What you need to know to get it done right
If you are losing your hair and thinking about a hair transplant you are not alone. In 2016 over 600,000 hair transplants were performed worldwide, about 133,000 in the United States alone.  It makes sense to get a hair transplant to address your receding hairline or thinning crown. But submitting to just any doctor who claims to perform hair transplant procedures is not a good idea. Not all doctors and surgical hair restoration clinics are alike.
Selecting a physician for your hair transplant isn’t always a simple endeavor. Hair loss sufferers who prepare by doing their research tend to enjoy better results. Far better results. If you’re considering a hair transplant you should carefully read this Hair Transplant Checklist. Learn what you need to be aware of to before begin your search.
Roles and Responsibilities
The most important step in selecting the best clinic for your surgical hair restoration is to know who the players will be and what their specific responsibilities are. Do not just rely on the doctor to surround himself with the best team and automatically do what’s right for you. In fact, the overwhelming majority of hair transplant doctors come up inexcusably short in this regard. So it is up to you to do a little digging that rarely extends past a few mouse clicks or a few questions that can be answered on the phone. In the hands of a top tier clinic miraculous looking results are commonplace, but one must learn how to distinguish the top 1% of clinics from the rest. There are things you need to learn.
- Who will be responsible for what ?
- What information should you specifically be looking for that you can depend upon to steer you away from the lower tier doctors and toward the best ones ?
- What important decisions are yours alone to make ?
 The players involved and what you should look for and why are as follows:
You, the Hair Loss Sufferer
It’s your scalp so ultimately all decisions come down to you in terms of what sounds, looks, and feels right. As such you need to be critical of all information each clinic offers you whether it is online or in person. As you read through this checklist you will see it is very easy to “grade” clinics once you know what to look for and what questions to ask.
The Doctor
The doctor, of course, plays a huge role in your hair transplant procedure, but not the only one. Do not believe that all hair transplant doctors are alike and definitely do not depend solely on him to make decisions for you just because he “seems nice”, or has a nicely appointed office. It is wrong to think that going to one hair transplant doctor is more or less the same as going to another. It most certainly is not-especially in the hair transplant field. Like every human, there are huge differences in experience, skill level, and enthusiasm for their work. The range of capability between doctors who possess the same medical license and identical education can be astonishingly, and even frighteningly, wide.
A Legal Misconception
A common mistake in the mind of the hair loss sufferer visiting a hair restoration doctor for the first time is the false belief and reliance that somehow the government or medical licensing body of the state monitors any particular doctor’s skill level- and that this somehow insures that the doctor’s track record falls somewhere within at least the “average” category. This is completely FALSE ! The government only monitors the most egregious departures from the “standards of practice”- and even then only when enough complaints have been made. In fact the physician you consult with may only have one tenth the experience and skill level of another doctor you have already consulted with. How can you tell the difference ?
In the days before the internet it was virtually impossible to distinguish top notch doctors from the average and below. But today it’s much easier.
How to distinguish the top Hair Transplant doctors from the rest. Look For The Following:
1. Number of years practicing hair transplantation EXCLUSIVELY and on a daily basis.
Most hair transplant doctors are part timers who perform hair transplantation as a sideline to their real practice in another specialty. Reject these doctors immediately.  Clearly you want to find a doctor who truly specializes in hair transplant surgery on a daily basis as this procedure is very meticulous and demanding. Without regular practice a part time doctor simply can’t perform to the high level those who perform them every day can. This is just common sense but you’d be surprised how many disappointed patients only learn this lesson only after they’ve had their procedure and seen their results.
2. Number and quality of before/after photos posted online.
Nothing reveals the quality and consistency of a physician like before/after photos. While just about every hair transplant doctor has photographs of their results there are three things to look for in this regard specifically when viewing a doctor’s website:
- The first is the quality of the results. Would YOU be happy with the before and after transformations you see in the majority of the photos ? How do they compare to results that you find on other doctor’s websites and hair transplant chat forums ?
- The second is how many result photos does the clinic display online for the world to see ? There should be a minimum of 100 patient cases. They should all be similar in quality, lighting, and head positioning. For example, many clinics show the top of the head in the “before” photo and a front face-on shot in the after photo. This is like comparing apples to oranges and is a common trick used by marketers to fool an uneducated public. Don’t fall for this deception. Only lower tier clinics engage in this misdirection because they simply do not have enough honest results to fill up a photo gallery.
- And third, are at least 20 of the patient results RECENT postings on the websites? Most lower tier hair transplant clinics use the same OLD photos for years because they don’t have enough high quality patient results to post new ones. This is a huge red flag that is easy to detect. In the past when asked why their online photo galleries contained the same old photos year after year, lower tier clinics would respond that they did have more great patient results but just couldn’t get them online for technical reasons. In fact years ago it was difficult for the average doctor to update their own practice website with photos and videos, but that simply isn’t true today.  With faster cheaper computers and easy to use software tools it is easier now for a hair transplant clinic to update their photo gallery on their own website than it is to place a paper photograph into a physical photo album. There is simply no excuse anymore for not having current representations of their results online for the world to see and comment on at any time.
