The International Society of Hair Restoration Surgery (ISHRS) publishes its practice census results every two years. I covered the 2020 one with worldwide hair transplant statistics in detail. Now its time for an update due to the release of 2022 data.
ISHRS 2022 Census Results
In April 2022, the ISHRS published its latest Practice Census results (covering 2021 data). It sent out the survey to its 858 Physician members, but only 197 replied back in time. Nevertheless, still some very useful findings. It seems like ISHRS membership declined from 929 to 858 during the past two years.
After extrapolations, the ISHRS estimated that 703,183 hair restoration procedures were performed worldwide in 2021. I always assume that the real number is much higher after including back-alley and unregistered hair transplants abroad in countries such as Turkey and India. The vast majority of hair transplants in the world are not performed by ISHRS members. In most countries, doctors and plastic surgeons often perform a few hair transplants every month as a “side gig” to their main practice.
Among the most interesting findings is that hair transplant surgeons are increasingly performing just one procedure per patient. Just a few years ago, it was common to perform 3 small procedures per patient.
Larger hair transplant megasessions of 3,000 to 5,000 grafts are now extremely common. Some surgeons are even performing gigasessions on rare occasions. Of course most patients will likely still need a second procedure in 10 plus years as their hair loss progresses.
Another important (but not surprising) finding is that Zoom and other methods of video communication have made people much more self-conscious about their hair loss. The so-called “Zoom effect”. I am glad that at my current workplace, no-one turns on their videos during Microsoft Teams calls.
The ISHRS hair restoration trends infographic has more interesting findings. I covered hair transplant surgery statistics in detail when the last 2020 census came out (keep scrolling for original post). This time, I only want to focus on this one table:
From the above table and earlier infographic, I find the most interesting developments to be:
- The percent of surgeons always or often prescribing oral minoxidil to treat hair loss rose from 10% in 2019 to 26% in 2021.
- The percent of surgeons always or often prescribing dutasteride to treat hair loss rose from 6% in 2019 to 12% in 2021.
- Almost one-half of all ISHRS members often recommend PRP for hair growth. This is surprising, but perhaps PRP does work at least modestly in most people. Even if just imperceptible to the naked eye hair follicle thickening.
July 4th, 2020
Hair Transplant Statistics 2020
Recently, the International Society of Hair Restoration Surgery published its 2020 census results. There are some very interesting hair transplant related findings presented in the summary.
However, the most interesting findings to me are those unrelated to hair restoration. Scroll through the end of this post to read about all the details.
The previous ISHRS census came out in 2017.
Future Treatments
My favorite question is on page 25: “What do you think will be the next technological “leap” in hair restoration?”
Out of 929 surgeons who were e-mailed this survey, only 201 surgeons answered this question. Hair cloning and stem cell therapies were the most popular responses:
How Many Hair Transplants Each Year?
Only 270 hair transplant surgeon members responded in time to this main survey question. After extrapolation and adjusting for anomalies, the ISHRS estimated that 735,312 hair restorations procedures were performed worldwide in 2019. This number represents a 16 percent increase from 2016, when an estimated 635,189 hair transplant procedures were tallied globally.
World Hair Transplant Surgery Totals by Region, 2019
Data Accuracy
Whenever I see such survey results, I am always highly skeptical about the annual global hair transplant totals. Although the ISHRS has around 1000 members across 70 countries, there are likely several thousand surgeons in developing countries who do not join this organization.
Many of these “missing” surgeons offer hair transplants as a side offering at their general cosmetic surgery and dermatological practice. And many hospitals have surgeons who perform hair transplants infrequently. e.g., during emergencies such as burning accidents or scalp injuries.
This under-representation is even more exaggerated when you consider the numerous sketchy “roadside” hair restoration clinics in many developing countries. Most of these assembly line type clinics would likely not even get ISHRS membership applications approved.
Moreover, many legitimate clinics and surgeons in poorer countries cannot afford to join the ISHRS and pay annual dues. And many probably do not deem it worth joining a US headquartered organization. Especially if most of their local clients do not care about certifications and international association memberships.
