Who is getting hair transplants?
It’s not always middle-aged men seeking help with their hairlines; Verma and Matthews see a mix of people in midlife and younger clients, too.
“I see more men than I see women, but in terms of people approaching us for treatment, it’s not always male-dominated,” Matthews says.
“We get a lot more inquiries from women about [hair loss] medication, but I would say [we get] more inquiries from men about transplant procedures.”
There are many reasons why people want hair transplants. Maybe you’re seeking a transformation after the end of a relationship or recovery from an injury. If you’ve had a skin cancer removed from your scalp and you can see it in the mirror, you may want to cover it up. Or maybe you’ve never been happy with your hairline.
Put simply, hair is a “big deal”, says Dr Garsing Wong of the New Zealand Hair Transplantation Institute.
“When we look at our pets and we look at the sheen of their coat, it’s the same with us – that we see ourselves as being healthy and vibrant when our hair is healthy. So if your hair starts falling out, then of course it can be a hint to you that you may be suffering from something.”
What causes hair loss?
While we naturally lose more hair as we age, there are many causes of hair loss – some more medically serious than others.
“The [reason for the] majority of hair loss in men is androgenetic alopecia,” Wong says.
“It’s partly related to hormones, the androgens, and [there’s a] genetic component … that represents about 80 to 90% of all men who present [with hair loss].”
By the age of 50, 50% of men will have some level of androgenetic alopecia – 80% by the age of 80. That statistic is similar for women, he says.
Wong believes hair loss can be more devastating for women as they don’t expect to be affected.
As women age, they produce less of the hormones estrogen and progesterone, which help maintain healthy hair growth. These changes can cause their hair follicles to become more sensitive to the hormone dihydrotestosterone, which contributes to hair loss in both men and women.
Conditions like scarring alopecia – hair loss caused by an inflammatory or autoimmune disorder that permanently destroys hair follicles, leaving scar tissue behind – are a “medical emergency”.
“[People] don’t realise it’s treatable and the aim of the treatment is to stop further loss of your hair permanently, because once it’s gone in scarring alopecia, it won’t come back because the follicle itself is destroyed.
“The brilliant thing about hair loss is that it’s become more of a science, whereas once upon a time it was in the realms of snake oil. There’s now so much good evidence, good meta-analysis and studies showing what treatments work for men and women that we can base it on science and no longer mumbo jumbo.”
What to know before you get a hair transplant
Whether a hair transplant will work for you may depend on the cause of your hair loss, Verma says.
Treatment will start with a detailed medical assessment to figure out if there are any underlying causes for the hair loss, like a thyroid hormone imbalance, iron deficiency or anaemia. Once those have been ruled out – or dealt with if they are a problem – Verma says medication is often recommended before they consider a transplant.
Some people will see improvement on medication and decide they no longer want a transplant.
“Before and after a transplant, it’s recommended to be on medication anyway to stabilise your hair loss and prevent the risk of needing a further hair transplant in the future.”
The procedure Wong most commonly performs is FUE – follicular unit extraction – which involves removing each individual hair follicle from a donor area (usually at the back of the head) and transferring them to thinning areas.
“You need to make sure that the out-of-body time for the follicles is low, and that the patient’s grafts, or the hair, is not compromised.”
The technology and tools for performing hair transplants have improved in recent years, helping reduce trauma to the patient during surgery and shortening the procedure time.
What to know before you travel for a hair transplant
Many of us have heard stories of someone flying to Turkey or India for a cheaper hair transplant – but are there risks that come with going overseas for the procedure?
Not necessarily, Matthews says, but it’s important to be informed.
“The risk can be higher overseas if you’re not dealing with an experienced and good clinic. A lot of people will go overseas because the cost is an element … if they’re going through a reputable and experienced clinic abroad, then they should be able to avoid some of the problems.”
In some overseas clinics, technicians are allowed to perform transplants, which isn’t the case here.
“The bar is much higher in New Zealand, which makes New Zealand in my opinion one of the safest countries to [get a hair transplant] … there are, to my knowledge, fewer than 10 doctors in New Zealand authorised to do hair transplants.”
