The hidden worries behind the boom of the "hair transplant economy": the difficulty of standards, qualifications and supervision

The process of hair transplantation is long and painful, and for Yuan Ziyi (pseudonym), the same is true for postoperative rights protection.

When it was visible to the naked eye that the 95% survival rate of hair follicles agreed by the hair transplant institution before surgery was not reached one year after surgery, Yuan Ziyi and the hair transplant institution, Beijing Xiduo Medical Aesthetic Clinic Co., Ltd. (hereinafter referred to as "Beijing Xiduo Medical"), started a tug-of-war, and he wanted to have an explanation.

The reporter's investigation found that behind the hair transplant advertisements that can be seen everywhere, it is difficult for consumers to protect their rights, and the effect of hair transplantation seems to have become a matter of complete luck. In many dispute cases arising from the failure of hair transplantation, they were finally judged to lose because it was difficult for consumers to identify or provide evidence.

Relevant experts believe that while the hair transplant economy is booming, there are also many problems such as lack of supervision and different industry standards. At present, it is urgent to establish unified and standardized industry standards and introduce corresponding supporting laws and regulations to effectively protect the rights and interests of consumers.

The "Vice President Chief" package costs more than 50,000 yuan

The hair transplant operation lasted 9 and a half hours, and "pain" was Yuan Ziyi's most intuitive feeling.

A local anesthetic injection is injected into the hair removal area at the back of the head, followed by a saline solution to strengthen the tension of the scalp and loosen the hair follicles. Then the hair follicles are extracted, and then anesthetized in the hair transplant area above the head, drilled, and planted in clusters, and the whole process is "full of blood".

Yuan Ziyi told reporters that four staff members participated in his operation. Before the operation began, a surgeon known as the vice president shook his hand. In the surgery, the chief surgeon completes the hair follicle extraction stage, and then hands it over to a male staff member for separation and culture, and finally two female staff members are responsible for implantation.

Due to the hereditary seborrheic alopecia in his family, 37-year-old Yuan Ziyi knew that he would face hair loss as early as his early 20s. As he grew older and the pressure of work increased, Yuan Ziyi's hair gradually became thin.

On the recommendation of a friend, Yuan Ziyi chose Beijing Xiduo Medical for hair transplant surgery. Before the surgery, the doctor gave a 5,000-unit hair transplant plan based on the degree of his hair loss. In the international classification of hair loss, male hair loss is divided into grades 1-7 from mild to severe, and the maximum number of hair follicles extracted by surgery for grade 6 and 7 hair loss is generally 5000 to 5500 follicular units.

Yuan Ziyi said that the staff of the institution recommended him a package of hair transplantation and maintenance, and the cost of surgery was different according to the chief surgeon. He chose the medium-priced vice president chief surgery package, paid more than 50,000 yuan on the spot, and performed the hair transplant surgery on January 29, 2022.

Yuan Ziyi said that he believed that the technology of hair transplantation was not complicated, and the gap in technology should not be large. But later he found out that this was not the case, and the "hair transplant in the morning and work in the afternoon" often claimed by hair transplant institutions was not realistic.

After the operation, Yuan Ziyi's head had a bloody scab, and it took a few weeks before it began to fall off, and he was falling off when he walked, when he was dressing, and when he was in meetings. For two weeks after the operation, he was constantly oozing fluid from the hair removal area, and he needed to put on four towels when he slept at night, and his pillow was still wet, "feeling like his head was soaked in half water and half in a sponge". After the operation, according to the doctor's plan, Yuan Ziyi also needed to inject one injection of auxiliary drugs every week for more than 50 weeks.

Yuan Ziyi said that after experiencing these pains, he has expectations for the effect of hair transplantation. However, half a year after the hair transplant, Yuan Ziyi looked in the mirror and found that the effect after the hair transplant was far from reaching the 95% survival rate promised by the institution, and he felt that the amount of hair visually did not improve compared with before the operation. He began to wonder, "The operation failed."

He found a hair transplant institution and, at the suggestion of the institution, paid 19,800 yuan on October 29, 2022, to buy nutritional products again.

Yuan Ziyi told reporters that he learned that hair follicles have a growth cycle and are in the process of closing and repairing growth 3-6 months after surgery. The hair will fall out once about half a year after planting, and then grow again. If the target rate is not reached after one year, it means that the goal of hair transplantation has not been reached.

Yuan Ziyi began to recall the whole process of his hair transplant. Whether the surgeon who operates the hair transplant has medical service qualifications, whether the maintenance process after hair follicle removal is professional, whether the location of the implant is accurate, and whether the density is uniform...... These questions haunted him.

