New Standards and Regulation of Hair Restoration Surgery

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 Clinic 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.”