Note From the Author: This article was originally written at the request of the editors of The Hair Transplant Forum International. Upon submission, to meet the Forum’s editorial agenda, I was asked to simplify the language. They expressed to me that they do not think their membership would fully grasp the editorial nor are fully prepared to read the truth as exposed in this piece. Conceding and adjusting the editorial to satisfy their desires would have been a grave disservice to the ISHRS’s membership who desperately need to hear the truth…before it’s too late. I hope you read it with an open mind and for what it really is: a call to action to save the hair transplant industry before it becomes completely beyond repair.

This article was originally posted in FUE Magazine Issue #2 release.

There is little room for the medical society’s conformance-obsessed culture in the commoditized hair transplant field of the 21st century. If an organization or business is going to outplay the future, it must have the freedom to bend outdated, self-imposed rules and circumvent the channels that have historically hindered progress. Let the past and the bureaucracy die with grace. It’s time to roll up our sleeves and get to work. Your careers and thousands of vulnerable consumers depend on it.

In June 2010, I recorded a two-part interview with Alan Bauman, M.D. after he released a NeoGraft device warning meant to educate both consumers and physicians. Our discussion centered around the future of the industry, as well as the distinct dangers associated with the perceived apathy of many physicians in the field concerning impending catastrophic events which I accurately predicted would lead, if not immediately addressed, to the inability of preserving any true, global standard of care for the hair transplant profession.

After the interview aired, an ISHRS officer reached out to discuss the potential dangers to both patients and the field, wondering how ISHRS and its membership could better control NeoGraft’s questionable message and marketing to protect consumers and help legitimate hair transplant surgeons from dealing with the infiltration of unqualified, unskilled, and/or unlicensed part-time hair transplant practitioners.

I explained that NeoGraft was not ISHRS’s nemesis; apathy was the enemy.

A simple, collective plan was the solution to secure the future of the hair transplant industry and incomes of its real surgeons. This plan would have simultaneously hindered current and future device makers from operating counterintuitively to consumer safety and the betterment of the field.

A well-defined problem almost always has a straightforward and sometimes obvious solution. However, if you can’t accurately define the problem or admit that the real problem might lie within your own ranks, then you risk chasing the wrong solution or, in this case, doing practically nothing. After years of inaction, the ISHRS eventually attempted to rectify the problem, but the horse was already out of the barn.

Many at the ISHRS and/or the ABHRS hold the false belief that to effectively and “legally” operate as a non-profit, professional organization, they must work within the pyramid of a manufactured structure.

In 2010, the “problem” was barely in its infancy, and as I explained to an ISHRS officer who reached out to me, the solution was relatively simple and practically effortless. Unfortunately, well-intentioned people who simply lacked the needed foresight made an inexplicable error in judgment. While unintentional, the impact of that decision to not take action, against my strong advice, and instead watch from the sidelines, has had profound economic and personal effects on many physicians and countless, vulnerable consumers.

I believe bureaucracies can be valuable, such as when organizing a large conference or educational grant. However, to enforce and protect ethical behavior, truth in advertising, and/ or the integrity of a profession, you need crisp decision-making, fearless flexibility, and the right skill sets to get the job done. Having spent more than 20 years in the field, I believe utilizing a blueprint of bureaucracy is ineffective.

I’ve been an entrepreneur my entire adult life. At age 19, I drew my first paycheck as an employee of my company, while in my dorm at Penn State University. It was 1984, and that first paycheck was more than my father was earning in 3 months working 60 plus hours a week. At 19, holding that check, I quickly learned the value of “opportunity cost” decision-making.

With that check as proof of concept, I made the decision to ignore conventional wisdom and to tell my parents college wasn’t in the cards for me. My parents were extremely disappointed. Yet the opportunity cost (trade off) of staying in college to eventually work for someone else didn’t hold enough value to me compared to the potential of having complete control and ownership of my ideas and, perhaps even more importantly, my time.

Two years later, my parents courageously acknowledged they should have been more supportive of my decision and apologized for doubting my instincts. They taught me the invaluable lesson of humility. They looked outside of themselves and their staunch belief system to recognize there might be a different way of doing things—perhaps a better way. Admitting to me that they were wrong wasn’t a sign of their failure or weakness, but was a sign of strength.

French-American diarist and novelist, Anais Nin described inflexible core beliefs perfectly:

“We don’t see things as they are, we see things as we are.”

The commoditization of this industry is not a recent phenomenon. As soon the first print ad was placed and the no-obligation, free consultation was born, the tone was set for the field. Consumers were sold the notion that hair transplantation is a simple, outpatient procedure that was as easy as a visit to the dentist. This paved the way for what we are facing today.

No amount of hard work or smarts is of any help to a person or group who focuses on the wrong problem(s). Bob Haber wrote in the last issue of the Forum:

“Once open, Pandora’s Box cannot be closed. What battles do we fight, what alliances do we form, to successfully protect the field of hair restoration from these threats?”