I would therefore not be surprised if the actual number of hair transplant procedures that take place worldwide is closer to 2 million or even higher. The ISHRS totals for vastly populated China and India are likely heavily underestimated. The cost of a hair transplant in these countries is a small fraction of that in the developed world.
Moreover, an increasing number of studies and articles suggest that rates of balding in China and India have gone up significantly in recent years. I think that there is also significant underestimation when it comes to places such as Turkey, UAE (Dubai) and Thailand. In fact, a number of online news articles from reputable sites suggest that 100,000 hair restoration procedures take place in Turkey alone every year.
However, before booking a flight, make sure to read my post on the dangers of getting a hair transplant abroad.
Other Hair Transplant Statistics
Among the other interesting hair transplant statistics and related findings in this census/survey include:
- An 85 percent to 15 percent split in the male versus female share of the hair transplant clientele. Not surprising.
- A 66 percent “FUE only” versus 30 percent “FUT (strip) only” procedure type performed division. Also not surprising to me. See my past post on FUE versus FUT. The vast majority of FUE procedures are performed by motorized techniques, usually without suction.
- Robotic-assisted FUE represents only 5.3 percent of all FUE procedures performed in the world.
- 99 percent of FUE surgeons used punches of less than 1 mm size. No-one used punches of less than 0.8 mm size.
- When it comes to FUE donor sites: 92.5 percent included scalp hair; 7.5 percent included beard hair; and 2.4 percent included chest hair. Body hair transplants (BHT) are therefore still not very popular.
- 57 percent of patients needed only 1 procedure to achieve their desired result. A bit surprising to me. However, my guess is that many of these satisfied customer will eventually come back for a second procedure after some years due to further hair loss.
- 81 percent of patients have between 1000-3000 grafts transplanted during their first procedure.
- 87 percent of patients were between the ages of 26 and 45.
- Only 13.4 percent of hair transplant surgeons’ patients came from a different country.
Present Hair Loss Treatment Survey
Another great section also does not involve any hair transplant statistics.
On page 16, there is a table titled: “How Often Various Treatments Were Prescribed to Patients in 2019“. 204 surgeons responded to this question. Not surprisingly, Finasteride and Minoxidil were by far the most popular treatment recommendations.
These two are the only ever FDA approved medications to treat androgenetic alopecia (aka male pattern baldness). The Finasteride recommendation breakouts in the table were split into 1% and 5% doses; as well as a separate topical Finasteride category.
I was surprised by the following findings:
- A higher than expected 10.2 percent of responding physicians stated that they “always or often” prescribed oral Minoxidil to treat hair loss. In my past post on oral Minoxidil, I mentioned how it was become increasingly popular in Australia and Thailand. I would be nervous about the side effects of taking such a medication to treat high blood pressure. Especially a potential increase in body hair. However, it seems like many hair loss sufferers are biting the bullet and hoping to get superior results to topical Minoxidil.
- Only 5.9 percent of the doctors “always or often” prescribed Dutasteride to treat hair loss. Very low in my opinion. Almost all comparison studies show that Dutasteride is superior to Finasteride in treating hair loss. But the former also has greater rates of side effects. It seems like hair transplant surgeons are reluctant to prescribe Dutasteride off-label to treat pattern hair loss. Even natural DHT blocker Saw Palmetto was recommended as a hair loss treatment more frequently (8.5 percent) than Dutasteride.
- Around 30 percent of patients were often recommended to take natural supplements, vitamins, herbs and Biotin. Nutritional deficiency related hair loss is not common, and is usually temporary in nature. So this number is higher than I would expect.
I can’t help but check this site almost daily, only to get sad and disappointed by the lack of real progress in this field. We have seen so many of these “sensational breakthroughs”, almost 2 (?) per year, but at the end of the day they didn’t lead anywhere. None of all the new upcoming treatments ( follica, samumed, breezula ) seem to hold any hope for a significant improvement. I’m being pessimistic and I’m sorry to be that guy, but do you really see us going from finasteride and minoxidil, both randomly discovered and partially effective, to a full cure in, let’s say, the next 5years? I just find it hard to believe it. The thinning progress is so hard to digest when you are young and still with normal looking hair, knowing that you are on a timer but things seem to only go backwards in this industry. I wouldnt care either if the cure was ultra expensive and I couldnt afford it, it would just make a difference to know there is a solution
Its like u read my mind and wrote a comment about it.
