Restoring faith – Glass speaks to Dr Greg Williams of Farjo Hair Institute, hair loss and hair transplant specialist and president of the British Association of Hair Restoration Surgery, who is a leading campaigner for regulation of hair transplant surgery in the UK
Hair loss is often seen as a topic for jokes and derision. For men, a thick head of hair is unconsciously linked with virility, and for many men and women baldness and thinning hair are something that they often find very embarrassing, and often impossible to talk about – almost a taboo. Hair loss can be a very sensitive subject and the psychological impact can be enormous.
I first met leading hair restoration and plastic surgeon Dr Greg Williams at the recent Get Ahead of Hair Loss (GAoHL) conference in London where he gave a presentation – with a trigger warning – as some of the slides accompanying his talk showing botched procedures , conducted by unqualified people, were truly disturbing. I was also very impressed with how successful hair transplants can be when they are done by qualified surgeons.
Dr Greg Williams
The Jamaican-born Dr Williams has practised medicine in the UK for 25 years and was a plastic surgeon and formerly the lead clinician in the burns unit at the Chelsea and Westminster hospital. He has now been in private practice for eight years. He is also the current President of the British Association of Hair Restoration Surgery (BAHRS). It is pretty safe to say that he is an expert in hair loss.
His interest in this field began while he was working in the burns unit. “People were getting burnt, and burnt in hair areas. They were having reconstruction but the techniques I was taught by my mentors were very archaic and rudimentary. So I went to Brazil and Canada where I learnt more cutting-edge techniques. Those reconstructive techniques are the same techniques that are used for hair transplant surgery as for other types of hair loss such as male and female genetic hair loss; secondary scarring alopecias for surgery or trauma and some dermatological conditions; and some congenital hair loss conditions are suitable for hair transplant surgery,” Dr Williams clarifies
“Some choose to do something about it and others choose not to do something about it. The psychology of hair loss is very unnerving, understudied and underappreciated. We need to get it out of the closet and start talking about it and normalise treating it.”
“It’s generally accepted that if a man is losing his hair, he should ‘man up’ and not worry about it. However, men are extremely distressed by their hair loss,” Dr Williams says.
Before and after: patient with hair transplant done at the Farjo Hair Institute
Properly done, hair transplants are usually very successful and not the crude transplanting of patches of scalp from hair rich areas of the head to the bald parts (which I had thought they were before attending the GAoHL conference).
I asked Dr Williams to explain to me, in layman’s terms, what a hair transplant entails these days. “Is it like taking a patch of the scalp and then placing it in a more visible position,” I ask.
“What you’re talking about was something that was done in the past. Basically, the hair grows on the head in little groupings; you may think they grow in single strands, but they grow in little groupings called ‘follicular units’ and those groupings have anything from one to three or four hairs, occasionally five, but usually one to four hairs.
Techniques are now more sophisticated and they are “two ways of harvesting the hair and the implantation, and the result is generally the same – regardless of which harvesting technique is used. The first technique is FUE, standing for ‘follicular unit excision’, and in that technique, the individual groups of hairs are basically drilled out, leaving tiny little holes that result in tiny little round scars about a millimetre in diameter.”
Before and after: patient with hair transplant done at the Farjo Hair Institute
Are these visually noticeable to the naked eye?
“Unless you have a shaved head, or if you harvest large numbers of follicular units, then you can thin out the donor area you are harvesting from so you need to be judicious about how many hairs you remove. With the other technique which is called a strip follicular unit transplantation, (abbreviated as ‘strip FUT’ you remove a long narrow ellipse of scalp from the sides and back of the head. And the size of that strip will depend on how many hairs you want to harvest.
“But if you want maximum amount, you will make the cut from ear to ear and then that wound is then closed with stitches or staples and leaves a permanent linear scar as opposed the hundreds and thousands of little dots with the other technique. Then that strip of scalp skin is dissected using microscopic magnification, by a team of assistants, into the same individual groupings as if you had extracted them individually; and then they are implanted as little individual groupings in the same way as the other technique.
“This is done under local anaesthetic and takes from 8 to 10 hours and we usually have a success rate of 90 per cent of transplanted hairs to growing with either technique”.
But what about the 10 per cent it doesn’t work for, I inquire.
“That would be rare and you have to see if there was an underlying dermatological condition that we missed, or if the patient was not compliant with their post-operative care,” Dr Williams replies. “Sometimes there is no explanation for a poor result and, if that was the situation where I work, we would tend to make that good with the patient without charging them and get them the result they paid for and I thought we should have achieved.”
Dr Williams is committed to offering the best service possible. “We decline a lot of patients for a variety of reasons. If they have a dermatological condition, such as alopecia areata or scarring alopecias, these are conditions where hair transplant is contraindicated.
