The actual day is divided into two parts, each of five hours or so; first extraction, then implantation. It starts with two jabs of local anaesthetic in the centre of the forehead, then Dr Kouremada-Zioga gets to work with a small, highly-specialised instrument which punches tiny holes, less than a millimetre in thickness, and scoops out precious hair.
Men go bald due to the frankly unnecessary secretion of a hormone called dihydrotestosterone, or DHT. Hair doesn’t simply fall out; it shrinks. Every hair on the head grows from a follicle, a purpose-built hair-growing factory that keeps churning the stuff out. Then, like a pernicious management consultant, the DHT shows up and shrinks the size of these tiny factories right down. They carry on pumping out their produce, even with their meagre resources, but it’s thinner. In the end it becomes so thin that it shuts down completely.
Why nature does it to us is something of a mystery. Given that age doesn’t rob men of their reproductive powers as it does women, it may exist purely to turn us hideous, to drag us screaming from the gene pool once it feels we’ve been in long enough. There is also confusion over whether it comes from the maternal or paternal side, and why it should lie dormant for generations.
Minoxidil, the active ingredient in Regaine, and the prescription drug Propecia, both work in the fight against DHT, giving the follicles some much-needed backbone. The first, a topical foam, just increases the blood supply to the area. The second actively blocks the creation of the hormone itself, but only at the crown, not the front. Both, of course, are merely delaying tactics, but they are effective.
Tom Peck before, during and after the FUE treatment
Of the many anti-balding products out there, it is only these two that the US Food and Drug Administration acknowledges actually work, and there’s little point in having a hair transplant unless you’re willing to get at least one of these too.
For some reason, DHT rarely wreaks its lethal menace on the follicles to the back and side of the head. The factories there remain almost fully productive for as long as their owner does. Transplanting follicles from here to the top and front of the head doesn’t alter their susceptibility to the dreaded DHT. They’re good for life, wherever they are reinserted.
As such, the thousands of little punctures Dr Kouremada-Zioga is making to the back of my head – the donor area – with her special little needle, scoops out not just a hair, but an entire follicle each time, the tissue, the sebaceous gland, the lot. Mmm. One by one they are passed to her assistant, who cuts off the actual hair, leaving just the follicle, and lines them up on a silver tray.
After five hours of this, we are done: 2,793 in total, but that’s hairs, not follicles. Some follicles will have two or possibly three hairs growing from them. How many hairs each follicle produces will affect where they are placed on the front of the head. Some people have 9,000 or more. That takes two days. But the donor area at the back of the head is a different size for everybody, and can only spare so many. It’s wise to keep some back in reserve, too. You may find yourself coming again.
It is the insertion in the afternoon that Dr Kouremada-Zioga says is the “creative” part. More anaesthetic is injected, and thousands more tiny little holes are punched. The challenge, when placing these follicles, is to make sure they are pointing in the right direction of growth, that the newly created hair line is natural. Human beings have a powerfully-tuned eye to even the slightest bodily imperfection. It is among our most basic instincts. Poorly-done cosmetic surgery regularly ruins lives. “No two surgeons are the same,” she says. “It comes from many years of practice.” It is certainly painstaking work. Hour after hour, extracting and inserting single hairs, one after the other, after the other. “You have to love your job. I love it.”
At the end of a very long day, I am shown my new head in a mirror. My once expansive temples have been covered in a sea of white and purple dots.
For the next five days, I cannot wash the top of my head, and it must be sprayed with saline solution every 20 minutes, and as often as can be tolerated during the night. I also have to take antibiotics. In these crucial days, the new follicles are desperately seeking to ‘vascularise’, to reattach themselves to the body’s blood supply.
By day four, the front of my head is still a white, purplish mess, a carpet of tiny, entirely painless little scabs. But on day five, the shampooing begins. Lather the front, leave to soak, apply the most delicate of strokes and the near microscopic little scabs gradually flake away.
On day six, something magic happens. There are actual tiny little bristles. Hundreds of them. Thousands. My great worry had been the prospect of a large swathe of skinhead-style stubble seeming to emerge from underneath my normal, fairly short hair, giving me the appearance of some kind of National Front werewolf, but my concerns were misplaced.