By Dr. Cole, FUE Hair Transplant Pioneer

Hair Transplant Patient Education

hair transplant education

Hair restoration continues to progress at an impressive rate. New treatments such as stem cell treatments and topical finasteride are showing tremendous promise. Meanwhile, the latest hair transplantation option continues to gain quality and spread wider. Patients can better access convincing results than ever before. There are also risks, though. Perhaps most unfortunate is that these risks are gaining in prevalence.


Patient references have long been essential in hair transplantation. In a competitive industry, many surgeons often put marketing before honesty. So too, can crooked advocates. Far from just leading to disappointment and a lighter wallet, going to the wrong clinic can lead to permanent disfigurement. Deferring towards established spokespeople is best for this reason.

The two most respected figures are Spencer Kobren of The Bald Truth radio show and Joe Tillman of Complacent, fee-obsessed, yes, men, these two are not; exactly why patients and surgeons trust them. Both are outspoken advocates known for their critical perspectives regarding the hair transplant industry. Each has their own stories regarding hair transplant surgery, too, a direct reason for why they became involved. Unfortunately, bad transplants are becoming wider spread. The rapid expansion of Follicular Unit Extraction (FUE), the latest technique, and increasing demand for it worldwide have had some negative effects. First, surgeons unfamiliar with the method are offering it to remain competitive. Second, the method’s increasing affordability leads many patients to assume the best bargain is the best option. This is rarely the case and a primary cause of bad, if not irreparable, hair transplants.


Finding a good hair transplant has always necessitated research. Critically, patients must also be selective in reviewing potential clinics or surgeons. Some background knowledge about the procedure and its current trends might seem overkill. Said information, though, helps patients sift through less reputable clinics that often get their facts wrong.


Adequate hair transplants have been available for decades. Follicular Unit Transplants (FUT), or strip surgery, can be persuasive but at a cost; a pronounced scar of unpredictable size and, as years passed, a plug-like appearance that resembles doll hair. The real goal of hair transplant research since the late 90s was to mitigate adverse effects while preserving gains in quality.

By the early 2000s, Follicular Unit Extraction (FUE) provenly cause less scarring and boost longevity. Of greater note, FUE transplant’s overall quality was superior to FUT. However, FUE also demanded greater time and training. Instead of simply extracting a strip of donor scalp and dividing it, ala FUT, FUE involved directly extracting each and every follicular graft from the donor area. Not only did procedures require vastly greater time, but hair restoration surgeons also had to train in the developing technique.

As time passed, innovators like Dr. Cole developed specialty FUE punches and techniques. The quality of FUE further increased, and the practice of the method slowly proliferated. It wasn’t until the mid-2010s that FUE became more prevalent than FUT. 


The quality of the surgeon and clinic matters a great deal, obviously. As mentioned, the availability of FUE has increased a huge amount. Proficiency at FUE, however, requires time, dedication, and training. The latter particularly requires involvement with established FUE surgeons.

Those offering FUE will typically mention their credentials, such as where they attained their degrees and the surgeons who trained them in FUE. Activity within hair transplant industry associations is also a good sign. Patients should be aware that subpar surgeons often falsely use said memberships to affirm their skills. Prospects should always check the surgeon’s experience and previous work. As with any research online, validating a surgeon’s presupposed work can be tricky. Suggestions on how to do so are under the header “Research Clinics and Hair Transplant Surgeons” further down this page.


Just as a surgeon’s skill set is essential, so is the clinic. Legitimate surgeons should always conduct the majority of each procedure. Their support staff and their skills, though, are also essential. Just as with surgeons, they also require specialized training to assist in hair transplantation procedures adequately.

Intake and outreach are also important. Worthwhile clinics will always offer a free consultation to gauge prospects’ eligibility for a transplant. An accurate consultation is absolutely vital. Experienced surgeons can typically eyeball the potential graft amount, but, to be sure, most will also use advanced software to calculate viability. Good results also depend on a solid recovery; this means clear, written instructions on managing for the first couple weeks after the transplant.   