Since October 2023, Yuan Ziyi has communicated with the hair transplant institution many times, and after not receiving a satisfactory reply, on March 11 this year, Yuan Ziyi complained to the "12345 Government Service Convenience Hotline" about the institution.

"I don't know who did the surgery."

On March 15, 2024, Beijing Xiduo Medical sent Yuan Ziyi a "treatment solution" stamped with the company's official seal. According to the plan, revaccination can be carried out, and the new surgical upgrade will be operated by President Li Huimin's team, and the hair follicle nutrition protection and reinforcement program will be adopted during the operation; after the operation, the treatment will be made according to the fine and soft condition of the implanted hair, the hair quality and scalp environment will be improved, and the scalp hair management program within one year will be provided, and the related maintenance costs will be borne by Xiduo; the second encryption effect is not good (the effect is not obvious compared with the preoperative) One year later, the refund process will be taken according to the scalp condition.

In this regard, Yuan Ziyi said that he did not accept it, "it is impossible to replant". He was worried that there would not be enough hair on the back of his head, and that the hair follicles that did not survive the first operation would be a "waste of limited resources".

On the afternoon of April 13, the reporter came to Beijing Xiduo Medical located in the middle of the East Fourth Ring Road, Chaoyang District, Beijing. Located on the corner of an office building, the office has a white geometric façade with a small entrance that requires the doorbell to open the door.

A customer service manager told reporters that she was aware of Yuan Ziyi's complaint, and that the agency had also received calls from the Health Commission and provided medical records, call records, and chat records to the relevant departments of the Health Commission.

Regarding the promise of "95% survival rate of hair follicles", the customer service manager said, "The survival rate is reasonably achievable, but it varies from person to person, and medical things are not 100%." She said that signing before the surgery meant that [the consumer] agreed, "If the survival rate is not reached, he will be given a second revaccination." If you don't agree with this thing, you can not do it. ”

According to the picture of the "Informed Consent Form for Surgery" issued by the customer service manager, the Beijing News reporter saw that the doctor's signature below was "Li Huimin". She said, "It is not clear who did it, but the chief surgeon on the medical record refers to Dean Li Huimin." She also said, "The signature of the medical record is very rigorous, and medical things cannot be falsified." ”

Who is the chief surgeon of Yuan Ziyi's surgery? This reporter has not been able to get an answer. In response to the reporter's request to view the relevant image data of the operation at that time, the customer service manager said that it was too long ago to provide it.

In the end, the customer service manager refused to provide the reporter with pictures of the medical records on the grounds that "I don't know if I have the right to access the official things of our hospital", and said that he had recorded these problems and would reply after confirming with the hospital after going to work on Monday (April 15). As of press time, the customer service manager and the organization have not responded.

According to the company's information, the registered name of the hair transplant institution is Beijing Xiduo Medical Cosmetology Clinic Co., Ltd., which was established in 2013 and its business scope is medical cosmetology department and cosmetic surgery. The company's shareholders are Beijing Xiduo Investment Management Co., Ltd. and Li Huimin. The shareholders of Beijing Xiduo Investment Management Co., Ltd. are Li Meiying and Li Huimin, and have invested in a number of beauty medical institutions in Guangzhou, Nanjing, Taiyuan and so on.

The reporter contacted the Beijing Chaoyang District Health Commission in response to Yuan Ziyi's complaint, but has not received a reply as of press time.

Some hair transplant ads are accused of being "exaggerated"

According to a research report released by Essence Securities in 2021, according to the judgment of Frost & Sullivan, a global business consulting company, the mainland hair transplant medical service market will grow from 13.4 billion yuan in 2020 to 37.8 billion yuan in 2025.

According to public information, the domestic hair transplant industry started in 1997. In the following two decades, hair transplant surgery has completed the transformation from "high-end" plastic surgery to mass medical consumer products.

According to the "2022 China Hair Transplant Industry Research Report", there are currently four main categories of domestic hair transplant tracks: national private chain hair transplant institutions represented by Yonghe Hair Transplant, Barley, Biliansheng, Xinsheng Hair Transplant, etc., accounting for 35%, hair transplant departments of private medical beauty and cosmetic surgery institutions account for 25%, regional private non-chain hair transplant institutions account for 30%, and hair transplant departments of public hospitals account for only 10%.

At the end of 2021, Yonghe Medical landed on the Hong Kong stock market and was known as the "first hair transplant stock".

