articles:

FUE and FUL hair transplants

Long Hair Transplant (FUL)

Androgenetic alopecia in men and women

Afro-American hair alopecia

Scar hair transplants


PRP Injections

Scalp assessment

Frontal fibrosing alopecia

Scalp flaps

Age and hair


FUE and FUL hair transplants:

  • Surgery of the scalp using micrografts

Surgical micrografting

The techniques of scalp micrografts are directly related to the mode of sampling. The removal of a strip of scalp without prior shaving makes it possible after cutting under a microscope to obtain follicular units with long hair (FUL) or after previous shaving (FUT). The drilling of a shaved scalp with a punch of about 0.8 mm allows the extraction of follicular units (FUE). The causes are mainly masculine and feminine androgenetic alopecia, as well as cicatricle alopecia, African American traction alopecia, or swelling of the pubis, beard, mustache, eyebrows and eyelashes.

  • Micrografts of hair: signs and options

Micrografts of hair: signs and options. Ann Dermatol and Vénéréol, 2002; 129: 837-840. See article: Micrografts of hair

The progress of current treatments makes it possible to propose a medical or surgical solution adapted to the severity of the loss of hair. The microtransplantation of follicular units and mini-micro-grafts is a groundbreaking technological advance. This technique allows a permanent hair replenishment of the baldness of man and woman by bringing, in a simple and painless way, hair which grows in groups of 1 to 3 and looks perfectly natural. The difference between the androgen receptors of the occipital regions and other regions explains the definitive nature of the growth of the replanted hair. The degree of depletion of male and female alopecia can be listed on a static classification (Hamilton, Ludwig) or be measured and monitored more accurately with a multi-factorial (Bouhanna) dynamic classification.

  • Eyebrow micrografts

The micrografts of eyebrows. Realities Therapeutics Dermato. Veneto, 2014; 231: 29-32. See article:The micrograft of eyebrows

The eyebrow is an aesthetic unit that plays an important role in the balance and in the expression of the look and the face. It is an essential component of one’s look. It consists of hairs with different orientation rendering it more complex to transplant. The main causes of eyebrow alopecia are repeated hair removal of the eyebrow, impairment via age-related density and post-traumatic alopecia. Follicular transplantation is a simple surgical technique that permits the permanent correction of most alopecia of the eyebrow. This involves implanting on the glabrous or sparse area of the eyebrow hair follicles taken from the scalp or, more rarely, at the level of a hairy region of the body. Rather than the follicular extraction technique (FUE) we prefer the long hair micrograft (FUL) which allows an adapted choice of the curvature of the caliber and the tint of each implanted hair. This transplantation can be performed on a dermopigmentation already present.


Long hair transplant (FUL):

  • Immediate long hair grafts

Immediate graft with short hair. Nouv Dermatol, 1989; 8 (4): 418-420. See article:Immediate graft with short hair

Continuous research in the field of hair transplants has improved the results of this type of surgery. We had been able to verify that the application of a Minoxidil lotion at 2% before and after transplantation of autografts allowed the persistence and continued growth of the hair on them. This efficiency has prompted us to develop the technique of grafts with long hair. These grafts can be of variable size and shape, squares, fusiform, micro and minigrafts. This new method allows the reconstruction of a bald area as immediately as that obtained by the transposition of flaps.

  • Long Hair Grafts: 20 Years of Experience

Long Hair Grafts: 20 years of experience. Hair Transplant Forum International. 2007, 17 (4): 127-128. See article Long Hair Grafts

Twenty years ago we set out the technique of long hair grafting based on a logical approach supported by repetitive observations and the discovery of new surgical techniques. This technique was developed in combination with the use of Minoxidil.


Androgenetic alopecia in men and women:

  • Dynamic multi-factorial classification of male and female androgenetic alopecia

Dynamic multi-factorial classification of masculine and feminine androgenetic alopecia. New Dermatol, 2000; 19: 540-546 See article: Dynamic multi-factorial classification of masculine and feminine androgenetic alopecia

Many classifications of male androgenetic alopecia have been described. In fact, all the evolutionary schemes proposed are only topographical and particularly imprecise with regards to the discrimination between the bald zones and the hairy areas. From the measurements of certain parameters, such as the distance with certain fixed markings of the face, the hair density, the elasticity of the scalp, the hereditary or acquired characteristics of the hair which can vary the covering effect: diameter, shape, length, color and speed of hair growth, the author has developed a practical and reproducible classification system, called multifactorial dynamic classification. All these objective and quantified data can be computerized. This more precise approach to the clinical examination of a scalp will allow a more appropriate appreciation of the spontaneous evolution or under treatment of male and female androgenetic alopecia.

