The Hair Restoration Industry in the UK

By Richard Rogers MB ChB MTTS

My brief address here today will focus on the following two issues.

The first is my experience within the hair restoration field and secondly, my views on the state of the hair restoration industry in the UK, particularly from the view point of hair transplantation.

I don’t want to say too much and I think it might be useful perhaps to have a question and answer session at the end. We don’t often get chance to meet up and discuss where we are going with this industry or whether we can influence it.

For those who don’t know me, I’m a doctor who originally started following a dermatology career. I became sidetracked by general practice for a short while before going back to dermatology. It was then that I accidentally stumbled across hair restoration. There was an apprenticeship going at a Birmingham hospital so I thought I’d get a bit of extra experience in that speciality before returning to dermatology. That was 7 years ago and I’ve enjoyed it ever since.
Some of you may know that I started Wellesbourne Hair Restoration in 1996 and I was the sole surgeon there until 2001. In that time, we were very busy and I often performed 12 cases a week. I believe in planting most of the grafts myself rather than using nurses and as graft numbers per patient increased over the years, it became increasingly hard to complete two cases a day. It was good experience but I realised that to improve the quality of my surgery further still, I had to change the way I worked. I’ve always tried to treat each patient holistically and honestly and I think that’s the only way to have a successful practice. Unfortunately, that did not sit well with my business partner and we had an acrimonious parting of the ways.
I then set up my own sole practice last year, Rogers Medical Ltd and it has completely re-energised me. I have rebuilt my team so that I am now starting to offer 1000 or more grafts per session. Since I’ve decided to treat only one patient per day, it doesn’t matter if we take a bit longer. Patients can have lunch between taking the donor strip and bringing them back in to plant the grafts. The patient experience is much improved and I’m less stressed. The downside to this is that I have to charge a premium but I think that a discerning patient will realise that it is worth it.
Some of you may have seen me featured in adverts over the years, standing with Francis Rossi of Status Quo. He is the only celebrity I know who has gone public about his hair transplant and he continues to talk positively about it.
We need positive publicity like this for our industry and I’m going to talk about that now.
It’s fair to say that Hair loss is very much a “Cinderella” speciality in this country.
Partly, that is because the hair industry has given itself a bad reputation over the years. Adverts for miracle cures, surgery that hasn’t really delivered, even shampoo companies promising too much, have caused disbelief in the public.
However, perhaps most importantly, the study of hair is not seen as “sexy.” This seems ironic to me as the vast majority of adults do worry about their hair, spending vast sums on haircuts and shampoos. There is even an expression “a bad hair day” which links hair with not feeling good, the day going badly and not feeling attractive.
And yet, Trichologists and hair scientists do not get the recognition they deserve.
Medical schools do not teach students anything about hair loss apart from noting the causes of it.
Even dermatologists know little about hair generally – they tend to see the scalp as “hairy skin.”
Many GPs are equally dismissive. Propecia has been marketed directly to GPs yet few appear to prescribe it.
A typical reaction is “don’t worry about it – hair loss is common or it’s not life or death.” But it is life or death to some people. I’ve seen quite a number of young men and women who are depressed and occasionally suicidal about hair loss. They have come to me as “a last resort.”
Contrast that with America. Obviously, all forms of cosmetic surgery are more commonly performed and it is more socially acceptable. For instance, there are more breast augmentations performed in New York City each year, than the whole of the UK.
In particular, hair restoration surgery is the most common male cosmetic procedure in the USA.
Perhaps some people wouldn’t want us to become like America but at least patients there are aware of the options available. In this country, many people are not sure that hair restoration surgery even exists, let alone works. Or they think it’s only for rich and famous Hollywood celebrities. Or that it’s those nasty “dolls hair” punchgrafts.
In America, patients talk to their friends about who’s a good surgeon and what they charge.
We therefore have a situation where we have a general public who are either unaware of the options available or are misinformed. There is a need for our skills and services but I don’t think we are reaching the people who need us. The better our results, the more invisible we become!
What can we do about it?
Well, I think we’ve already started. The Trichological Society is taking a much more professional, pro active stance. The Society is bringing together different groups of people, doctors, trichologists, hair scientists and bio chemists and presenting a unified front. We have a website, an identity and a clear mission to educate. We must applaud ourselves for that and continue the good work. We should encourage others to join us and be careful not to disparage our various colleagues because that would send out a negative message.
Regulation has its place too and the government has already implemented this. As you may know, the National Care Standards Comission came into being in April2002 and has set higher standards for all cosmetic clinics.
There are two guidelines which may have far reaching implications.
Firstly, the guidelines require the cosmetic surgeon to consult personally with his patient before the day of surgery. Patients may still see advisors first but not as a substitute for a proper consultation with the surgeon who will be performing the surgery. Many clinics will struggle with this as it is not so easy to have a “production line” going. There are likely cost implications to patients because of this.
Secondly, from April last year, only doctors who are on the cosmetic surgery register will be allowed to perform cosmetic surgery. To be on the register, you have to be a fully qualified FRCS surgeon. It is unlikely, such surgeons will want to perform hair restoration.
The exception to this are doctors like myself with expertise and experience before April last year and we can continue to practice.
This may mean that the speciality of hair restoration could slowly die out in this country as there will be no new blood.
These guidelines are a good thing but could in fact damage our speciality.
So, I think we are at a cross roads. We need to work together, ideally even within the same premises. I certainly intend to share my practice with a trichologist when I open it in Harley St. It simply makes sense.
These are my opinions but I would now like to invite comments and questions.