November 11, 2026 | Hair Restoration, Hair Transplant
Today, November 11, is World Hair Transplant Repair Day. It is the sixth one. The International Society of Hair Restoration Surgery started it because its members kept seeing the same patient: someone who paid for a transplant at a clinic where no physician ever touched the scalp, and came home with a hairline that sits too low, a donor area harvested to the point of patchiness, or a scar nobody warned them about.
I am a member of the ISHRS, and the numbers in this year’s release are the reason I am writing this instead of something else tonight. In the society’s 2025 practice census, 59 percent of surveyed members said black-market clinics operate in their city, up from 51 percent in 2021. An average of 10 percent of the repair cases those members did in 2024 followed a black-market transplant, up from 6 percent three years earlier. About 100 volunteer physicians around the world offer a pro bono corrective procedure on this day; patients sign up at HairTransplantRepairDay.org.
So here is what I tell patients in my own exam room: how to tell a licensed practice from a clinic that is dressed up as one, and what a repair involves when the first operation went wrong.
What “Black Market” Means
The ISHRS definition is blunt. These are clinics where unregulated people are illegally performing surgery that should only be done by a trained physician, under the false pretense of a legal, physician-performed medical establishment. The lure is a steep discount and photos of results that may not be theirs.
Technicians are not the problem by themselves. Trained technicians handle grafts in every good hair practice, mine included. From a consult with a man who wanted a small FUE case:
“We do a minimum of a thousand grafts at a time, just because I bring the techs in from out of town, but that will fill in pretty nice.”
The problem is when there is no surgeon at all. Nobody examined you, nobody designed the hairline, nobody chose between strip and FUE for your hair and your haircut, and nobody is answerable when it heals badly. I said as much to Men’s Fitness last month, in a piece on transplants for men over 50: a price that is far too cheap often means a technician is operating.
Five Questions That Separate a Practice From a Clinic
Who did my consultation? In my practice, I do. The conversation that decides the plan is the one where I look at your donor hair and your haircut:
“So when people wear the hair short on the back, that’s where we get the hair from. So those are the follicles that we use to fill in the front. So one way to take them from the back is doing the FUE, which is the one by one, the neograft. We take them one by one, it heals in, and you don’t see any scars. The other one is doing a strip where I actually cut like a sliver of hair follicles or scalp, but it does leave a scar. So if you wear your hair short, you would see that long scar.”
If the person who sold you the package is not the person who will be in the room, ask why.
Who designed the hairline? A hairline is drawn by a surgeon who has watched hairlines age. A wish photo is a starting point, not a template:
“I got your wish picture, which creates a very tight straight hairline. So there is a lot of area we have to fill in to create that. But it is definitely doable.”
A hairline placed too low or drawn too straight on a 25-year-old becomes the repair I see at 40.
What does the donor area allow? The number of grafts is a function of your donor hair, not of what you are willing to pay. From the same consults:
“With the FUE, we can do maximum twenty-five hundred, sometimes twenty-eight hundred follicles.”
“Three thousand’s the limit, because more than that we really can’t get out of one strip.”
A clinic that promises 5,000 grafts in a day from an average donor area is going to over-harvest it. That is the repair with the fewest good options, because the hair that was taken does not grow back.
Whose name is on the consent, and whose license? The ISHRS advice is to check the physician’s credentials with the local medical licensing authority. Mine are easy to check: the American Board of Plastic Surgery, the Texas Medical Board, and the ISHRS member directory.
Who sees you at a year? The result is not visible for a long time, and a practice has to still be there when it is:
“Remember the hair does take four to six months to start growing. So at six months we’re only like fifty percent of the results. At a full year, year and a half is when we have a hundred percent of all the hairs are growing.”
The ISHRS puts it as a lifetime relationship, not a one-day transaction. A clinic that disappears after the deposit clears cannot see you at a year.
What a Repair Involves
Repairs fall into a few patterns, and each has a different answer.
Not enough density, or a hairline that stops short. The easiest repair, and sometimes it is not a repair at all but a planned second session. Two years after a strip transplant, one of my own patients told me the front still looked thin to him:
“We can definitely put some in between here and the front to get your hairline stronger, and then in between here and the forelock, and then we can start moving here toward the back and give you more density. I think that’s very doable. It looks good, but you can see that there’s a little bit of distance between them, because that’s the way we have to do it. So now we can go in between.”
A pluggy or unnatural front. Older or careless work put grafts in rows or in large clusters. The fix is to remove the worst of them, re-divide the follicular units under magnification, and re-place them with single hairs at the front edge, then add density behind. It usually takes more than one session.
A low or too-straight hairline. The grafts at the lowest edge come out; some can be reused higher. Laser removal of the stragglers is an option when there are few of them. This repair is about restraint; the temptation is to fill everything.
A scarred or over-harvested donor area. Strip scars can be revised, and hair can be grafted into a widened scar to soften it, which is the same trick I use for other facial scars:
“The absolute best way to hide that scar is to actually take some hairs from the back and transplant them in front of the scar so it hides it.”
An over-harvested FUE donor area is harder. Beard or body hair can sometimes be used as a secondary source; sometimes the honest answer is that the donor supply is spent and the plan is medical, not surgical.
Scar tissue in the recipient area, and thin surviving hair. This is where the growth factors earn their place. From a consult with a woman whose temples had scarred from years of tight ponytails:
“Here the exosomes would also help you a lot, and you can even do them before the transplant, because it helps the hair you still have get thicker and grow faster. So that also helps a lot, because you have density, obviously you have the scar, but the hair is very fine. So that improves the quality of the hair.”
In my transplants I inject PRP with the grafts for the same reason:
“We do use PRP, which means we draw a little bit of your blood and get the platelets, and we inject that into the area so that the hairs grow faster with the growth factors, and we get that really high take.”
When a repair is not possible. If the donor area is gone and the scalp is scarred, a transplant cannot help, and I say so. Scalp micropigmentation, a hair system, or medication to protect what remains are honest answers. A transplant moves hair; it does not make new hair.
The Short Version
| Ask | A licensed practice | A black-market clinic |
|---|---|---|
| Who examined me? | The surgeon, in person or on video | A salesperson or a form |
| Who designs the hairline? | The surgeon | Whoever is in the room that day |
| How many grafts? | What your donor area allows, 1,000 minimum, about 2,500 to 3,000 maximum per session in my hands | Whatever you will pay for |
| Whose license? | Checkable with the state medical board and the ISHRS | None you can find |
| Who sees me at a year? | The same surgeon | Nobody |
Why Choose Dr. Agullo
I am certified by the American Board of Plastic Surgery and the American Board of Surgery, completed my plastic surgery fellowship at the Mayo Clinic, and serve as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly has listed me as a Top Doctor every year from 2014 through 2026. I am a member of the International Society of Hair Restoration Surgery, and I have had a hair transplant myself, by strip, which is why I can tell you from both sides of the table what the scar looks like and what a year of waiting feels like. The strip versus FUE decision is covered in my FUE questions post, and the procedure is on my hair transplant page. My commentary on the black-market numbers is on Dr. WorldWide, and the practice’s version, with the PRP and exosome side of a repair, is on Southwest Plastic Surgery.
Ready to Talk?
If a transplant somewhere else did not heal the way you were promised, bring photos from before it and your operative record if you have one. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