  • Multifactorial classification of male and female androgenetic alopecia

Multifactorial Classification of Male and Female Androgenetic Alopecia. Dermatol Surg, 2000 ; 26 : 555-561. See article: Multifactorial Classification

Male or female androgenetic alopecia induces a relatively early hair loss. Several intermediate evolving circumstances exist between minimal thinning due to a decrease in hair density (frontotemporal recessions, crown or vertex) and the stage where only a narrow horseshoe-shaped band remains. Classifications of baldness require a more objective, precise and detailed approach for the different modifications determined by the evolutionary process. This is equally true for all the experimental, medical and surgical approaches of alopecia. Therefore we propose the combined use of two classifications, one of the various simplified or detailed classifications, and a dynamic, detailed, multifactorial classification in which we have accurately integrated several parameters: elasticity and density of the scalp, and hair characteristics such as diameter, length, shape, color and growth rate.

  • Androgenetic alopecia: combining medical and surgical treatments

Androgenetic alopecia: combining medical and surgical treatments. Dermatol Surg, 2003 ; 29 : 1130-1134. Voir l’article : combining medical and surgical treatments

Androgenetic alopecia is a specific type of alopecia that is characterized by progressive miniaturization of hair scalp follicles. Hair follicle sensitivity to circulating androgens is genetically predetermined. Nowadays, two drug molecules (5% minoxidil solution and finasteride orally) were used to stabilize hair loss and promote hair regrowth. These molecules stimulate, through various mechanisms, increase in diameter and length of preexisting fine hairs. Microtransplant of follicular units and of minigrafts and micrografts is a mere technical progress by itself. In fact, it does not only give a definitive hair restoration of male and female baldness, but also brings hairs that naturally emerge from a single orifice in a group of one to three hairs. Hair implantation is made in a simple and painless way. Therefore, it is logical to combine the stabilizing and trichogenous effects of both molecules to a surgical technique that brings about natural and definitive hairs.

  • Current treatments for male and female androgenetic alopecia

Current treatments of masculine and feminine androgenetic alopecia (hormonal treatments excepted). Praxis, 1997; 86: 996-999. See article:Current treatments for masculine and feminine androgenetic alopecia

Various non-hormonal treatments, prescribed by the general route, such as certain hair-specific vitamins and topically, such as 2% Minoxidil, make it possible to normalize androgenetic loss. The trichogenic action of these products should be verified on each individual, comparative study of trichograms and phototrichograms. Alopecia associated with a more or less progressive hair loss may cause an aesthetic discomfort. At present, no medical or cosmetic prescription can give hope for a consequent and definitive regrowth. Only the reimplantation of micrografts, hair by hair, allows a definitive aesthetic densification of the bald region. Androgenetic alopecia is a physiological hair loss, occurring under the influence of androgens, in some genetically predisposed individuals the condition is autosomal dominant. The histological study of the hair follicles in the receding zones shows their progressive miniaturization. This small hair follicle produces a very fine hair, akin to down (intermediate hair). This phenomenon is due to a shortening of the growth phase (antigen) of the hair, under the effect of androgenic stimulation, this shortening results in a reduction in the hair size. The resting phase (telogen) having a fixed duration of three months, the hair cycle (anagen + telogen phase) is accelerated. A follicle is programmed to produce an unlimited number of cycles (and therefore hair). Each hair thus undergoes a phenomenon of apoptosis. The cycle being shorter than expected, the follicle arrives prematurely to exhaustion and produces only small fluffy hair.

