Did you know that there is not even a single officially trained and certified hair transplant surgeon in the world? If you want to learn more, read until the end of this article. I’m sure you’re going to be surprised with what you’re about to learn about the global hair transplant industry.
For those who don’t know me, I’m Dr Ali Karadeniz, plastic surgeon practicing hair restoration surgery exclusively in the last 15 years and I’m located in Istanbul, Turkey. Let me first answer the question: “who performs hair transplants?”. Hair transplant surgery is a team’s work which requires a medical doctor and multiple adjunct personnel and this adjunct personnel is generally referred to as “technicians”. Let’s look at who is a hair transplant surgeon and who is a technician. As I mentioned in the introduction, there is actually no officially trained hair transplant surgeon. Any medical doctor who calls himself or herself “hair transplant surgeon” is a hair transplant surgeon. How do hair transplant surgeons actually learn doing these treatments? They learn from a colleague or by experimenting, i.e. trial and error.
Hair transplant surgery is a very labor intensive procedure, it takes many hours to perform, therefore it needs to be performed by a large team. The technicians do most of the work therefore the training and education of the technicians is also very important.
If you look at the history of hair restoration surgery, in the 1990s which I call “the experimental period” a number of medical doctors who were interested in the field, started working on this topic and they started experimenting it, exchanging ideas amongst colleagues. At that time surgical techniques were not advanced enough to provide a cosmetically acceptable hair restoration. Years passed and in 2000s these techniques had already started improving. But the limited number of doctors were not enough to fulfill the demand for hair restoration surgery.
A second generation younger doctors entered the field from the years 2000s, I was also amongst this group of doctors. The initial group were already quite old and the improvement of the skills and surgical techniques were at a certain limit. The second generation of doctors came into the field and the advancement continued. In the late 2010s the public started learning about hair restoration surgery, it became widely known and the demand grew logarithmically. The demand for hair hair restoration surgery grew so much that the first and second generation doctors became insufficient for that demand. And also the costs of hair restoration surgery were quite expensive because of the limited supplies. That led to the market splitting into two. Two separate markets being formed which I call the “real hair transplant market” and “the fake hair transplant market”.
The real hair transplant market consists of these first and second generation doctors. These clinics produce their own know-how and teach and train their own surgical teams. Fake hair transplant clinics are basically marketing and sales companies who want to take a share from the growing market. These companies do not have the know-how for performing hair transplants.
Fake hair transplant clinics have what I call “signature doctors”. Signature doctors are doctors who have no experience in the field of hair restoration surgery and just oversee procedures performed in that clinic and these doctors just sign surgical documents for legal purposes, but they have no know-how to add to the surgery. Sometimes these signature doctors may pretend to be physically involved in the surgery and learn bits of doing the procedure – usually from technicians – but because they don’t have this fundamental know-how, they do not add to the quality of hair transplant, therefore I call them “signature doctors”.
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The basic thing about fake clinics is that they recruit hair transplant know-how outsourced, they don’t create it within themselves and they hire freelance technicians or they may recruit them full-time but they do not control the training of these people. So, they have no control over the quality. The problem here is that there is no official training for both medical doctors and technicians which is why recruiting people with unknown training provides no quality. Let’s say an investor wanted to build a hospital, let’s say a plastic surgery clinic, they could recruit plastic surgeons fully trained and certified by the system and provide high quality plastic surgery. But since medical schools do not train medical doctors in the field of hair restoration or they don’t train hair transplant technicians in the field of hair transplantation there is not a supply of these medical staff which companies could recruit. So they recruit people with unknown training, which is why I call these clinics “fake clinics” because they have no control over the quality and the system has no control over the quality that these people choose.
One thing I want to point here is there’s no relationship between the physical involvement of a medical doctor and categorizing clinics as fake and real clinics. Because, once you have these signature doctors it doesn’t matter if they are involved in the procedure or not, because these doctors don’t have any knowledge, they don’t add anything to the quality of the procedure. Trained technicians would do a much better job than untrained medical doctors. It’s a myth and it’s actually a marketing lie that some fake clinics use is they will recruit multiple newly graduated doctors and take a profile picture of these doctors on their website and say “look we have five medical doctors for hair transplant surgery”. These doctors don’t have any knowledge, they haven’t performed any hair transplants, they haven’t been trained, nobody has taught them and they have no prior experience. There are just certificates, nothing else. You have to understand that the distinction between fake and real hair transplants has nothing to do with how many doctors actually work there or how much they’re physically involved in the surgery. Actually there could be a real hair transplant clinic where most of the work is done by technicians but trained technicians.
How do fake hair transplant clinics do marketing? This is where you will understand more how to identify fake hair transplant clinics from real ones. When you look at websites or social media channels of fake hair transplant clinics you quickly discover a few things. One is that, these companies will mostly tend to emphasize a company name rather than the credentials of a medical doctor. Since these companies do not have a real hair transplant surgeon, there will be no hair transplant surgeon to put on the forefront. These companies will either be led by a signature doctor, in that case you will see this doctor in the profile because it’s led by the doctor, of course it would take a little bit research to find out if this doctor is really one of these first and second generation doctors which I will go into later or there will be fake clinics that employ signature doctors which in this case they will mostly not put these doctors in the forefront because it simply doesn’t matter who these doctors are.
