Hair transplant patients in Turkey hail from all over the world – the Middle East, Europe and the US. It is such a popular destination for medical tourism that the national airline has been dubbed “Turkish Hairlines” and the airport in Istanbul is known as the “hairport.”

Superior quality at competitive prices

Written by Delia von Neuschatz

Thinking of getting a hair transplant, but are daunted by the costs? Perhaps you’re contemplating going to Turkey for the surgery, lured by the low prices. If so, you’re not alone. With an estimated one million such surgeries performed in 2022, Turkey is now considered to be the hair transplant capital of the world. Revenues stemming from hair transplants topped an astonishing $2 billion last year, according to the Turkish Health Tourism Association.

To be sure, the costs are lower. A patient will pay as little as $2,000 for the procedure in Turkey vs $10,000 – $20,000 in the US and even more in cities like New York, Miami, and LA. But, what about the quality? Here is where cautionary tales abound. That’s not to say that there aren’t reputable doctors and clinics on the Bosphorus. By best estimates, there are a handful. But there are also a multitude of hair mills where dozens of procedures are performed in a day – without a doctor’s supervision. A medical professional may draw the hairline and give a quick consultation, but the actual work of punching the holes, implanting the grafts, even determining where and in what direction the hairs will grow is carried out by a team of often under-qualified assistants with no supervision at all. The fact of the matter is that hair transplants are exacting, meticulous operations where a doctor or technician makes thousands of small incisions at the front of the scalp, then takes hair follicles from the back of the head and inserts them into those incisions in the front. There is no substitute for expertise born of proper training and experience.

Complications have included significant scarring, abnormally low or oddly shaped hairlines, patchiness in overly-harvested donor areas, and infections. Post-op care is virtually nonexistent as patients travel back to their own countries within a few days of the procedure. Ditto for any recourse should anything go wrong. “The reality is that probably 15% or my work is reparative,” says Miami-based, double board certified hair transplant surgeon, Dr. Jeffrey Epstein. I’m seeing some of the downsides of what has come out of Turkey.” He is not alone. Over 96% of members of the International Society of Hair Restoration Surgery (ISHRS) – a non-profit medical association (which also includes Turkish doctors) – reported that up to one quarter of the hair transplant repairs they performed in 2022 were due to previous black-market surgeries.

Dr. J. Epstein

So, what if you want a hair transplant, but don’t have the funds to get it done in the US and yet, you don’t want to take a risk on quality halfway around the world? Happily, a new model of hair restoration is about to open its doors in several cities in the US, offering affordable pricing with superior quality care and results. Enter Foundation Aesthetic Hair Restoration. Patients won’t need to incur international travel costs; consistent, quality results are available in several locations across the United States, provided by board certified, experienced surgeons. Further, each surgeon has been trained in hair restorations, including transplants and hairline lowering surgery, by Dr. Jeffrey Epstein.

“We’re more expensive than the Turkish model, but we’re miles ahead in terms of quality and expertise,” says Dr. Epstein, who founded the group. “That’s because our physicians are board certified plastic surgeons with unsurpassed prior training in aesthetic surgery. These elite surgeons are now being properly trained in FUE and hairline lowering and will be actively involved in performing hair restoration procedures.”

Turkish Hair Transplants – Buyer Beware

There’s more on the Foundation’s exacting standards below, but first, a little background on the hair transplant industry in Turkey. Why are the prices so low? For one, wages and overhead are lower in Turkey than in the West. Two, the competition is fierce – there are hundreds of hair clinics in Istanbul alone – and in order to cut costs, many hire unqualified people to perform the procedures. There is no shortage of stories of underpaid and overworked Syrian and North African refugees. “The demand is so high, reports are that taxicab drivers and Syrian refugees do the surgery in some overseas countries. Patients are the ones that suffer when they realize too late who did the surgery and end up with botched complications and scars and hairlines that are not normal and disfiguring,” cautions Ricardo Mejia, MD, chair of the ISHRS Committee on Issues Pertaining to the Unlicensed Practice of Medicine. Despite legal requirements that all hair transplant operations in Turkey be performed by a doctor, the reality is that most clinics, even the larger, more established ones, disregard this rule in the race for clients. Oftentimes, a doctor isn’t even on the premises to supervise the procedures.

