In recent years, an increasing number of men and women are opting for hair transplantation as a definitive solution to hair loss.
According to recent data from the International Society of Hair Restoration Surgery (ISHRS), demand for hair transplants has surged by approximately 60% over the past four years. This dramatic rise in demand has led to increased revenue in the field, attracting many—sometimes even non-medical professionals—who, driven by easy profit, offer often more affordable procedures. However, the end result is frequently poor outcomes and dissatisfied patients.
The two leading medical organizations worldwide in the field of hair transplantation, ISHRS and ABHRS, have highlighted the risk of misleading the public. They strongly encourage their specialized physician members globally to inform patients about the dangers of choosing non-specialists or non-medical practitioners for hair transplant procedures.
Change in the FUE Technique: What You Need to Know
Recently, at the 25th ISHRS World Congress, a significant update regarding the FUE hair transplantation technique was announced. The primary goal is to shift public perception and understanding, emphasizing that FUE is a highly meticulous surgical procedure that must be performed correctly and only by a specialized, certified surgeon—not by just any general practitioner or nurse.
Dr. Anastasakis is the first Greek physician certified by the ABHRS as a Diplomate and specialized hair follicle transplant surgeon. Since 2016, he has been elected annually as an oral examiner for the highly demanding certification exams conducted by the ABHRS for new physician members.
A significant honor for both Dr. Anastasakis and the Greek scientific community is that, as of January 1, 2018, following elections among ABHRS members, Dr. Konstantinos Anastasakis was elected to the ABHRS Board of Directors for a three-year term.
This marks the first time a Greek physician has held such a position within the highest governing body of the ABHRS
“It is the first time that a Greek physician has assumed this position in the highest governing body of the ABHRS.”
Dr. Anastasakis is a member of the ISHRS and participated in the annual conference held in Prague in October 2017 as a member of the organizing committee and Chair of one of the most important sessions of the ABHRS & ISHRS—the Morbidity & Mortality Conference. This session achieved 100% attendance and left an excellent impression on the attending physician members.
For this reason, the ISHRS has once again selected Dr. Anastasakis to serve as Chair of the Morbidity & Mortality Conference and member of the organizing committee at this year’s event, which will take place in Hollywood, USA.
On such an important topic, Dr. Anastasakis addresses some of the most frequently asked questions.
Question: Doctor, what is this important development in hair transplantation?
Dr. Konstantinos Anastasakis: At the end of December 2017, we witnessed the latest significant advancement in hair transplantation.
In reality, it is a subtle scientific change, but one that we hope will bring a major shift in public perception and understanding of hair transplantation, as well as among doctors who currently practice or intend to professionally engage in hair transplantation in the future.
Over the past 15 years, hair transplantation has seen remarkable growth. In particular, the FUE (Follicular Unit Extraction) technique has gained considerable popularity among patients.
This change is being promoted and supported by the two most prominent medical organizations in the field of hair transplantation:
The International Society of Hair Restoration Surgery (ISHRS), founded in 1993, with more than 1,200 physician members across 72 countries. ISHRS members are doctors from various specialties who actively perform hair transplantation and are trained in the most advanced techniques. I have been an official member of ISHRS since 2009, served on the organizing committee, and chaired roundtable discussions at the 2017 World Congress in Prague. I will hold a similar position at the 2018 World Congress in Hollywood, Los Angeles
- The American Board of Hair Restoration Surgery (ABHRS) is the only certification body worldwide for physicians actively involved in hair transplantation. I have been a member of the ABHRS since 2015, and since 2016, I have served as an elected member of the examination committee, overseeing the rigorous written and oral exams required for certification. In December 2017, I was elected to the Board of Directors of the organization—an exceptionally honorable position, and the first time a Greek physician has held this role.
The purpose of this recent change, which I will elaborate on below, is to ensure that the public fully understands what FUE hair transplantation entails, what the procedure includes, and the seriousness of it as a surgical intervention. Ultimately, this aims to protect patients from unacceptable and potentially dangerous practices carried out by “clinics” and “institutes” and to raise awareness among regulatory bodies to establish clear guidelines on who is authorized to perform FUE hair transplantation procedures, thus safeguarding public safety.
Regarding Greece, as President of ELAMAT (Hellenic Academy of Hair Transplantation & Restoration), the non-profit medical society that serves as the national/regional chapter of the ISHRS, I have been appointed to inform the public about these changes. ELAMAT’s mission is to promote the practice of Hair Transplantation and Hair Restoration Surgery exclusively by trained, certified, and experienced physicians who possess the qualifications to perform these procedures with the highest skill, artistry, and ethical standards.