When a clinic produces excellent results on a consistent basis the doctor enjoys posting them online for the world to see. Not just on their own website, but in online hair transplant chat forums and other public platforms where the public may view these results and discuss them openly. The top 1% of clinics do this on a routine basis, lower tier clinics do not offer such transparency.
3. The kind of hair transplant procedures he performs.
Does the doctor perform BOTH major hair transplant techniques: FUT (strip) and FUE ? Only contact clinics that regularly perform BOTH procedures on a full time basis. If a clinic cannot perform FUT (the strip procedure) this is a massive red flag and should not even be considered for a hair transplant. Here’s why:
The gold standard for hair transplantation has been, and continues to be, the FUT  (strip procedure) since the late 1980s. It was this procedure that made the hair transplant industry the juggernaut it is today.  In the early 2000’s, however, the FUE procedure was introduced. For the first ten years of existence this technique was largely ignored and even chided by most hair transplant doctors because it was difficult to learn, time consuming, and traumatized the follicles and skin very badly when compared to the much more gentle FUT procedure. That said, the FUE procedure did find its place not as an alternative to the FUT procedure but as an adjunct. A procedure to be used only if FUT couldn’t be used (which was rare).
It was in this LIMITED role that the FUE procedure survived and thrived. However, it wasn’t long before unethical doctors seeking to find a new income source for their existing practices in other specialties misused and mischaracterized this adjunct procedure as a stand-alone ALTERNATIVE procedure  in order to find a shortcut into the hair transplant industry.
You see, it takes hundreds of thousands of dollars and years of training and experience to create a successful  full time FUT (strip) clinic. One needs to build and maintain a large facility and large staff which all cost money, time, dedication, and effort. It was through the hard work of doctors who took up this task that made hair transplantation a procedure you would ever consider for yourself today.
However, to set up a clinic that performs  only FUE to the exclusion of FUT one only requires an extra room about the size of a closet in an already existing practice (dedicated to some other medical specialty)  one part time medical assistant, and a few simple surgical tools that cost a couple of hundred bucks. After doing this any non-specializing doctor could claim to be a “hair transplant specialist” and start performing hair transplants using only the FUE technique. But as stated above, this procedure is brutal on hair follicles when compared to FUT, and none of these new FUE-only doctors had any real hair transplant training or experience so theses combined to make the procedure very long and exhausting while producing substandard results.
Seeing an opportunity, equipment manufacturers created machines that would speed up the FUE procedure for these inexperienced doctors. And those seeking a shortcut to get into the hair transplant industry started to buy them and mislead the public by claiming these devices were “revolutionary” advances in the hair transplant field ! Of course they weren’t as evidenced by the fact that not a single top tier clinic to this day has abandoned the FUT methods they built their practices and reputations upon in favor of any of these machines or gadgets.
In fact, these machines only make the performance of an FUE procedure faster for the doctor. They do not improve the results for the patient. And even at it’s best the results produced by these machines pales in comparison to a properly performed FUT procedure by an experienced full time top tier clinic.
Despite the hype published online and in airline magazine advertisements, FUT is still the king of hair transplants putting the FUE procedure at a distant second. So beware:
If  a doctor you are considering can only offer FUE, then you should avoid him. FUE-only clinics have been popping up all over the world like fast food restaurants and have produced some of the most unsatisfying and atrocious results in the hair transplant industry. Almost all of these clinics utilize so-called hair transplant machines to help perform their procedures and are (de facto) run by unlicensed technicians with very little involvement of a physician This practice is outright illegal and unethical. You may believe such unlawful clinics exist in countries out of the United States, and you would be correct; but more and more such practices are beginning to pop up in this country as well.
If the doctor you consult with can’t offer both FUT and FUE himself then he is not a full fledged and experienced hair transplant doctor and you would do better to go elsewhere.
4. Does he use in-house assistants or travelling technicians ?
Since all lower tier hair transplant clinics are part timers they do not train and maintain their own in-house medical technicians. These technicians are vital to the performance of a proper hair transplant because the doctor can’t do all the labor himself. The very best hair transplant clinics train and maintain 6-8 and even more assistants per patient to insure the best quality. Lower quality clinics use travelling techs-which are unlicensed non-professionals who jump between offices with no accountability or responsibility to the patient. The doctor often employs these people to actually perform most of the surgical procedures for them. This is an illegal practice that is just becoming known to state authorities and clinics engaging in this activty are now becoming known as “Black Market Hair Transplant Clinics” (https://ishrs.org/bewarehtblackmarket/).  ONLY use clinics that train and maintain their own full time in-house staff.
