The World’s Top 25 Hair Transplant Surgeons: 2021 Edition (by ApetoGentleman)

Men’s grooming blog ApetoGentleman have released their Top 25 Hair Transplant Surgeons list for 2021, and I’m very pleased and honored to announce that Spencer Stevenson, the writer of the list (more commonly known as Spex Hair) has considered me and our work to be amongst what he considers to be the Top 25 in the World. 

This came unexpectedly to me as I was not aware that he’d been following my work closely. So it was in fact a pleasant surprise. We did a quick video interview that we released last week, and now I wanted to write a bit more about it in the blog. I have been aware of Spencer for quite a while now. Whenever I had time, I listened and watched Spencer Kobren’s Bald Truth Blog as well as Spex Hair/Bald Truth UK little after I started working in this field. I was aware of his story, which unfortunately is similar to many that I’ve seen in my office over the years. He had his first hair transplant at the age of 24, with a terrible outcome, making him have to work over many years (around 15, if I’m not mistaken), learning, researching until he was able to find a good doctor, able to help him and finally set him on the right path.

I quite admire that he took what he learned and decided to share it with others, helping them find skilled and reputable surgeons, avoiding a similar fate as his.

Once again, I’m quite happy that my work has been of the high-quality and standards required to find its way into this list. I strive to be a better surgeon every day, and I do have an amazing team. People who work very hard and diligently every day. Together we produce amazing work, of which I am proud of. Thank you!

I’d also like to thank our patients. They are the ones who allow me to do what I love every day. And of course, I’d like to thank Spencer. For keeping aware of what goes on in this field, for helping others find solutions for their hair loss, for taking enough interest in my work to consider me for his list.

You can watch the video interview here

Why Travel For Surgery?

Ok, so the first challenge for me here is to write this without it ending up sounding like an infomercial. Because of course I really enjoy having patients come from all over the world and we do get business from them. So let’s just get that “disclaimer” out of the way.

We’re an international clinic. Patients contact us from all over the world, all the way from Australia and New Zealand (yep, literally the most distant civilization from where we’re located) to South Africa, to North America, to…well…next door. This is something I take pride in. Our philosophy revolves around very high quality of service and results, not volume. So we get to really spend time with patients and actually have the privilege of learning from other cultures and experiences while doing the work we love.

Porto (OPO) Airport. Photo by Xavier Sanz (flickr.com)

I firmly believe this is way better for the patient’s experience and result, since we really end up dedicating ourselves to one case at a time, thinking thoroughly about the strategy and performing the surgery without any sense of time constraints, stopping only at the closest we can possibly get to perfection. It’s nice to see patients relaxing and totally surrendering the outcome of their surgery to us. This is the highest level of trust there is and means a lot to me.

So, with this in mind, I know other people from around the world might want to benefit from this type of experience. They might really like the results we achieve and how we achieve them. They might resonate with our philosophy and way of doing things. Or they might simply trust me and my team as their best option to fulfill their desires of achieving the hair they want to have.

And we don’t take this lightly.

When someone takes the darn to actually get up and travel to a different country to get surgery with THAT doctor at THAT specific clinic, that means they care immensely about their result and went through the work of researching who could be the best option for them. There is of course a second type of person who travels for surgery, on the basis of price. These people are usually not as well informed, not as demanding with their results and are just looking for the cheapest way of getting surgery. They don’t compare doctors, they compare prices. I guess there is a market for that and rightly so. I just advise people to do their due-diligence and please keep your health and well-being a priority.

On our end we work continuously to make the experience as seamless as possible for the patients who choose to travel to us. And we’re still developing new ways and services to improve on this. Having better and closer patient support before, during and after. Creating ways for patients to always know what their next move is and not feel like they need to figure anything out, so that they’re always at ease and comfortable. Fortunately, Portugal is a very welcoming and friendly country. Actually, Portugal is the third most peaceful country in the world according to the Global Peace Index 2020 only topped by Iceland and New Zealand. The Portuguese have this habit of going out of their own way to help strangers and try to understand even languages they don’t speak. Most of the important signs are written in multiple languages and thus tourists find it very easy to navigate around here. We also have excellent weather year-round, which should not be a deciding factor for a hair transplant, but it’s nice to have and nice to know.

