Category: Hair Restoration
In recent years there has been an explosion of “low cost” hair transplant clinics offering large procedures at very low cost. This is partly the result of “cosmetic medical tourism” in low-cost countries but also due to unscrupulous business people entering the field and minimising, if not eliminating, the role of the doctor.
Stories abound of people travelling overseas and only briefly seeing the doctor for the administration of the local anaesthetic prior to the procedure. The doctor is then never seen again!
What this means is that the whole procedure is carried out by “surgical assistants” whose training or qualifications are never stated. Indeed, most of these assistants have no nursing background and may be performing illegal actions by cutting the patient’s skin. In addition, to save cost, there are clinics that have multiple patients being operated on in the same room! This is highly unsafe as cross contamination is highly likely. As well, some of the results coming from these clinics are very poor in both design and execution.
The International Society of Hair Restoration Surgery (www.ishrs.org) has taken the lead role in publicising the dangers posed by this non-medical model of rogue clinics and the authorities are starting to act in some jurisdictions with criminal charges being brought against clinic owners allowing illegal performance of hair transplantation by non-medical personnel in their clinics.
The ideal model, which is practised in the Knudsen Clinics, is to have both the consultation and the surgical procedure performed by the doctor. Only the doctor is allowed to cut the skin. Only the doctor is allowed to make the surgical plan. The assistants are there to assist the doctor. Even the ARTAS robot is controlled by the doctor in our Sydney Clinic.
One of the reasons the cosmetic tourist model exists is because patients confuse the difference between a product (the hair transplant) and the service (the performance of the hair transplant). The result is going to depend upon the skill of the doctor (and his assistants). Make sure a doctor is going to be the person performing the hair transplant.
There has been a lot of publicity in recent times about a possible new treatment for hair loss (of any cause) that is called Platelet Rich Plasma (PRP). This is argued to be a “stimulation” therapy for hair loss. The theory is that the multiple skin growth factors that live inside platelets (the blood cells responsible for clotting) can be utilised to stimulate hair by “cracking open” the platelets after the patient’s own blood has been centrifuged (spun down). These growth factors are then re-injected into the scalp in areas of thinning hair.
The idea has been around for a while but the evidence for hair stimulation has not been strong. We do know that PRP is helpful with wound healing but it is less clear which thinning patients might benefit. One of the problems is that the technique has no stringent set of rules and different centrifuges produce different results. Current research is directed at assessing whether higher concentrations of growth factors produce a stronger stimulating effect on weakened hairs.
Another possible line of research involves combing PRP with an extracellular matrix product that acts as a scaffold to assist the effect of the growth factors. Further research is needed in this area.
At best, current evidence is inconclusive that PRP is as effective as other stimulatory products such as minoxidil or techniques such as low level laser therapy.