I thought 2020 would be the cure year .
Thats sucks tsuji is not update us what hapning.
I highly recommend getting an FUE transplant. I live in Australia and went to turkey. If you still have a reasonable amount of hair. The results have been amazing. I joined a Facebook group and really did my research. I was really hesitant, but am now pleased. I will probably have to go back for a second, but the price was very reasonable. I have had so many comments. I like you was at my wits end.
I still have hair, I might hop on finasteride eventhough i’m scared to death about side effects, since i struggled before with hyperthyroidism and went through radio iodine therapy and I know what it can be like to mess with your hormones. Problem with hair trasplant is that they don’t solve the problem. I need something that makes me stop obsessing about my hair, plus you need to take finasteride or you will eventually lose the non trasplanted hair. Obviously hair trasplant is an option and Im truly happy for you if you are pleased with the result, but the fact itself that you said you might need to go for a second trasplant is what triggers me, because it’s a temporary solution and you ( i hope not, i truly do ) might still lose hair. I, and many others I believe, will not have peace of mind untill I know there is something I can do if I want a head full of hair, maybe ill be fine with balding, but it has to be a choice. I hope admin proves me wrong and gives us some good news, but it just feels like it’s something we will have to cope with for a long time
Who was your surgeon Jimmy. I’m pondering a second transplant.
I went to Clinicana in Istanbul. My baldness was reasonably progressed so I’m very happy with results, and I’m a fussy person. Just need to do the crown and you would never know. Got 3600 grafts. I’m happy to take minox and finasteride. For me this was a stop gap until something permanent comes along. I’ve had a lot of people who were amazed at how well it worked.
Thanks Jimmy
Can you point to the information demonstrating an increasing rate of baldness in China and India?
https://www.hairlosscure2020.com/are-men-and-women-losing-their-hair-earlier-than-in-past-generations/
Being a disappointed optimist when it comes to hair loss breakthroughs-I hear you Shu. We all do. It’s getting old. No need to apologise. Who the hell wants to look like a toe-head for life? I certainly don’t! We all have the right to look good. I have a friend who’s girlfriend is losing her hair. She puts on a brave face, but you can’t tell me that doesn’t destroy her soul. A solution would bring a lot of joy to a lot of people around the world, but real medical breakthroughs take time unfortunately-if they even make it at all? Pretty sh#t when you’re on a timer though, but that’s life on planet earth! Lets hope they crack the code one day soon.
For some of us soon is too late…
I agree, there are really no significance progress to date. My hope is on “stem cell replacement”.
As someone allergic to topical minoxidil, I’ve recently started oral minoxidil as a last ditch attempt to get some regrowth. I was lucky in that I caught my hairloss relatively early, and finasteride has been excellent at halting further loss. I was also a good responder to topical minox before developing contact dermatitis from its use.
Unfortunately I don’t believe the UK prescribe oral minox for hairloss so I had to purchase via other means; this makes me nervous. Has anyone had this medication perscribed in the UK, or does anyone have any idea how I might go about getting a prescription?
Dermatologists and hair transplant surgeons will prescribe oral minoxidil. I’d recommend asking before you see one whether they do prescribe it. I was prescribed it but unfortunately I experienced side effects.
@Adam. You could try contacting Sinclair Dermatology in Melbourne Australia. They have a product called the Hairy Pill which includes minoxidil, with or without finasteride at differing ratios, but from memory, I don’t think they ship internationally yet? They prescribe oral minoxidil and might be able to put you in contact with someone in your country or another country that compounds it?
i leave in france and nobody prescribe oral min here.
According to you 1.25 mg daily is safe? no risk of hypertrichosis/ puffy upper eyelid/ weight gain from water retention?
I have been on minox topical and dutasteride for years but it is not working..
