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.

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.