Hair Restoration in Foreign Clinics & “Hair Mills“: Risky Business

Man modeling hair restoration.

I was recently out with my family at a local shopping center when I heard a familiar voice calling, “Dr. Chaffoo!” Turning around, I was greeted by one of my patients, Walid, who had undergone hair transplant surgery in our San Diego area practice La Jolla Plastic Surgery & Dermatology. He hadn’t been into the office in several months as he was doing so well. He eagerly showed me how his new hair had grown into the previously balding areas and said that his wife was perhaps even more pleased than he was with the results.

This patient’s new hair growth looked completely natural; no one would ever detect he had a hair restoration procedure. While talking with Walid, he introduced me to his best friend, Joseph. Walid couldn’t suppress a smile as he commented, “Dr. Chaffoo, Joseph was really impressed with my hair transplant. Instead of coming to see you, however, he went to Turkey for the transplant. He wanted to save money! Look at his hairline. See how thin it is? It doesn’t look like mine. I told him to see you, but he didn’t listen. Now he has to do it again. So much for saving money!”  We spoke for a few minutes longer before I rejoined my family shopping.

You get what you pay for.

This is a common scenario I have seen several times.  Patients come to our practice after having undergone hair replacement surgery in another clinic, such as one of the highly advertised hair clinic franchises that are now household names. Others have traveled overseas for treatment, often to third world countries in Asia or the Middle East. The stories are all too familiar to us: the promises of great hairlines for cheap prices. However, after returning home and waiting a year for the hair transplants to “grow in,” many patients are greatly disappointed with the lack of hair growth, unnatural hair lines, and noticeable scars on the back of the head. Sometimes we can fix these problems, sometimes we cannot. Often, the donor area along the back and sides of the head have been “over harvested” so that insufficient hair follicles remain for further hair restoration surgery. Many times, the patients’ only options are to shave their heads or wear hair devices. These patients regret their decisions, but there is no time machine that would allow them to go back and make a more informed decision about choosing a qualified hair transplant clinic.

So what makes hair restoration in foreign clinics or hair “mills” risky business? There are many reasons, ranging from improper techniques leading to the loss of the limited hair follicles and other complications to the lack of artistry in the design of a pleasing hair line.

You only have so many hair follicles.

Hair transplant surgery is permanent.  All humans are born with a finite, limited number of hair follicles, meaning there are not unlimited opportunities for transplantation. Unlike skin and other types of cells, humans cannot make new hair follicles. If they are not harvested and handled appropriately, they will not take, forever reducing the number available to secure coverage of concerning areas. Doctors who are trained in residency and fellowship programs, such as in plastic surgery or dermatology, spend many years gaining the knowledge and skill to handle what I call the “tissue issue” appropriately.  My strong recommendation is that patients seeking this treatment ensure that the physician they select has actual residency and fellowship training in a “core” specialty such as plastic surgery or dermatology so that the tissue issue can be addressed.

There is an art to hair transplant surgery.

Moreover, a patient will want to confirm that the physician has the ability and judgment to create a natural, pleasing presentation. Once hair grafts are inserted improperly, they grow that way for the remainder of your life. If your hairline was designed incorrectly or in an unnatural shape or position, you will see this every day in a mirror; so will everyone else. Again, a physician trained in a specialty like dermatology or plastic surgery has dedicated years to the study of aesthetic medicine and surgery. There are very good reasons why doctors are trained in specialized residency and fellowship programs, and the training they receive often impacts on the ultimate results.

Specialized training is important.

A patient who travels to a foreign country loses assurance in the quality of both the physician and the hair transplant team.  Many foreign hair clinics employ technicians with little to no medical training. There are reports of secretaries and even taxi drivers who are brought in to perform hair restoration surgery!  Even in the United States, many physicians who were unsuccessful in their trained-for medical specialty see hair transplantation as a way to make a quick buck and leap into the field without having the benefit of completing a highly competitive residency training programs in dermatology or plastic surgery. Many of these physicians have received little to no formal surgical residency training.  While all licensed physicians can practice medicine, would you take a luxury sports car to a mechanic who was trained to work on scooters?

“Board certified” doesn’t always mean qualified.

It is equally important that the public be aware that while it is possible for an organization to be promoted as a specialty group, there are only a limited number of American Board of Medical Specialties (ABMS) recognized, such as dermatology and plastic and reconstructive surgery.  The American Board of Dermatology and the American Board of Plastic Surgery are the 2 ABMS boards that include hair restoration as part of their specialty boards. While other organizations may claim to be “boards”, a key question to ask is whether that “board” is ABMS certified.  It is telling if the answer is no. Some doctors who do not have that type of training might create or join organizations with fancy sounding names that are not, in fact, a recognized ABMS specialty. This can exploit a patient’s lack of knowledge about the physician’s training and experience because the name sounds legitimate.

It’s important to do your homework.

As educated consumers, I encourage prospective hair restoration patients to do their homework. Become informed in the same manner as patients who seek breast augmentation surgery, laser resurfacing, and even fillers. Your aesthetic result from a hair transplant procedure is important; therefore, you should select a provider who has the skills and training to maximize your satisfaction. Here is my list of recommendations for any patient who suffers from hair loss and is interested in medical as well as surgical treatment options:

  • Look for a hair clinic under the direction of a physician who is certified by the American Board of Dermatology or the American Board of Plastic Surgery, and is a member of the American Academy of Dermatology or the American Society of Plastic Surgeons.
  • Ask to meet the hair restoration team that assists the physician. What is their training, experience, and credentials? The members of the team should be full-time employees indicating a large volume of cases are performed each month.
  • Review actual practice before-and-after photos.
  • Shop for results; don’t be penny-wise and pound-foolish.
  • Select a practice that performs a significant volume of cases each month.
  • Find a practice in the United States.
  • Ask to speak with former patients about their experiences.
  • Look for a practice that receives referrals from physicians or where physicians become patients themselves.
  • Find a practice that offers the latest technology in hair restoration as opposed to more dated techniques that leave permanent scarring on the back of your head.

If you’re interested in hair restoration in the San Diego area, I encourage you to contact us online or call 858-256-4458. It never hurts to explore your options!

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