Before and after: patient with hair transplant done at the Farjo Hair Institute
“Also we take into account patients’ expectations and what they want to achieve. Are they unrealistic? There are some sets of patients who will have psychological disturbance such as body dysmorphia, but also a lot of younger patients who are likely to have advanced progressive hair loss. It’s a bad idea to do a hair transplant because by the time we see the result of the transplant they will have more hair loss and then they won’t be satisfied with what they have achieved.”
So you have to wait until they get older? “Yes. We can’t talk about hair transplant as a single entity. It depends on what your patient wants. Whether it’s a man or a woman; whether they are young or old; what kind of hair loss you are treating. But generally, we are talking about male pattern hair loss and it’s important that it is treated medically if possible, to try and stabilise the hair loss. Surgery isn’t the only option, however, and there are good medical treatments available also such as the topical cream Menoxinal, and also oral Finasteride. These are proven medical treatments that men should consider which give good results to slow and stop hair loss.”
I was stunned to learn that hair transplants are not regulated at all in the UK. This is because they are viewed as a cosmetic procedure and not a surgical one, and patients seeking them are ripe for exploitation – which regrettably does take place. These scams don’t just take place overseas but in the UK too.
Dr Williams explains, “Hair transplant surgery sits between what has traditionally been surgical and non-surgical. It absolutely is surgery – both harvesting techniques should be viewed as surgical procedures and should not be viewed as cosmetic surgery. It’s sitting between different categories of surgery, and the biggest problem is that there is no training in any medical curriculum for it. It’s not taught in medical schools; it’s not taught in plastic surgery specialisation and it’s not taught in dermatological specialisation. There is no training in the UK for it because it is viewed as a cosmetic procedure. It has just flown under the radar of recognition.”
This is a huge problem because in the UK the law is very vague on who can, and cannot, do it and the only law that exists is that any clinic that advertises they offer hair transplant surgery in England should be registered with the Care Quality Commission (CQC).
“There is an increasing problem in the UK, and globally, of non-doctors doing some of the surgical steps of hair transplant procedures, particularly making the incisions for the FUE technique. This should be seen as wholly unethical and inappropriate, that patients in the UK and overseas are alarmingly being operated on by untrained people, particularly in Istanbul, which is a mecca for hair transplant surgery and where the majority of hair extraction is done by non-doctors,” Dr Williams goes on.
And some of the results of these are horrifying, when they are botched, as they often are. I ask Dr Williams what can be done about this.
“I’m the president of the British Association of Hair Restoration Surgery, and we have approached the Advertising Standards Authority (ASA) about misleading advertising, but unfortunately they not very enthusiastic about dealing with the problem. We reported 46 clinics to the CQC in November 2017 but are yet to have any official report from the CQC.”
The bigger problem, however, is British patients going overseas for cheap hair transplant surgery. So the International Society of Hair Restoration Surgery (ISHRS) has a campaign which they have called Beware of the Hair Transplant Black Market.
In fact, a recent member survey gauging ISHRS members’ familiarity or experience of treating patients who have suffered a botched hair restoration surgery, found that 77.5 per cent of survey respondents saw six or more cases per year, and that this number is climbing drastically. To highlight this scandal, ISHRS are rebranding to a new snappier name – the Fight the FIGHT (which stands for Fight the Fraudulent, Illicit and Global Hair Transplants).
The only way forward, Dr Williams suggests, is through raising awareness and public education and for responsible hair transplant surgeons to emphasise to patients they really have to do their homework very carefully before undertaking surgery and warn them not to be swayed by cheap prices and celebrity endorsements.
The world of hair loss is lucky to have an advocate as committed and expert as Dr Williams fighting its corner against the dire consequences of exploiting the vulnerable.
by Caroline Simpson
If you are considering a hair transplant, there are four main points to think about:
- Number one, when you are choosing a hair transplant clinic and you look at their website, make sure that the doctor is clearly listed along with their qualifications and experience.
- Number two, never let a non-doctor make your surgical planning decisions – that includes the method of harvesting the hairs, the number of hairs that will be transplanted and the transplant design.
- Number three, if you are planning to have an FUE procedure, ask at the time of consultation who will be making incisions in your skin to extract the hairs and make sure it’s a doctor and make sure that is what actually happens at the time of surgery.
- Number four, if you are having your surgery in England, the clinic website and the facility where you are going to have it done must registered with the CQC. If you are having the surgery in Northern Ireland, Wales or Scotland there are similar regulations by the regulatory bodies in those countries: Healthcare Improvement in Scotland, Healthcare Inspectorate in Wales and The Regulation and Quality Improvement Authority in Northern Ireland.