Crown Clinic surgeon Asim Shahmalak answers 7 of the most common questions about hair loss

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What are the main causes of premature hair loss?

Asim Shahmalak, consultant hair transplant surgeon at Crown Clinic,  said: “Premature hair loss is primarily a hereditary
condition. You can see how this gene is passed down the generations
most powerfully if you look at the royal family.

Male pattern baldness has gone from the
grandfather (Prince Philip), to the father (Prince Charles) and now on
to the son, Prince William. We can only hope that it skips the next
generation – young Prince George!

“Experts are split on whether this hereditary gene is more powerful on
the mother or the father’s side. From my long experience working in this field, I would say the father’s side is more powerful. That
certainly seems evident when you look at the royal princes.
“There are other causes for premature hair loss. Obviously ageing is a
factor – 20% of men under 30 experience hair loss, increasing to 40%
by the age of 35 and 65% by the age of 60.
“Around half of women experience some kind of hair loss by the time
they reach old age.

“There are medical factors which can also prompt hair loss.
“Stress is one factor because it can constrict the supply of blood to the hair.
“Other medical factors can also have an effect such as an under-active or
over-active thyroid.
“Women can suffer premature hair loss through polycystic ovary syndrome.”

What are your top tips when it comes to working out which treatments
or products are likely to work and which are a waste of time?

Asim Shahmalak said: “When looking for treatments or products, I
recommend that patients use only those which are medically proven.
“There are two that I consistently use with clients – Finasteride and Minoxidil.

“I recommend that these are taken at the same time – Finasteride as a
pill and Minoxidil as a mousse spread on the scalp.
“Both have been shown through clinical trials to halt the loss of hair
and, in some cases, promoting the regrowth of small baby hairs.
“What Finasteride and Minoxidil are very effective at is helping men suffering from male pattern baldness to retain their natural hair. In 90% of cases, they have been shown to halt the process of baldness.
“What they don’t do is grow new hair.
“The only long-term, permanent solution to baldness – both in men and women – is a hair transplant – either by FUE (follicular unit extraction) or FUT (follicular unit transplantation). Hair is taken from the the back or sides or scalp where there is an abundance of follicles and replanted in the areas where hair loss is most prevalent.

“I will often use Finasteride and Minoxidil in conjunction with a hair transplant. The transplant repairs the areas where the hair has been lost – all the transplanted hair will be permanent and should last the patient for the rest of their lives. Finasteride and Minoxidil halt the baldness and ensure that the patient will not need a further transplant because they will not lose any more of their natural hair.
“Most other products are a complete waste of time.
“There is NO pill or shampoo that can promote the growth of hair. What some shampoos can do is nourish the hair so that it looks shinier and healthier.
“If there was so much magic pill you could take, why are 65% of men suffering from baldness by the time they are 60?”

Are there any risk factors which can make premature hair loss more likely?

Asim Shahmalak said: “Most people normally shed 50 to 100 hairs a day. This usually doesn’t cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair loss occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue.

“The main risk factor making premature hair loss more likely is obviously illness.
“Patients who undergo chemotherapy or radiotherapy are likely to lose their hair but this tends to grow back a year or two years after treatment.
“Hormonal changes and imbalances can cause temporary hair loss. This could be due to pregnancy, childbirth or the onset of menopause. Hormone levels are also affected by the thyroid gland, so thyroid problems may cause hair loss.

“Infections, such as ringworm, can invade the hair and skin of your scalp, leading to scaly patches and hair loss. Once infections are treated, hair generally grows back.
“Diseases that cause scarring alopecia may result in permanent loss at the scarred areas. These conditions include lichen planus, some types of lupus and sarcoidosis.
“There is also a hair-pulling disorder. This condition, also called trichotillomania, causes people to have an irresistible urge to pull out their hair, whether it’s from the scalp, the eyebrows or other areas of the body.”

How do you think treatments and products will improve over the next decade?

Asim Shahmalak said: “I am very excited about the developments happening in stem cell research. I don’t think anything major will happen overnight but in around 15 years we could be in position where scientists can take hair from the back of your skull and grow new follicles. This could lead to permanent solution to baldness.
“The advances being made are very exciting and I have been delighted to help an exciting research project into this area which was conducted by Professor Ralf Paus at Manchester University.”