While there are some – perhaps a handful, according to Dr. Epstein – of reputable doctors who practice in Turkey with several having been board certified in the US – the fact is that many of these clinics are owned by laypeople and it is a layperson who hires the technicians. “So not only do you have clinics that are doing 10 to as many as 20 procedures a day, sometimes working on patients in the same room. But there is no doctor on site,” says Dr. Epstein. “It’s not like there’s one doctor supervising 8 or 10 or 15 rooms. There’s literally no physician in the office. Maybe there’s a physician in name, but that physician doesn’t do the hair procedures.” Inevitably, quality is sacrificed for quantity.

Technicians performing hair transplants. Photo ISHRS

But you wouldn’t know that from the marketing push in recent years touting the quality of Turkish hair transplants. Which brings me to reason number three for the popularity of these procedures. “The brilliance of their marketing – they’ve gotten pieces in GQ magazine, they’ve encouraged reporters to get free transplants and suddenly the emphasis has been on high quality to the point where I now see sophisticated patients, successful professionals asking ‘Are you as good as Turkey?’ which is mind boggling to me because I’m board certified in both facial plastic surgery and hair restoration,” says Dr. Epstein. “I’ve been doing this for 29 years with a full-time team – and they’re asking me if I’m as good as what they’re doing in Turkey. The marketing to change the perception that it’s not just low pricing, but also really good quality has been very effective. But I’ve seen the disasters, and it is really unfortunate for these individuals.”

This patient came to see Dr. Epstein six months after FUE in Turkey. The scalp donor area had been overharvested. Photo: Dr. Jeffrey Epstein.

This patient came to Dr. Epstein after a hair transplant in Turkey which resulted in a poorly created hairline with unnatural rows of grafts. Photo: Dr. Jeffrey Epstein

This patient is the victim of a botched beard transplant done overseas. Photo: Dr. Jeffrey Epstein

This patient had “4,500 grafts harvested in a single session. This is an exhausted donor.” Photo and source: ISHRS

One of the risks associated with transplants performed in Turkey is over-harvesting the donor site at the sides and back of the scalp. As Dr. Epstein explains, because the price per graft in Turkey is low and because the practitioners are unlikely to see the patients again and contend with post-op complications, the tendency is to perform mega-sessions whereby 3,000, 4,000, 5,000 even 6,000 grafts are removed and implanted in a single procedure. Not only can this result in an unnatural appearance due to excessive hair density in the scalp and an abnormally low hairline, but it can also lead to baldness and “devastating scarring in the donor area.”

Poor growth: these pictures show “destroyed grafts caused by improper excision or handling or poor placement technique. There are many factors that need to be controlled by a good doctor to assure proper growth.” Source and photos: ISHRS

Poor hairline design and grafts placed at wrong angles and direction are additional risks. Hair grows in different directions. A good surgeon will match the direction of the existing hair follicles. Notes Dr. Epstein “I’ve seen hairlines, as well as beards, created with grafts containing three, four, even five hairs per graft, that need to be removed.” When done properly, the results should be undetectable. And perhaps more critically, there’s the added danger of infection. Patients in a factory type of environment are at risk of HIV and hepatitis cross contamination, along with a variety of bacterial skin infections.

Before and After photos of repair of a hair transplant performed in Turkey. The case required removal of grafts that were placed too low and were too flat. States Epstein “I’ve developed an almost cottage industry, a sub-specialization, in doing FUE removals, where I’m removing and replanting grafts that were placed too low or at a poor angle and/or have scarring. I’m now doing on average two cases a week of these procedures.” Photos: Dr. Jeffrey Epstein.