  • Alopecia of menopausal women

Alopecia of menopausal women. Human Reproduction and Hormones, 1988; 1: 33-41. See article:Alopecia of menopausal women

Alopecia is defined as rarefaction or disappearance of hair. Menopause can cause progressive alterations of the bulbs and excessive weakening of the hair stem. Medical, surgical and cosmetic treatment will be established only after a specific dermatological and endocrine clinical review completed by some specific or general supplementary examinations. Two endogenous etiological factors and one exogenous factor may occur alone or in combination. The hormonal upheaval of menopause is the main cause. The process associated with aging does not seem to intervene on the hair thinning, on the other hand, it can cause bleaching of the hair. Excessive embrittlement of the stems due to the possible decrease in seborrhea can determine alopecia by breakage after abuse of hair care.

  • Treatments for female alopecia

Treatments for female alopecia. Medical Innovation, 1996; 15: 33-35. See article:Treatments feminine alopecia

The causes of hair loss in women are several, but the androgenetic origin is the most frequent. Several recent therapies have changed the prescription in this field. And the progress of the surgery allows an aesthetic and definitive correction. A loss is recognized as abnormal by simple examinations, such as the traction test and phototrichogram. The various other causes of hair loss must be imperatively looked for and possibly treated. Some medical treatments can currently stop any abnormal loss, or even initiate some regrowth. The progress of surgery allows an aesthetic and permanent correction of most female androgenetic alopecia.


Afro-American alopecia:

  • Hair transplants in African American patients

Hair transplants in African American patients. Dermatol. Practice, 2010, 344; 12-13. See article: African-American hair transplant

Hair transplantation makes it possible to provide, in African American patients, an aesthetic and permanent solution to most hair issues. The main reasons for treatment are androgenetic alopecia, in both men and women, and the final defects secondary to traction alopecia.

  • 10 questions about traction alopecia

10 questions about traction alopecia. Miss Ebène, 2012, Hors série Coiffure, 78-79. See article: Traction alopecia in African hair

Alopecia, kaseko? While it affects many women of African and Caribbean origins, many do not even know its name. How to prevent this hair loss? How to treat it? The facts with Dr. Bouhanna, a surgical dermatologist specializing in dermatology and affections of the scalp and frizzy hair at the Sabouraud center.


Scar hair transplants

  • Diagnosis of scarring alopecia

Diagnosis of scarring alopecia. Dermatol Practice, 1990; 88: 29-41. See article:Diagnosis of scarring alopecia

In this initial article, the essential elements of positive diagnosis and differential diagnosis are discussed. The prognosis and medical or surgical treatments will be studied in a forthcoming publication. Definition: integumentary alopecia characterized by atrophy and irreversible disappearance of sebaceous follicles. There are many causes.


Minoxidil :

  • What about the Minoxidil at the moment?

Minoxidil: what to think about now. New Dermatol, 1 991; 10 (1): 24-34 See article: Minoxidil what to think about now

The 2% Minoxidil in local application is surely the product that has a stimulating effect on hair growth in the context of androgenetic alopecia that has been the best studied. As early as 1987, we were tempered by the precision of certain methods of objectification, such as the phototrichogram, our initial focus. We confirmed the indisputable loss-prevention effect of this molecule but also pointed out the limitations on the possibilities of regrowth. The multiplicity of work done in recent years has made it possible to better understand the different mechanisms of action, to better objectify the different efficiencies and, as a result, to better identify indications and modalities of prescription of this product.

  • New aspects of minoxidil

New aspects of Minoxidil. Nouv Dermatol, 1991 ; 10(1) : 24-34 See article new aspects of minoxidil

The efficiency of Minoxidil seems to rely on many mechanisms of action, either proved or still hypothetical. The favorable trichogenous action of this molecule has been confirmed by many methods of investigation, such as in-vitro cultures and in-vitro phototrichograms. A quantitative objectification of the “normalizing” effects on hair loss, and of the “stimulating” action on hair regrowth enabled to deliver better indications and prescriptions in cases of androgenetic female or male alopecia, in cases of alopecia areata and auto-graft surgery . The development of the long hair graft technique has been possible due to the trichogenous action of Minoxidil. Moreover, the interest of the association of retino-acid and Minoxidil has been contemplated. The diversity and mildness of the side effects induced by Minoxidil as the hypertrichosis observed on women, seem to depend either directly on the doses applied or on the individual sensitivity of each patient.