The other thing is that fake clinics use what I call “postmodern marketing”. Postmodern marketing to me is making people ask questions you want asked, so you will provide the answers you want to provide. Obviously everybody knows that a candidate consumer is going to consult multiple companies and compare and choose from. Postmodern Marketing wants you to ask questions to your competitors they want you to ask, the questions they want asked, so the answer to the question will point at the company that is doing this marketing.
Let me give you an example: A fake clinic will claim they have the newest and latest technology. Mind you, this is one of the main methods fake clinics use. They will market latest and newest techniques and technologies whereas in reality the quality of a hair transplant doesn’t matter on the techniques and technology, it matters on the training and skills of the surgical team. This is just like a good quality food not depending on the brand of the knife or the saucer or the pan, it’s the skills of the chef that’s going to determine the quality. Fake hair transplant clinics will frequently market “latest techniques” and “technologies”. When they do their marketing – let’s see one of these things they frequently use is – they say “we’re going to use sapphire blades, this is the latest technique and technology”. They will say “we use this technology”, so they want you to ask other clinics “are you going to use sapphire blades?”. Once the question is asked, the company wins no matter how the competitor answer that question. Because if I say “I don’t use it because it’s nonsense” but the customer doesn’t know it, so when I say “I don’t use this”, the customer will think “oh they don’t use the latest technology”. That’s the trick. If I say “I use it”, then they’re going to say well “they copied from us, we invented sapphire blades and they’re copying from us”. So no matter how the question is answered it always points at who’s doing the marketing. This is what fake clinics usually do.
Another difference between fake and real hair transplant clinics will be seen in the number of surgical cases done per day in that facility. Let me give you an example, I practice in Turkey and there are approximately 2000 hair transplants performed every day in Turkey, but I would quantify the number of real doctors maybe 10 or 20. This means that 99% of the surgeries done there is not real hair transplant surgeries. Since the people doing the surgery in fake clinics is what I call “nobody” or “anybody” from the street they have no limit. They could do 30, 50 or 100 surgeries per day whereas in real hair transplant clinics – even if most of the work is done by technicians, even if the surgeon is partially involved physically in the surgical team – there is only a number of surgeries that can be done simultaneously with the involvement of this doctor, that would be like maybe one, two or three surgeries a day, no more. If you’re seeing 20 cases per day in that facility you should automatically understand that this is a fake hair transplant clinic.
A frequently used argument by fake hair transplant clinics is they will do one hair transplant session, transferring the most number of grafts and complete the treatment. They know this is what the customer wants to hear, whereas in fact this is not the reality. The reality is that, hair transplant surgery is a progressing problem, there is so much work to be done, it’s rarely possible to complete the treatment in a single session unless the hair loss is very mild. In most cases, multiple surgical sessions are required to get a decent job done, because of the progression of hair loss there will be more sessions needed in the future anyway. Fake care transplant clinics will emphasize or will say “yes” to all requests to do more done or all done in a single surgical session.
Fake hir transplant clinics will frequently use arguments or put content on their social media and websites like “the best doctor in the world award” or “the best health tourism company in Europe”. If you see that, this is a fake hair transplant clinic. Prestigious scientific organizations will never give a doctor an award such as the “best doctor in the world”. You can get the “best scientific study of the year” or you can get the most “best poster award” but you can never be “the best doctor in the world”. If you see awards or award ceremonies like that, it’s fake.
Another thing is before and after pictures. Obviously patients looking for cosmetic surgery, looking for hair transplant want to see hair transplant before and after results to feel how much improvement they’re going to get. Unfortunately, this is misused. Before and after pictures used by companies are cherry picked from thousands of cases, these are the most favorable cases, cases that look much better than how they actually are. When you look at these before and afters they don’t represent the average result you should get, they’re the very best results. Not to mention that latest photoediting technology allows companies to produce totally fabricated before and after results which you would never tell. I think patients shouldn’t rely much on before and after results and companies emphasizing before and after pictures and especially showing unbelievable results are likely fake, the pictures are fake or are edited or are cherry-picked from thousands of cases and they don’t actually represent the average result.
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Another topic is “patient reviews”. Obviously a consumer or a customer would like to see reviews from a company to see if previous customers were happy and satisfied with the product or service, it’s a natural instinct. However you have to see how it really works. Most people will naturally not provide any reviews as consumers. Consumers put reviews like internet reviews or video reviews in two main situations: (1) If they’re motivated by the clinic or they have a special agreement to do so or (2) if they have a the complaint and they want to criticize or even protest or punish the company for a poor service, they put down a negative review.
What happens in real life is – let’s say when I practice as a hair transplant surgeon and if I do nothing proactively for getting hair transplant reviews – firstly I will get very few hair transplant reviews and secondly maybe half of those those reviews will be negative reviews because those will be the people not necessarily had bad results but they may be unhappy for a reason or some people simply have unrealistic expectations. Because they don’t get that miracle they will just put down a negative review.
