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| A "consultation" at a hair transplant clinic usually means meeting with a salesman, instead of a doctor. Hair transplant clinics like to pretend that the role of the "consultant" is to "educate" potential clients, but they are often nothing more than salesmen. They often dress in white lab coats or surgical garb, to appear as if they had medical training. "Consultants" routinely break the law by "playing doctor": examining patients, making medical diagnoses, prescribing surgical treatments, and scheduling surgery without the patient even meeting an actual physician first. This is the illegal practice of medicine without a license. Many clinics have sales quotas or targets that need to be met every month or every quarter. Some consultants earn a commisssion or bonus for every new patient they sign up. Consultants are under pressure to sell as many surgeries as possible, because otherwise they can lose their job. That prompts consultants to "oversell" the surgery to people who may be better off without a hair transplant. Consultants routinely mislead patients about the results they can expect from hair transplant surgery. Bosley Medical (the worlds' largest chain of clinics) has been fined for using airbrushed "after" photos in consultations. Potential patients were shown photos of models who had never had any hair transplant surgery, and told that these models were former Bosley patients. A common sales ploy is "lowballing" which is deliberately underestimating the costs or amount of surgery that the client will need, in order to make the sale. Humiliation is used to pressure people into surgery... For example, saying things like "Wow, you are really losing your hair!" or handing the client a mirror and asking him to "Point out all the areas where you'd like more hair". I pull several quotes from Dr. O'Tar Norwood's 1973 medical textbook "Hair Transplant Surgery", in order to contrast the "conventional wisdom" in his textbook against the misconduct of the Cleveland Hair Clinic. Click here to read why I chose to quote from this textbook, when I could have easily made the exact same points by quoting from a contemporary medical text. My "consultation" was at the Cleveland Hair Clinic (CHC), in Rosemont, Illinois. Dr. Carlos Puig was the main surgeon for this branch of the CHC chain, as well as the Medical Director and business partner for the entire franchise. Dick Malmin was the "consultant". At the time of my first consultation, I was 20 years old, and knew nothing about how hair transplants worked. I was just there to "check it out" because I recently had some minor thinning in the crown area. Dick Malmin has had a 30 year career selling awful-looking hair transplants, by saying whatever it takes to make a sale. For example, Dick promised me that if I got a hair transplant, it would be "undetectable" and "customized", which were both completely untrue. I mistakenly assumed that a surgical clinic would not try to take advantage of me, and that any medical practice that wasn't 100% legitimate would be quickly shut down. I didn't realize that the hair transplant industry is completely unregulated. I trusted the clinic because I trusted medical doctors in general. "The goal of the interview (consultation) is twofold. One, the patient should be given the facts about the procedure in as clear, concise, and simple a manner as possible. Two, depending on the results of the examination and interview, a good candidate should be advised that the procedure would probably be successful, and a poor candidate should be discouraged from starting the procedure" I didn't know what "hard questions" to ask, and my "consultant" offered me no clues about what the drawbacks and negatives would be. I now understand that I was not a good candidate for surgery, according to the established medical knowledge of that time. But instead of turning me away, Dick Malmin urged me to "take control of your hair loss" and overhyped the surgery with false statements. The clinic cared more about making a sale than they cared about my well-being. A few weeks later I underwent my first surgery.
Like many people, when I went to my consultation I had some basic misconceptions about what a hair transplant was, and what a hair transplant could do. Instead of clearing up those misconceptions, the clinic used them as leverage to make a sale. I was mainly concerned that a hair transplant would look unnatural or obvious. I had seen a few hair transplants and they had looked pretty obvious to me. I asked if it was possible for me to get a hair transplant that "didn't look like a hair transplant", and Dick Malmin promised me that would be exactly what I would get. He told me that hair transplants from Cleveland Hair Clinic were "undetectible" and that I had probably seen some of their work already and not realized that it was a hair transplant. He exaggerated the results I could expect, to make the sale. "Prior to surgery, patients should be aware that hairlines rarely appear entirely normal, and especially patients with dark hair and light skin will have an abrupt, tufted hairline." "Because it is impossible to predict final results, it is particularly important during the initial interview to emphasize the fact that even with ideal candidates, transplanted hair is usually not as dense or thick as original hair. If the patient realizes this prior to beginning the procedure and does not expect miracles, he is much more apt to be satisfied with the final results. If he is expecting too much from the procedure, he is going to be disappointed even with a good result." My "consultant" LIED TO ME when he told me that their crude plug-graft transplant would be "undetectible"! Instead, what I got was a horrible DOLLS HAIR transplant.