  • Topical minoxidil used before and after hair transplantation surgery

Topical minoxidil used before and after hair transplant surgery. Macrophotographic follow-up. In Van Neste D., Lachapelle J.M., Antoine J.L., Trends in Human Hair Growth and Alopecia Research, Kluwer Academic Publishers, 1989 ; 247-255. See article Trend in human hair growth and alopecia topical minoxidil

A 2% topical Minoxidil solution was applied to the recipient bald scalp of sixteen patients aged 25 to 52 years with Hamilton classification of androgenetic alopecia from III to IV. Therapy began 4 weeks before surgery, then stopped during 3 weeks and started again for 3 months. 4 mm grafts were inserted into 3.5 mm. A macrophotographic follow-up was done for 3 months on four grafts near a tattooed located area. About 71% of the 64 grafts, partial or total hair is still growing without the shedding that usually occurs 2-4 weeks after transplantation. Topical Minoxidil seems to be an adjunct for transplant surgery.

  • Il minoxidil: Cosa pensarne oggi?

Il minoxidil : cosa pensarne oggi ? Dermotime, 1993 ; 1 : 15-20. See article : il minoxidil cosa pensarne

Il dott. P. Bouhanna (Parigi) è senza dubbio tra i più noti esperti europei di chirurgia della calvizie. ln numerosi lavori si è occupato del ruolo del minoxidil nell’alopecia androgenetica e del suo impiego complementaire nella chirurgia della calvizie.Di recente ho avuto modo di incontrarlo e gli ho chiesto di fare il punto per Dermotime delle sue esperienze al riguardo.

“Tra le sostanze con effetto stimolante sulla ricrescita dei capelli – dice Bouhanna – il minoicidil al 2% per uso topico è sicuramente quella maggiormente studiata. Dal 1987 abbiamo ridimensionato il nostro entusiasmo sulla sua efficacia, soprattutto per la precisione di nuovi metodi di valutazione, quali il fototricogramma. Abbiamo confermato l’indiscutibile effetto anticaduta di questa molecola ma anche segnalato i suoi limiti circa la possibile ricrescita dei capelli. La molteplicita dei lavori fatti in questi ultimi anni ha permesso di conoscere meglio i differenti meccanismi di azione, di valutarne l’efficacia e, quindi, di precisare le indícazioni e il dosaggio di questo farmaco.”



  • Autologous PRP injection in androgenetic alopecia.

Autologous PRP injection in androgenetic alopecia. Prime, 2015 (03); 25-34. Voir l’article Autologous PRP injection in androgenetic alopecia

Both male and female hair-loss and baldness can be treated using a range of methods. The indications consider a range of parameters included in multifactorial classifications. Minoxidil and finasteride have shown some efficacy as treatment methodologies. The newest molecules and cellular therapies are currently under investigation. However, the newest follicular unit transplantation, carried out via extraction (FUE) or with long hair (FUL), provides a definitively aesthetic and natural looking hair transplantation for the majority of scalp alopecia, or for a better correction of the eyebrows, the eyelashes, the pubis, the beard and the moustache.

  • Baldness: on the trail of new treatments

Baldness: on the trail of new treatments. Figaro, Anne prigent 23/03/2012 See article: Baldness: on the trail of new treatments

The arsenal to combat androgenetic alopecia could be enriched with new molecules. To hide their baldness, men may soon no longer need to sacrifice the fashion of the shaved skull or make expensive implants. American researchers have indeed identified a molecule responsible for hair loss: prostaglandin D2. Treatments targeting this pathway are already under development, according to the American journal.


Scalp assessment:

  • The computerized assessment of hair loss in women

The computerized assessment of hair loss in women. Anti-aging magazine, 2011; 4, 47. See article: computerized assessment of hair loss in women

When faced with female hair loss, a full assessment will guide the clinical examination which will allow the choice of the different analyses. The assessment will allow for:

  • The measurement of the severity of the hair loss and possible future loss.
  • The determination of the cause of the hair loss.
  • The choice of the appropriate medical or surgical treatment.
  • The follow-up of the patient’s progress and check of the effectiveness of the given treatment.
  • The objective assessment ofthe various methods of hair loss and alopecia.