Global Peace Index 2020.

The beach where I sometimes go to relax or for a run after a long day of surgery.

Our clinic is located 5 minutes away from the beach which is also a pleasant way for patients to recover from their surgery or get ready for it, even if they can only look at it during their first post-operative days. Porto the city as also won the European Best Destination award 3 times and once again, while that should not be a deciding factor, it’s nice to know/have. And since some patients are very busy and may want to bring their family during the little free time they have during the year, their family get to enjoy the city while they’re in our company.

But this is 2020, and we’re now in the midst of a pandemic. Fortunately things have improved greatly since March, which was when we had to go into lockdown and suspend all our clinical and surgical activity. We were also very fortunate here in Portugal since we were hit much less seriously than other western-European countries and I’m very glad to say that, at the point of this writing, Porto hasn’t had a new case of COVID-19 in 6 days.

Porto, Portugal

Of course traveling is still restricted and it may take a while for things to get back to a resemblance of normal, but we’re getting there. We’ve also taken many different measures to ensure safety at the clinic and thus, things have been going rather smoothly.

I can’t wait for when we’ll be able to provide our new services to our patients, but in the meantime, we’re very happy with how things are progressing and patients as well.

But the pandemic was not the focus of this article. Actually, I started writing this long before there was even a SARS-CoV-2. So, in conclusion, traveling for surgery is like traveling for any specific thing someone may wish to do or see. It’s not located where they are and thus they must travel to obtain it. Our goal is to make as enjoyable, as easy and as comfortable as possible and we continually work on that.

Why I Divide My Bigger Cases into Multiple Sessions and Multiple Procedures

With the trend of the “mega session”, we’ve started seeing thousands of grafts being transplanted in a single session. 4000, 5000, 6000 (!) grafts being transplanted in a single day of surgery. That’s quite a feat! This means, in theory, that patients are able to restore their hair quicker and by spending less calendar time. But one question comes to mind when so many grafts are transplanted in a single session: how do the results compare?

There are a few variables to bear in mind when considering this.

Firstly, we have to consider the quality of the donor area. Is the donor area large and dense enough to withstand having 4000+ grafts extracted without damaging adjacent follicular units and/or being subject to excessive scarring, or even worse, necrosis?

And this is not just for one session VS two sessions. This is for one procedure versus multiple procedures. It’s better for healing and donor preservation to be gentle with the donor area. Not to risk over-harvesting and depletion. When we plan multiple procedures, we have a clearer view of the donor area and can achieve better homogenization.

We need to also consider the team. How big and experienced is the team. Fatigue is a real thing. We must consider this when planning a strategy for a hair transplant. A larger team will get less tired, but it’s harder and more expensive to gather a team within which all members are very experienced.

Still on the subject of fatigue, we must not forget that patients get tired too.There are only so many hours a patient can patiently (pun intended :)) withstand of surgery. When the patient starts to get impatient (I did it again :P), or worse, when complications arise (popping, bleeding, etc), you still have all theses grafts you’ve extracted to implant. And they absolutely have to be put back into the patient’s skin. Which makes us think of the next thing to bear in mind: Ex-vivo time.

Ex-vivo time, time grafts spend out of the body. The more grafts you extract, the longer the surgery is going to take, the longer those grafts are going to stay out of the body. After a certain amount of hours, survival starts to decrease. We must consider this as well.

When I’m performing surgery, my goal is to have the last graft extracted and implanted with the same quality and mindfulness as the first one. When we have more time to do the same work (and mind you, surgeries are still pretty intense) we tend to do better work. The team’s happier, the patient’s more relaxed, the whole experience is just much better and easier for everyone. And, of course: results are better!

That’s why I much prefer to divide surgeries larger than 2000-2500 grafts into 2 sessions. It gives us time to think, to double-check, to not rush, to have a chat and a laugh between ourselves and with the patient. I think it’s better to transplant 4000 grafts over 2 days and have 100% of those grafts survive than to transplant 5000 grafts in one day and have a fraction of those survive. It’s definitely not as profitable, but profit is not our priority. Results are.