Dick Malmin "lowballed" me when he told me that 300 grafts (3 sessions of 100 grafts), would be all I need. Because I trusted medical practices and because I didn't understand hair transplants , I believed him. However his estimate was deliberately low, which makes the process seem easier and more affordable, in order to help make the sale. Keep in mind we are talking about full-size plug grafts, and not modern Follicular Unit grafts. Look at this diagram from Dr. Orentreich dated 1971, which describes how "four procedures are necessary to completely fill even the smallest area":  "If grafting is to be extensive, as many as ten or more sessions may be required." "The more grafts that are done the better the result, so it is better to overestimate the number of grafts that will be required." "In discussing the number of grafts that will be required with patients prior to surgery, the author prefers to overestimate rather than underestimate. Patients after having been given an approximate number seldom agree to get more grafts even if they are needed." "After the initial four procedures, it will appear that there is no more room for grafts. At about six months to a year, when the hair is grown, it will be apparent that many areas will tolerate considerable (sic) more grafting." In his 1973 textbook, Dr. Norwood states that a patient with Level 4 baldness would require 500 full-size grafts, and warns that the grafts should be saved for "areas they will do the most good". At least 500 grafts would be necessary for a Level 5 just to get a "minimal coverage". Level 6 patients will need at least 500 grafts and these patients are considered poor or marginal candidates for surgery. And Dr. Norwood said that Level 7 patients should probably not be grafted at all, because they will usually not get good results. (p48).  When you look at my Results page, you can see that Dr. Puig spread my grafts over a large area, which is contray to standard procedure. The actual surgical approach that Dr. Puig took does not jibe with the low graft estimate from Dick Malmin, and is clear evidence that I was lowballed by the clinic. Instead of giving me a realistic estimate or telling me that I wasn't actually a good candidate for a hair transplant, I was "lowballed" in order to make a sale.
I was NOT a "good candidate" for the surgery, according to the established medical knowledge of that time, and I should have been turned away. Instead, the Cleveland Hair Clinic sank their fangs into me. "Previous reports do not emphasize the importance of proper patient selection. Consistently good results are obtained only by strict screening of potential candidates. Because of the utter simplicity of the procedure it is easy for the beginning hair transplant surgeon to carry out the procedure with good and proper technique and wonder why he is dissapointed six months later with the results. More often than not, it is because he started with a poor candidate. The importance of being conservative and cautious cannot be overemphasized. Most patients are not ideal candidates, many will have one or two compromising features, but there may be enough good features to offset the poor ones. Some cases will be plainly marginal in all respects, but with careful planning a good result might be expected. The best advice for the beginning surgeon is to reject all doubtful cases."
"Frequently young men in the late teens or early twenties who are just losing enough hair to have an adult male hairline inquire about and request hair transplant surgery. Individuals at this age should be screened very carefully for a number of reasons..."
"Family history is probably most helpful in the young man who is just beginning to lose his hair and examination affords no clue as to what extent the alopecia might eventually attain. Grafting should not be started in someone who may never need them and by the same token, it should be avoided in subjects who could conceivably eventually become a Type VII. (*fully bald) Chapter 2: "Interview" p.24
"Pattern and Extent of Alopecia" If you look at my "Results" page, you will see that Dr. Puig placed the grafts over a very large area, which shows that he anticipated I would have extensive hair loss; this would contradict the conventional wisdom of the time, that patients with extensive hair loss should not be transplanted. Unlike Dr. Puig's advertising, hair transplants did not actually "put an end to receeding hair lines". My father was fully bald by age 21, and I walked into Dr. Puig's clinic at age 20 in the beginning stages of a diffuse pattern of hair loss,indicating that I was quite likely to become fully bald. Hamilton documented the progressive nature of hair loss in 1951, and Norwood's studies in the early 1970s reinforced the medical understanding that hair loss is progressive. According to Dr. Norwood's guidelines suggested in his 1973 textbook, I was not a good candidate for a hair transplant. But I was urged into the surgery by Dick Malmin. Dr. Puig himself spent only a minute or two with me before the surgery, and in those few moments we didn't talk about family history or anything like that, he had an attitude of "let's get started". I trusted Dr. Puig - a BIG MISTAKE.