On March 28, 2024, Yonghe Medical released its 2023 annual financial report. According to the financial report, Yonghe Medical's revenue for the year was 1.777 billion yuan, of which the hair transplant business achieved revenue of 1.354 billion yuan. In 2023, Yonghe Medical's gross profit will be 997 million yuan, the number of patients receiving hair transplant surgery will be 61,071, and the average consumption of hair transplant patients will be 22,174 yuan.

A number of interviewees in the industry told reporters that while the hair transplant economy is booming, there are also many problems in the entire industry. The Beijing News reporter saw from the cases disclosed by the judgment document network and the complaint information of the third-party platform that in the hair transplant industry, false publicity, false reporting of hair follicles, inducing consumption, unsatisfactory planting results, difficult identification, arbitrary charges, preoperative on-the-spot change of doctors, unauthorised use of surgery-related photos, postoperative disputes and other chaos are frequent.

According to the 21st Century Business Herald, during the International Consumer Rights Day on March 15, 2023, many head hair transplant brands, including Yonghe Medical, Barley Hair Transplant, and Xiduo Hair Transplant, were exposed and complained. Among them, Yonghe Medical was involved in inducing consumers to apply for loans, the survival rate of hair transplantation was low and "alopecia areata" appeared, and unaudited drugs were used; Barley Hair Transplant was exposed as a non-committed attending doctor for the patient's surgery; Xiduo Hair Transplant users said that there was no effect on supplementing the hairline, but the survival rate of the company's self-testing was 96%.

In subways, elevators, and social platforms, the overwhelming hair transplant advertisements always remind people to pay attention to the problem of "hair loss". In the promotion of merchants, the hair transplant process is simple, the risk is extremely low, and the success rate is extremely high.

Chen Yinjiang, deputy secretary-general of the Consumer Rights Protection Law Research Association of the China Law Society, mentioned that these hair transplant advertisements are often easy to magnify the severity of hair loss and the role of hair transplantation, and objectively have the effect of exaggerating anxiety.

Chen Yinjiang believes that the "95% survival rate" in some advertisements is an absolute term, and "medical treatment cannot promote medical effects". Some absolute language, such as specific curative effects and achievable effects, is suspected of violating the relevant provisions of the Advertising Law.

A number of hair transplant doctors in tertiary hospitals suggest that there are different types of hair loss, and drug treatment or surgical treatment should be recommended according to the diagnosis. Hair transplantation itself is to remove the east wall and make up the west wall, which is to adjust the density of the hair, not to increase the overall hair volume.

"Not everyone is suitable for hair transplant surgery, and it is necessary to screen", Guo Zhenhe, a plastic surgeon at the Third Affiliated Hospital of Southern Medical University, mentioned that for example, in the early stage of hair loss, if it is detected that the hair follicle is atrophied, it will be treated conservatively first, and the growth of the hair follicle will be stimulated with oral or applied drugs;

According to Guo Zhenhe, there are two mainstream hair transplant methods: FUT (follicular unit extraction technology) and FUE (follicular unit extraction technology). In the former, a long, narrow strip of scalp tissue from the back of the head is removed and follicular units are isolated under a microscope. The latter is extracted by cutting into the skin with a small-diameter ring drill punch.

He also mentioned that all the hyped and exaggerated technologies on the market, such as 3D and microneedling, are a marketing gimmick, which is essentially FUT or FUE.

Regarding the "hair follicle survival rate" often mentioned before surgery, Guo Zhenhe mentioned that the hair growth can be detected by the hair microscope, but there is currently no special instrument that can scan and calculate the specific hair follicle survival rate. Especially for the encrypted part, it is difficult to distinguish between the hair transplant and the raw hair mixed together. Regarding the 98% survival rate claimed by the market, Guo Zhenhe said that "it is an exaggeration".

There is a phenomenon of illegal hair transplant surgery by unqualified personnel

According to the Catalogue of Hierarchical Management of Medical Cosmetology Projects, hair transplantation is a first-class project, that is, "a cosmetic surgery project with no complicated operation process, little technical difficulty and little risk".

Tang Songjia, a doctor at the hair loss clinic of Hangzhou First People's Hospital, told reporters that all plastic surgeries such as hair transplantation are consumer medical treatment, which is still a medical act in essence, and there is no 100% thing in itself, and it is necessary to explain to the patient what may happen before the operation.