While I agree with the honorable attempt to pass legislation to eliminate the ability for technicians to perform any surgical aspects of hair transplant procedures, this effort has only caused device manufacturers to shift gears. The reality is, considering the rules of opportunity cost, almost every decision the ISHRS makes has a potentially more beneficial alternative. In this case, the effort will have little-to-no impact or value for the ISHRS’s bottom line or to the safety of the consumer. Bob Haber noted: “Any NP or PA can now or soon will be able to open a hair transplant practice without supervision. Violating no laws at all.” He is correct. While attempting to extinguish one fire, another less controllable blaze rapidly ignited, giving qualified physicians even less time to regroup and consider how to best compete in this new environment. Sometimes, the fastest way to lose control is to try to control everything.

The ISHRS must no longer be blinded by their own vulnerabilities. The assumptions from which the organization has been built and is being run no longer fits reality. To continue to view your size and history as an impenetrable, well-utilized asset is simply unrealistic. But that can change.

Leaders and administrators who have greater self-awareness and understanding of how to evolve their collective, outdated belief systems are not afraid to give something up— even perceived power, status, or position to practice opportunity cost in order to create greater benefit and value for their businesses, organizations, and those affected by their decisions. The future of the hair transplant field depends on those who have such awareness and humility.

It is our job, as pillars of the ethical hair transplant industry, to collectively create enough consumer awareness so potential patients recognize and honor the unique skill set necessary to perform these surgical procedures. Consumers must fully understand that if a physician is untrained, unskilled, and not 100% involved in all surgical aspects of the hair transplant process, that their hair transplant results can at best be sub par or, even worse, disfiguring or possibly deadly.

Bottom line: The ISHRS is currently fighting a battle without the weapons to win. Unless you are willing to make sweeping, comprehensive, unified changes to correct the trajectory of the field, you will continue to play a game of Whac-A-Mole. Those truly interested in saving this field must face the fact that any change that doesn’t directly address the architectural rigidities and ideological prejudices—of which many in the field refuse to let go, despite knowing they no longer serve you—will only continue to erode your power and ability to properly and successfully compete in the marketplace and practice your profession.

The ISHRS can’t “hire” this away. Against this crumbling backdrop, the only way the society and its membership can ensure it controls its own future is to never again allow crisis to set your agenda and to practice opportunity cost by recognizing the importance of gaining sustained control and influence. You must be willing to let go and trust the process. Nothing is as constant as change.

Everyone has to have skin in the game to make the industry what it should be. The ISHRS has to be willing to share its space and create meaningful alliances with organizations and people who can get the job done. This can be done relatively easily at this point, but you cannot do it alone.

Teamwork is essential. Instead of trying to insulate the ISHRS, you need to grow into the changing environment and embrace those around you.

But it’s not just about ISHRS. I’m not here to point fingers. It’s also time for me to evolve. Part of my evolution may be to better promote the strengths of the ISHRS. I’ll do whatever it takes to help consumers receive the best care possible and to ensure this extremely elegant, and nuanced discipline of cosmetic surgery is no longer simply considered a commodity. That’s what I’m most passionate about. I’m open to change, and I hope I can implore everyone at the ISHRS to also be.

Every person, including myself, must take a step back and re-examine how we have been operating our organizations.

We must combine forces so we can thoroughly and effectively educate the consumer about the real dangers they are facing in the hair transplant industry’s “new normal.” This is both seen at cut-rate, turn-key hair transplant mills popping up practically on a daily basis as well as in the flourishing cosmetic surgery tourism sector that is now a dominating presence. With the ISHRS’s strength in numbers and with the reach of organizations and resources such as mine, we could turn this ship around. You have a platform to properly educate doctors. My resources have the infrastructure, visibility, and mainstream credibility to pound the internet with content to properly educate consumers. But it will take your numbers to create the continuity of message so together we can reset the narrative that will save this field, your practices, and countless thousands of hair transplant patients.

It’s time to refocus. It’s time to let go. It’s time to unite.

Hair Transplant United


Spencer David Kobren is the author of the groundbreaking international best seller The Bald Truth: The First Complete Guide to Preventing and Treating Hair Loss (Pocket Books/Simon & Schuster) and The Truth About Women’s Hair Loss: What Really Works for Treating and Preventing Thinning Hair (Contemporary Books/ McGraw-Hill). Spencer is a contributing editor for Consumer’s Digest Magazine and WebMD as well as the Founder and Director of Consumer/Patient Affairs of The International Alliance of Hair Restoration Surgeons and the Founder of The American Hair Loss Association. Now in its 20th year, Spencer Kobren’s The Bald Truth First aired on 77WABC radio in New York City and was soon nationally syndicated through WestwoodOne Radio Networks. “The Bald Truth” is currently one of the most listened to and watched live, call-in internet broadcasts on the web.


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