Before and After photos of two patients who had FUE restorations to the scalp and to the beard in Turkey. Both cases are characterized by grafts unaesthetically placed, repaired with FUE removal where a large percentage of the grafts were extracted. The beard patient is shown immediately after the excision and five months later. Photos: Dr. Jeffrey Epstein

These Before and After photos show a female patient who had a prior hair transplant done overseas resulting in low density and scarring. Dr. Epstein performed a complete hairline excision via hairline advancement/forehead reduction surgery, removing the entire poorly-placed hairline to give a more natural, fuller appearance. Photos: Dr. Jeffrey Epstein

These Before and After photos illustrate complete hairline excisions performed on patients who had unaesthetic prior hair transplants overseas. Photos: Dr. Jeffrey Epstein

A Happy Medium

Foundation Aesthetic Hair Restoration is not the first multi-clinic hair transplant group (the Bosley commercials spring to mind), but what sets it apart from the rest is the high caliber of doctors involved. Only plastic surgeons will perform the hair transplants. Moreover, these doctors will be personally trained by Dr. Epstein, one of the most highly regarded hair transplant specialists in the world. “I’m working with a group of plastic surgeons -right now we have five and we’ll soon be up to eight throughout the country – that are going to be focusing on

There are two main types of hair transplants: Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). The FUE method involves excising individual hair follicles from the donor area and transplanting them into other areas of the scalp. The FUT method involves removing a long strip of scalp, separating the follicles and then transplanting them. Because it results in minimal, nearly invisible scarring, FUE is considered the gold standard of hair transplants. Foundation Aesthetic Hair Restoration will offer FUE transplants including no shave FUE which allows patients to be fully presentable the next day.

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Before and After photos of FUE procedures. Photos: Dr. Jeffrey Epstein

In addition to offering hair transplants and the attendant post-op care, the clinics will also offer a surgical procedure called hairline lowering/forehead reduction surgery that requires the surgical skills that only a plastic surgeon possesses. These hairline lowering surgeries are able to lower overly high hairlines by as much as one inch or more in a single procedure taking 90 minutes, achieving better density – at a lower cost and literally overnight – than two hair transplant procedures. Women in particular may be very good candidates for hairline lowering surgery – something most doctors do not perform so therefore it is not offered to their patients – but the reality is that this surgery may be the far-superior option for addressing a high hairline.

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Before and After photos of hairline lowering/forehead reduction surgery in female patients. Photos: Dr. Jeffrey Epstein

Provided also by the clinics will be a whole host of the most cutting-edge minimally invasive and noninvasive hair restoration procedures. These range from oral medications to custom-compounded topicals containing minoxidil, finasteride, dutasteride, bimatoprost, caffeine and/or melatonin that will be guided by a genetic test called TrichoTest®. “It looks at 46 genetic variations, taken from a cheek swab, to determine the DNA which will reveal what medications are most likely to be effective,” says Dr. Epstein. “We can get a printout of 30-50 potential therapies and we can then create oral medications and topicals that have a greater chance of working and reducing the risk side effects because there’s less of a guessing game.”

DNA testing could be particularly useful for women for whom surgery is not always the answer. About 70% of transplants are done for men, according to Dr. Epstein who reveals that for women, it’s often an issue of controlling hair loss. This entails blood tests and making sure that there are no nutritional or hormonal imbalances. “And then,” says Dr. Epstein, “we can go ahead and create these medical therapies for patients which have a much greater chance of working.”

Last but certainly not least, patients will also benefit from Dr. Epstein’s personal approach. “The tenets of each practice are going to be under my supervision,” says the surgeon. “I really try to provide a personalized experience where patients are not just one of multiple procedures being done that day and have no interaction with the doctor. That’s always been my approach. The plan is to replicate it – to have active communication with patients and have thorough aftercare, as well as offering full medical management.” In addition to the already well-established Miami office, the expansion will begin in January with a clinic opening in Fort Lauderdale/Palm Beach followed by four more in Scottsdale/Phoenix (February) and Fort Myers, Atlanta and NYC (spring 2024).