Everything is there, except for hair clippers, the assistant tells the hair transplant doctor. Fine, thinks Dirk Jan Aldewereld (55) from Abcoude, then we can postpone shaving our heads for a while. At Beauclinic in Nieuwegein he sits on a stool in front of the white wall, mirror in hand, surgical gown on. Today he is getting a hair transplant, and he points out to doctor Eva Klint what he finds disturbing about his hairstyle: his hair is full and there is hair on the crown, but it is bald in between. “The moat,” he says, “can you fill it?”
The number of men opting for a hair transplant is increasing. There are no national figures, except for the seven Dutch clinics NRC all say they have seen an increase in the number of treatments over the past five years. A relatively large number of clinics have also been added: five years ago there were seven, now there are around twenty clinics. In addition, many people go to Turkey for a hair transplant. A KLM pilot, who does not want his name in the newspaper, says: “When I fly to Istanbul, on the way back I have a plane full of bald men.” Yes, the men come often without hair from the clinic: during the transplant, all hair is usually shaved, because this makes ‘harvesting’ hair follicles easier. In the Netherlands, treatment costs between 4,000 and 10,000 euros, in Turkey 1,500 to 5,000 euros including accommodation.
At the seven clinics approached, about 80 to 90 percent of the customers are men. The ages vary widely, from young twenties to men in their seventies. At Hairtec in Delft, “the significant increase in the number of customers” started during corona, says founder Duygu Sahan. “Working from home made it easier to keep a transplant hidden. And people couldn’t go to Turkey.” After the pandemic, that upward trend continued, says Sahan. Compared to five years ago, she is performing 70 percent more transplants.
Photos: Simon Lenskens
At Global Hair in Barendrecht, the number of treatments has doubled compared to five years ago, says founder Berkant Dural. “We then did two treatments in one day, five days a week. Now four days a day, six days a week and we have a second location.” What strikes him: customers are getting younger and younger. And the number of women is increasing because there is now a technique that does not require you to completely remove your hair. Dural: “Men make decisions much faster, they often want to plan a date during the intake. Women think about it for six months.”
There are a lot of emotionally charged conversations in the clinic, he says, and there is a fair amount of crying. Young people with hair problems experience more shame than older customers, he says.
Drilled loose
Yet the taboo seems to have almost disappeared, say all the doctors we spoke to. ‘People in hiding’ – people who take leave or long holidays to undergo a transplant unnoticed – are seen less and less. This is due to the famous Dutch people and influencers who talk about their experience, says Freek Broekhuijse of Beauclinic, including Arie Boomsma, DJ JeBroer, Gijs Staverman, rapper Bizzey Charly Luske and Özcan Akyol. “They are open about it. Rightly so, because going bald is a process that happens to a lot of people.”
The treatment has started in Nieuwegein. Dirk Jan Aldewereld lies on his stomach on the operating table, face in a hole, nose and mouth free. “Harvesting” takes place in the morning and “planting” takes place in the afternoon, says doctor Eva Klint. Using a hollow needle, a kind of mini apple corer, hair follicles are drilled loose and plucked from the scalp with tweezers. “We leave the hairs around it. The donor area therefore becomes slightly thinner because we move hair follicles, but you cannot see this optically.” The total number of hair follicles on the head does not increase, but is better distributed.
A saltwater solution is injected under the scalp to bulge the skin and create more space between the hair follicles. “The body eventually absorbs that fluid, and the swelling will subside later today,” she tells Aldewereld.
The extracted hair follicles are placed in a petri dish on a cotton ball soaked in hair growth agent. The assistants sort these by the number of hairs in a hair follicle: one, two or three. Hair follicles with a few hairs are used for the inlets and the hairline at the front, “that looks natural”, the rest is placed back on the crown and the back of the head, “for density and volume”.
After removing the groups of hair follicles (grafts), small cuts (incisions) are made in the area where the hair follicles will soon be replaced. The doctor pays attention to the direction of growth. The grafts are replaced one by one with tweezers. This is called the FUE technique – currently the most commonly used method in Dutch clinics. Previously, the ‘Strip method’ (FUT technique) was used, in which a strip of skin with hair was removed in order to harvest hair follicles, resulting in a large scar. “All kinds of terms are used to name variations on the FUE technique, which can sometimes be confusing,” says Jantiene te Voortwis, co-owner of Zantman Kliniek. Examples are DHI, FUE hair sparing and Hair Stem Cell Transplantation.
Just grass
Hair transplant treatment came to the Netherlands in 1976 thanks to hair specialist Theo Zantman and since then the technique has been improved and, above all, more refined. With the FUE technique, the recovery time is considerably shorter and the scars in the donor area are minimal.
Of course there are risks. Sometimes transplanted hair does not grow back properly or the hair growth direction is wrong, says Edwin van Wooning of the Dutch Hair Foundation. The foundation regularly receives complaints. “Hair that sticks out straight on the side of your head is almost impossible to style and difficult to correct with a recovery operation.” Other risks include skin infections, inflammation and scarring. These types of complications, he says, occur in patients treated in the Netherlands and abroad. “There are a number of excellent clinics in Turkey, but also some very cheap ones that often save on operating space, are inexperienced, work too quickly and sometimes even employ untrained people. And aftercare is often lacking.” When customers are disappointed, it often has to do with unrealistic expectations, he says. “People are sometimes shown before and after photos that are not realistic for their situation.”
Dirk Jan Aldewereld has had 2,360 hair follicles moved to ‘the moat’, up to his hairline. He hoped for at least 2,200 so is “very satisfied”. The first days after the operation he slept poorly, he had to lie on his back with a special inflatable pillow, but he could not relax his neck. Later, literally on one ear, things got better. At work he receives many compliments about his shaved haircut. People also want to know if it was painful. “And they ask why I did it, they think this short haircut also looks good.” Still, he is looking forward to next summer, because only then will the results be visible. It’s just like grass, the transplant doctor had said – sow first (then the planted hairs will all fall out), and later the new hairs will grow.