What’s been the biggest development/improvement with regards to
treatments for premature hair loss over the past ten years?

Asim Shahmalak said: “The biggest development has been the introduction of the hair transplant technique known as Follicular Unit Extract. This is the method favoured by celebrities such as actor Jack P Shepherd, who plays David Platt in Coronation Street and the model Calum Best, both clients at Crown Clinic.
“In FUE, hair follicles are removed individually and transplanted into the areas of the scalp where hair is receeding. Immediate scarring is minimal – just a few red pin pricks in the area of the scalp where the hair is harvested.

“Many patients favour this more modern method which is particularly beneficial if you like to wear your hair short and don’t want scarring around the donor area on the scalp.
“The traditional form of hair transplantation, Follicular Unit Transplantation or strip harvesting, is still popular – this is where a strip of hair is surgically removed from the scalp and the follicles are extracted.
“The other big development has been the introduction of proven methods to halt hair loss such as Finasteride and Minoxidil.”

Is there a reason why customers should expect to pay more for a hair
loss shampoo or conditioner?

Asim Shahmalak said:”I would be wary of any customers buying shampoos or conditions which claim to promote hair growth. No such shampoo exists.
“Be wary of paying more for any shampoo or condition promising ‘cures’ for hair loss or promising to give you full hair.
“They won’t give you fuller hair – they will give you better looking hair. There is a crucial difference.”

Are there certain ingredients which you’d recommend within these types
of product?

“That is not to say that shampoos and conditioners cannot nourish hair and make it look much better. I do believe that caffeine shampoo – products such as Alpecin – can benefit the hair. There have been studies in Japan showing that caffeine can penetrate the hair roots, protecting the hair from hair loss.”

Our Surgeon

Dr. Asim Shahmalak

Dr Asim Shahmalak is a world-renowned hair transplant surgeon who performed the UK’s first eyelash transplant in 2009. He runs Crown Clinic – one of Britain’s most successful and best known hair transplant clinics. He has treated a number of high-profile industry leaders and celebrities including the medical broadcaster Dr Christian Jessen, best known for Channel 4’s Embarrassing Bodies.

Related Articles

Spurs manager Antonio Conte is one of a number of people in football who have benefitted from a hair transplant.

Another is the Liverpool manager Jurgen Klopp, who has been very open about seeking help with his hair.

Conte, 52, looks completely different in the before and after pictures shown on this page and is likely to have had several procedures to boost his hair.

Like a lot of men, Conte started losing his hair in his late 20s and early 30s when he was a successful player in the Italian league and playing for the Italian national team.

He was pictured several times during this time showing all the signs of advanced male pattern baldness.

Since becoming such a successful manager, Conte has had at least two hair transplants to cover up the bald areas at the front of his hairline.

It is likely he would have opted for a FUE (follicular unit extraction) procedure. This is where the grafts are removed individually from the back and sides of the scalp and then replanted in the balding areas.

Around 80% of patients coming to Crown Clinic to our consultant surgeon Asim Shahmalak now opt for FUE.

This is a big change on five years ago when the majority of our patients chose the more traditional method of hair transplantation known as FUT (follicular unit transplantation) or strip surgery.

The advantage of FUE over FUT is that there is less scarring. Most FUE patients are simply left with some red pin pricks where the donor hair is harvested and replanted which go away after a few weeks.

Famous Crown Clinic FUE patients include the Coronation Street star Jack P Shepherd, model Calum Best, and the football pundit Didi Hamann.

FUE is slightly more expensive than FUE because it requires more time to carry out. This is because the donor grafts are removed individually rather in one single strip of skin which is surgically removed, which is what happens under FUT.

Crown Clinic’s most famous FUT patient is the TV doctor Christian Jessen who has had two FUT transplants with Dr Shahmalak. Scarring is greater with FUT and all patients are left with a lined scar on the scalp where the strip for the donor hair is removed. This soon heals and if you wear your hair relatively long, like Christian Jessen, it is very difficult to see the scar because the hair grows over it. However, the scar is visible if you like to wear your hair short or shaved, like Calum Best, so we recommend FUE for all patients who like their hair short. Around 20% of Crown Clinic patients still prefer FUT. There is evidence to show that slightly few grafts are lost in the donor hair harvesting process by removing the grafts in one go – so that is an advantage of FUT.