QUESTION: Could you please explain this in more detail?
Dr. Konstantinos Anastasakis: We all read daily about the FUE technique, which stands for Follicular Unit Extraction. This term was coined by the “inventors” of the technique, Dr. Rassman and Dr. Bernstein, in their 2002 publication that described the original FUE method.
The problem is that when Dr. Rassman and Dr. Bernstein introduced the term “Extraction” to describe their technique, they could not have anticipated how easily the meaning of this word would be distorted—often at the expense of patient safety and health. Unfortunately, this has sometimes been exploited by individuals seeking to profit from vulnerable patients eager to restore their hair with this innovative method.
QUESTION: How exactly has the meaning of the word “extraction” been distorted?
Dr. Konstantinos Anastasakis: Unscrupulous parties have implied and advertised that hair follicles can somehow be “magically” extracted from the scalp without any surgery involved! They even talk about “harvesting grafts,” as if these were flowers picked gently from a field. In reality, however, the surgical removal of follicles using the FUE technique is a delicate microsurgical procedure where even the smallest mistake can be disastrous for the follicle.
Unfortunately, the goal of those promoting FUE hair transplant procedures with this trickery is to reassure unsuspecting patients that the entire process is almost like going to the hairdresser! The word “extraction” sounds milder, less intimidating, and suggests something simple, painless, and relaxed. We’ve all seen advertisements on entertainment shows, magazines, and the internet promising hair transplants “Without Incisions, Without Scars, Without Stitches, Without Surgery.” Of course, these “clinics” often perform these “procedures” without a certified physician present—but more on that later.
All of this is misinformation, misleading marketing, and ultimately falsehoods designed to make prospective patients believe that FUE hair transplantation is as easy as going shopping.
In reality, it is a major aesthetic surgical procedure that can dramatically improve a patient’s appearance and psychology—provided everything is done perfectly by a specialized physician and their team. On the other hand, it can also ruin a person’s appearance and psyche if the procedure is unnatural or sparse, which usually happens when FUE is performed by untrained, uncertified doctors—or worse, by non-physicians. This malpractice is common in many “clinics” and “institutes” that heavily advertise online and on daytime TV.
To protect the public from these practices, the International Society of Hair Restoration Surgery (ISHRS) and the American Board of Hair Restoration Surgery (ABHRS) have proposed a change: the term “Extraction” should be replaced with “Excision” to better reflect the true nature of the procedure.
QUESTION: Why is this terminology changing?
Dr. Konstantinos Anastasakis:The aim is to provide a more scientifically, clinically, and academically accurate description of the entire process, while clearly communicating to the public that hair transplantation using the FUE technique is a highly precise surgical procedure. It can only be properly performed by a specialized and certified surgeon—not by just any untrained doctor or nurse, as unfortunately often happens in Greece in many so-called “clinics” and “aesthetic institutes” that treat FUE hair transplants like mass-market products!
The term Excision stems from the words Extraction + Incision = Excision, and it more accurately describes the complex FUE technique, which involves surgically cutting the skin around the hair follicle and removing the follicular unit with a specialized instrument. More precisely, the official scientific definition of the procedure according to the new terminology is:
“Follicular Unit Excision (FUE) is a surgical technique involving a peripheral incision of the skin around the follicular unit with the purpose of extracting a full-thickness skin segment that contains an intact follicular unit along with its associated subcutaneous fat, dermis, and epidermis.”
Since early 2018, physician members of the two largest international hair transplantation organizations I mentioned earlier, ISHRS and ABHRS, are required to update their educational materials and adopt this new terminology. This change is essential because it provides a clearer and more precise explanation of the intricate surgical steps involved in FUE hair transplantation.
In this way, starting—unfortunately—with the relatively few Greek doctors who are currently members of ISHRS, we all aim to “clear the landscape” of hair transplantation, properly inform patients, and protect them from the malpractice of opportunists. Our hope is that the so-called “clinics” and “institutes” will also comply by being truthful with the public and approaching FUE hair transplantation with the seriousness and ethical standards it demands.
QUESTION: How do you believe the public will be protected by this change in terminology?
Dr. Konstantinos Anastasakis: By understanding right from the name of the procedure—Follicular Unit Excision (FUE)—that this is a genuine surgical operation, not a simple cosmetic treatment like a facial cleansing or eyebrow shaping!
