Patients who research clinics independently before booking a consultation have 45% lower revision rates, and the most important research tool available to you is the before and after photo gallery. This case study walks through a real evaluation process, showing you exactly what to look for, what questions to ask, and how to separate genuine results from misleading marketing.
The Patient Profile
For this case study, consider a 34-year-old male at Norwood Stage 4, which involves further recession with an enlarged vertex area. At this stage, a patient typically needs 2,500 to 3,500 grafts for full coverage. With an average of 2.2 hairs per graft, that translates to roughly 5,500 to 7,700 transplanted hairs.
The patient was comparing three clinics: one in the US (FUE at $4 to $6 per graft), one in Turkey ($1 to $2 per graft), and one in the UK ($3 to $5 per graft). Total procedure costs ranged from $2,500 at the low end in Turkey to $21,000 at the high end in the US.
Step 1: Collecting the Photo Evidence
The first task was gathering before and after photos from each clinic's website and social media accounts. Here is what was collected:
| Clinic | Photos Available | Norwood 4 Cases Shown | Post-Op Timeline Shown | Consistent Lighting |
|---|---|---|---|---|
| Clinic A (US) | 85+ cases | 12 cases | 3, 6, 12, 18 months | Yes |
| Clinic B (Turkey) | 200+ cases | 40+ cases | Before and "final" only | Inconsistent |
| Clinic C (UK) | 45 cases | 8 cases | 6, 12 months | Yes |
Right away, Clinic B raised a concern. Despite having the most photos, none showed progressive healing stages. Every case jumped from pre-op directly to a final result with no timeline specified. This pattern often indicates cherry-picked outcomes.
Step 2: Analyzing Photo Consistency
Lighting and Angle Checks
Authentic before and after photos should match in these specific ways:
- Camera distance: The head should appear the same size in both frames
- Lighting direction: Shadows should fall the same way in both shots
- Head angle: Tilt and rotation should match precisely
- Background: Clinical setting should remain the same
Clinic A's photos met all four criteria in every case reviewed. Clinic B's photos frequently showed the "before" shot under harsh overhead lighting (which accentuates thinning) and the "after" shot under softer, more diffused lighting. This is a well-known manipulation tactic.
Hair Styling Differences
One of the most common photo manipulation techniques is changing the hair style between before and after shots. In the before photo, hair is often pulled back or unstyled. In the after photo, hair is blow-dried forward to maximize the appearance of density.
Clinic C's gallery specifically addressed this by including both wet-hair and dry-hair after photos. Wet hair reveals true density because it eliminates the visual boost from styling.
Step 3: Verifying Graft Count Claims
This is where knowing your numbers becomes critical. For a Norwood 4 patient, the expected graft range is 2,500 to 3,500. Any clinic showing a Norwood 4 patient with a full, dense result from only 1,500 grafts should raise immediate suspicion.
Clinic B listed a case as "Norwood 4, 2,000 grafts, full coverage." At 2.2 hairs per graft, 2,000 grafts produce roughly 4,400 hairs. Covering the typical Norwood 4 area (approximately 80 to 100 cm2) with only 4,400 hairs yields a density of about 44 to 55 hairs per cm2. Natural density for Caucasian hair is 170 to 230 follicular units per cm2. The math simply does not support the claimed visual result.
Expected Graft Ranges by Norwood Stage
| Norwood Stage | Graft Range | Total Hairs (at 2.2/graft) |
|---|---|---|
| Norwood 2 | 800 to 1,500 | 1,760 to 3,300 |
| Norwood 3 | 1,500 to 2,200 | 3,300 to 4,840 |
| Norwood 3V | 2,000 to 2,800 | 4,400 to 6,160 |
| Norwood 4 | 2,500 to 3,500 | 5,500 to 7,700 |
| Norwood 5 | 3,000 to 4,500 | 6,600 to 9,900 |
| Norwood 6 | 4,000 to 6,000 | 8,800 to 13,200 |
| Norwood 7 | 5,500 to 7,500 | 12,100 to 16,500 |
Step 4: Checking the Timeline
Hair transplant results take 12 to 18 months to fully mature. FUE recovery takes 7 to 10 days initially, but transplanted hair goes through a shedding phase around weeks 2 to 6 before new growth begins around months 3 to 4.
Any clinic showing a "final result" at 6 months is presenting an incomplete picture. Legitimate galleries include:
- Day 1 post-op: Shows graft placement pattern and density
- Month 3: Early growth beginning, still noticeably thin
- Month 6: Roughly 50 to 60% of final density
- Month 12: 80 to 90% of final result
- Month 18: Full maturation
Clinic A included all these milestones for 10 of their 12 Norwood 4 cases. This level of documentation builds genuine trust.
Step 5: Cross-Referencing with Independent Sources
The final verification step involves looking beyond the clinic's own marketing materials.
Where to Find Independent Patient Results
- RealSelf: Patient-submitted reviews with photos and verified procedures
- HairRestorationNetwork: Forum with detailed patient journals spanning months of progress
- Reddit (r/HairTransplants): Unfiltered patient experiences with progress photos
- TrustPilot: General reviews, though photos are less common
For Clinic A, independent forum posts showed results consistent with their marketing gallery. For Clinic B, forum reviews revealed several patients whose results were significantly thinner than the gallery photos suggested. Three independent patient journals showed density that did not match the clinic's marketing photos for similar graft counts.
The Decision and Outcome
Based on this analysis, the patient chose Clinic A. The higher per-graft cost ($4 to $6 vs. $1 to $2) was offset by confidence in the expected outcome. The procedure involved 3,000 FUE grafts with a 90 to 95% expected survival rate, producing approximately 6,600 transplanted hairs with a net yield of 5,940 to 6,270 surviving hairs.
At the 12-month follow-up, the result closely matched the comparable Norwood 4 cases in Clinic A's gallery, confirming that their photos were an honest representation of what patients could expect.
Key Takeaways from This Case Study
- Volume of photos alone means nothing. Quality and consistency matter far more than quantity.
- Always check lighting and angles. Mismatched conditions between before and after shots indicate manipulation.
- Do the math on graft counts. If the numbers do not add up for the claimed Norwood stage, the photos are misleading.
- Demand progressive timelines. Clinics that only show "before" and "final" are hiding the full story.
- Cross-reference independently. Forum posts and independent reviews reveal the gap between marketing and reality.
Before you start comparing clinics, know your own baseline. Understanding your Norwood stage and approximate graft needs puts you in a much stronger position to evaluate whether a clinic's results are realistic for your specific situation. Use our complete photo review checklist and learn about common mistakes when reviewing photos to further prepare yourself.
Get your free AI hair analysis at myhairline.ai/analyze.
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Hair transplant outcomes vary by individual. Always consult a board-certified hair restoration surgeon before making treatment decisions.