While hair transplant surgery is a highly sophisticated and extremely elegant subspecialty of cosmetic surgery, most patients are surprised to learn that becoming a hair transplant surgeon does not require an actual surgical residency or any form of postgraduate training. Most people assume all surgeons have completed accredited surgical residency programs after graduating from medical school and carefully trained in at least 1 of the 14 surgical specialties the American College of Surgeons recognizes. However, shockingly, when it comes to hair transplant surgery, this is typically not reality.
Of course, a handful of board certified general and plastic surgeons practice hair transplant surgery exclusively. But their accreditations are not required nor status quo. In fact, their surgical training is barely relevant since accredited surgical residency programs do not offer any hair transplant surgical training and the ACGME (Accreditation Council for Graduate Medical Training Education) does not recognize fellowship programs for physicians interested in practicing this very specialized discipline of aesthetic surgery.
How is this possible?
Legally, in the US and in some other countries, a physician's license to practice medicine is unrestricted, meaning that any physician—M.D. or D.O.—can essentially perform any medical action, including surgery, without any specific surgical training as long as the patient consents. Just because physicians legally perform surgery in no way qualifies them to be surgeons.
With that said, an elite subset of physicians are practicing hair transplant surgery from various medical specialties, including family medicine, internal medicine, dermatology, otolaryngology (ENT), emergency medicine, and urology. These physicians have dedicated their lives to the art and science of hair transplant surgery, taking it upon themselves to do independent, intensive postgraduate training, which sometimes includes preternships. Preternships are usually relatively low-paying, private internships that place physicians in the operating room with experienced hair transplant surgeons who teach their craft. It’s intensive, on-the-job training in a private practice setting that may last a year or longer. Physicians may also take independent courses to gain the knowledge needed to successfully work alongside experienced hair transplant surgeons and eventually perform hair transplant surgeries independently.
Prospective patients must fully understand the true qualifications of every physician offering hair transplant surgery and not allow credentials to confuse them. While a surgeon’s credentials may seem impressive, patients must know exactly what these credentials represent.
This list provides a detailed explanation of possible credentials, education, and affiliations those in the field of hair transplant surgery may cite.
Board Certification: The American Board of Hair Restoration Surgery (ABHRS)
Currently, the American Board of Medical Specialties (ABMS) has no certification process nor an approved medical specialty board sanctioned for the specialty of hair transplant surgery. The ABMS is an organization of 24 approved medical specialty boards, of which the American Board of Hair Restoration Surgery is not part. The intent of the certification of physicians is to provide assurance to the public that those the ABMS Member Board certified have successfully completed approved training programs and evaluation processes that assess the physicians’ abilities to provide quality patient care in the specialty. Since the ABHRS is a self-designated board with no ACGME residency requirements for hair transplant surgery, it does not meet the basic standards the ABMS requires to ensure physician competency.
In the U.S,11 states have incorporated advertising regulations or resolutions stating only physicians who achieve ABMS or AOA (American Osteopathic Association) certification may use the term “board certified” in their advertising, including but not limited to all digital media, websites, and signatures.
If a physician claims to be board certified in hair transplant surgery or certified by the American Board of Hair Restoration Surgery (ABHRS), he or she is not certified in the traditional sense and may be in violation of state policy. Check with your individual state. For this reason, the American Board of Hair Restoration Surgery has implemented a strict advertising policy to ensure consumers are not misled by possible false claims; all members of the ABHRS must sign and adhere to this standard that states they will advertise themselves as being a “Diplomate” of the ABHRS as opposed to being “Board Certified” in hair transplant surgery.
In saying this, the American Hair Loss Association recognizes the ABHRS requires its Diplomates to not only pass a comprehensive written and oral examination covering a wide scope of the specialty but also demonstrate evidence of their hair transplant training and post-training experience. While this process does not ensure surgical or aesthetic competence, it does indicate a physician’s dedication to the specialty.
Fellowship Trained: Most fellowship programs provide bare minimum training in this field; in fact, most programs are merely used for promotional purposes for the group or practice providing "fellowships." Also be aware that most groups do not currently teach state-of-the-art hair transplantation techniques.
The American Hair Loss Association recognizes a very small handful of surgeons underwent fellowships/preternships with truly skilled, ethical physicians and practices. However, this is not commonplace.
The American Hair Loss Council: Nonsurgical hair replacement business owners founded this nonprofit trade organization. The hair loss consumer should not look to the AHLC as an educational resource since membership or a board position constitutes no professional qualifications specific to this field.
The information the AHLC provides the public is remarkably outdated and can be dangerous in some instances, and is not affiliated with the American Hair Loss Association. We recommend avoiding the AHLC when researching medical treatment for hair loss.
The International Alliance of Hair Restoration Surgeons: The IAHRS is a consumer organization that selectively screens skilled and ethical hair transplant surgeons. The IAHRS does not offer an open membership policy to doctors practicing hair transplantation, and is the only group that openly recognizes all surgeons are not equal in skill and technique. In 2001 the IAHRS became the first hair transplant society to implement a minimal case requirement to apply for membership. While there is no application fee required, a 500-minimum case log is the first criteria in the application process that ensures applicants have extensive “time on tissue” and clinical experience.
Since the IAHRS is a patient-centric society its elite membership seeks to represent the best in the discipline, the true leaders in the field of surgical hair restoration. The IAHRS's goal is to provide a safe place for prospective patients to research a surgeon based on skill and not on his/her ability to buy public opinion through advertising.
The American Hair Loss Association recognizes IAHRS membership as an elite credential in this field.
International Society of Hair Restoration Surgery: The ISHRS is a nonprofit voluntary organization of more than 1,000 hair transplant doctors. The ISHRS provides continuing education to physicians specializing in hair transplant surgery. Part of its purpose is to advance the art and science of hair restoration by licensed physicians whose scope of practice permits hair transplantation. The ISHRS also encourages medical professionalism and promotes amicable relations among its membership.
Qualification for membership is reserved for physicians, (M.D., D.O., or non-U.S. equivalent) of good moral character and good standing in the community with an invested interest in hair restoration and scalp surgery. Membership in the ISHRS does not constitute competence in the field and should not be considered a qualifying credential.
The American Hair Loss Association acknowledges the tremendous value of the ISHRS in the field of hair transplantation. However, its educational efforts should not be confused with any credentialing process.
Fellow of the ISHRS (FISHRS): According to the International Society of Hair Restoration Surgery, for a member to distinguish themselves as a “fellow” the hair transplant physician must achieve a specific level of points in a system of various educational parameters. These parameters include volunteering and serving in ISHRS leadership positions, being a Diplomate of American Board of Hair Restoration Surgery (ABHRS), writing scientific papers, and teaching at ISHRS-sanctioned scientific programs. To maintain this status, the surgeon has to continue to meet the organization’s educational criteria over time. This fellow distinction was established to recognize ISHRS members who meet its educational criteria and functions as a participation distinction, affording members voting rights and the ability to hold office in the organization. If hair transplant surgeons choose to place FISHRS as part their post-nominal letters or initials after their names, know these initials do not represent a specific or advanced academic degree.