Six common questions about hair transplantation

POSTED: 02 December 2019

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

He often contacted by the media to provide his expert opinions on developments in hair transplantation. Patients comes to him with the same very sensible questions.

Here he answers six of the most common questions he gets from patients and the media. 

1 What determines the most effective transplant procedure for an individual?

Dr Asim Shahmalak said: “Hair transplantation is the only permanent long-term solution for baldness. Anyone who has experienced permanent hair loss may be a candidate for hair restoration surgery including men and women with pattern baldness. At Crown Clinic we do not operate on patients under the age of 25 - largely because it is difficult to establish how a patient's baldness will progress before that age. 

People seek transplants for a number of reasons but the most popular is to restore or change the shape of their hairline. People with areas of scarring from injuries such as burns from an accident may also be suitable for a transplant. 

There are two types of hair transplantation - FUE (follicular unit extraction) and FUT (follicular unit transplantation). With FUE, the donor hairs are removed individually from the back and sides of the scalp before being replanted in the balding areas. With FUT, the donor hair is removed all in one go by surgically cutting a strip of skin from the scalp. The donor grafts are then extracted from this strip by technicians under a microscope and then replanted in the balding areas in the same way as FUE.

The main advantage with the FUE method is that scarring is minimal.  I have also noticed a surge in men wanting to wear their hair short around the back and sides of the scalp – and this style favours FUE over FUT. With FUT, all patients have a linear scar where the strip is removed. If the patient wears their hair long, the hair covers up the scar. But FUT is not suitable for patients who like the hair short at the back or sides.”

2 How have the different hair transplant procedures used here improved or changed in the last decade? 

Dr Shahmalak said: “Big advances have been made in the effectiveness of hair transplantation procedures in the last ten years. It has allowed surgeons to provide a much more natural look for patients. The most striking advances have been with FUE technology.

Over the last five years FUT has been superseded as the most popular method for treating baldness in men and women by FUE.  Several high profile celebrities who have had hair transplants using the FUE method – most notably the England football captain Wayne Rooney and model Calum Best  – and this has definitely lead to a growth in popularity for the FUE treatment. This shift in the preferences of patients is evident at Crown Clinic. Five years ago, 80% of my patients opted for FUT and 20% for FUE; now, it is the complete opposite with 80% opting for FUE.

Due to the smaller punch holes developed over the last five years for FUE surgery, the scarring is barely visible two weeks after the operation. For the first few days, a patient has red pin-pricks in the areas of the scalp used for harvesting but these fade. All incisions and cuts leave a scar, but a FUE scar is barely visible to the naked eye because each FUE scar shrinks to less than 0.5mm.

The main improvement in hair transplantation have been over the last 20 years. Everyone can remember those very early transplants featuring Elton John 30 years ago where the transplanted hair looked completely artificial - like the hair on a doll. That ended many years ago and good hair transplantation these days looks completely natural and blends perfectly with the existing natural hair.

The real skill in this type of surgery is in the placement of the hair. Experienced practitioners achieve a completely natural look which is why clinics such as mine are so busy.

3 Based on patient interactions, is there less stigma around receiving a hair transplant than, say, five years ago?

Dr Shahmalak said: “Yes it is fair to say there is less stigma around receiving a hair transplant than five years ago. I would go as far as to say that there is no stigma attached to a man having a transplant these days. A big factor in the change of attitudes has been a number of high profile celebrities going public with the fantastic results from their procedures. Wayne Rooney got a very positive reaction when he revealed the results of his first transplant eight years ago. He has since had a further procedure and received no negativity from fans. Since then, other big names have spoken about their procedures including singer Robbie Williams and my clients Calum Best and Coronation Street star Jack P Shepherd. The general reaction from the public to all of these stories is: ‘Good for you.’ People admire the fact that balding men are proactively taking action to improve their appearance. A man having a hair transplant is viewed in much the same way as a woman having breast implants - it is a simple way to improve body confidence.”

4 If patient inquiries have increased over time, to what do you attribute the increase?

Dr Shahmalak said: “There is no doubt that the growth in the number of celebrities going public with fantastic results from hair transplants has been behind the boom in the number of procedures over the past five years. Bookings at Crown Clinic shot up by 25% after Wayne Rooney and Calum Best went public with their results. Men see their favourite stars looking ten years younger after undergoing a procedure and want the same benefits. Image is becoming all important and there is research to suggest that men with a full head of hair earn more and have more successful careers than balding men. This is certainly true of anyone in the public eye. Do you think Wayne Rooney would be as attractive to sponsors if he was completely bald, which he would be if he had not sought treatment for his male pattern baldness? Similarly, how many leading Hollywood heart-throbs are bald? You would struggle to think of more than a handful over the past 50 years. We all look better with a full head of hair.”

5 Do doctors make any link with specific occupations/lifestyles as factors for increased hair transplants? 

Dr Shahmalak said: “In terms of occupations, I treat a proportionately high number of people who work in the public eye. These could be actors, TV presenters and particularly leading sportsmen, notably footballers. Why do so many footballers have hair transplants? Because their image rights are worth millions and a significant proportion of their income comes from commercial endorsements. Brands want to work with stars who look young - going bald in your 20s is not a good look with sponsors. I treated the former Man City and Liverpool footballer Didi Hamann. He is now a successful TV pundit both here and in his native Germany. He had the procedure because he knows you need to stay young looking to prosper in TV. I also work with a number of footballers who come to me as private patients and would rather no one knew they had had help with their hair. I enjoy seeing their hair looking so much better when I see them on Match of the Day.

In terms of occupations, obviously hair transplantation is not available on the NHS and it is relatively expensive procedure costing between £6,000-£15,000 depending on the procedure used and the number of grafts. I treat a lot of successful businessmen and high achievers - men who often have highly stressful jobs.  Stress is a factor in hair loss but this hair loss tends only to be temporary and any hair lost through stress tends to grow back. These high-flyers seek a hair transplant because they want to look good and retain their youthful looks - that can definitely benefit their careers.”

6 What concerns would you have with patients engaging with medical tourism industry, e.g. going to Turkey to get a transplant instead of in their home country. 

Dr Shahmalak said: “Many of the clinics operating in Turkey which advertise in the UK do not have a licence - that means they are operating illegally. You can find out more about the large numbers of Turkish clinics operating illegally here.There are 650 hair transplant clinics in Turkey compared to only around 40 in the UK. The industry there is huge and not properly regulated - you are really take pot luck with the clinic you choose. Prices are cheaper but there is very little regulation and patients expecting their operation to be carried out by a qualified surgeon can find they are left in the hands of junior technicians.

Research carried out by Leeds University found that one in six patients (16.5%) who had cosmetic surgery abroad suffered complications. In the UK, all clinics are inspected annually by the Quality Care Commission. If they are not up to scratch, they are closed down. Can you be sure that similar checks are being made in Turkey? 

If you pick a surgeon in the UK, you can visit their clinic beforehand and have a face-to-face consultation. You can be sure of what you are getting before embarking on a procedure.That is not the case with foreign clinics where consultations are often done by Skype or Facetime and patients only realise they have made an expensive mistake when they have gone to the expense of travelling abroad.

Getting any kind of compensation or redress is very difficult when you travel abroad for a procedure. Do you really want to pursue a case in the Turkish legal system?”

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