Expert guide: Cosmetic & Plastic Surgery 2015 14 June 2015 June 2015 15 come measures although members do have to sign a Code of Conduct agreeing to abide by the Associa-tion’s Professional Standards for eth-ical behaviour and advertising prac-tices.A cursory internet search will reveal many hair transplant clinic web-sites where the doctor’s name is not shown. This is because these clin-ics are run as businesses by non-hair transplant surgeons, who employ doctors to perform the surgery. Of-ten these doctors are from overseas and are licensed to work in the UK, but do not necessarily have con-trol, or even input, into the running of the clinic and are employed on a freelance basis.Picture Caption #3: ARTAS Robot donor harvesting with patient lying face down and the doctor controlling the robot making incisions Consultation Many clinics offer an initial consul-tation with an advisor but it should be made clear from the onset who the supervising doctor in charge of the patient’s care is. ‘Before and af-ter’ pictures on websites can be very misleading depending on lighting and angulation, so patients should be given realistic expectations that are not based on sales tactics. If the patient has initially met with an ad-visor, then this should be followed up with a consultation with the Hair Transplant Surgeon and there should be a ‘cooling off’ period prior to the surgery being booked. Doctors or clinics who are overly aggressive with follow up calls aimed at convincing a patient to have surgery should be regarded with suspicion, as should those who try to discredit other doc-tors or organisations. Most reputa-ble clinics will have patients avail-able who have had surgery and are willing to talk to or meet with those considering a procedure with the same doctor.Cost In any ‘market’ there will be a range of costs but patients should beware united kingdom of doctors offering surgical fees that are well below the average; espe-cially those offered on Groupon or similar sites. Financial inducements and discounts are against the recom-mendations of The Royal College of Surgeons6 and the Department of Health’s Review of the Regulation of Cosmetic Interventions7. Cheap surgery abroad may seem like an at-tractive option but, whilst general costs of providing surgery may be cheaper in some countries than in the UK, this is often accompanied by less stringent regulations on facili-ties such as those by the Care Qual-ity Commission (CQC). There are numerous overseas clinics that offer ‘consultations’ in the UK (although these may or may not be with a doc-tor) but who perform the actual sur-gery in another country. This may have implications for follow up and redress if the patient develops com-plications or is dissatisfied with the outcome, especially as genetic hair loss is usually an on-going process and hair restoration may require re-peated procedures over time.Picture Caption #4: Hair Transplant Surgical Assistants (non-doctors), who routinely place Follicular Unit Grafts into incisions made by a doc-tor, working behind the patient’s head.Surgery On the day of surgery, patients may be anxious for a number of reasons and if there are several staff in at-tendance, they may feel reluctant to ask who is who or be intimidated by the experience. When dressed in scrubs, doctors, nurses and non-qualified staff may all look the same. It is likely that patients will be given some form of sedation, either oral or intravenous, and, with the major-ity of the work being done on the back of the head or from behind, and sometimes with the patient ly-ing face down, it is easy to see why a patient may not have any idea who is actually doing the work. The detail of who is legally allowed to perform the various steps in a hair transplant procedure in the UK is not clear, but the BAHRS only endorses doctors