Watch the Replay
Watch the replay of an ISHRS patient educational live stream hosted on January 11, 2023, in collaboration with the Australasian Society of Hair Restoration Surgery as part of the ISHRS Fight the FIGHT consumer awareness campaign on the unlicensed practice of medicine.
Topic: Do you know who is actually performing your hair transplant?
You will be able to interact and ask questions live with six of the top hair restoration experts in Australia.
-Russell Knudsen, MBBS, FISHRS
-Jennifer Martinick, MBBS, FISHRS
-Mario Marzola, MBBS
-Vikram Jayaprakash, BM, FISHRS
-Johnathan Chan, MBBS, MFM
-Masroor Alam, MBBS, FRCS, FACCS
For discussion:
There has been a recent massive increase in overseas cosmetic surgery tourism for hair transplantation performed by unlicensed technicians. The market for this is spreading globally, with cheap surgeries and massive social media advertising stimulating much interest in medical tourism, which lures you with vacation packages plus the procedure.
Also Read: Over-harvested Donor Area After Hair Transplant in Istanbul
What patients need to realise is that the very cheap surgeries usually have NO doctor involved in the surgery. In Australia, we are seeing patients return with poor results needing correction, and we now have copycat clinics opening in Australia that promote cheap surgeries, again without a doctor being involved in the actual surgery. Patients should be very careful in their research and find out who is actually performing the surgery.
Who Really Performs Your FUE Hair Transplant? The Questions Patients Need to Ask
In a hair transplant advertisement, the surgeon may seem central to the process. But that image can be misleading. Australian hair-transplant surgeons say that in some low-cost overseas clinics, a doctor may have little or no involvement in the procedure itself, which can be performed by technicians instead. The difference matters: FUE surgery requires more than moving hair from one part of the scalp to another. Decisions made before, during, and after surgery can shape a patient’s appearance for years.
Low-cost surgery can obscure who does the work
Australians have travelled overseas for cosmetic surgery for many years. Thailand has been a longstanding destination, and the discussion’s host noted that experienced surgeons there have trained other doctors. More recently, hair-transplant tourism has expanded across several countries, with Turkey among the destinations frequently advertised to Australians.
The panel’s concern was not that every overseas clinic delivers poor results. Patients who are happy with their surgery may never seek help from Australian doctors, so local surgeons are more likely to encounter people with problems. The concern is that advertising can make it difficult to tell who will actually perform the operation.
The host cited Istanbul as an example, describing more than 300 clinics but estimating that only around 20 had a doctor who performed the surgery. In this model, a doctor’s name may appear on clinic materials while assistants carry out much of the procedure. Patients may be attracted by low prices without understanding how limited the doctor’s role could be.
A transplant is a series of decisions, not just a set of punches
FUE involves extracting individual hair grafts from a donor area and placing them in recipient sites. The panel emphasized that the technical steps are only part of the work. A successful plan also depends on choosing what to harvest, designing a suitable hairline, and considering how hair loss may progress.
Planning determines what can be preserved
The donor area contains a limited supply of hair. One surgeon described large graft counts, including offers of 4,000 or 5,000 grafts, as tempting but potentially misleading. A patient’s donor supply is not unlimited. Once hair is removed, those reserves are no longer available for later procedures.
Overharvesting can leave visible patches or a depleted appearance. The panel noted that some patients return with grafts placed at unusual angles, hairlines set too low, or poor growth. These problems may limit what a surgeon can do to improve the result. Beard or body hair can sometimes be considered when scalp donor hair is exhausted, but the panel described this as a second or last resort, with less favourable results.
Execution takes skill and coordination
The panel rejected the idea that FUE is a simple matter of extracting and planting hair. The grafts must survive the move from the donor area to the scalp, and the work requires coordination across multiple steps. Surgeons also need to select which grafts to remove and which to leave behind.
That judgment matters particularly for younger patients. A large transplant may look acceptable at first, while later hair loss exposes depleted areas or an unnatural pattern. The panel warned that a technician following a fixed number of punches in a set area may not be weighing those long-term consequences.
