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Hair Restoration Surgery

Hair Restoration Surgery replaces hair in hair bearing areas where it has been lost or never existed. For the purposes of the JCCP, it includes Hair Transplant Surgery and also Prosthetic Hair Fibre Implantation but not hair bearing flaps.

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What is hair restoration surgery?The procedure: harvesting donor hairImplanting the graftsRisks and side effectsProsthetic hair fibresPatient selection and expectationsWho performs your surgeryQuestions to askInformation sheet and standardsWhat training does a practitioner need?
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Classification

Level 1b invasive surgical procedure

Performed by

A doctor licensed to practise by the General Medical Council (GMC)

Anaesthetic

Usually local anaesthetic, with or without oral sedation

Where

A Care Quality Commission (CQC) registered facility

What is hair restoration surgery?

It is defined as a Level 1b invasive surgical procedure and, in the UK, it should only be performed by a doctor who is licensed to practise by the General Medical Council (GMC). It is usually performed under local anaesthetic with or without oral sedation.

Hair Transplant Surgery is one of the commonest male cosmetic procedures and is usually requested for genetic male pattern hair loss. It is also commonly requested by women with genetic female pattern hair loss or eyebrow hair loss, by male to female transgender patients wanting to create a feminine hairline, and for other aesthetic indications. It can be used for reconstruction to restore hair to scars and for some dermatological conditions that cause alopecia (hair loss).

The procedure: harvesting donor hair

There are two methods of harvesting donor hair - Follicular Unit Excision (FUE) and Strip Follicular Unit Transplantation (Strip FUT).

In the FUE method, individual follicular units are extracted using one of a variety of manual, motorised or robotic punch devices. The extraction sites leave small round scars and there is a reduction in donor zone hair density. Whilst the donor location is usually the scalp, in men, body hair can be extracted from the beard and chest.

Implanting the grafts

In both methods, the harvested grafts are inserted in the recipient site - using sharp implanters (the incision is made and the graft inserted in one step), dull implanters (grafts inserted into pre-made incisions), or forceps into pre-made incisions.

Not without risk

Hair Transplant Surgery should not be described as ‘painless’, ‘scarless’, ‘non-invasive’, ‘not requiring incisions’, ‘no cutting’, ‘no touch’, ‘hair multiplication’ or ‘eliminates the need for further procedures’ and is not without risk.

Risks and side effects

General risks of surgeryThe general risks and complications of surgery are bleeding, infection and pain.
FUE donor siteRisks specific to the donor site for FUE include donor hair depletion, extensive punctate scarring and skin necrosis.
Strip FUT donor siteRisks specific to the donor site for Strip FUT include wound healing problems, skin necrosis and widened unsightly scars.
Recipient siteRisks related to the recipient site include incorrect hairline design, low density, suboptimal aesthetic appearance (hair direction/angle), and scalp pitting/cobblestoning.

Prosthetic hair fibres

Some Prosthetic Hair Fibres are legal in the UK and can be implanted to simulate real hair. However, they do not grow, are prone to getting infected, produce scarring, and implantation results in some lifestyle restriction. The long-term implications of implanting artificial hair have not been evaluated in the UK. The JCCP recommends that only Hair Transplant Surgeons implant prosthetic hair fibres.

Patient selection and expectations

Poor patient selection, failing to take into account ongoing hair loss, can result in an unnatural appearance with transplanted hair isolated from receding hair, especially in the hairline, temples and crown in men. As with any cosmetic procedure, failure to manage expectations can result in patient dissatisfaction.

Who performs your surgery

Hair Transplant Surgeons are supported by Hair Transplant Surgical Assistants who prepare and place follicular unit grafts, and remove FUE grafts from the donor zone where the FUE incisions have been made by a doctor or doctor-run robotic device. These assistants may be nurses, but they may also come from backgrounds with no medical training. Assistants should not perform any of the surgical steps of a hair transplant procedure such as making FUE incisions or recipient site incisions, including those made by sharp implanters.

Questions to ask

Who is operating?Patients should be clear to whom they have given consent to be operated on by, should ask who will be performing the various elements of their hair transplant surgery, and should be aware during the procedure of who is operating on the back of their head when they cannot see them.
Is the clinic CQC registered?Hair Restoration Surgery must be performed in a Care Quality Commission (CQC) registered facility and the CQC licence should be clearly displayed for patients to see. In addition, all clinics advertising hair restoration surgery on their website should be CQC registered even if the surgery is performed in a separate location that is CQC registered.

Information sheet and standards

JCCP Information Sheet - Hair Restoration SurgeryThe JCCP information sheet for this treatment (PDF).CPSA Standard - Hair Restoration SurgeryCosmetic Practice Standards Authority

What training does a practitioner need?

LEVEL7

Education pathway

Successful completion of a course with knowledge & competence assessment enables the practitioner to:

HRSPerform hair restoration surgery

Restriction

GMC registered practitioners only

Restrictions: see also CPSA standards.

Choose a registered practitioner

Check the JCCP Register to find a practitioner who meets the standards for hair restoration surgery.

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