Different methods of objective assessment of hair loss and alopecia. Praxis, 1997; 86: 1000-1003. See article:Different methods of objective assessment of hair loss

The increasing number of patients concerned about hair loss and the variety of local or general therapeutic treatments prompted the clinician to use simple, accurate and reliable objective assessment methods. The evaluation of the intensity and the evolution of hair loss and of an alopecic process in the context of androgenetic alopecia must therefore be based on strict criteria. The clinical examination and the traction test have only a directive value. Microscopic examination of tufts of hair or trichogram is a semi-invasive, moderately accurate and poorly reproducible examination. The histological examination allows a quantification of certain parameters by realizing a folliculogram. This method provides interesting results, but it is too invasive to be practiced routinely. Macrophotographic investigations such as phototrichogram and tractiophototrichogram allow a finer and more reliable analysis and especially non-invasive analysis of the hair cycle.

EObjective exploration of alopecia: different trichogram techniques. Practice Dermatol 1994; 142: 2-3. See article: Trichogram techniques

The tractiophototrichogramme, method of objective assessment of a hair loss. Ann Dermatol Vénéréol, 1988; 115: 759-764. See article Tractiophototrichogramme

  • El tractiofototricograma, método de apreciacion objectiva de una caida de cabello. 

El tractiofototricograma, método de apreciacion objectiva de una caida de cabello. Dermatologia Cosmetica, 1991 ; 3 : 25-30. Voir l’article El phototrichograma

El número creciente de pacientes preocupados por una caída de cabellos, y la diversidad de terapéuticas locales o generales que se pueden proponer, incitan al clínico a recurrir a métodos de apreciación objetiva que idealmente deberían ser simples, precisos y fiables. La evaluación de la intensidad y la posibilidad de medir la evolución de una caída de cabello o un proceso alopécico en el cuadro de una alopecia androgenética, debe reposar sobre criterios extrictos. El examen clínico y el test de tracción no tiene más que un valor orientativo. El examen de los bulbos o tricograma es un examen semi invasivo no absolutamente preciso e irreproducible. La técnica macrofotográfica de Saitoh ha permitido una apreciación más fina y más fiable del ciclo de los cabellos. Nosotros hemos llamado fototricograma a una simplificación y estandarización del material y el método. El tractiofototricograma es un perfeccionamiento de esta técnica.

  • The phototrichogram

The phototrichogram allows for an objective assessment by the macrophotographic of the hair growth and the variations of the hair cycle.

The phototrichogram. Proceedings of the Paris Days of the French Society of Dermatology, March 1983: 15-16. See article: The phototrichogram

  • ll fototricogramma: Tecnica di valutazione obiettiva nella diagnusi e sorveglianza delle alopecie diffuse
  • The phototrichogram A technique for the objective evaluation of the diagnosis and course of diffuse alopecias

Diverso dal classico tricogramma, il fototricogramma permette, con tecnica microfotografica, una valutazione obiettiva della crescita dei peli e delle variazloni del ciclo del capello. ln una zona da studiare individuata con precisione sul cuoio capelluto si puo ottenere una conta di capelli anagen e telogen. La ripetizione di questa analisi permettera di apprezzare l’evoluzione del ciclo del pelo. lnoltre, lo studio macrofotografico obiettivera il numero del capelli per unita di superficie e la velocita di crescita del capello.

In contrast to the conventional trichogram, the phototrichogram involves the use of a macrophotographic technique. The number of hairs in the anagen and telogen stages on the scalp to be studied can be counted, serial examinations providing data on pilary cycle changes. The macrophotographic study can also be used to determine the number of hairs per unit area of scalp and the rate of hair growth.

The phototrichogram. A technique for the objective evaluation of the diagnosis and course of diffuse alopecia. In Montagna et al, Proceedings of the 1st Internationational Multidisciplinary colloquium of Cosmetology, Salus Edit, Roma, 1983 ; 277-280 See article the phototrichogram – il fototricogramma

Frontal fibrosing alopecia:

  •  Post-menopausal frontal fibrosing alopecia

Post-menopausal frontal fibrosing alopecia. Dermatological Review of the Hair, 2005; 8: 22-26. see article: Post-menopausal frontal fibrosing alopecia

Postmenopausal frontal fibrosing alopecia is a scarring alopecia that affects women after menopause and is characterized by a gradual retreat of the fronto-temporo-occipital hair implantation line. Punctuated perifollicular erythema is usually seen on this line of implantation. Sometimes a total or partial loss of the eyebrows and pubic hair can be observed. Its evolution is slowly progressive and we have for the moment no really effective treatment, apart from the eventual permanent reconstruction by hair transplantation. This condition is considered a particular variant of the Lichen Multifocal Pilar Plan.