Equipment, of course, matters too. There are numerous variants of FUE, most with specialty utensils. Effectiveness ranges, however, and counterintuitively the most advanced or cutting-edge equipment is not always the most effective. The below header, “Techniques,” goes into further detail.

Aside from hair transplant tools, quality clinics have equipment and treatments that encourage quality results. This includes items such as chilling pods for grafts and treatments to aid recoveries, such as Platelet Rich Plasma (PRP) and ACell. More information on the latter is available under the header “Hair Restoration Treatment Patient Awareness.”


The amount of FUE techniques continues to grow as new equipment hits the market. Initially, the only option was manual FUE; surgeons would use a simple punch to extract and transplant grafts. This still remains one of the most effective techniques if the surgeon is capable of it. Mechanical FUE punches, basically mechanically assisted manual punches, are similarly effective with additional training and enable the surgeon to extract grafts faster. Regardless, surgeons who reuse their punches (they should be discarded after around 1,000 grafts) are compromising on results to cut costs.

A pioneer of the method, Dr. Cole himself has developed a range of equipment for his technique, Cole Isolation Method (CIT®). This includes the world’s sharpest and most widely used punches, mechanical options for quicker transplantation, and a slew of relevant equipment under the brand Cole Instruments. CIT® enjoys high regard due to its incredibly low transaction rate (less than 3%), unnoticeable scarring, and minimal invasiveness. In fact, it remains the only technique that, with the application of ACell, leads to between 30% and 40% donor regeneration. This enables its practitioners to extract more grafts without causing a sparse donor area.

Two new techniques are also available: automatic FUE and robotic FUE. The ideas behind these techniques have promise. The equipment itself, though, is still developing. Both automatic and robotic FUE have higher transaction rates (around 10%). Automated FUE, further, has a reputation for using surgical techs instead of surgeons, leading to less convincing hairlines and a greater chance of scarring. Robotic FUE, meanwhile, only applies to some patients (those with dark, straight hair) and also has a higher chance of scarring.

The number of surgeons routinely practicing FUT continues to drop. However, those disinterested in training for FUE, or just plain lousy at it, continue to market FUT as the best option for most patients. This is patently false. Some patients may prefer the technique, but its detractions overshadow its benefits. This includes a noticeable scar, longer recovery time, and less chance for convincing results.   


As FUE proliferates, a greater number of clinics are offering it worldwide. Many surgeons and clinics are valid regardless of their location. However, there is also a growing trend of less scrupulous practitioners using crooked marketing techniques.

There are plenty of ways such hacks entice patients; false patient testimony, false credentials, false anything for the most part. Most will use the veneer of an upper strata location and stylish clinic to allay cynicism. The appearance of glamour also plugs into one of the most common enticements; travel packages.

Increasingly reasonable, many patients still dig into their savings or use credit to afford their transplant. As with most instances of medical tourism, travelling can lead to greater bargains. The idea of saving money and visiting a foreign locale can be tempting. And crooked surgeons are aware of such. The results, though, can be hideous. Further, there is next to no recourse for most patients. Those accustomed to the protections of better-off states will find they have no legal avenue to pursue a malpractice suit or be refunded. For this reason, it is absolutely essential for patients to research prospective clinics offering travel packages critically.


Hair restoration treatments, if anything, are advancing at an even greater pace than transplantation. Surgeons and researchers have experimented with treatments for years. Clinically proven take-home pharmaceuticals first began appearing in the late 80s. Not until the 2000s, though, did viable outpatient treatments arise.

Treatments’ effectiveness varies according to the individual. However, their manufacture and ingredients can also matter a great deal. For every effective take-home option, there are several that are ineffective. Similarly, the effectiveness of outpatient treatments depends on their processing. Using legitimate options is important, as is being aware of side effects. The latter can be quite severe; a primary reason research continues pursuing alternatives and altogether new solutions.