Hair loss needs a long-term plan
A hair transplant does not stop a person’s existing hair from thinning. Several surgeons said patients may arrive believing surgery will permanently fix the problem, unaware that hair loss can continue and that the donor hair taken from the back does not grow back there.
Some patients are also not told about medical therapy that may help manage future loss. Without counselling and follow-up, they may make decisions without understanding how surgery fits into the longer course of their hair loss. Australian doctors who see patients after overseas procedures may have to reconstruct what happened, often without enough information about the operation.
Medication decisions affect future appearance
The panel described medication as part of a discussion about managing ongoing hair loss, not as a requirement every patient will accept. Some patients are reluctant to take medication, and doctors said their role is to explain the possible consequences clearly. In some cases, a surgeon may advise against operating when the patient’s expectations or plans do not support a suitable outcome.
One surgeon explained the contrast this way: without surgery, a person who stops medication may continue to lose hair in a natural pattern. After a transplant, the transplanted hair may remain while surrounding hair thins, potentially creating an unnatural pattern. The concern is especially significant when a large area has been transplanted and the patient has not planned for future loss.
Advertising and regulation can leave patients exposed
The panel raised concerns about both overseas marketing and similar business models appearing in Australia. The host described clinics advertising that technicians perform FUE while a doctor is present on the premises. He also recounted contacting the Health Care Complaints Commission after a patient complained about one such clinic.
According to the host, the response he received said that delegation could be legally acceptable if a doctor was on site and the procedure was delegated to a trained health-care professional. The host said the commission could not define what “trained health-care professional” meant in this context. This is the host’s account of the response, rather than a detailed explanation of the regulation itself.
Surgeons also warned that before-and-after images may not always show a clinic’s own work. One panel member said photographs can be altered or taken from other doctors’ websites and presented as the clinic’s results. A patient may therefore struggle to verify both the people performing the procedure and the standard of work being advertised.
Questions to ask before agreeing to surgery
The panel’s message was not that patients should never travel overseas. It was that patients should investigate carefully and know who will be responsible for their care. A consultation should be with the surgeon who will actually operate, rather than only with a sales consultant. Patients should also seek clarity about the surgeon’s experience, the roles of everyone involved, and what follow-up and long-term management the clinic offers.
The panel’s advice points to a practical standard: if you cannot confirm who will perform your surgery, treat that as a warning sign. A clinic’s low price or polished advertising cannot answer questions about planning, donor limits, future hair loss, or post-operative care. Patients need specific answers before committing, and they should be wary of promises that one operation will solve hair loss for life.
Conclusion
FUE surgery can have lasting effects on both appearance and future treatment options. The panel’s central point is simple: patients need to understand who will perform the procedure, how the plan accounts for limited donor hair, and what happens as hair loss continues. Overseas care is not automatically poor, and Australian care is not the subject of the warning. The responsibility is to investigate the clinic, speak with the operating surgeon, and make decisions with the long term in view.
Frequently Asked Questions
Who should perform an FUE hair transplant?
Patients should find out exactly who will perform each part of the procedure. The panel recommends speaking directly with the surgeon who will operate, rather than relying only on a sales consultant.
Why can taking too many grafts be a problem?
The donor area has a limited supply. Overharvesting can leave visible patches and reduce the hair available for future treatment, making later repair difficult or impossible.
Does a hair transplant stop future hair loss?
No. The panel describes hair loss as progressive. A transplant moves hair but does not prevent a patient’s existing hair from thinning over time.
Why discuss medication before surgery?
Medication may be part of a plan for managing ongoing hair loss. Patients should understand their options and what may happen if transplanted hair remains while surrounding hair continues to thin.
What questions should I ask an overseas clinic?
Ask who will perform the surgery, whether you can consult with that surgeon beforehand, what follow-up is provided, and how the plan accounts for future hair loss and limited donor hair.
Are all overseas hair-transplant clinics unsafe?
The panel acknowledged that some clinics in lower-cost destinations provide good care. Its warning is to research carefully, verify the surgeon’s role, and avoid assuming that every clinic works the same way.