Why hard sell tactics in aesthetics surgery have got to stop

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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.

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.