5. How many technicians work exclusively for him during each hair transplant ?
Hair transplant procedures routinely include the removal, preparing, and re-implantation of thousands of grafts the size of a grain of rice and smaller. Suffice to say, the work is meticulous and fatiguing. To perform such a task successfully the doctor needs help. Lots of help. So when you evaluate a doctor find out how many technicians he uses for each and every procedure. How many technicians will he use for YOUR hair restoration procedure? If it is less than one tech for every 500 grafts on average you should look for another clinic. Low tier doctors who do not have enough patients to support a proper sized staff tend to be understaffed for all their procedures and their consistently poor results are testament to this. Only patients who are uninformed because they didn’t do their online research nor have a checklist resource like the one you are reading right now available to them pick clinics they later regret.
6. How long has his most senior technician worked EXCLUSIVELY for him ?
Having a good staff is one thing. But hair transplantation is a “team sport” that requires coordination and unspoken understanding between doctor and staff throughout the day. The only way this can be achieved is if the doctor is successful enough to be able to keep his staff for years. So if his longest employed staff member has only been with him for a few months or just over a year. Look elsewhere.
7. Web Presence: When you google his name what websites, other than his own, come up ?
Of course if you go to the website of any particular doctor it will say only the greatest things about him. This is natural and expected, but be sure to dig down a bit deeper. Take his name and the term “hair transplant” and plug them into a Google search together. See what comes up. If there is very little or only generic listings this is an indication that he has very little web presence- and that is a bad sign. In 2019 there is no excuse for an experienced full time hair transplant doctor to have anything less than multiple pages of substantial Google hits for him and his practice. You should be seeing patient reviews, videos, and before/after photos posted by both him and his patients. If there aren’t any, or very few, the reason is most likely that the doctor you are researching is not as experienced and skilled as you may have hoped he’d be. Look somewhere else.
8. Does he contribute his time and expertise voluntarily to online hair transplant platforms and chat forums ?
The best doctors tend to be natural teachers and usually enjoy educating people about their specialty. Good hair transplant doctors are no exception. Physicians passionate about what they do for a living are usually drawn to venues where they can share their expertise and experience. At no time in history has this been made easier than with the introduction of the internet.
There are several high profile hair transplant platforms online where doctors may  participate to share knowledge and help the public understand the details of their craft. Stands to reason that if a doctor is truly enthusiastic about what he does and wants to share it with the world that he would voluntarily join these platforms and participate. Using chat forums hair loss sufferers can ask questions to the doctor and receive answers in a format that the entire world can read. There is no greater transparency available to the public as to how a particular doctor treats his patients and performs his procedures than through the use of such internet wizardry. Doctors who are lower tier tend to avoid these websites like the plague. So look for a doctor who routinely and enthusiastically participates on these third party hair transplant platforms because they are the ones who are most transparent and willing to be critiqued openly by the public.
9. Does he perform the entire procedure by hand, or does he use gimmicky gadgets, hair transplant machines, or robots ?
You do not want any gadgets or so-called “robots” to be employed during your procedure. While this “technology” may sound beneficial it really isn’t. No experienced high tier doctor uses anything other than hand tools to perform this demanding procedure. Gadgets have only been designed to make the labor easier for the less experienced lower tier doctors. They in no way improve the quality of the procedure no matter how much unethical physicians and equipment manufactures hype these products. There are no exceptions to this rule: The best hair transplant doctors use only hand tools. Period.
The Hair Transplant support Staff- Techs
If the doctor passes the checklist above then it’s time to turn your attention to the staff that he will use for your procedure by asking the following questions during your consultation:
1. How many staff will the doctor be using for my particular procedure ?
If the answer is less than one staff member for each 500 grafts you should look elsewhere. This is due to the fatigue factor inherent to moving thousands of rice sized grafts in a single visit. So let’s say you are scheduled for a 2,000 graft FUT procedure. Use this formula:Â 2000/500 = 4 technicians at a minimum. In top notch clinics they will have this minimum plus one or two more techs as back ups (see number 4 just below) for a total of 6 technicians for your 2,000 graft procedure alone.