She mentioned that hair transplant surgery is generally performed by a team, in which invasive operations such as extracting hair follicles and drilling holes during implantation must be done by doctors, and the separation can be done by nurses. Hair follicle removal is the most technical part, and the more experienced the doctor, the more you can ensure that the hair follicles removed are not damaged. If it is not done properly, it can easily cause permanent damage to the hair follicles.

According to the group standard of "Hair Transplantation Specification" issued by the China Plastic Surgery Association in 2021, the chief surgeon must obtain a medical practitioner qualification certificate in dermatology or surgery, undergo formal training in hair transplantation, pass the assessment, and have participated in more than 50 related surgeries. It is also necessary to pass the systematic training and assessment of hair transplantation technology recognized by the health administrative department at or above the provincial level.

Tang Songjia suggested that if you want a hair transplant, you must choose a formal institution, and you can check the filing information of medical cosmetology attending physicians in the physician management system of the National Health Commission. Although a hair transplant is a minimally invasive epidermal surgery, the results vary from doctor to doctor. In addition, hair transplantation is not a one-time thing, hair transplantation does not guarantee the loss of raw hair, and it should be combined with drugs in the later stage for regular follow-up.

The reporter found from a number of administrative penalties that it is not uncommon for unqualified personnel to illegally carry out hair transplant surgery. On February 19, 2024, the administrative penalty announcement issued by the Shanghai Huangpu District Health Commission showed that Shanghai Yonghe Hospital, a subsidiary of Yonghe Medical, was fined 10,000 yuan for "using non-health technicians to engage in medical and health technology work". Damai Medical has also been administratively punished for "using non-health technicians to engage in medical and health technology work".

On April 11, 2024, Dalian Xiduo Medical Aesthetic Clinic Co., Ltd. received an administrative penalty from the Health Bureau of Zhongshan District, Dalian City, for "carrying out diagnosis and treatment activities beyond the registered diagnosis and treatment subjects, using non-health technicians to engage in medical and health technology work, and failing to fill in and keep medical records in accordance with regulations", and was given a warning and a fine of 50,000 yuan.

Rights protection encounters "difficulty in appraisal and difficulty in adducing evidence"

There are also consumers who use legal means to protect their rights and interests.

The reporter searched the judgments on "hair transplant disputes" in recent years and found that "hair transplant disputes" are a new thing, and there are some differences in judicial practice in various places.

A small number of judgments supported the consumer. For example, a judgment from the Gulou District People's Court in Nanjing, Jiangsu Province, shows that Li underwent autologous hair transplantation at a medical company in Nanjing in June 2019. Li said that the operation not only failed to achieve the promised survival rate of more than 85%, but also damaged other healthy hair follicles around the transplanted hair site.

The court found that the case was a dispute over a medical service contract, and based on the postoperative consultation opinions and the comparison of pre- and postoperative photos, it ruled that the agreed effect was not achieved after the operation, and the defendant medical company constituted a breach of contract and should refund Li's operation fee of 5,280 yuan.

Another judgment from the Yanta District People's Court of Xi'an mentioned that the court found that "the plaintiff lost a large amount of hair after receiving the additional issuance service, which did not achieve the purpose of the contract agreed by the parties to issue an additional 10,000 sticks, so the defendant should refund the plaintiff the additional service fee paid by the plaintiff." ”

More precedents have ruled against consumers. A reporter from the Beijing News checked the online judgment documents in China and found that a number of dispute cases arising from the failure of hair transplantation were ultimately judged to be defeated because it was difficult for consumers to identify or provide evidence.

According to the relevant verdict, in late November 2019, a consumer was in a medical beauty clinic in Guangzhou. Spent more than 24,000 yuan to do hair transplant cosmetology, and the hair transplant beauty contract clearly stipulated that 4,500 units of hair transplantation were made, and the survival rate of hair follicles after hair transplantation exceeded 95%. Dissatisfied with the effect of the hair transplant, the consumer filed a medical service contract dispute on the grounds that the hair transplant institution had false publicity and breach of contract.

The defendant argued that the patient should go through a forensic evaluation of medical damages to determine whether the hospital was at fault in the process of diagnosis and treatment. As for the survival rate of hair follicles planted in the hair transplant area, the Yuexiu District Court determined that Guangdong Hengzheng Judicial Appraisal Institute should conduct the appraisal, and the firm subsequently replied that it would not accept the case on the grounds that it exceeded the scope of its judicial appraisal business. The court of first instance found that the evidence adduced by the consumer in this case was not sufficient to prove that the defendant had breached the contract and ruled against the defendant.