"Hair transplants in diffuse patterned androgenic alopecia and diffuse unpatterned androgenic alopecia take and produce viable hairs in both men and women but have not been very satisfying in the author's experience. The transplanted hair is similar to that in the more common patterned types of androgenic alopecia, but the surgery causes a temporary and possibly permanent loss of existing hair in the recipient areas. This decrease in density of existing hair is apparently the result of the shock of surgery similar to that which occurs in the transplanted hair. The difference, however, is that the hair does not completely regrow. Apparently the surgery causes the hair to go into a premature permanent telogen stage.
This was known as the "Open Donor" method of harvesting grafts. It is shocking to most people, but for over 30 years, hair transplant surgeons used a large punch to "harvest" tissue grafts from the back of a patient's scalp, and deliberately would not suture up the resulting HOLES in the patient's scalp.These were not simply "surface cuts" but went deep, 4 or 5 millimeters in diameter (and approximately 5 millimeters deep) through the dermis and epidermis to the fatty layers below. The patient was wrapped in bandages and sent home while oozing blood from dozens of gaping bloody holes in his scalp. This crude approach results in MASSIVE SCARRING. I was promised that these wounds would "close up" on their own and be "undetectible", which was a BLATANT LIE. For over thirty five years, OPEN DONOR was the predominant hair transplant technique, even though doctors knew that patients were being mutilated. See the section of this website called "A Punch Graft Procedure" to see just how crude this technique actually is.  As you can plainly see by looking at these scars, open-donor sites do NOT "shrink" OR "disappear". That claim is a LIE. ALMOST NOBODY WOULD HAVE PAID FOR THIS CRUDE SURGERY, IF CLINICS TOLD THE TRUTH ABOUT OPEN DONOR HARVESTING. The only way to create a high turnover of patients and maximize profits was by LYING TO PATIENTS.
I show four different examples of "educational material" in the FALSE ADS sections of this website. The word "SCAR" is NEVER MENTIONED in any of these "educational" materials. "Following multiple procedures, the top of the scalp will become numb due to denervation." de-ner-vate tr.v. Medicine
"Variation in Transplanted Hair's Color, Texture and Type" New hair, when it first appears, very often is coarser and more curly than it was in its original site. Sometimes it is almost kinky and difficult to manage. A certain amount of this change in texture may be permanent.
Many patients have serious swelling post-surgery. "Cosmetic Disability" When patients are not told the truth about issues like open donor scarring and permanent loss of sensation in the scalp, they are prevented from making an INFORMED DECISION about a life-altering cosmetic surgery.
Illegal sales practices are common in the hair transplant industry. It is illegal for a salesman to make medical diagnoses. It is illegal for a salesman to recommend surgical procedures to patients. It is illegal for a salesman to schedule a surgery, before the patient has been evaluated by an actual physcian. Yet many hair transplant clinics hire salesmen, with no actual medical training, to perform the specific functions that are the sole responsibility of a trained physician.
I never met a doctor at the clinic, until the day of surgery, when I met Dr. Puig just a few scant minutes before he began operating on me.
He told me I had "unrealistic expectations" about what a hair transplant could do. The ironic thing is that it was Dick Malmin himself who had created all of those "unrealistic expectations", during my consultation. When I complained that my results were not what I had been promised, Dick Malmin told me that I should schedule some additional surgeries, and that I should use hair spray to tack down my hair in a "combover". Of course Dick never mentioned hairspray, combovers, or "realistic expectations" when he was selling me on a hair transplant in the first place. These things were only brought up afterwards, as a way to dismiss my complaints. Pictured below: Dick Malmin circa 1997, a professional "Consultant" for the "Cleveland Hair Clinic" aka "Puig Medical Group". In my opinion, Dick Malmin's ability to lie to people is the key to his 30-year career as a "consultant". Keep Reading:
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