Dr. Juan Ruiz Alconero

Calle Viriato, 55 Madrid, Spain

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+34 911 610 699



Why is my hair falling out?

Androgenic alopecia or baldness is an (unpleasant) situation in which certain follicles on your head are sensitive to the action of a hormone, DHT, which causes them to cease to carry out their normal function, that is, to make hair grow. It follows a common pattern in all men, beginning by causing the hairline to recede and the crown to thin out until in extreme cases there remains only a strip of hair on the rear of the head.

What about in women?

Though less frequent, it also occurs in women, but it has a different pattern, being more diffuse, that is, it is more spread out over the whole hair, causing the hair to be sparser and thinner. Nevertheless, the commonest cause of hair loss is not this but telogen effluvium, which has a very good prognosis if appropriate treatments are followed (and in suitable clinics).

It has recently been observed that in women the hormonal cause is not the sole cause, there are broader causes, such as nutritional and seasonal causes. This causes hair loss in women more difficult to categorise and treat.

Is there no cure?

Nobody is currently able to make hair grow where DHT has been. It is true that we have an oral medication which cause the action of said hormone to be detained (finasteride), and another, topical medication which promotes blood flow to the affected follicles (minoxodil). But we have no medication that can make hair grow.

Is it painful?

The only thing that is irritating are the pinpricks from the anaesthetic, which allow numbing both the donating and the receiving area, such that the patient feels nothing during the intervention.

Perhaps the period of greatest irritation is the afternoon after the surgery, because the anaesthesia wears off (it lasts about 6-7 hours) the area of the suture begins to irritate, but nothing that painkillers won't calm. The next day everything is much milder and normally there is no need to take any type of medication.

Is the scar going to be very visible?

The main with the capillary transplant technique using FUSS is whether the scar is going to be very visible. The first thing to say is that it is much less aggressive than, for example, a dental implant.

The scar that remains is quite fine (1-2 mm) and it is made irregular using trichophytic suture, and "zip-zap Closure" suture learned in the USA by Dr Juan Ruiz Alconero. It's true that you won't be able to wear your hair shaved to number zero, but with the length of a number 3 it will be totally invisible, and as a rule not even your hairdresser will be able to see it.

When can I do sport again?

It is recommended to refrain from doing light aerobic sport until the suture is removed, in about 12 days. Contact sports and weights can resumed after 3-4 weeks.

How long will I have to wait to see my hair?

The transplanted hair falls out from 2-3 weeks after the intervention, and remains in the telogen (rest) phase for about 10 weeks, such that the hair does not begin to emerge until after 3-4 months, and this is in the form of fluff, so that to see acceptable results you need to wait until 6-7 months have passed, and the final results after a year or a year-and-a-half has passed.

Does that hair no longer fall out?

The implanted hair is free of hormonal action, though the rest of the hair is not, so that before undergoing a transplant many factors must be assessed, such as the development of hair loss, taking medication, to make a proper assessment.

What does it involve?

The follicular units are extracted one by one using a very small punch, of between 0.8 mm. The area is anaesthetised and it can be extracted manually or mechanically.

It is necessary to shave your hair?

Yes, it's one of the requirements of FUE. Although it's possible to attempt to make extractions of long hair, it hugely complicates the process and reduces the number of units extracted.

The best thing is for the patient to shave it to number one or 0.5 the day before the surgery; that way the process is simpler and quicker.

Does the extracted hair grow again in the area from where we have removed it?

No, since it is in another area, the hair we have extracted no longer grows, and there remains a small scar which is not visible at first sight. That is why not many FUE interventions can be carried out in the same area, due to the risk of thinning that may arise.

For this reason we have to extract alternate follicle, to avoid creating visible bald areas.

After how long do the little holes from the FUE cease to be noticed?

In general, after about 6 days they cease to be noticed due to growth of the native hair. Moreover, with the Plasma Rich in Growth Factors system, scarring is achieved earlier.

Is FUE the most modern Hair Transplantation method?

Contrary to what is believed, this is not true. FUE has improved greatly in recent years due to an improvement in the instruments, but it is really a method previous to the FUSS technique, since what we know as modern FUE was designed by the Japanese Inaba in 1991, a year before Bob Limmer the standard for FUSS surgery.

Does the hair implanting look artificial?

Like everything in life, if it is done well the result is natural and aesthetically proper. This happens when material of less than 1 mm is used to not leave marks, follicular units of 1, 2 and at the most 3 hairs are used, to not lend the horrific appearance of "doll's hair". Good design, correct use of the extracted units (regardless of the extraction techniques) ensures that the hair transplant can be carried out without any kind of mark.

Which technique looks better, FUE or FUSS?

That is a very frequently-asked question, but some people forget that both are extraction techniques, that is, that the manner in which the hair is put in place is the same once we have the follicles in our Petri dishes, whether through FUE or FUSS.

It is therefore a question for the patient to decide, in agreement with Dr Juan Ruiz Alconero, since it depends on your hairstyle, the quality of the donating areas and your expectations.