Hair transplant surgery has become one of the leading aesthetic procedures in men. It is due to the increasing concern of men for their baldness. With the increase in demand, there is an increase in people trying to provide that service. But who is the right person to do Hair transplantation? In most developed and regulated countries the law only permits qualified plastic surgeon to perform the procedure and in some a dermatologist is recognized to be equally qualified for the job. But in India, anybody and everybody is jumping on the bandwagon, with the greed of making quick cash. 

As for many people, ignorance is bliss, the common man generally not aware who is really wearing the white coat and what sort of risks complications they are exposing themselves to by trusting these unqualified surgeons. 

The International Society of Hair Restoration Surgery (ISHRS) is a global non-profit medical association and the leading authority on hair losstreatment and restoration with more than 1,200 members throughout 70 countriesworldwide. The ISHRS believes the following aspects of hair restoration surgeryshould only be performed by a licensed physician*:                                                                                                                                 

  1. Pre-operative diagnostic evaluation and consultation          
  2. Surgery planning
  3. Surgery execution including:
    - Injection of local anesthesia and sedation
    - Donor hair harvesting
    - Hairline design
    - Recipient site creation
  4. Management of other patient medical issues andpossible adverse reactions
  5. Post-operative care

The other elements of hair restoration i.e. Preparation of grafts and insertion of grafts can be performed by trained medical technicians under the supervision of qualified doctors.

An essential safeguard to take is to know who will perform hair transplantation. The use of unlicensed technicians or doctors to perform aspects of hair restoration surgery is getting common.

 They might be trained hands, but they will not be able to diagnose issues and can lead to-

  • misdiagnosis; 
  • failure to diagnose hair disorders and related systemic diseases; and 
  • the performance of unnecessary or ill-advised surgery all of which jeopardizes patient safety and outcomes. 

The biggest scare of all is an unlicensed technician and doctor is not be covered by malpractice insurance.

Although no clear guidelines are available in India, The Association of Hair Restoration Surgeons, India is making all efforts to curb the use of unqualified personnel performing hair transplantation. 

Hair transplantation is a surgery that involves use medications such as lidocaine, adrenaline, sedatives and all these medications, if not injected in appropriate doses, or using the right method, can cause life-threatening risks to patients. Only a qualified plastic surgeon or dermatologist have adequate knowledge and skill to administer it in patients body and deal with the medical emergencies arising out of the use of such medications.

Beyond that, any surgery should be performed in a licensed and accredited medical and surgical facility that has adequate infrastructure backup to take care of any possible emergencies that may arise during or after the procedure. Are these unlicensed Centers investing in patient safety – I doubt that.  Performing an invasive procedure in an unsterile environment without a facility for crash-cart may subject patients to serious risks of infection and other possible medical emergencies. Recently we had a case in India, where a patient died, due to infection. 

A lot of education is required for people who are contemplating hair transplantation surgery for themselves or their near and dear ones.

Patients Should Ask These Questions:

  1. Who will evaluate my hair loss and recommend a course of treatment?  What is their education, training, licensure, and experience in treating hair loss?
  2. Who will be involved in performing my surgery,what role will they play, and what is their education, training, licensure, and experience performing hair restoration surgery?
  3. Will anyone not licensed by the state be making incisions or harvesting grafts during my surgery?  If so, please identify this person, explain their specific role and why they are legally permitted to perform it.
  4. Is everyone involved in my surgery covered by malpractice insurance?

Although hair transplantation is considered low-medium risk procedures that are performed under local anesthesia on an outpatient basis,however like any other procedure a standard of care is necessary and safe surgery practices should be applied to ensure a safe outcome.

In my experience of over two decades  as Plastic surgeon and performing hair transplantation, the best practices are the following

  1. Procedure should be performed in an accredited and equipped medical center with proper sterility and surgery protocols
  2. Only a team of qualified and licensed doctors and technicians who work under direct supervision
  3. Patient to be evaluated clinically and medically thoroughly to ensure they are ideal candidates and healthy to undergo the procedure.
  4. All medications including local anesthesia are administered by qualified doctors after checking the content and expiry dates and in a controlled manner.
  5. Continuous monitoring of the patient is mandatory by using pulse oximetry to measure oxygen levels throughout the procedure and blood pressure monitoring.
  6. FUT i.e.  strip harvesting is performed by a surgeon qualified in managing scalp wounds
  7. FUE i.e. Is follicular harvesting is performed either by a surgeon, dermatologist or a qualified allopathic medical doctor.
  8. Site making is performed by the licensed doctors
  9. Hair grafting is performed by qualified and trained medical Technicians under direct supervision of the doctors
  10. Patients discharged after proper monitoring and assessment by the senior qualified doctor
  11. Regular follow-up protocol is undertaken to ensure the safe and effective outcome of the procedure.

Dr. Sanjay Parashar