To perform hair transplants here, a doctor must hold MBBS (Bachelor of Medicine, Bachelor of Surgery) and be registered with the Medical Council of New Zealand.
Wong says the biggest risk with travelling overseas for any cosmetic procedure is not knowing who will be performing it.
“[If patients are] choosing on price and they’re not talking to a surgeon, they’re talking to a broker … so [the surgeon is not] checking [if] you have a medical condition that should be treated first, whether a [transplant] is doable or not.”
A red flag would be if an overseas clinic advertises themselves as “doctor-led”, Matthews says. This can mean the operation is performed by technicians and supervised by a doctor.
“Ask the person you’re speaking to, ‘Is the procedure going to be performed from start to finish by the doctor or not?’ And the answer should be yes.”
If you’re travelling for a transplant, you should also confirm what follow-up and aftercare the clinic will provide, and factor in recovery time as well as the overall costs – of the procedure itself, flights and accommodation.
It’s not recommended to fly internationally for two weeks after a hair transplant.
“The pressure on that flight will affect how swelling works, it will affect the grafts and the grafts’ survival rates,” Matthews says.
“You can trade clinical oversight and reduce the safety of what you’re going through, you’ll just get an outcome that reflects the price. If you go to a good clinic in Turkey, it will cost much the same as what I charge, because people who are good at their jobs don’t sell their services cheaply.”
The price of a hair transplant will vary according to an individual patient’s needs. At the Auckland Clinic, the overall cost ranges from $15,000-$31,000.
At the New Zealand Hair Transplantation Institute, the initial consultation costs $150. The cost of a transplant starts from $5700 for a minimum of 400 follicular units, roughly 1000 hairs, though most patients will need around 1000 follicular units, or about 2200 hairs, or more.
In New Zealand, the cost per graft or follicular unit can be up to $14, while in Turkey it can be from $1-$4.
What can go wrong?
In some cases, there may be a risk of spreading undetected skin cancer cells across the scalp via the tools used during a hair transplant.
“If, for example, during a transplant you have someone who doesn’t know how to diagnose a skin cancer … if they hit that melanoma with a drill tip to create the graft, you can have thousands of grafts made in a day and you’ve now spread a problem that may have been able to be dealt with earlier,” Matthews says.
However, because skin cancer can take a year or longer to develop, it would be hard to definitively trace it back to the transplant as having spread it.
“If you have someone who gets a skin cancer on their scalp following a hair transplant and you remove it and then they develop another one in another site, you don’t necessarily blame the transplant.”
Verma adds that this phenomenon is more commonly reported in cancer biopsies, but because so many incisions are made during a hair transplant, the risk can be compounded.
Wong says when patients come to him to correct a hair transplant gone wrong, it’s clear they often haven’t been spoken to about how to prevent further hair loss.
“By the time I get to see them, they’ve already got continuing hair loss and it makes it very hard to correct things. Often they’re over-harvested and therefore there’s very little donor hair that I can use to do a correction … several years down the track, they’ve got the transplanted hairs but it’s an island unsupported, and it’s really sad.”
This doesn’t mean if you seek a hair transplant overseas, you’ll necessarily get a bad outcome.
“Some patients have had fantastic results because they went to bona fide clinics, saw great colleagues who are ABHRS qualified.”
ABHRS stands for the American Board of Hair Restoration Surgery, which is the only international body that certifies doctors have the expertise required to perform a hair transplant.
When is a hair transplant not the best treatment?
Matthews says it’s important to assess if someone is a candidate for a transplant from a health and safety perspective, as well as cosmetic reasons.
“If someone’s got telogen effluvium – stress-induced hair loss – this can be quite dramatic and patchy. The prevailing treatment for that would be, don’t do anything and let it self-correct over the next few months.”
Health history and medical conditions must be taken into account, he adds; “Safety has to come first”.
Wong sees “a high percentage” of patients who have body dysmorphia, and screens for this before taking them on, as well as for any pre-existing skin or scalp conditions, or possible skin cancer.
Bethany Reitsma is a lifestyle writer who has been with the NZ Herald since 2019. She specialises in all things health and wellbeing and is passionate about telling Kiwis’ real-life stories.