New Colin Jahoda study on Hair regeneration.
https://www.researchgate.net/publication/342226283_174_Dermis-hair_follicle_communication_Extracellular_microvesicles_signaling_for_hair_regeneration
Joe this guy has been doing research for decades he’s made a career out of it just from publishing studies. If Mr jahoda and Angela Christiano really wanted to cure baldness with they would at least get in waters on bored for repunzel biosciences I don’t think they have done that. That’s why it’s still in pre clinical a year and a half later it will be 2 years in December since there study of hair cloning came out in nature. It correct me if I’m wrong but it only takes 30 days wants you file a IND application with the FDA to start first in human there’s no excuse! They should have started first in human trial a long time ago. They are waist of our time because they know want they get this to the public they won’t have a job anymore. They need to update there website also looks like they have been on repunzel biosciences for a long time which tells me they aren’t serious about this.
Sorry for the spelling errors. “I meant to say they would at least get investors on bored” line 5
True – but there’s been a LOT of progress on Hair follicle basic science in the past decade. There’s a never ending release of new studies on Hair follicle regeneration. Like this new study where HMx and DP spheroids were co-cultured shortly in vitro and then placed into human scalp skin, small HF organoids positive for VERSICAN, K85, and K6 formed during 10 days of organ culture.
https://www.jidonline.org/article/S0022-202X(20)31040-X/fulltext
That’s good! First hair cloning study using actual human skin and not mice that I be seen! So they cloned hair follicles and then transplanted on an actual human skin? Do you think they transplanted on a human? Or just a little piece of human skin in a dish? Thanks
Yes, they transplanted it into “organ-cultured human skin”. So – Real human skin grown in the lab.
IDK just to chime in here I just see and accept that we’re multiple decades past randomly discovering minoxidil. If you’re still not a fullblown NW6-7 then FUE + fin alone might give you good enough results, meanwhile there are a lot of fringe alternatives on the market that are already out there. At this point if breezula is a success then you’ve already solved the side-effect problem of fin overnight and that combined with a more powerful topical like samumed etc.. they’ve successfully cloned hair follicles for christ’s sake, it’s just going to be a long ass time before that translates to any of us getting a perfect replicated organ transplant (10-20 years before anyone on this blog will truly have access to that, my guess). but by that point we will mostly likely have effective therapies (pop into a dermatologist’s office and lacerate your scalp while injecting therapeutic agents) and at worst every balding guy in their 20’s, 30’s and beyond will opt for a hair system for $20/week once the market drives up the supply sufficiently and the stigma begins to vanish.
I’m with Baumer. I know how Shu above feels as I am for some strange reason still losing hair despite using fin, minox, niz, an microneedling for over 2 years. I’m checking sites like this often hoping for good news. It moves slower than we all would wish but we cannot deny progress is being made.
If breezula enters phase III this year, and follica as well, then we are two years away from two new treatments. Samumed is already in a Phase III and could release a product in Turkey soon. The hair cloning giants, which would represent a real cure, are in the works by several companies. Things are being worked on.
I might look like s soon and have to embrace balding just like my dad and millions of other men have had to do. but life goes one. and by the looks of things, my children, when I have them, will not have to go through this. Balding sucks but its not a death sentence.
Been here a long time. You are on the money with this.
Hi all, I am considering a ht somewhere in europe or turkey. I see on the tv some dutch celebreties with very good natural hairline results and with high density ht ( real ht) and some with poor results. There are a lot of clinics, especially in Turkey. But there is everywhere a lot of manipulation etc. in the ht industry.
In general I would be prepared to pay a bit more but of course for quality and relevant service ( do not care about their limousine pick you up from airport etc) , and not pay for their marketing/ overhead costs for unnatural mass production or old reputations that no langer correspondents with current max results ( outdated tech). But pay for result. Research is a maze. You guys who had a HT in europe or Turkey, can you recommand a very good clinic and the ht doctor? I am a norwood 3 or 3,5.
Thanks in advance!!!!
Someone messaged me the below recent Cotsarelis and Oh Sang Kwon patent update from late June.
https://patentscope.wipo.int/search/en/detail.jsf?docId=US297154452
@admin does this have anything to do with follica? Looks like it be the compounds?