The reporter saw in the "Civil Ruling on the Civil Application for Retrial Review" of the medical service contract dispute between the consumer and the relevant medical cosmetology clinic that the consumer had successively consulted the Guangdong Harmonious Doctor-Patient Dispute People's Mediation Committee, the Medical Identification Department of the Guangzhou Medical Association and many other institutions, but none of them could do the identification of the survival rate of hair follicle transplantation.

The Guangzhou Intermediate People's Court held that the original trial was not improper and rejected the application for retrial.

Lawyer Qian Zhou of East & Concord Law Offices once mentioned in an article that consumers' test reports in other hospitals can only be used as unilateral evidence, and according to the relevant provisions of the litigation law, the court often does not accept them. In view of the current lack of relevant standards, forensic appraisal institutions generally reject the application on the grounds that the appraisal is beyond the scope of business. Therefore, in disputes arising from the survival rate of hair follicles, the consumer is often in a disadvantageous position to provide evidence.

In response to the issue of judicial appraisal of hair follicle survival rate, the Beijing News reporter consulted a number of judicial appraisal institutions in Beijing as a consumer, and the other party said that it was impossible to conduct relevant appraisal.

A staff member of a forensic center said that he could not do it because there were no experts who could do the appraisal. The staff of another forensic appraisal center said that at present, there is no "hair follicle survival rate" item in the forensic appraisal business of judicial administrative organs under registration management, and because there is no standard, medical aesthetic surgery cannot be appraised, so it is recommended to consult other appraisal centers.

There is an urgent need to establish standardized and unified industry standards

The "In-depth Report on the Hair Transplant Industry" released by Guohai Securities Research Institute in 2022 mentioned that at present, in terms of domestic supervision, hair transplantation is still under the medical beauty sector, and there are no directly related policies for the hair transplant industry. Globally, developed economies with relatively complete medical systems such as the United Kingdom and the United States also lack supervision of the hair transplant industry, and the regulation of the hair transplant industry relies more on industry associations to organize self-discipline.

Chen Yinjiang believes that for the current problems in the field of hair transplantation, the top priority is to establish industry standards and introduce corresponding supporting laws and regulations.

Chen Yinjiang said that the development of the medical cosmetology industry is hot, and the disputes caused by it are also increasing, and many consumers have no way to protect their rights because of the difficulty in obtaining evidence, the difficulty of medical cosmetology identification, and the difficulty of unifying the standards of medical cosmetology effects. As a new phenomenon, medical cosmetology disputes should be paid sufficient attention by the regulatory authorities. He suggested that first of all, we should establish and improve the corresponding legal norms, such as clarifying who supervises and who is responsible, and clarifying the identification path; secondly, the industry should strengthen self-discipline, take the initiative to publicize the doctor's qualifications, guide industry institutions to introduce projects truthfully and objectively, and smooth the channels for rights protection.

Zhao Liangshan, a senior partner of Shaanxi Hengda Law Firm, believes that hair transplant institutions, as professional institutions, know that the survival rate of unquantifiable hair follicles still guarantees consumers, which is obviously false publicity. According to Article 20 of the Law on the Protection of Rights and Interests of Consumers, business operators shall provide consumers with information on the quality, performance, use, and validity period of goods or services, and shall not make false or misleading publicity. If the hair transplant institution constitutes false publicity, it will face administrative penalties.

Zhao Liangshan said that if there is consumer fraud behind the false publicity and misleading consumers of hair transplant institutions, consumers can claim civil liability for refund of one and compensation of three. In this regard, consumers should first fix evidence, such as collecting contracts, consumption bills, and WeChat chat records and text messages with the staff of the hair transplant institution, so as to prove that the original commitment of the hair transplant institution is seriously inconsistent with the actual effect and does not achieve the expected effect of the consumer.

Zhao Liangshan mentioned that hair transplantation is a kind of medical aesthetic surgery, which is different from ordinary medical services to cure diseases, and the purpose is to beautify the appearance, so hair transplant disputes are between consumer rights protection disputes and medical disputes. This means that there is no authoritative evaluation standard for the evaluation of the effect of hair transplant surgery, the determination of responsibility is not clear, the industry standard is not uniform, and it is difficult to obtain evidence, so it is difficult to file a case and pursue it.

He also agreed with Chen Yinjiang's statement that the hair transplant industry urgently needs to establish standardized and unified industry standards. Zhao Liangshan said that the establishment of quantifiable identification methods and standards for the survival rate of hair follicles and treatment effects, strengthen the examination of industry qualifications, raise the entry threshold, and require certificates to work, so as to avoid chaos in the industry.

Editor: Li Kexin