Once a reasonable, adult person realizes that FUE hair transplantation is a critical surgical procedure, they will no longer accept what various “institutes” and “clinics” try to sell them daily through advertisements:
- They will refuse to be operated on by a non-physician or an unqualified doctor,
- They will refuse to accept repeated small transplant sessions every month until the area is “filled,” just to pay in small amounts, risking serious scalp damage,
- They will insist on meeting their doctor before the procedure,
- They will refuse to talk only with counselors dressed in medical coats instead of speaking directly with a qualified physician,
- They will refuse to be treated like supermarket customers!
However, we remain realistic. Of course, there will still be some people who, desperate to regain hair “cheaply and at any cost,” will believe whatever these “institutes” advertise on television and knowingly allow non-doctors to perform their surgery to save money! We especially see this in people traveling to Turkey or Pakistan for hair transplants precisely for this reason—cheap hair transplants and… “God help them.” But these individuals are exceptions. Any sensible person, once they understand that their health is in the hands of a non-specialized individual, will be more cautious in their decisions, no matter how appealing the sales pitch may sound!
QUESTION: Do you believe this initiative will achieve its goal?
Dr. Konstantinos Anastasakis: In every field of aesthetic medicine and surgery, there are opportunists and advertisers who simplify and beautify messages and procedures to convince the public to undergo medical treatments without much thought. This often has devastating consequences for patients’ appearance, health, and psychological well-being.
Personally, every day at my clinic—the only ABHRS-certified hair transplant clinic in Greece—I see young patients whose appearance and self-image have been ruined by unsuccessful hair transplants, leaving them ashamed to go out without a hat or cap! Many even struggle to remove their hats in front of me for examination.
Almost without exception, these patients have had hair transplants at some “institute” or “clinic” where no doctor performs the surgery—only nurses, or even hairdressers dressed as doctors, pretending to be medical professionals.
As President of ELAMAT (Hellenic Academy of Hair Transplantation & Restoration), I have repeatedly written articles warning those interested about this issue.
These articles and ELAMAT’s warnings have had some effect, and the change in terminology for the FUE hair transplant technique will also play a role. However, we should not expect these unacceptable practices to stop overnight—there will always be those who profit by exploiting the perfectly natural desire of people to restore their appearance. What we hope for is greater public awareness and protection, and for the responsible authorities to recognize the problem and take legislative action to regulate the sector.
QUESTION: What do your colleagues say about this change?
Dr. Konstantinos Anastasakis: The proposal from ISHRS and ABHRS was met with impressive unanimity by doctors specializing in this field. The original inventors of the technique, Dr. Rassman and Dr. Bernstein, even commented:
“Times have changed, and updating the term FUE will clarify to the public that it is a surgical procedure, and we hope it will help them understand the seriousness of this intervention.”
At the same time, authors of medical textbooks on Hair Transplantation worldwide have unanimously and spontaneously decided to update the terminology in the next editions of their books to reflect this new, more accurate term instead of the old one.
Personally, as the author of the only comprehensive worldwide textbook exclusively on Androgenetic Alopecia (896 pages, 7,450 bibliographic references, Zevelekakis Publications, 2015), I will also update the term to Follicular Unit Excision in the corresponding chapter in the next edition of my medical book.
QUESTION: What are the essential steps for someone considering a hair transplant?
Dr. Konstantinos Anastasakis: The decision to undergo a hair transplant must be a conscious one, made after careful and mature consideration—and only if it is truly what the individual desires. This is something I always tell my patients: “It is important to pursue a hair transplant because you love and care for yourself, not because of others.” For me, this is the first and most significant step before selecting the right doctor.
Next, choosing the surgeon or hair transplant clinic is the most critical factor that will largely determine the successful outcome of the procedure. When researching options, there are three key criteria that every candidate should use to evaluate and select their doctor or clinic: the surgeon’s experience, scientific expertise, and certified specialization in Hair Transplantation. I emphasize “certified” because many will present themselves as specialists—even non-medical practitioners!
Keep in mind that doctors specialized in Hair Transplantation are, without exception, members of the International Society of Hair Restoration Surgery (ISHRS) and have completed their medical specialty training.
My team and I welcome daily anyone interested in learning more or moving forward with a hair transplant at my clinic. We explain in detail all the parameters of the procedure, conduct a personalized assessment for each individual personally by me, and we guarantee that the outcome of every hair transplant will satisfy and bring happiness to those who place their trust in us.
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