On the streets of Istanbul, it is impossible to miss the groups of young men with gauze wrapped around their heads, their scalps stained red with tingling.
All year round, they can be found marveling at the grandeur of the Blue Mosque, haggling at prices in the Grand Bazaar and queuing at airport check-in counters.
Few Turks are in town, and none stay for more than a few days — they stay only long enough to recover from surgery before returning home.
But they all arrive with the same, singular mission: to find an antidote to baldness.
“We’ve all lost our hair on both our mum and dad’s side,” said Payman Shahrokei, who came to Istanbul from Sydney last summer after noticing her receding hairline.
“It’s only a matter of time. I was going on holiday to Europe. Why don’t you come and do it?”
Since the turn of the century, Turkey has become a mecca for hair transplants, a cosmetic procedure in which healthy hair follicles are harvested from the back of the head and transplanted to the top of the head.
A client talks with a doctor during a hair transplant procedure. (ABC News: Tom Joyner)
Hundreds of thousands of people, mostly young men, from around the world make the pilgrimage every year, contributing to a tourism industry worth $3 billion by 2022, tourism officials say.
In Australia, the procedure can cost more than $20,000, but in Turkey it can cost between a tenth and a quarter of that amount and still provide a high standard of care.
Clinics use flashy marketing to sell all-inclusive packages and compete fiercely for clients, who mainly come from Arab countries, the United States and Europe.
Promotional videos show clients confidently showing off their lush hair a few months after the treatment, while their wives or girlfriends proudly marvel.
Celebrities such as Lewis Hamilton, Steve Carell, Matthew McConaughey and Gordon Ramsay have also reportedly undergone the treatment.
Deep in Istanbul’s Asian side, in a high-rise building overlooking a busy highway, the waiting room at Smile Hair Clinic feels more like a luxury hotel lobby than a doctor’s office.
A post-surgery patient sits in a clinic waiting room. (ABC News: Tom Joyner)
Glass chandeliers hang from the ceiling, and staff offer drinks to customers waiting for their reservations.
A barbershop-style room next door doubles as a social media studio, recording customer feedback and posting it to the company’s more than 1 million Instagram followers.
In addition to surgical staff, the clinic employs a team of six people who distribute content through online channels, where it finds the majority of its new customers.
A member of the clinic’s social media team prepares to photograph their next client. (ABC News: Tom Joyner)
Salespeople profess to be “selling trust” and often negotiate directly with potential buyers’ wives or girlfriends.
“Being bald may not be a big deal to some people, but most people who come here say, ‘Oh my gosh, you’ve changed my life,'” said Gokay Bilgin, a hair transplant surgeon and co-founder of Smile.
“It’s really important to them to get a nice photo and have that intimate connection.”
Essentially, hair transplants are simply grafts carefully placed to give the impression of dense hair, creating the illusion that hair is growing.
If patients do not properly care for their heads during the months-long recovery period, they may damage the transplanted hair follicles.
For the first few weeks after surgery, patients are instructed to avoid showering or exercise, as the pressure of the water and sweating on the scalp could detach the newly transplanted hair follicles.
Many people find that once they get home, they are unable to lie down in bed for fear that contact with the sheets and pillow will ruin their sleep progress, causing sleep problems.
On the day of Sharlocay’s surgery, staff first shaved his head, then used a black marker to draw lines around the crown and hairline to indicate where the new hair transplants would be placed.
Nurses prepare Paymaan Shahrokei’s head to be shaved. (ABC News: Tom Joyner)
“Before” photo of Payman Shahrokey. (ABC News: Tom Joyner)
Then, in an operating room upstairs, surgeons injected a local anesthetic into his scalp before beginning the first stage of the operation: extraction.
Between 3,000 and 5,000 hair follicles were individually plucked from healthy areas at the back of the head and placed in a petri dish in preparation for transplantation.
A television on the other side of the room played a recorded message of a man in a white suit warning patients not to make any sudden movements during surgery.
“If you have a stiff neck or need to catch your breath, please let the team know and we will take a short break,” the man said in English over the screen.
Surgeons begin the first stage of surgery. (ABC News: Tom Joyner)
Dr. Gokai Bilgin performs surgery on Payman Shaflokey. (ABC News: Tom Joyner)
Used needles and razors are piled next to petri dishes used in hair transplant surgeries. (ABC News: Tom Joyner)
In the waiting room, about six men with bandages on their heads from that morning were absentmindedly fiddling with their cell phones or gazing out the window.
“It’s a strange experience,” said Alex, who flew in from London for the procedure. “It feels like I’m wearing a helmet. I have no feeling in my head.”
This will be followed by a period of several weeks of recovery, during which she will not be able to shower or sleep on her back. If all goes well, the full effects of the treatment will be seen in around 18 months.
“Whenever I went out with friends, I was always conscious that the wind would blow and mess up my hair, exposing the areas where I didn’t have any hair,” he said.
Back in Sharlocay’s room, three surgical staff members gathered around his head, lifting the plucked hair follicles from the tray and gently pressing them into the newly drilled hole on the top of his head.
They worked silently, moving their arms in a practiced rhythmic motion that made the task look simple to the untrained eye.
A nurse carefully hand-transplants thousands of hair follicles into Paymaan Shahrouki’s scalp. (ABC News: Tom Joyner)
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 health system, private clinics targeting wealthy foreigners are an attractive opportunity for many.
The rapid growth of the industry in Turkey has led to the emergence of illegal clinics that circumvent regulations and operate with poorly trained staff, leading to potentially disastrous operations.
It can be difficult for foreign customers to judge on the surface whether a clinic is reputable and trustworthy.
According to the International Society of Hair Restoration Surgery, a Chicago-based nonprofit, botched procedures performed by unlicensed staff (who often lack malpractice insurance) can cause dangerous and irreversible health problems.
The association says the problem is not limited to clinics and men in Turkey, but occurs in countries around the world.
Even at a reputable clinic, transplants aren’t the perfect solution for everyone who suffers from hair loss.
Female pattern hair loss, the most common type of hair loss in women, is different from male pattern hair loss.
While hair loss in men is typically concentrated on the crown of the head, women generally tend to experience thinning across the entire head, which can make it more difficult to find suitable donor areas for transplants.
“I would not recommend hair transplants to women considering them as a treatment option for hair loss,” says Gina, a retired teacher from the northeast US, who underwent a hair transplant after her hair started thinning in her early 20s.
Hair transplants in women are not as widespread as in men and are less common as they involve medical risks for women.
Gina claims that after researching potential clinics, staff failed to inform her that the procedure, which involves transplanting hair follicles from the back of the head to a particularly thinning area on the top of the head, would not work as well as it does for men.
Her hair seemed to grow back for the first six months after the surgery, but then it started falling out again. She felt betrayed.
“I ended up back at square one,” she said. “For a lot of women, hair is such a big part of their identity. It’s devastating. Why did this have to happen to me?”
Since then, Gina has tried to come to terms with her botched operation by wearing “hair toppers”, wigs that blend in with her own hair, and by connecting with other women like her on Instagram.
“It may sound silly in the grand scheme of things, but my confidence has sky rocketed.”
Payman Shahrouki poses for an “after” photo with the in-house content team. (ABC News: Tom Joyner)
Payman Shahroqei is driven back to her hotel after surgery. (ABC News: Tom Joyner)
A nurse bandages Payman Shahrokei’s head the day after surgery. (ABC News: Tom Joyner)
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