The main concern with take-home treatments is their validity. A few clinically-proven pharmaceuticals are available. Most of these options require a prescription, and for a good reason, nasty side effects can occur. Patients looking to save money will typically shop around online. Many legitimate online vendors offer these pharmaceuticals but also be weary; counterfeit pills are a huge industry and can have unknown effects on the patient. There are a few take-home treatments to choose from.

Under the brand Rogaine, Minoxidil was the first available clinically proven option. First launched in the late 80s, the topical formula helps some people retain or grow their hair. The exact reason for this effect is still unknown. Most physicians believe it results from increasing circulation within the scalp.

Finasteride next came onto the market under the brand name Propecia. Initially an oral pharmaceutical, it proved more effective for most people than minoxidil. The oral form also has side effects for some users, though. This includes depression and erectile issues. The chance of such side effects is small but has led to new research into alternative options. Topical finasteride is proving incredibly effective without any risk of side effects but is still only available at select pharmacies and hair restoration clinics.

Other DHT Blockers are also available but typically are less effective and may have more severe side effects.

Several options also exist that use all-natural ingredients. See our page on hair restoration treatments for a list of options. Of particular note, however, is that both the formula and the ingredients’ quality matter. Patients should make sure to research their products, particularly if shopping online for specialty items.


Outpatient treatments have been growing in popularity for quite a while. They also range quite the amount. Near all such treatments are internally produced at a said clinic or otherwise made nearby. Platelet Rich Plasma (PRP) is among the most common and ranges in effectiveness depending on how it is made. Prospects should ask the given clinic where they create the PRP, the kit used, and the ingredients. One blog post last year is particularly informative about such.

New treatments are also gaining traction. For instance, Cytokine Rich Plasma (PRP) has greater potency than PRP through sonication. Such potency leads to both better results and, notably, faster hair transplant recovery than PRP. Stem cell serums and endosome treatments, meanwhile, are showing great promise. No matter what a clinic advertises, though, patients should be cautious. Ask how these treatments are made and verify that patients received such at the given clinic notice results.


As mentioned numerous times, research is essential when finding a solid clinic. There are thousands to select from too. This is one reason many prospects refer to acquaintances who already underwent a transplant.

Not all prospects know someone happy with their transplant, though; further research is necessary. As mentioned at the beginning of this article, this is why patient advocates are crucial. However, the surgeons and clinics they endorse often have long waiting lists and are less likely to offer bargains. Lesser-known clinics and surgeons can still deliver optimum results if the patient knows how to find them.


Qualifications, obviously, matter a great deal. Surgeons obviously need medical schooling and training to receive such a distinction. Additionally, surgeons must undergo specialty training in hair transplantation. Patients should always look up their prospective surgeons, ask who they trained with, and then look up that surgeon. Membership in associations is quite common and a sign they are keeping up with industry trends. Research should never be shallow, though. Be sure to use multiple websites for reference and, if unsure, contact the schools they attended and the training surgeons they learned from.  


The hair transplant surgeon should always commit to the vast majority of procedures. Unfortunately, this is becoming less of a reality with increasing demand and the advent of options such as automatic FUE. Patients should make sure to be upfront with their surgeon about how much of the procedure they will conduct.  


Any worthwhile hair transplant surgeon has worked on a multitude of patients. It takes time and patience to build experience, which is one reason clinics typically feature several patients’ before and after shots. As important, many clinics will also use patients as references for prospects. These references will talk about both the clinic as well as the results. However, less scrupulous clinics will go so far as to pay for positive references; the person prospects talk with may not even have undergone a procedure. One can never be too sure, but precautions can make a big difference. Be sure to ask specific questions and pay close attention to the details. Then mentioning these details to the clinic rep can provide inferences if the clinic is legitimate.  


A leading clinic worldwide, Forhair has a reputation for excellence. Along with dedication, original research, and mastery of hair transplant techniques, Forhair enjoys commendation for its advocacy. Not only one of the patients’ best options, but Dr. Cole is also very active in the hair transplant industry. From training to discussions on best practices, he has helped encourage the industry’s progression and set positive trends. See for yourself how our clinic sets itself apart.


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