A Hair Raising Experience

ISTANBUL // Tourists take a glance at package tour promotions hanging on the door of a travel agency on Istanbul’s Taksim Square as a young man enters the small office with a folder in his hand.

Ismail is in a hurry and takes a document out of his folder with a list of potential customers and hands it to the owner of the travel agency, sitting in her chair.

“I think we can transfer some five or six people this week,” he nods with a smile.

This everyday ritual reveals how the local black market manages its network of unlicensed hair-transplant businesses spread across Istanbul and in other major Turkish cities.

This expanding network of clinics profits from an ever-growing number of visitors from abroad, mainly from Arab countries, the vast majority of whom do not realise they are being treated by illegal and often dangerous operators.

According to data from the Turkish Healthcare Travel Council (THTC), 746,000 foreign visitors landed in Turkey for medical treatment in 2015. As many as 100,000 arrived for hair implant surgeries and nearly two-thirds of them were from the UAE. Turkey earned US$5.8 billion from legal medical tourism in 2015, or nearly $10,000 per visitor. Medical treatment in Turkey costs as little as half the price in countries such as Germany and the United States, the THTC says.

It is perhaps little wonder the illegal clinics are growing. Everyday scores of clients’ documents and lists of customers are delivered by middlemen such as Ismail to and from dozens of tourism agencies in central Istanbul.

Then the agencies introduce the patients to a clinic, which in return pays the tour agency a certain amount of commission per visitor. Once those seeking hair-replacement therapy have decided on a treatment, they usually arrive on an all-inclusive package covering a welcome at the airport, transport in luxury cars, a hotel reservation in a central location and transfer back after the treatment is finished.

Turkey’s booming health tourism industry has been driven by increased investment in health facilities and treatment technology over the past decade. Cosmetic surgery options such as hair implants, as well as eyebrow and facial hair implants, have led this boom. More than 200 hair transplants are carried out in Turkey per day, the country’s health ministry says.

Most foreign patients come from the Arabian Gulf region looking to reverse hereditary hair loss or treatment to make repairs after botched operations at illegal clinics.

One such is Sayeed, 32, from Saudi Arabia. As he leaves a new clinic he found recently for post-surgery treatment with a large bandage around his head discoloured by dried blood, he readily admits he initially did little research into his first treatment. With his blood-soaked, bandaged head, he does look unsettling.

Sayeed was in Istanbul a year ago, hoping to get an attractive new look from a local implant clinic he signed up with in advance. He did not know it was unlicensed. “It could have been easy to spot these illegal places but I made very little research on that,” he says.

The treatment was not a success and so he was forced to return to Istanbul to repair the damage done.

Many patients are lured by bargain prices and geographical proximity. Most recently a sub-industry has emerged – moustache transplants – attracting male patients inspired by Turkish soap opera actors or Hollywood celebrities, the general manager at the licensed Natural Hair Turkey, Ersin Murtezaoglu, tells The National. Most patients bring a picture of their favourite movie star or singer whom they want to look like, he says.

“The fake clinics offer a 100 per cent guarantee that the patient will look like his dreams, which of course, ends in frustration,” he adds.

After years of hard-work, many Turkish surgeons and dermatologists have built good reputations for hair implant surgeries but now the mushrooming illegal clinics threaten to undermine Turkey’s regional place in the sector while also damaging tourism.

Istanbul used to have only a handful of hair transplant clinics, all with a valid health ministry licences, a decade ago, today as many as six out of every 10 clinics operate illegally. Observers say the local authorities have long turned a blind eye to this problem and a lack of monitoring and auditing have contributed to the growth of such places to a great extent. When contacted by The National for comment, Istanbul City Health Council, which represents the health ministry locally, says only that “it is the health ministry’s duty to audit the clinics” and it “cannot further comment”.

Professional clinics are primarily concerned that their unlicensed rivals are putting the patients’ lives at risk, while also stealing potential customers.

The Turkish Society of Plastic Reconstructive and Aesthetic Surgeons and the International Society of Hair Restoration Surgery have both issued warnings for patients to be aware of potential health risks due to illegal clinics in Turkey.

In what is called follicular unit extraction, hair implantation is simply removing hair from the back of the patient’s head and replanting it on the balding parts.

It is predominantly male patients who seek this treatment, while female visitors often opt for surgeries such as eyebrow implants. It takes three days to finalise the implant process and another six to eight months before transplants settle and hair grows normally. The official price of hair implant surgery by a licensed clinic starts from $1,500 but this can drop to as low as $800 among the illegal black market operators amid cut-throat competition to lure patients.

Officially, hair transplant surgeries can only be performed in a hospital by a doctor, dermatologist or plastic surgeon. The hospital must clearly state the procedures of hair implant surgery treatment in its records, it must be equipped with an emergency unit and at least one surgery room as defined by the health ministry. It also has to be properly registered with the national healthcare system according to Turkish laws. But illegal clinics are mostly operating in residential buildings, offices or sometimes at very small-scale hospitals.

Many patients are risking their health by not thoroughly researching the clinics they choose to visit, licensed surgeons tell The National.

“In all unlicensed clinics surgeons leave the work to technicians, inexperienced medical students and sometimes even to drivers or cleaners,” says Gülten Ünveren, the general manager of the licensed Istanbul-based hair implant centre Mega HairTrans.

“These people are playing with the health of hundreds of tourists.” Apart from post-surgery infections or disappointing results, the patients’ lives are at stake, Ms Ünveren says, adding that a hair implant is not simple surgery as promoted by clinics in the black market.

In some cases, if the patient has a heart disease for instance, there is a very real danger of serious injury or even death, she adds.

Ms Ünveren points to an example of how easy it is for black market clinics to set up. Earlier this year, she says, a driver who worked for a hair implant clinic in Istanbul told her that he had opened his own clinic in a central district and that now he earns as much as 30,000 Turkish lira (Dh37,023) per month, more than 20 times Turkey’s minimum wage. “I knew this guy before; apparently he was allowed to join surgeries and learnt how to make incisions and harvesting grafts,” she says.

“After six months, he opens his own place. This is ridiculous since the whole sector and local authorities are aware of this but nobody is taking action.”

It is all to easy for a patient to be attracted by what appears to be a bargain, but anyone considering such cosmetic surgery must be careful she says.

“The customers ask if they can get this treatment for below $1,000. Well, you have to be suspicious with any price offered below the $1,500 mark; imagine that they do this job for $15,000 in the US.”

She says that alone should be warning enough for those considering surgery and is surprised so few seem to get suspicious. “How can customers be fooled by such people if the price is so low – and the treatment so dangerous?”