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Plucking and implanting thousands of hair follicles, one by one, these surgeons are ‘selling confidence’

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On the streets of Istanbul, they are unmissable: groups of young men with heads swaddled in gauze, their scalps pricked a glistening red.

You can find them year-round marvelling at the grandeur of the Blue Mosque, haggling at the Grand Bazaar, and queuing at the check-in counter at the airport.

Few are Turkish, nor stay in town more than a few days – just long enough to recover from their surgeries before travelling home again.

All however come with the same singular mission: to find an antidote to their baldness.

“My father’s side, my mother’s side, they’ve all been losing their hair,” said Paymaan Shahrokhey, who arrived in Istanbul from Sydney last summer after he noticed his receding hairline.

“It’s just a matter of time. And I thought we’re going on a holiday to Europe. Why not come and get it done?”

Since the turn of the century, Türkiye has become a mecca for hair transplants, a cosmetic procedure that involves taking healthy follicles from the back of the head and implanting them on the crown.

A customer talks to a doctor during his hair transplant procedure.()

Hundreds of thousands of mainly young men make the pilgrimage from around the world every year, according to tourism officials, to contribute to an industry that was worth $3 billion in 2022.

In Australia, the procedure can cost more than $20,000, but in Türkiye it’s anywhere between a tenth to a quarter of that, while still offering in some instances high standards of care.

Clinics compete fiercely for customers who largely come from the Arab world, the United States and Europe, offering all-inclusive packages sold using flashy marketing.

Promotional videos show customers months after their procedure confidently showing off lush heads of hair as their wives and girlfriends marvel proudly.

Celebrities like Lewis Hamilton, Steve Carell, Matthew McConaughey and Gordon Ramsay are reported to have had the treatment.

At the Smile Hair Clinic, a multi-storey building overlooking a busy highway deep in Istanbul’s Asian side, the waiting area feels like the lobby of an upmarket hotel rather than a medical practice.

Six peolpe sit on couches in a waiting room, several are bald men with bandages or caps
Post-surgery clients sit in the clinic’s waiting room.()

Glass chandeliers hang from the ceiling and staff offer refreshments to customers waiting idly for their appointment.

An adjoining room fitted to look like a barber shop doubles as a social media studio to record customer testimonials, which are posted to the company’s more than a million Instagram followers.

Aside from surgical staff, the clinic employs a team of six to push content through online channels, where the vast majority of new clients are to be found.

A woman wearing a navy tank top stands at a desk inside a salon environment, using a computer
A member of the clinic’s social media team prepares to film the next client. ()

Sales staff say openly they are “selling confidence”, and often deal directly with the wives or girlfriends of prospective customers.

“It may not be a great issue for some people to be bald, but most of the people who come here tell us, ‘Oh, you changed my life,'” said Smile co-founder and hair transplant surgeon Gökay Bilgin.

“It’s really crucial for them to take nice pictures or maybe even to get intimate.”

At their core, hair transplants offer little more than an illusion of hair growth using carefully placed grafts to give the impression of a dense head of hair.

If a patient does not take proper care of their head during the months-long recovery, it can cause damage to the implanted follicles.

In the first weeks after the procedure, patients are instructed they cannot shower or work out – water pressure and sweating on the scalp risk dislodging newly implanted follicles.

Upon returning home, many find their sleep suffers as they cannot lie flat in bed for fear contact with bedsheets and pillows might similarly undo progress.

On the day of Mr Shahrokhey’s surgery, staff began by shaving his head before using a black marker to sketch out where new hair grafts would go on his crown and along his hairline.

A man sits in a barber's chair while someone wearing surgical gloves shaves the back o f his head, and two nurses watch
Nurses prepare to shave Paymaan Shahrokhey’s head.()
A man with shaved head and lines drawn around it sits in a chair, his back to two people with cameras
Paymaan Shahrokhey has his “before” photos taken.()

Next, in an upper-floor theatre, his scalp was injected with a local anaesthetic before a surgeon began the first stage of the procedure: extraction.

One by one, between 3,000 and 5,000 hair follicles were plucked from healthy areas at the back of his head and placed into Petri dishes ready to be implanted.

On a TV facing him across the room, a recorded message showed a man clad in white who warned against sudden movements during the surgery.

“If you have a stiff neck or just want to catch your breath, let the team know and we’ll give you a small break,” the man said in English through the screen.

A man wearing blue hospital gown lays back while a doctor in scrubs uses an instrument on the patient's scalp
The surgeon begins the first stage of the procedure.()
A doctor and patient are seen in the reflection of a mirror. The patient has bandages on his head
Dr Gökay Bilgin operates on Paymaan Shahrokhey.()
Used needles and a razor with specks of red blood sit on a tray covered with blue plastic
A pile of used needles and razors lie next to Petri dishes used in the hair transplant surgery.()

Out in the waiting area, about half a dozen men sat idly on their phones or staring out the window, their heads wrapped in bandages from the morning.

“It’s an odd experience,” said Alex, who flew from London for the procedure. “It feels like I’m wearing a helmet. I can’t really feel my head at all.”

He then faced a recovery period of several weeks, when he wouldn’t be able to shower or sleep flat on his back. If all went well, he’d see the full results of the treatment in about 18 months.

“Going out and about with friends, it was always the constant consciousness of the wind blowing and catching your hair and exposing the parts where you don’t have any,” he said.

Back in Mr Shahrokhey’s room, three surgical staff huddled around his head, lifting plucked hair follicles from a tray and pushing them delicately into newly drilled holes on the crown.

Working in silence, their arms worked in practised rhythmic motions, making the process look simple to the untrained eye.

Through an open door, two nurses in surgical scrubs sit near a patient's head, using instruments on his scalp
Nurses carefully implant thousands of hair follicles manually into Paymaan Shahrokhey’s scalp.()

Hair is a lucrative business, but transplants aren’t the only option

In a country with poor working conditions and low wages in the public healthcare system, private clinics targeting wealthy foreigners present for many an irresistible opportunity.

The industry’s boom in Türkiye has given rise to illegal clinics that skirt regulations and operate with poorly trained staff, leading to procedures that can go catastrophically wrong.

Sometimes for foreign customers, it can be hard to tell on the face of it if a clinic is reputable or trustworthy.

A botched procedure by unlicensed staff – who often are not covered by malpractice insurance – can cause dangerous and irreversible health problems, according to the International Society of Hair Restoration Surgery, a non-profit association based in Chicago.

Such problems, the association says, are not limited to Turkish clinics nor only to men, but are present in countries across the world.

Even at reputable clinics, transplants don’t offer a perfect solution for everyone who experiences hair loss. 

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