New Standards and Regulation of Hair Restoration Surgery

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We operate to the very highest standards at Crown Clinic.

This means we regularly have to pass an inspection by the Care Quality Commission (CQC) which examines all aspects of the care we provide.

Our consultant surgeon Asim Shahmalak is a member of medical bodies which have been set up to maintain the highest quality of care in hair transplantation surgery (HRS) and expose any clinics which do not meet these standards.

One of these bodies is the British Association of Hair Restoration Surgery (BAHRS),  of which Dr Shahmalak is proud to be a member.

Last month, the BAHRS announced it had contributed to the development of a CQC inspection guide on hair restoration surgery with the aim of promoting patient safety in the HRS field. The guide is said, by BAHRS President and hair transplant surgeon Dr Greg Williams, to provide CQC specialist advisors with clear guidance when inspecting clinics that provide HRS, to ensure they meet CQC standards.

By law, clinics offering surgical procedures must register with the CQC. Some time after registration, a CQC team, including specialist advisors, should inspect the clinic to ensure that it meets CQC standards. The new HRS guide aims to assist the specialist advisors, who are unlikely to have specific knowledge on professional areas such as HRS, to make a proper and valid assessment. According to Dr Williams, it will give the advisors a general description on the different types of hair restoration surgery procedures and the areas of patient care that need extra scrutiny.

Confusion over HRS registration

There has been recent confusion over whether all HRS clinics need to register with the CQC. The BAHRS and surgeons such as Crown Clinic’s Dr Shahmalak strongly believe that all HRS clinic should have to register. This is a fundamental safeguard for any patient planning HRS surgey.

Why has this confusion arisen?

Crown Clinic offers two types of hair transplantation procedure. The first is strip follicular unit transplantation (FUT), which involves an incision in the skin to obtain the donor hair for transplantation and is clearly surgery. Around 20% of patients at Crown Clinic have FUT. The second procedure is follicular unit extraction (FUE)– where the harvesting of the donor hair is achieved by extracting grafts with multiple small round punch incisions. Around 80% of patients at Crown Clinc have FUE procedures. Some practitioners claim that FUE is not surgery because it is less invasive than FUT. The BAHRS and Dr Shahmalak strongly dispute this point. With FUE, the total cross-sectional area of the round incisions is large and there is potential for significant bleeding and serious complications. The newly formed Cosmetic Practice Standards Authority (CPSA) has clearly acknowledged both techniques as Level 1b invasive surgical procedures.

Some hair transplant clincs are not registered with the CQC

This confusion has lead some practitioners to possibly put themselves at risk of breaching the law by not being registered with the CQC. “I believe that there are a large number of clinics offering HRS that are not CQC registered,” says Dr Williams. He explains: “Some practitioners may have misinterpreted the scope, some may have realised it was vague and therefore chosen to interpret it differently, and others may have been told they did not need to register.”

HRS now comes under the authority of the Joint Council for Cosmetic Practitioners (JCCP). The CQC has now recently clarified that all hair restoration surgery procedures are indeed ‘in scope’, and therefore all clinics offering these procedures must be registered with the CQC.

The BAHRS will report all clinics who are not registered with the CQC

The BAHRS will be reporting all clinics it is aware of that are offering HRS but are not registered. Once reported, it is up to the CQC to take steps to stop clinics operating until they are registered.

Dr Williams said: “Any service provider offering hair transplant surgery or prosthetic hair fibre implantation must be registered with the CQC. A service provider can be an individual, a partnership or an organisation [such as companies, charities, NHS trusts and local authorities]. A service provider, which is a subsidiary of another company that is CQC registered must still, itself, be registered.”

Future developments

Two new HRS standards are due to be released in early 2018 by the CPSA – one on hair transplant surgery and one on prosthetic hair fibre implantation. For practitioners who practice HRS, to be included on the JCCP register, they must meet the standards of the procedures they offer to patients.

Dr Williams, who has worked with the CPSA on these standards, explains: “We can certainly say at this stage, it is proposed that only GMC registered doctors should perform the surgical steps of hair transplantation procedures, which includes making FUE incisions to harvest donor hair, and that only GMC registered doctors who are also hair transplant surgeons should offer prosthetic hair fibre implantation.” The standards will also reiterate that both forms of HRS must be undertaken by CQC registered service providers.

However, Dr Williams says patients need to be made more aware of the dangers, “I think there needs to be wider public awareness campaigns about HRS, who can offer it, and the type of facility where it should be performed. I also believe patients and practitioners should not hesitate to report any clinics to the CQC that offer HRS and are not registered.” Dr Williams concludes, “If you are operating on patients in a non-CQC registered hair transplant clinic then you are operating illegally.”

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.

Expert hair transplant surgery by Dr Shahmalak

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When the sun comes out, we know that we need to apply sunscreen to protect our skin, but many people forget to pay the same care to protecting their hair. Between the sun, sea and swimming pools, many of our favourite summer activities can significantly damage our hair – so the next time you go out to enjoy the sunshine, find out what you can do to protect it.


Why does sun damage the hair?


Sun damage to the hair is caused by the harmful UVA and UVB rays, which damage the outermost layer of the layer – the cuticle – and weaken the protein structure of the hair, making it dry, brittle and more prone to breaking. Some people find that their hair lightens in the sun, as the rays act in a similar fashion to bleach, stripping the melanin from the hair.


