Six common questions about hair transplantation

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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?”

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.

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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.