What I’m trying to say is that if it’s not manipulated, there will be few reviews with a high ratio of negative reviews. But when you look at these fake clinics you’ll see five star reviews and thousands of them. This in reality is not possible. Why? Because of two reasons. One is they have a special program to get reviews from patients and most of these reviews are provided before actually the patients see the result, they’re taken at the clinic right after the procedure. Maybe person is treated well and they put down a good review but they don’t actually have a result. So, most of these reviews don’t reflect much, but the companies have a a policy, they have a program to get these reviews out so they keep getting these positive reviews which actually don’t reflect any result.
The other thing is they manage complaining patients which is good thing in a way, they don’t leave those people with negative reviews, but they will do anything to get those negative reviews removed. They can even pay, they can reimburse the patient or give presents or free treatments. I’m not saying this is a bad thing but like they remove negative reviews which were there by managing the reviews. They keep getting positive reviews and whenever they have negative reviews they manage those reviews. You can’t actually just look at reviews or the number of five star reviews and decide whether this is a fake or real clinic.
Another thing fake clinics do is they in order to come up higher on internet search they will buy internet links. This is a more sophisticated process but there are many websites that will provide internet links to any website when they’re compensated. These fake clinics know this and for SEO purposes – Search Engine Optimization on Google – they will get paid links. Obviously this is not recommended by Google but nobody tells that these links are bought. They keep recruiting internet links and they come up higher on keyword searches in Google. Let’s say you’re interested in having a hair transplant in Turkey and you type “hair transplant turkey” and you click on Google and when you see the first two three pages, they’re all fake clinics. None of the real clinics will come up on the higher searches because it’s the fake clinics that will keep investing in these paid links whereas real clinics will usually just be interested doing good work but obviously Google doesn’t know who’s doing the good work, they just check on the links and the fake links are always higher ranked on Google.
Let’s now shortly look at what happens when you choose a fake hair clinic, what’s the disadvantage, what happens if you go to a fake hair transplant clinic? What’s happening here is you’re having a hair transplant done by people who don’t have proper training, there’s no quality control and they’re just doing what they know is best but the company’s not aware of that. These people are mostly freelance people, most of the hair transplants done in Turkey every day are by freelancers, it doesn’t matter which brand you bought the hair transplant from, they just call the freelancers, they come in and do the hair transplant for you.
Companies that do let’s say 30 surgeries per day, they have some teams, they were also from outsource but they recruit these teams full-time but maybe five team or three teams but for the remaining 20-25 cases freelancers come in and do the surgery for, you don’t know that. You will meet the signature doctor that was advertised on the first page of the website or social media but it will never come across to you that who’s actually going to do the surgery is those freelancers that just came in for the day.
These people will do your surgery and as a consequence, there’s obviously risk to your health. Thank God hair transplant surgery is a relatively safe procedure and it’s very unlikely that something life-threatening happens. The most risky part of a hair transplant is where local anesthetics are applied and although rare we see some fatal cases where a patient is lost and most of the time it’s due to either using these local anesthetics at too high doses also usually associated with misdiagnosing risks that patients have and just rushing into surgery with those patients who had prior risks which were not diagnosed. Combining those two, the risk happens. But as I said this is very rare.
Most of the time what’s going to happen is two things: (1) The design of the hair transplant is going to lead to unnatural results so it’s going to look unnatural and (2) Donor hairs which we take from the patient’s back of the head – which we call the donor area – donor hairs are going to be severely wasted during the procedure. Unfortunately you will not be aware that your donor hair was wasted unless you apply for a second hair transplant. You may realize the unnatural appearance but that also is a sophisticated thing because like bold people will be happy when they’re less bold even if the design was not so natural. It may not be the patient’s priority to complain about an unnatural design.
I recommend everyone to think about the differences between services and products. As opposed to products you could get “negative value” from a service, in the case of Health Service you could lose your life, you could lose your health or you could lose the beauty of your appearance. Always mind the difference between products and services and I think we should all be more careful much more careful when we are purchasing services over products especially if these services are health related services.
The quality of service is dependent on the philosophy. What’s the most important determinant of the quality of a hair transplant? Nobody I heard has been able to answer the question in the way I’m going to answer it. The most important determinant of the quality of the hair transplant is the people performing it wanting it to be good. If the people who perform the hair transplant don’t care and hence don’t want it to be good, there’s nothing on earth that’s going to make it good. The highest the latest technology, the most luxury hospital, the best social media, best before and afters, nicest reviews, “world’s best doctor awards”; nothing will save you if they just want to take their daily salary and run, there’s no chance you’re going to get a good hair transplant. There’s no difference between getting a good cup of coffee and having a good hair transplant. The only way to have a good cup of coffee is the coffee maker doing the coffee with love, “I’m wanting to give you a nice cup of coffee”, otherwise you’re not going to get it.
Thank you for reading and I hope it’s going to help you make a decision through your journey of having a hair transplant and choosing a clinic.