Conte has not spoken about his hair transplants, so we don’t know for sure which method he chose.

Whichever one it was, he is to be congratulated on his choice and the work of his hair transplant surgeon because he has an excellent result.

Dr Asim Shahmalak from Crown Clinic is one of the world’s leading hair transplant surgeons.

He is the surgeon to the stars and has performed procedures for celebrities including Jack P Shepherd from Coronation Street, the model Calum Best and the TV doctor Christian Jessen.

He has pioneered new hair transplant procedures in the UK such as eyelash, eyebrow, beard and sideburn transplants.

His main clinic is close to Manchester Airport and he also has consulting rooms in Harley Street.

A former general surgeon in the NHS, he switched to hair transplantation private practice 15 years ago and is one of the most acclaimed surgeons globally in FUE (follicular unit extraction) and FUT (follicular unit transplantation) hair transplant procedures

Are more women enquiring about hair transplants/procedures/treatments and if so why? Is demand growing?

Asim Shahmalak said: “Yes, more women are enquiring about hair transplants. They are still far outnumbered by men but around 10% of my patients are female.

“Most of them come because they have permanent thinning hair and this can be even more damaging to a woman’s self-esteem than a man’s simply because it is more unexpected and it can have a devastating impact on a woman’s confidence.

“I also treat increasing numbers of women for eyebrow and eyelash transplants. Most eyebrow transplants are down to women permanently damaging their brows due to over-plucking. Hair is transplanted from the scalp and replanted in the brows.

“I also do eyelash transplants on women. I was the first surgeon in the UK to perform an eyelash transplant here – way back in 2007 on a young woman from Greater Manchester. Most eyelash transplant patients seek treatment after suffering from trichotillomania – a condition where sufferers rip out their eyelashes due to psychological issues. Hair is extracted from the scalp and replanted in the upper eyelid. Because it is scalp hair, it goes as it would on the scalp when replanted in the eyelid so it can curl when longer and needs to be straightened. I provide kits so patients can do this themselves.

“Demand is growing for general female hair transplants. The reason for this is greater awareness that hair transplantation is the only long term solution to permanent hair loss in women.

“There is also a lot of concern about hair extensions and the damage they can cause to the scalp. Women can wreck their hair with hair extensions which can pull out their natural hair and cause permanent damage to the scalp.

“Lots of women have seen successful male transplant patients such as Calum Best or Jack P Shepherd and thought, ‘That could work for me, too.’”

Why have women been slower than men to enquire about hair procedures?

Asim Shahmalak said: “I think women have been slower than men to enquire about hair transplants in the past because they thought that hair transplants were a ‘man thing.’ You didn’t read about women having procedures and there was this assumption that while women could benefit in lots of ways through plastic surgery – breast enhancements or browlifts or facelifts – hair transplantation was not for them. One of the reasons is that a lot of female hair loss is hormonal and non-permanent. The hair eventually grows back and so hair transplantation is not necessary.

“However, a significant number of women do suffer permanent hair loss for a number of reasons including the same hereditary reasons which is the main factor in men going bald. A receding hairline at the front ages a woman far more quickly than a similar condition in men. You expect some women in their eighties or nineties to have thinning hair, but not in their forties or fifties. It is those younger middle aged women who are coming to me for help in increasing numbers.”

Are more younger women enquiring about hair transplants/procedures/treatments and if so why?

Asim Shahmalak said: “Yes, more young women are inquiring about treatments and there is a simple reason: vanity. In the age of social media, where we can all enhance our appearance with photographic filters, a hair transplant is like having a permanent positive filter on your hair. You can wave goodbye to bad hair days and have the hair you have always wanted every day.

“So many young people want to look their best when sharing pictures on Facebook and Instagram and come to me for procedures which will improve their self confidence and how they present themselves to their friends and the world on social platforms.”

Are more women going through the menopause enquiring about hair transplants/procedures/treatments and if so why?

Asim said: “Menopause is a natural physiological process that all women experience at some point in their lives. During this time, the body goes through numerous physical changes as it adjusts to fluctuating hormone levels. Many women have unpleasant symptoms during menopause, including hot flashes, mood swings, and insomnia. Hair loss is another common occurrence.