2. How long has each person been performing hair transplantation on a full time basis?
Only the best hair transplant clinics employ hair transplant  technicians in-house on a full time basis for years. Some have done so for decades. Low tier hair transplant clinics rarely employ staff who work on a full time basis. This is for a simple reason: they are not successful enough to afford them and they don’t attract enough patients to keep staff. Instead, they may employ traveling techs which is illegal in New York and other states. Do not go to such clinics. A hair transplant is no different than a superbowl game. It takes an experienced team of veterans who have worked together so long for years that they don’t even have to speak to each other anymore to communicate. That’s the kind of tech team you want working on you and it exists in fewer than 1% of all hair transplant clinics.Â
 3. How long has the senior technician worked for the doctor ?
In the top tier clinics the senior technician should have been working exclusively for that doctor for a minimum of ten years. Successful and well run practice should easily maintain staff for that long. Every team needs a captain and the senior tech is usually it. If a practice cannot attract, train, and keep a leader for at least ten years then there is likely a serious problem that you don’t want to get involved with.Â
 4. What happens if a staff member calls in sick the morning of my procedure ?
This is important since all low tier clinics are understaffed to begin with. So losing a staff member on the morning of your surgery can mean an unnecessarily long and uncomfortable surgery along with some serious corner cutting on the part of the clinic just to get you done. In the end it is you who is stuck with the poor results. Â The top tier clinics are usually overstaffed by two or more. So even in the unlikely event that two staff members call in sick on the morning of your surgery it will not affect your procedure or your result.
 5. How many of the staff will be dissecting my grafts ?
The general formula for the top tier clinics is one technician for every 500 grafts on average. So let’s say you are going to have 2,500 grafts implanted on the day of your procedure. 2,500/500 = 5 technicians for your surgery. Add 2 more for a margin of safety and you are looking at 7 technicians plus the doctor for your procedure.
 6. Do  ALL technicians use microscopes to dissect the grafts ?
Most clinics only have one microscope that they generally use as a prop to impress lay potential patients. In reality they don’t use it or perhaps just one technician uses it and the rest do not. Make sure to see at least 7 microscopes at 7 workstations. If you only see one microscope and 7 seats at a counter ask where the other microscopes are. Each technician must have their own microscope. If they don’t, look elsewhere.
  7. Will staff be dedicated for my surgery from beginning to end ?
 It is important that your procedure be fully staffed from start to finish so that if your procedure takes more time or the doctor decides he needs to take more hair out of the donor to put into the recipient area he always has the staff to do it. In many low tier clinics several staff are dismissed after the grafts have been cut to save the clinic money. You do not want to be in one of these hair transplant offices.Â
The Hair Transplant Facility
One of the most obvious ways to grade a hair transplant clinic is by the clinic itself. The presence of certain things. or lack thereof, can give you major hints as to the quality of that particular doctor and practice.Â
1. Is the name of the doctor who you are going to have surgery with on the door ?
The doctor should have ownership in the practice. If he is just an employee of some company you may want to consider a physician that is more dedicated and entrenched in his profession. All the leading doctors in the hair transplant field to date run their own practice and are featured as the primary surgeon in all media.Â
2. Does the clinic have its own reception area with full time receptionist ?
This may seem trivial, but it isn’t. Practices that can’t afford a full time receptionist probably are not very successful for a reason. Busy practices require capable front office staff to coordinate between patient and doctor and have no problem hiring one or even two to keep things running smoothly for their patients and doctors. If you walk into the doctor’s office and he escorts you in, there is likely something wrong.Â
3. Is the facility dedicated solely to hair transplantation or is it shared by other medical specialties?
 First tier clinics are never shared offices. There is no way a successful full time hair transplant practice can share space with any other specialty as there simply would not be enough room. Part time hair transplant practices, however, do this all the time and is a reliable indicator that you are in a low tier office and should look elsewhere.
4. Is the facility large enough to accommodate a large staff ?
You should ask the doctor to give you a tour of his hair transplant office during consultation. If all he shows you is one room in the back of the office with a single countertop and three chairs you should consider a different clinic. The average top tier clinic has at least 8 dedicated workstations complete with high end stereo microscopes and at least two separate dedicated procedure rooms.
5. Does the facility have it’s own private bathroom ?
Like most medical procedures hair transplantation is a private matter. Nobody should have to walk down the public hallway of an office building in the middle of a procedure just to relieve themselves. Low tier clinics tend to share offices and can’t afford an in-suite bathroom. So lack thereof is an indicator of the low success level of that particular hair transplant practice and should be avoided.Â
6. Does the facility have ample parking ?
Again, this may sound trivial, but most procedures start in the early morning and patients are usually excited and a bit anxious so the last thing they need is to have parking problems when they arrive at the building. Also, since most procedures will last about 5 hours or more there really isn’t going to be much time to be able to run out to the street and put money in a meter.
The best clinics all have more than enough parking for their patients and other visitors. Only Second tier clinics cut costs by letting patients fend for themselves and is an excellent indicator as to what level of practice you are dealing with. This applies double to practices located in major cities.
Finally
If during consultation you feel you are being sold by the doctor you should go somewhere else. Successful physicians do not act like salesman and they do not employ them either.
Print out the checklist (top of the post) and bring it with you to your next consultation. If the doctor refuses to acknowledge it or sign it, go somewhere else. A hair transplant is not a hair cut. Skill, experience, dedication, and specialization matter.
