Turkish Hairlines: Istanbul is a mecca for bald men

As we get older, nature is merciless. Sight deteriorates, wrinkles appear and men lose their hair. The only consolation is that celebrities are also affected: Just think about Andre Agassi, Bruce Willis, Prince William.

However, such celebrities are only of limited use as role models. In reality, many men find it difficult to come to terms with their bald patch. It makes them feel older and unattractive. To stop hair loss, some people take medication or use special shampoos. Others opt for hair transplants. Prominent examples include Christian Lindner, Jürgen Klopp and Robbie Williams.

Many European men fly to Turkey for the procedure. The country has become a mecca for hair transplants, mainly because of lower prices. A meme is circulating on the internet that takes aim at the boom. It shows men with half-bald heads in an airplane and the slogan, «Turkish Hairlines.» The full hairline from Turkey is so popular that the airplane has become a beauty shuttle.

Swiss photographer Mario Heller accompanied a young man from Berlin to Istanbul for a treatment. The transplant was carried out at the Elithair Clinic, which claims to be the largest hair clinic in the world.

Up to 100 patients per day are treated on 13 floors. Grafts are removed from the back of the head: Tiny pieces of skin with one to five hair follicles each. The follicles are structures that surround the hair roots and anchor the hair in the skin. The grafts with the follicles are then transplanted to the bald areas.

A weekend transplant, including two overnight stays and airport transfers, costs 3,200 euros. In Germany, the same procedure costs between 5,000 and 10,000 euros. Prices are similar in Switzerland.

Most of the clinic’s patients come from German-speaking countries, with 579 patients traveling from Switzerland last year alone. On-site interpreters facilitate communication.

Hair loss is usually genetic

In recent years, Turkey has developed into one of the world’s most popular medical tourism destinations. Patients come from all over the world for dental treatments, stomach reductions, cosmetic surgery and hair transplants. Hair loss in particular is a sore point for many men: Up to 80% are affected in the course of their lives.

The reason for this usually lies in their genes. In people with a genetic predisposition to baldness, the hair roots are sensitive to the sex hormone dihydrotestosterone. This leads to the roots being damaged and hair falling out.

The desire to turn back time is powerful – and a huge business for Turkey. In 2022, an estimated one million people traveled to the country for a hair transplant, according to the Association for Health Tourism. This generated a turnover of $2 billion, half the total turnover generated by medical tourism in Turkey.

The actual figures are probably much higher, says Mariam Asefi, head of the medical tourism research department at Bonn-Rhein-Sieg University of Applied Sciences. «The patients enter the country as normal tourists, and there is no central recording system for treatments,» she says.

Some men’s hair thins out at an early age. This was also the case for Felix Hofmann,* the patient accompanied by photographer Heller.

Mr. Hofmann, you are 28 years old. Why did you decide to have a transplant?

I developed a receding hairline in my early 20s, and because my father and grandfather went bald early, I knew what I was in for. At first I had come to terms with it, but I was secretly concerned about the hair loss. One often sees oneself on video calls or in party photos. At some point, a friend went to Istanbul for a transplant. He made it sound quite relaxed.

What bothered you about the onset of baldness?

A full head of hair makes you look young and vital. A receding hairline makes you look old. Something is missing. When I see some friends again after a long time, I am sometimes shocked. With a half-bald head, they look completely different, like a different person.

Is hair loss an issue in your circle of friends?

Nobody talks about it openly. Men don’t like to show such weakness. But I can tell that it bothers some of them. Some avoid social occasions, others always wear a baseball cap. If the cap falls off, they turn red. But as soon as a friend has a transplant, everyone starts talking about it.

Anyone interested in treatment sends photos of their head to the clinic. The clinic estimates how many grafts are needed and gives a cost estimate. A more detailed hair analysis, preliminary examinations and an anesthetic consultation take place on site.

Hofmann was initially supposed to have 2500 grafts transplanted, but in the end it was 4200. He says that the number of grafts often increases on site. «I was given the option to have more hair transplanted to achieve a better result. I accepted that,» he says. This also caused the price to rise slightly.

«Technicians» often work instead of doctors

The modern market for aesthetic hair transplants emerged in the late 1980s. In the early days, strips of skin with hair were cut from the back of the head, shredded and implanted in the bald patches. This procedure is now considered obsolete.

Today, individual hair follicles and or group of follicles are loosened with a rotating hollow needle, removed and implanted with a stylus. Unlike in the past, there is hardly any scarring, and healing is faster.

A scalpel is not necessary, nor do large wounds need to be stitched. This has led some providers to advertise that a hair transplant is not a real operation, writes the International Society for Hair Restoration Surgery (ISHRS), a leading global body of experts. However, this is not true. Such treatment is very much a surgical procedure that should only be conducted by doctors, according to the website.

This applies in Turkey as well, but it is not always checked, as medical tourism researcher Asefi explains. «An estimated 40 to 60% of providers, or more, work without a license,» she says. Instead of doctors, semi-skilled «technicians» do the work – and are paid significantly less. That is why prices in Turkey are sometimes so low. In addition, the local chamber of commerce promotes the clinics’ marketing campaigns abroad. Providers can get around 70% of their advertising expenditure reimbursed by the government.

Felix Hofmann, how did the transplant go?

It was a bit like a science fiction movie. We started on Saturday morning. I was standing in line with the other patients, all wearing bright surgical shirts. First someone shaved my hair, then I had to pay. Every work step was optimized, and everything went very quickly.

And then?

I was injected with a ketamine cocktail and felt dizzy all day. First, hair was removed from the back of my head, then it was inserted in the front. There were always three or four people working around me. It all took eight hours total.

Experts warn against «hair factories»

In the meantime, doctors in Switzerland and Germany frequently see men who were treated in Turkey and whose transplants failed. Patients report consultations via WhatsApp and doctors who were only in the background but had nothing to do with the treatment itself.

Experts are already warning against «hair factories,» providers for whom quantity is more important than quality. Because many grafts are transplanted, for many patients the new hairline is often completely fine, writes the Swiss Society for Hair Transplantation. However, there is a risk that too much donor hair could be removed.

This can lead to light patches at the back of the head and the depletion of potential hair reserves. Such reserves are important for any follow-up treatment.

Thinned back of the head, low hairline

On the internet one can find photos of botched treatments. They show thinning backs of heads, hairlines that protrude too far into the forehead and operating theaters in which several patients are treated at the same time.

There was also a similar case in Zurich. In the fall of 2022, a man was treated on Bahnhofstrasse by two female nurses who had come to Switzerland from Turkey via an agency. The customer had to be taken to hospital with his head covered in blood.

Mr. Hofmann, how did you feel after the treatment?

I had no pain, but I hardly slept for the first five nights. You can’t let the grafts stick anywhere, otherwise they could be torn out. So patients get a neck pillow and are only allowed to sleep sitting up. After 10 days, the swelling on my head had gone down, and after 14 days I was able to go out in public again. I had to regularly upload photos of myself to the clinic so that they could check that everything was healing well.

Are you satisfied with the result?

Yes, it turned out great, but everything took a while. When the hair follicles are removed, they receive a kind of shock. So the transplanted hair falls out shortly after the treatment. But that was only temporary. After two to three months it grew back. I felt really good after six months, when my hair was reasonably thick again.

However, the final result of a hair transplant only becomes apparent years later. In addition, natural hair loss continues in the untreated areas. Because the additional hair needed for a transplant is missing, it may then be too late for a follow-up treatment.

* Name changed.

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