“Hair loss tends to be subtler in women than it is in men. Most women experience overall hair thinning rather than noticeable bald spots. The thinning can occur on the front, sides, or top of the head. Hair may also fall out in large clumps during brushing and showering.

“Research suggests that hair loss during menopause is the result of a hormonal imbalance. Specifically, it’s related to a lowered production of estrogen and progesterone. These hormones help hair grow faster and stay on the head for longer periods of time. When the levels of estrogen and progesterone drop, hair grows more slowly and becomes much thinner. A decrease in these hormones also triggers an increase in the production of androgens, or a group of male hormones. Androgens shrink hair follicles, resulting in hair loss on the head. In some cases, however, these hormones can cause more hair to grow on the face. This is why some menopausal women develop facial “peach fuzz” and small sprouts of hair on the chin.

“For women going through menopause, the cause of hair loss is almost always related to hormonal changes. However, there are many other factors that can contribute to hair loss during menopause. These include extremely high levels of stress, illness, or a lack of certain nutrients. Diagnostic blood tests that can help rule out other causes of hair loss include thyroid tests, and/or a complete blood count.

“Hair loss may make you feel self-conscious about your physical appearance, but the condition isn’t permanent in most cases. Obviously where it is non-permanent a hair transplant is not appropriate.

“However in some cases the hair loss is permanent and a hair transplant is appropriate. We have seen growing number of post-menopausal women seeking help for the same reasons of vanity that attract younger women to the clinic.”

Do you have any concerns about the hair transplant industry, particularly the popularity of going abroad?

Asim Shahmalak said: “I have great concerns about the numbers of patients of both sexes going to countries such as Turkey for hair transplant procedures.

“Do you really want to take a risk on such an important decision on what could be a completely unregulated clinic? The main drawback of going abroad for a procedure is that patients have almost no recourse if the procedure goes wrong or they don’t get the result they desired.

“Do you really want to start legal proceedings in a Turkish court and would you have the first idea about what to do? If you need further care from the surgeon, you will need to fly thousands of miles for a remedy which again may not work. It may be a little more expensive to have treatment in the UK but it is money very well spent.

“One of the main areas of my work is repair surgery. Patients come to me after having a terrible experience in a country such as Turkey and ask me to repair the damage. In most cases, I can help and sort out their problems but, in a few cases, nothing can be done and patients can severely damage their appearance by going to an unregulated ‘cowboy clinic’ abroad.

And I would be keen to know if you have any case studies of women who have had the procedure who would be able to tell me about their experience?

Asim Shahmalak said: “Most of my female patients would rather not be fully named and pictured when talking about their hair transplant procedures.

“But several have been so pleased with the results that they are okay to share pictures and their experiences in a way where they are not fully identified. Here are some of my very happy former female patients.”

He maybe the world’s richest man, but all those riches could not save Elon Musk’s hair.
That is why the founder of the Tesla car company transformed his appearance with a hair transplant.
You can see the remarkable change in his appearance in the before and after pictures below.

His hair is clearly thinning at the front in the before picture on the left, taken in his 20s.

Fast forward more than 20 years and the 50-year-old Musk has a full head of hair in the after picture on the right.

Musk will almost certainly have had a Follicular Unit Extraction transplant – chosen by 80% of the patients at Crown Clinic.

With FUE, the donor hair is extracted individually from the back and sides of the scalp – keeping any scarring to a minimum.

Celebrity patients of our consultant hair transplant surgeon Dr Asim Shahmalak who have had FUE transplants include Jack P Shepherd from Coronation Street, the footballer Didi Hamann and the model Calum Best.

Dr Shahmalak also offers the more traditional method of hair transplantation, FUT – follicular unit transplantation.

With FUT, all the donor hair is removed in one go by surgically cutting a strip of skin from the scalp. The donor grafts are then extracted from the strip by technicians and replanted in the balding areas of the scalp by Dr Shahmalak in the same way as FUE.

The TV doctor Christian Jessen has had two FUT transplants at Crown Clinic with Dr Shahmalak. We don’t recommend FUT for patients who like to wear their hair short or shaved because the scarring is more noticeable than FUE. If you grow your hair slightly longer, as Christian Jessen does, the scarring cannot be seen.

Whatever method he chose, Elon Musk is to be congratulated on his transplant – his new hair looks fantastic.