Nothing new.
“This application is a continuation application of U.S. patent application filed Aug. 2, 2011″… and even further back to filed 29 Mar. 2005.
Looking forward from 2005, who’da thunk we’d still be nowhere in 2020! Damn.
PureTech updated their site, but not sure if anything new on Follica in there:
https://www.puretechhealth.com/
https://www.puretechhealth.com/programs/details/follica
To interest of those with Alopecia Areata. Today – the U.S. FDA gave breakthrough THERAPY DESIGNATION FOR CTP-543 FOR THE TREATMENT OF ALOPECIA AREATA.
https://ir.concertpharma.com/news-releases/news-release-details/concert-pharmaceuticals-receives-fda-breakthrough-therapy
Good news for areata. Fda is even going to fast track phase 3. Mpb treatments would never get fast tracked like that. We have to wait years or start over for no fking reason like histogen lol. Hey we are starting phase 3 in Mexico and release in 2020…jk we are going to start from scratch and waste another 8 years for the same results lol. Complete utter joke
Mjones I’m right there with you. I’m not a happy man.
Maybe something is just about to happen … it’s now now or never… this 5 years BS doesn’t make sense anymore…
If the fda doesn’t fast track phase 3 for Follica a device that’s basically micro needling then something’s very suspicious. We already now it’s safe and effective.
Woofy I think follica would have to apply for fast track…I doubt they do that knowing their track record.
I still believe if they truly wanted a really ground breaking treatment for mpb it would have already been out by now. In reality, if aderans released their cell based therapy which worked to halt hair loss we would be in a great position. My hair was good in 2012. Nw 1.5 good density. I would have been happy with that. Now nw3 thinning and on big 3 with no stabilizing. Millions of people would have been saved. Aderans just shut down shop. Maybe my facts are wrong but I believe they didn’t move forward because it didnt grow back hair.
For the past 16 years or so, Kelly Slater (11 time world surfing champion), is one of the few who can get away with sporting a bald head. I wonder though, if a ‘real’ cure/treatment came along, whether he’d jump on it too? In the meantime, apart from duck-diving waves, I imagine he’s not holding his breath?
That’s what I dont get about this industry. It seems the public feels the product is a failure if it only halts hairloss. This makes no sense to me. Millions of men in the USA alone would jump at the chance to keep their hair without any side effects barring the treatment wasnt too expensive….think about how many men in your family alone would jump on it? I can think of 5 just in my family alone…. Makes no sense to me.
Tomjones the public does not want to do a treatment everyday of their life to halt hair loss like fin, while halting hair loss is very good the treatment will not be perfect i’m not talking about side effects i’m talking about how many years this treatment will work for the person before gene expression and more hair loss. fin doesn’t work for some men and they continue to lose hair. A halting product will only work if you use crispr or (not a product but it will work) castration, also if you’re like me young… younger then 25 i’m a norwood 5 :( i cant get a transplant so now i’m stuck on finasteride i don’t want to take finasteride everyday of my life and i also want my hair back being a norwood 5 well its not fun and halting does not bring my hair back. and a hair transplant wouldn’t help me because my hair pattern is not naturally stable at the moment so i’m now just waiting for Dr Tsuji.
woofy tsuji will not come before 2030
Ok Woofy. I understand and feel for your position..however I feel that many would benefit and pay for a side free treatment that simply halts hairloss.
The ISHRS 2020 Census is very interesting. However, because of the member structure of ISHRS the census is blind on cost transparency and hair transplants abroad. Although, these are the most relevant topics for patients nowadays. According to the medihair platform prices range between 1.07 USD and 7.00 USD per graft globally. What also struck me is the fact that 45,81% of people who are interested in a hair transplant are willing to travel abroad for the surgery (https://medihair.com/en/hair-transplant-study/). I believe the hair transplant industry is the most globalized treatment in plastic surgery.
Reading all your comments… imagine being a woman in this. It stops our life. I have sadly zero hope. We all have been reading about all the upcoming breakthrough options for years… years! I never thought i’d hide behind a hat and never get married or date or present at a meeting again. No one cares about us.
