Five of the most common questions about hair transplants answered by our surgeon Asim Shahmalak

Dr Asim Shahmalak, from Crown Clinic is one of the UK’s leading hair transplant surgeons. He is known as the surgeon to the stars through his work with Coronation Street star Jack P Shepherd, who plays David Platt in the soap, model Calum Best, TV doctor Christian Jessen, Homes Under the Hammer star Martin Roberts and Gogglebox star Chris Butland-Steed. Dr Shahmalak, who also has consulting rooms in Harley Street, was a general surgeon in the NHS before switching to private hair transplantation surgery 12 years ago when he opened his own clinic. As well as hair transplants, he also does more unusual procedures such as eyebrow, eyelash, beard and sideburn transplants. He was the first surgeon in the UK to perform an eyelash transplant – on a young woman from Greater Manchester 10 years ago.

1 What are the different types?

Dr Shahmalak said: “There are two different types of hair transplant for men and women – FUE and FUT.

FUE (follicular unit extraction) is the most popular and the one is chosen by around 80% of the patients at my clinic – Crown Clinic in Manchester.

With FUE, individual follicles are removed from the back and side of the scalp and then re-planted by the surgeon on the balding areas on the top of the scalp. The advantage of this method is that the scarring is minimal. Patients have small scabs where the hair is extracted and replanted which tend to heal after two weeks. FUE is particularly suitable for patients who liked to wear their hair short or shaved because the scarring is not particularly noticeable. Most stars have FUE for their transplants: my patients Jack P Shepherd, David Platt from Coronation Street, Calum Best and other big names such as Wayne Rooney.

FUT (follicular unit transplantation) is the more traditional method. The donor hair is obtained by surgically removing a strip of skin from the back or side of the scalp. From this strip, the donor follicles are extracted under a microscope and then replanted in the balding areas in the same way as FUE. Patients are left with a lined scar on the scalp which is not noticeable if they like to wear their hair relatively long. The TV doctor Christian Jessen has had two FUT procedures with me. FUT is less labour than FUE so it is slightly cheaper.

“FUE has gradually taken over in popularity from FUT in the last five years, thanks in large part because of FUE’s popularity with celebrity clients. Lots more men are wearing their hair very short or completely shaved at the back and sides and FUE is more suitable for those hair styles.

“As well as these conventional transplant procedures, other more unusual methods are also available using the same techniques.

“I am one of the few hair transplant surgeons in the world to perform eyelash transplants – most commonly on women who have naturally thin eyelashes or have damaged their eyelashes through the use of stick-on false eyelashes. The donor hair is extracted from the scalp in the same way through FUE or FUT and then sewn into the upper eyelid. It won’t work on the lower eyelid. Because head hair is extracted, it grows in the same way as head hair, so these new eyelashes need curling (to blend in with existing lashes) and trimming.

“Patients can also have eyebrow transplants – most commonly women who have damaged their eyebrows by overplucking. It works in much the same way as the eyelash transplant and again the transplanted hair needs trimming.

“Finally, I do beard and sideburn transplants for men who have thin beards – a surprisingly high number of men have this problem. It means they can grow a full beard without any gaps.”

2 How does each procedure work?

Dr Shahmalak said: “FUE takes around six to seven hours. Most patients start their surgery in the morning and are ready to go home the same day.

“The donor area at the back of the scalp is numbed with anaesthetic and then the donor follicles are removed individually, leaving small red scars where the hair is attracted.

“We typically extract around 1,500 follicles which amounts to around 3,000 hairs (because there is more than one hair in each follicle root). These are then replanted in the balding areas, again leaving small red scars which heal in around two weeks and just drop off like any scab.

“I advise most patients to take a week off work to allow for recovering after surgery.

“The procedure is relatively pain-free and most patients watch films on DVD during the extraction and replanting process. Some are so relaxed they fall asleep.

“Patients have to sleep with pillows propping up their back for the first couple of nights after the procedure so they don’t dislodge any of the transplanted hair. They should avoid strenuous exercise for at least week. But most patients feel as right as rain the day after the procedure and can lead normal lives while they wait for the scars to heal.

“My client Jack P Shepherd from Coronation Street was back filming the show two weeks after the transplant with viewers unaware that he had the surgery. That shows how quickly the scars heal.

“It takes up to a year for the transplanted hair to grow back so patients need to be patient – you don’t get an instant overnight transformation.

“FUT is a little quicker than FUE because the extraction of the donor hair is quicker – so the whole procedure takes around five hours. Scarring heals a little more slowly than FUE because a strip of skin is removed from the patient to obtain the donor hair rather than individual follicles.

“Eyelash, eyebrow and beard transplants take even less time – around four hours – because fewer donor hairs need to be extracted as you are covering a smaller bald area.

3 What are the benefits of using one over the other?

Dr Shahmalak said: “Around 80% of my patients chose FUE because the scarring is minimal and they would rather the donor hair was extracted individually rather all in one go with the removal of a strip of skin.

“FUE patients can wear their head short or shaved following a procedure without the scars being visible. It is why this procedure is so popular with celebrities.

“It is more expensive as a result because the extraction of the donor hair is more labour intensive.

“Around 20% of my patients still chose FUT – partly because it is cheaper than FUE. The scar from the removal of the strip of skin for the donor hair is noticeable but not if you wear your hair longer. There is some evidence to suggest that slightly fewer follicles survive extraction by being removed in a strip rather than individually, though I find that FUE is a highly effective form of hair transplantation and it has gradually taken over from FUT.”

4 Why might a hair transplant be needed?

Dr Shahmalak said: “A hair transplant is needed because the vast majority of men will experience hair loss at some point in their lives.

By the age of 30, around 40% of men will be losing their hair, this figure rises to half of men by the age of 40 and 60% of men by 50 onwards.

“As my patient Jack P Shepherd explained, a hair transplant is like the male equivalent of a boob job – it is a quick fix cosmetic procedure which will make a huge difference to their appearance. It can make men looks years younger and research shows that, as well as improving their self-confidence, it can also enhance their career prospects. There is a body of research pointing to the fact that men with a full head of hair earn more than those who are bald.

“But the main benefit is just to look and feel better. You can transform your life for the same cost as changing your car.

“We should not forget that 40% of women also experience hair loss in their lives. For many this is temporary – post-pregnancy or during menopause. However, a significant number of women have naturally thin hair or experience permanent hair loss and can benefit from the same procedures as men. About 10% of my patients are women.”

5 How does he think he has helped patients?

Dr Shahmalak said: “You only have to look at the experiences of my celebrity patients to see how hair transplants can help patients. They all say they look years younger and they are frank enough to admit that restoring their balding locks has benefited their careers. Their income depends on them looking good and they are to be congratulated on going public with their procedures and showing to millions of men how this simple procedure can transform their lives. Please read my testimonials to see what a difference I have made to patients’ lives.”