Scalp Flaps

  • High-hinged scalp flaps

The scalp flaps with a high hinge. Ann Chir Plast Esthét, 1990; 35 (5): 397-404. See article:Scalp flaps with a high hinge

The retrospective study of 207 high hinge transposition flaps of different sizes and locations made it possible to verify the aesthetic interest, the reliability, the complications and the indications of this surgical treatment of baldness. Four kinds of high hinged flaps were thus transposed separately or jointly for the immediate correction of all or part of an alopecic zone. The long flaps were transposed after prior automatization. The short flaps were transposed in one procedure.

  • The Post-auricular Vertical Hair-Bearing Transposition Flap

TThe post-auricular vertical hair bearing transposition flap. J Dermatol Surg Oncol, 1984; 10 (7): 551-554. See section on Post-auricular vertical flap

Flaps have been described by Passot and more recently by Juri. These techniques have some disadvantages:

  • The difficulty in obtaining a natural frontal hairline.
  • Decreased height of the crown when the flap is taken horizontally.
  • The hairs of the flap grow backward; the hairline scar becomes visible, with an artificial aspect.

In 1976, Nataf described the temporal vertical flaps (pre- or postauricular). The frontal hair orientation of those flaps is forward, and this gives a natural frontal hairline.


Age and Hair

  • Age and Hair:

The age of the hair. Skin & Body, 1996; 8 (3): 6-8. See article: The age of the hair

In terms of hair, unlike many misconceptions, the only real age-related damage is its whitening. On the other hand, it is undeniable that hormonal fluctuations especially in women (menopause) and the individual susceptibility of hair bulbs to androgens, can determine an unattractive hair rarefaction. This demerit is most often psychologically badly experienced by both sexes. The impoverishment of a hair in the elderly woman may also be related to the acquired fragility of the stems of the hair. These cannot withstand various aggressions such as sun, sea, abuses of hairdressing, and so on.

  • • Why does hair become white?

Why does hair become white? The Generalist, 1996; 1720: 10-11. See article:White Hair

Some families show an early whitening of their hair, others do not. Heredity is at stake: each individual has its own genetic program that determines the age from which its hair will lose its color. This often begins between the ages of 35 and 40, but mostly occurs between the ages of 50 and 60. Women often seem less affected than men, but it is only an appearance; they use more hair dye as a general rule. It is a physiological phenomenon that rests, on the one hand, on the destruction of pigments of the hair by phagocytes, and on the other hand on the penetration of microscopic air bubbles at the bulb or hair root.



  • Hair research and the newest micrograft techniques

Hair research and the newest micrograft techniques. Prime, 2011, 1 (2) ; 44-57. See article hair research and the newest technology

Both male and female hair loss and baldness can be treated using a range of methods, determined using the multifactorial classifications. Minoxidil and finasteride have shown some efficacy as treatment methodologies. The newest molecules and cellular therapies are currently under investigation. However, the newest follicular unit transplantation, carried out via extraction (FUE) or with long hair (FUL), provides a permanent aesthetic and natural looking hair transplantation for the majority of scalp alopecia, or for a better correction of the eyebrows, the eyelashes, the pubis, the beard and the mustache.

  • Clinical and macrophotographic study of the percutaneous implantation of synthetic hair (Nido SHI)

Clinical and macrophotographical study of the percutaneous implantation of synthetic hair. In Van Neste D., La Chapelle J.M., Antoine J.L., Trends in human hair growth and alopecia research, Kluwer Academic Publishers, 1989 ; 257-265. Voir l’article Study of synthetic hair

A clinical study was made on the scalp at 3 days, 1 month, 3 months and 6 months following implantation of synthetic fibers developed as artificial hair in Japan. Sixteen male and female patients with cicatricle androgenetic alopecia were implanted. The clinical follow-up was completed by macrophotography of the same located areas. We have evaluated the density, durability and after-complications of synthetic hair implanting small bald areas (0.25 cm2).