Why hard sell tactics in aesthetics surgery have got to stop

Crown Clinic‘s surgeon Asim Shahmalak was recently commissioned by Aesthetics magazine to write a first-person piece on an issue he felt passionately about.

Dr Shahmalak wrote the following piece below on why hard-sell tactics have to come to an end in the aesthetics industry. The article was published in December’s issue of Aesthetics magazine – the leading monthly publication for the cosmetic surgery industry.


The most important thing we all have working in aesthetics is our reputations. Without that, we are nothing.
Patients quite rightly expect us to put their interests first regardless of the benefits to our businesses.

I have spent more than 30 years building up my reputation as one of the leading hair transplant surgeons in the world. I started out as a general surgeon – working first in Ireland after leaving medical school before coming to the UK to work in the NHS.

Around 10 years ago, I wanted to try something new and I began to train in hair transplantation before making the full-time switch and establishing my own clinic, Crown Clinic near to Manchester Airport, eight years ago.
I have never regretted making the switch. Making a real difference to hundreds of people’s lives every year is enormously rewarding. Male and female patients come to us with low self –esteem due to hair loss. Seeing their faces light up when they realise there is a permanent solution to the problem is the only professional satisfaction I need.

I am well known in the industry for my work with famous clients. I have performed hair transplants on well-known people such as the TV doctor Christian Jessen from the Channel 4 medical show Embarrassing Bodies and the model Calum Best. More recently, I have been working with the former Liverpool and Man City footballer Didi Hamann, now a respected TV pundit.

For every celebrity who has a hair transplant at Crown Clinic, there is another that I have turned away. Some of the biggest names in sport have walked through the doors of my clinic, but I have not been able to help them because it would not have been in their best interests.  At Crown Clinic, we would have benefited enormously by the global publicity such cases would attract, but I had to say no because I would have been failing in my duties as a doctor.

I set strict rules on which patients I will operate on. I won’t work with anyone under the age of 25, for instance, because it is impossible to establish a pattern of baldness in a patient before that age. Go too early and the consequences can be damaging to the patient.
I have noticed big changes in the aesthetics industry in the last 10 years. While the technologies have developed right across the board, offering patients highly sophisticated treatments which produce far better results than ever before, the ethics underpinning some of the clinics in our field leave a lot to be desired.
It is obvious to me that hard-sales tactics are being used to the detriment of the patient. There are only four hair transplantation clinics in the UK which are doctor-owned and run – including my own. Many others have excellent doctors working in them – providing fantastic hair transplant surgery for patients – but they are not the people in charge. The clinics are run by the sales team – or ‘consultants,’ as they are described to prospective patients. Their primary interest is not that of the patient – it is getting the sale and generating profits for the business. This can mean patients being operated on too early or when there is little chance of successful treatment because they are not suitable for a transplant.

I often see the results of this recklessness. Around 10% of my workload is what we could call ‘repair work’ – fixing the poor surgery provided by other clinics. Many other patients come to me after being left disappointed by work performed by other surgeons – particularly at clinics abroad.

It pains me to see the hard sell tactics being used so blatantly. It is evident right across the internet.  Salesman will set up websites offering hair transplantation at bargain prices. Dig deeper and there is a reason for these bargain prices: the surgery will be performed thousands of miles away from the UK, at clinics where there is not the level of regulation you have here. You see clinics heavily discounting their treatments during quiet periods – selling healthcare like it is a product on a supermarket shelf. Patients are incentivised to make a quick decision on surgery when they would be better served by a period of calm reflection before deciding whether to undertake a treatment.

Many patients are lured in by these hard-sell tactics and end up making a mistake which they regret for the rest of their lives.  The fact is: you pay for quality. The most important decision you make when you embark on cosmetic surgery is the choice of your surgeon.
It is not just in the field of hair transplantation that I see these hard-sell tactics – but right across the aesthetics industry. From breast implants to laser eye surgery, there are rogue operations that are damaging the reputations of us all and making some patients wary of seeking treatment which could transform their lives.

Anyone working in cosmetic surgery is heavily regulated. All clinics need approval from the Care Quality Commission which applies stringent checks to each clinic it licenses.  You are subject to spot checks and only the very best clinics are approved. But applying the same standards to the sales tactics employed by some clinics is far harder. There will be some borderline cases where a sales consultant might say yes to a procedure whereas a surgeon might say no.

We need to be putting more power into the hands of doctors and clinicians who are experts in their field and relying less on salespeople and consultants who may sometimes put the bottom line ahead of the interest s of their patients. It’s time to end the hard sell.