Protecting your hair from the sun


Wearing a hat is an easy way to protect your hair and scalp from the sun, especially if you’re outside when the sun is at its strongest. Hair SPF is also an option, which can usually be bought as a spray to be misted over the hair. Pay extra attention to the scalp – many people forget that the scalp can burn just as easily as the rest of the skin, ending up with an itchy, flaky, burnt scalp. If you do burn your scalp, rinse your hair in cool water and apply aloe vera to the affected areas, and make sure to keep your head covered when going outdoors.

If your hair is looking dry, try a deep conditioning treatment to restore some of the lost moisture to the hair, and avoid wearing your hair in any tight styles that may pull on the scalp. Summer is also a good time to temporarily stop using hairdryers, straighteners and any other hot tools to avoid adding to the sun damage.


Protecting your hair from the sea


Salt water is notorious for drying out the hair. It leaches moisture out of it, making it incredibly brittle and tangled, which can cause significant breakage. Before you go swimming, saturate your hair with clean water to prevent it from absorbing as much salt water, and don’t let it sit in your hair – rinse it thoroughly as soon as you get out of the sea. Deep conditioners and hair masks will also help replenish the moisture.


Protecting your hair in a swimming pool


Just like salt water, chlorinated water is very harsh and drying on the hair, so you can take similar precautions to swim in the sea. You could also try a swimming cap, as this not only prevents the chlorine from damaging your hair, but it will also protect your scalp from sunburn. If you have highlighted or blonde hair, be especially careful when in a swimming pool, as the copper and chlorine in the water have been known to form a film that sticks to the proteins in hair, turning it a green shade. Thankfully, this isn’t permanent, but make sure to enter the pool with wet hair and rinse it as soon as you get out.

However you are spending your summer, if you have any questions or queries about your hair, take a look at our hair advice or give our team a call.

Over the past few months, there have been a significant number of reports in the news of people experiencing hair loss after being diagnosed with COVID-19. As a result, the Centres for Disease Control and Prevention (CDC) has listed hair loss as a possible long-term effect of the illness, along with symptoms such as fatigue, dizziness and joint pain. 

A study published by the medical journal The Lancet reported that 22% of the patients it had observed suffered from some degree of hair loss six months after falling ill, with women being more affected than men. 


Why does COVID-19 cause hair loss? 


Although there are several studies linking coronavirus and hair loss, many of the reports we hear about are anecdotal – at the moment, it’s too soon for scientists to officially establish a link between the two. 

However, the type of hair loss that COVID-19 sufferers are reporting seems to be consistent with telogen effluvium. Telogen effluvium occurs when more hairs than usual suddenly enter the shedding phase of the hair growth cycle at once, causing a more noticeable amount of hair to shed at once. It’s normal to lose up to 150 hairs per day, but if you spot that you’re losing much more than that – such as clumps coming out when you’re brushing or washing your hair – it could be telogen effluvium. 

Due to the length of the hair cycle, telogen effluvium typically occurs two or three months after a period of significant stress, which can include illnesses such as COVID-19. When undergoing stressful situations, the body puts all its resources into maintaining essential functions only – which, unsurprisingly, does not include hair growth. As a result, you end up with hair loss. 

However, several other conditions can cause hair loss – such as thyroid issues or nutritional deficiencies – so if you are concerned, visit your GP, who can rule out other underlying causes with a simple blood test. 


Will my hair grow back after having COVID? 


If the hair loss is the result of telogen effluvium, most people will find that the hair will eventually grow back without the need for treatment. Typically, once the trigger or stressor is removed, the hair will grow back on its own. 

If you notice that the hair loss is persisting, there are a number of medical, cosmetic and hair transplant treatments available to help – Crown Clinic offers a range of options to support those struggling with hair loss, so don’t hesitate to get in touch

When performed by a qualified, experienced hair transplant surgeon, hair transplants are a very safe procedure. Hair restoration is a minimally invasive treatment that allows patients to return home the same day, with the procedure only requiring local anaesthetic. 

However, if you undergo a hair transplant abroad – such as in Turkey – the risk attached is much higher. 


Risks of hair transplants in Turkey 


It’s no secret that undergoing hair transplant surgery in countries such as Turkey is a gamble. Every year, countless patients are reeled in by the low prices and package deals offered by overseas clinics. Many of the clinics boast ‘five-star’ ratings and an active social media presence, duping unsuspecting patients into thinking they are visiting a reputable clinic. Although, when you dig a little deeper, you may discover the reviews are faked and the ‘after’ pictures are heavily edited or taken from other clinics. 

Another trick that patients fall for is believing that a surgeon will be carrying out the procedure, as many of the clinics advertise that a surgeon leads them to convince patients that they are legitimate. Unfortunately, that doesn’t mean a surgeon will be carrying out the hair transplant itself. In fact, many clinics hire under-qualified technicians with little training to keep the costs down, only seeking the supervision of a surgeon if the procedure goes wrong. 

Over the years, Crown Clinic has fixed countless botched hair transplants, mainly from overseas clinics. The most common problems that we see are unnatural-looking hairlines and unsightly scarring as the result of the surgery being carried out by unlicensed practitioners. Other risks are infections, as sanitation is often extremely poor at the clinics and damage to the scalp due to the result of the incorrect tools being used to carry out the surgery. 


Are there any side effects to having a hair transplant? 


If you choose to have a hair transplant in the UK with a reputable surgeon, side effects will be minimal. The hygiene standards will be incredibly high, meaning the risk of infection is negligible, and you will be given clear instructions on how to take care of your scalp after the procedure. Crown Clinic has an excellent aftercare service, offering a day-by-day guide to ensure optimum healing and results.  

Unlike at overseas clinics, where it can be impossible to follow up after the procedure to discuss any concerns related to your hair transplant, Crown Clinic is more than happy to answer any questions you may have during this phase.