Without a doubt, much much worse for women.
FYI — While most women (and men) do not want a hairpiece, I met two black women in the past couple of months who wore wigs/hairpieces and looked good. They both had great skin though and seemed to be ok with the wig. Just a thought in case you ever feel like trying. The expense, maintenance and fakeness are all a problem for most people, but some might change their mind after a try.
They do PRP as a means to increase their practice revenue and also to get people in the door. You (meaning me too) get excited about doing something positive for your hair that’s seems like it’s on the cutting edge of a break through. $5K later after 4 treatments and negligible results, if any, the good doctor recommends a transplant. Even if the doc doesn’t do any PRP until your transplant that crap isn’t for free. Sure, they can point to the studies of PRP’s effectiveness (I’m sure there’s some result for early stage and women primarily), same can be said for laser combs, Stimoxodine, etc. etc. Yoda has been around the block with this crap for quite a few years, stay away from PRP!
I’ve had my differences with Yoda in the past, but agree 100% on this one. I tried PRP too once. Didn’t do a thing for me personally except empty my wallet. Didn’t tickle either! Buyer beware.
I remember we had differences in the past SK, but for the likes of me I can’t remember what they were? When I read your posts I do think you can be a funny son of a gun, so hat’s off to ya mate!
Cheers for that. If only all my sisters thought the same. (They think I’m a dill!) Hope that $5K circles back one day and karma deals with Mr Godfather.
PRP 4 times with the Godfather of PRP/CPR who has Admin referenced in a previous post and SK said…”. Didn’t do a thing for me personally except empty my wallet” of $5K.
You went to Greco 4 times Yoda?
Call me paranoid Admin, I prefer not to name a specific doc in a public forum. Let’s just say I truly believe that any form of PRP by any doctor on the planet would be a huge disappointment and money grab for the vast majority of visitors to this site.
I tend to mostly agree, but would try it once with someone like Greco or Cooley if I lived nearby. I think Greco is considered the father of hair loss related PRP.
Again, without naming names, drawing on my experience, I would strongly urge you not to do it even if you lived inside the clinic of either of those docs. Additional context, I was also using topicals and oral fin at the time. This wasn’t a standalone treatment, I was addressing DHT both orally and topically. I get that what may work for one might not work for another, I’ve not seen too many success stories for PRP for AGA. Just mainly docs weaving straw into gold.
Perhaps it’s just helpful for women. I haven’t heard too much success from men.
Correct True, women and very young men in the early stages of hair loss, it might have some positive effect. They take that data and extrapolate it across the entire population suffering from AGA. There’s a doc that has occasionally posted on this blog, seems credible, offers everything under the sun and gives the impression he’s Dr. Cutting edge. Same dude offers “At Home PRP” which are vitamins. Some of the crap probably has grown hair on mice, again it’s extrapolated into being a real treatment. My only agenda is to take my almost 40 years of fighting this dreaded disease, shine some light and maybe help a brother (and sister) or two. I’ve spent my fair share of hard earned dollars and emotions on quite a bit of BS as well as some stuff that does work (keep your expectations realistic).
The cure is close. Histogen is the cure. Wait, stay strong.
You’re trolling aren’t you? I remember reading Histogen was done.
Big 3, collagen, keto 2%, eat healthy, exercise and then do fue with a top doc. Everything else is bs and a scam. Prp being one of them. When hair salons start offering it then you know it’s bs. If it worked we all wouldn’t be questioning it. We know the big 3 works for most and see proof.
The well known transplant Doc that offers “At Home PRP” along with other treatments also has salon services…is that close enough MJ? ;-)
Harvard found the cure identify the protein that causes baldness. We can all go home, k thanks
huh ? Where did you see that ? And even if true, it won’t be able to be on the market before what 10 years ?
https://original.newsbreak.com/@joel-eisenberg-561469/2606277778172-harvard-scientists-determine-elusive-protein-may-be-key-to-a-cure-for-baldness
Seriously, they haven’t even tested it in human yet, another mice test…