What you need to know about getting a hair transplant from London's top surgeons
Is there anything that terrifies men more than losing their hair? A reminder of our mortality, a threat to our vanity and often hard to discuss, baldness afflicts many of us.
For some who are thinning (including yours truly), a hair transplant might seem like a logical step. But it’s a tricky world out there for a patient: knowing that balding men are vulnerable, nervous and desperate for help, a lot of shysters have opened up less than optimum practices, trying to hoodwink people into paying less for worse results. “I’ve lost track of the number of patients who wish they’d paid double for half the result,” said Spencer Stevenson, an advisor for hair transplant patients via his website spexhair.com. He himself has had 13 procedures and paid more than £40,000 for that work.
We spoke to patients and specialists about what people should be looking for in their doctor, what to expect during the process and what to look out for in the aftermath. If you’ve ever wanted to consider taking action against your tonsure, this is the guide for you.
The two types of surgery
There are two common types of hair transplant surgery available on the market: "FUT" and "FUE". There are other types, involving stem cells and other things, but they are more experimental.
FUT stands for follicular unit transplantation and is otherwise known as "strip surgery". This involves removing a piece of skin, dividing it under a microscope into individual groupings of follicular units and then those are transplanted into the recipient area.
FUE stands for follicular unit excision. It used to stand for extraction, except excision sounds more like the sort of thing only a doctor should do and so it was changed. Rather than a strip, FUE involves “individual follicular extraction in which follicles are removed within a small circular punch that is less than a millimetre in diameter,” explained Dr Munir Somji of Dr MediSpa. FUE is newer, but both types have merit and both should be considered.
“There is, realistically, only a handful of surgeons who perform very good, state of the art surgery and who utilise the right hairs in the right place,” said Stevenson. A lot of clinics are trying to open up, cutting corners and quality in an attempt to profit off the increased interest in surgery thanks to celebrity examples.The cost is a good guide to whether it’s a trustworthy clinic or not. You should be looking to pay anything between £3,000 and £7,000, depending on the amount of follicles being transplanted. Anything less is a warning sign.
One important rule that every surgeon I spoke to repeated: you should be looking for a doctor who is not desperate or keen to get you into the operating theatre.
“You have to take people back a few steps, because people need to know what’s going to happen to the rest of their hair,” said Dr Edward Ball of The Maitland Clinic, who says that it should always be seen as a last option for a very specific catchment of patients who have a suitable donor area of follicles. “We have a limited amount of hair and an increasingly large area of loss. Ill-informed decisions by people desperate for a quick fix, or a doctor just trying to take someone’s money, can end up making such bad decisions.”
“You need somebody who tells you what you need to hear, not what you want to hear,” said Stevenson. “They’ll tell you it’s easy to do. They’ll get you in next week, offer you a discount. A good practitioner will inform you and educate you that surgery is a last resort and they should try other proven treatments.”
Dr Somji said it’s important to have a good bond with whoever you end up speaking to: they will, after all, be a doctor for a very important surgery and be part of your aftercare for up to a year. “Hair restoration is a personal procedure and you will be continuing to lose hair throughout your lifetime. Therefore finding a surgeon who makes a ten- or 15-year plan is the one for you.”
Dr Ball agreed: find a surgeon who is thinking about how your hair will look your whole life long. “Patients often can’t see beyond the first one or two years. They just want to look good in their twenties and they get a hairline put in that looks terrible once the rest of their hair falls out.” A good doctor, he said, will ward you away from quick fixes.
“A lot of clinics want to get you in the chair and need you more than you need them,” said Stevenson.
What to look for in a doctor
Dr Ball provided a checklist of things to look out for that he said all prospective patients should bring in to a consultation:
1. Who is doing the surgery?“If the person you’re talking to can’t tell you who the doctor is going to be that’s an alarm bell, as they might be flying in an unlicensed, unaccountable doctor,” he explained. If a clinic is fronted by a salesperson and not a doctor, take heed.“A lot of clinics want to get you in the chair and need you more than you need them"
2. Look for quality, rather than quantity, from a doctor.“My number of surgeries may be quite low versus someone from a cheap clinic,” explained Dr Ball. “If we do one surgery a day where the patient is the only focus, that’s how you get the best results.”
3. What parts of the procedure are done by the doctor?Cheaper clinics may aim to have nurses or technicians perform the entire procedure. But there are certain parts, said Dr Ball, that only a doctor should do: “The cutting of skin and the injecting of the anaesthetic, the planning of the hairline, seem like simple things, but in reality you’ve got to be able to plan something that works for the rest of the patient’s life.”
4. Are the team doing it the doctor’s own trusted team, or are they drafted in?
5. Qualifications.Stevenson recommends checking for surgeons in your area via the International Alliance Of Hair Restoration Surgeons. Dr Eibi Iniekio of The Chiswick Hair Clinic recommends looking to see if a doctor is a member of BAHRS (British Association Of Hair Restoration Surgery) or IAHRS (International Alliance Of Hair Restoration Surgeon). Dr Ball recommends looking to see if they’ve qualified with the American Board Of Hair Restoration Surgery. “If you’re a diplomat of that it shows a higher level of qualification.”
6. Proof of their work.“You may be shown a lot of pretty pictures that may be evidence from another company,” said Ball. “You want to see really detailed photos, not slightly out of focus, poorly lit images where you can’t see the softness of the hairline and they’re wearing product in their hair. You want a clinic to be demonstrating really honest photo or video evidence.”
7. Meet patients formerly treated by the doctor.Some clinics – Dr Ball’s included – have a bank of former clients who are happy to be spoken to. Many patients also complete vlogs documenting their experience independent from the clinic themselves – “Terrifying, of course. You have to hope they get good results,” said Ball – but they are honest accounts of their journey, freely available on YouTube, not endorsed by the people who treated them.
8. Other simple questions.What’s the success rate? What happens if things go wrong? What’s your policy if you’re not happy with the results? The support during aftercare and accountability are both huge things any patient should seek from a good clinic says Dr Ball. “Overseas, the people working on you are not accountable because it’s highly likely they’ll never see you again.”One safe bet might be to consider a doctor that someone you’ve seen with a hair transplant has previously used. Edward Lemont, a fashion and grooming blogger who goes by The Discerning Man, decided to get in contact with the Harley Street Hair Clinic because they’d done Wayne Rooney’s transplant.
It's worth noting that it's far from essential for your doctor to have experience of a hair transplant themselves, though it can help if they have lost their hair and had to go through the process of consideration themselves. Dr Iniekio lost his hair in his twenties and knows full well how tough it can be. "My hair is not suitable [for a transplant] so I have had to have that conversation with myself and come to that conclusion and know it would be a better idea not to have it at all. That's something I try to transfer to my patients," he explained. "I actually look terrible with hair, by the way."
Lemont had several consultations with the clinic’s director, where his donor area – the back of his head – was checked for strength and density, as were his bald patches. “My doctor advised a transplant of 2,000 grafts over a two-day procedure, lasting eight hours per day,” he said. “The big day started off with having my head shaved, which confirmed how badly I needed the transplant.”
After the area was cleaned and he was given local anaesthetic, the doctor began with his FUE procedure.
“After 1,000 hairs had been extracted over a four-hour period, the doctor spent the remaining four hours implanting the hairs to the bald areas at the front of my head,” explained Lemont. “This same process was repeated on the second day.”
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