Presently, in many parts of the world, there is little to no regulation on hair transplant surgeries and procedures. Almost any surgeon with a random board certification can launch a clinic and claim to “fix baldness forever” with one-time transplant procedures, and with competition rising steadily, everyone is pulling out the big guns to siphon clients or risk being thrown out of business.
Pattern baldness (androgenic alopecia) is the commonest natural cause of hair loss in humans. More extensive in males, a third of men would begin balding by 35 and about 80 percent would experience widespread male pattern baldness by their 70s. There’s no shortage of hair restoration enthusiasts looking to either slow down baldness or regrow what they’ve already lost. While the FDA and other health bodies approve Minoxidil and Finasteride as clinically proven treatments for hair loss, transplant surgeries are usually more effective – even though they should always be considered last.
According to international hair transplant mentor and specialist, Joe Tillman, feeding people with superficial bits of information to have them sign up with your clinic is purely ethical malpractice.
“Most clinics will only give the upsides of having surgery and gloss over the negatives,” says Joe Tillman, the founder and CEO of Hair Transplant Mentor, an online community educating people with unbiased information on hair restoration processes. “Some go so far as to ‘guarantee results’, which, in the end, means nothing. To guarantee a positive outcome from ANY surgical procedure is ludicrous, and in the hair transplant world, it is usually an inducement to have surgery for patients that may otherwise give it more thought.”
How does hair transplant work?
Hair transplant surgery involves grafting hair follicles from a part of the head where they are abundant – the donor area, usually the sides and back – to the parts where they are thinning or balding – the recipient area. Pattern hair loss is caused by the genetic susceptibility of some hairs to the hormone dihydrotestosterone (DHT). Lucky people that never bald have genes encoded to block DHT action. Also, hair at the sides and back of the head is more efficient at fighting off DHT and would usually remain healthy while the frontal hairline recedes.
Hair transplant surgeries are performed in two techniques: Follicular Unit Transplantation (FUT) and Follicular Unit Extraction (FUE). In FUT, the surgeon takes a long, narrow strip of hair bearing scalp from the donor and cuts the strip into tiny follicular units with the aid of microscopes. Micro-cuts are then made in the recipient area and the units are grafted into the scalp. In the long run, the patient would be left with a scar running from ear to ear, but hidden under the hair.
FUE is the more modern, more expensive but less painful, and less scarring option where the surgeon removes individual hair follicles from the donor area and transplants them into the recipient area using a microneedle. FUE also leaves tiny but less visible scars – appearing like dots all over the scalp.
For both methods, the transplanted hair would shed within two or three weeks and should gradually regrow in three to five months – if all factors are in favor.
“I always tell patients that the worst part of having hair transplant surgery isn’t the surgery; it’s waiting for the hair to grow which can start in three to five months but not reach full maturity for a year or longer,” says Tillman, Manager of Medical Media for the Global Hair Loss Summit 2020 and co-host of The Bald Truth, a hair loss radio show anchored by Steve Kobren.
Facts VS Fiction about hair transplant
Before opting for hair transplant surgery, setting yourself up with unbiased information and uncoated truth is as important as selecting the right surgeon for the process.
Lie #1: “No matter how bald you are, a hair transplant can make a difference.”
Some clinics take the false advertising scheme to the extreme, often creating before-and-after flyers of completely bald persons suddenly sporting full, lush waves of hair. It’s all aesthetics, and in reality, you must have healthy hair somewhere on your head for a transplant to work. You cannot have someone else donate hair for your transplant without anti-rejection medication. It is impossible with hair follicles, just like with a kidney, because your body would reject them.
Lie #2: “It’s always a one-time treatment”
A very common and highly marketable mistruth. Transplanted hair that grows back will continue to shed, naturally. The process may slow it down but the hair will not be permanently stuck in place forever. Especially for patients in the younger age groups, returning at intervals over the years should be expected.
Also, people with severe balding situations may require more sessions than one for reasonable results. A full-blown NW6.5 at the age of 31, Tillman underwent two surgeries at the start of his transplant journey that left him with a ‘pluggy’ and unpleasant hairline for years. Documenting the entire journey, it took three repair procedures to get his hair looking healthy and full again.
“Patients rarely have one surgery, even if the initial result looks great,” Tillman explains. “Most of the time, they’ll have a second surgery, or more, due to a misrepresentation of the reality of the patient’s situation by the clinic. Sometimes, however, the patient will get ‘hair greed’ and try to achieve perfection (usually for density) with more surgery. This, too, can lead to disaster – if subsequent surgeries fail.”
Lie #3: “Everyone can at least try.”
Not everyone should waste their time, money, and emotions attempting a hair transplant. People who suffer hair loss caused by medical conditions such as Alopecia Areata, Alopecia Universalis, other autoimmune diseases, cancer, chronic stress, trauma, and people on special medications shouldn’t bother with hair transplantation. People suffering from hemophilia and allergies to anesthesia are also not viable candidates. It’s unfair and highly unethical to encourage them to “try”.
Lie #4: “0% transection rate”.
Transection, mostly occurring during FUE, is the accidental injury to hair bulbs – the lower part of the hair follicle. A damaged hair follicle has lower chances of growing back and often occurs as the surgeon or technician harvests each graft one at a time. This process is extremely tedious for thousands of follicles but many clinics work hard to have transection rates as low as 5%.
However, a 0% transection rate is a rather aggressive lie, often coupled with claims that every single transplanted follicle will grow back.
Lie #5: “Zero downtime after surgery:”
While hair transplant surgeries are considered minimally invasive procedures, it’s unadvisable and even detrimental to recovery to carry on normally immediately after each session. The grafts transplanted need time to seal in and the micro-injuries have to heal. You need at least three to five days to be fully rested and take care of your scalp to avoid the risk of infections.
In conclusion, integrity has remained a rarity in the hair transplant industry. However, arming oneself with uncoated information is extremely helpful in discerning the pros from the sharks.
“Getting legitimate and honest information about the facts of hair restoration has always been tough, but it’s tougher today than ever before,” says Tillman. “This is why I recommend that patients look at each clinic with caution. A solid tip I always offer is that if a clinic makes a claim during a consultation, check on their website to see if this claim is documented with results. If it isn’t, walk away. There are more clinics to sift through before the best one for you becomes obvious.