The number of grafts that can be harvested depends more on availability of grafts and not much on availability of time!
Secondly, if donor density is not a problem, the virgin scalp can allow 3500-4000 grafts and the beard 500.
This is routinely done in a single day megasession in my Clinic.
Doing this over 2 days will not increase graft number, it will only increase pain since healing has set in.
On the second day however, chest grafts can be harvested. Usually good donors have 500 chest grafts available in one sitting.
The chest harvest is always done on the second day simply because the anesthesia has a safety limit.
Transplanted density will never match natural density. At the most, is only half.
With limited area of donor available, we cannot cover a full head with natural density nor is this possible since the grafts so implanted will run out of precious blood supply and none will grow.
Hair transplant is an illusion that we seek to create. How good is the result is how good you can create the illusion.
And this is the art of hair transplant.
You have diffuse alopecia areata.
There is a confluent alopecia areata scarring over the recipient area and numerous scars over the donor areas.
Even otherwise there is scant donor density.
This does not make you a candidate for a hair transplant.
Finasteride should never be taken before the surgery. It will sustain thinning hair and the quality of grafts taken will be indeterminate.
The hair maintained with Finasteride before the procedure will not grow well when you will stop Finasteride 6 months after the procedure.
It will then affect the quality of the result.
I advise patients to stop Finasteride 3 months before the procedure.
This is usual in most patients. However, there is no chance of damage to nerves in FUE (unlike in FUT) since the depth of puncture is only 2-3 mm in donor and 4 mm in recipient site.
However the superficial cutaneous nerves on the surface get punctured but reconnect within 6-12 weeks.
This numbness is more felt in the recipient area. Donor area nerves reconnect faster since depth of puncture is less.
It is often said that the crown area is the “Black hole” of hair transplant. It consumes too many grafts without even giving the semblance of coverage like the planted hairline.
The reasons are 2 fold-
- The crown is seen end-on while the hairline is seen side-on. In the hairline we see the illusion of greater density since the images of hair at a distance overlap with those of the front few rows making it look a lot denser. This is akin to seeing the forest from the road and then from the top of a mountain- when you see it from the road,the density appears much better while when seen end- on from the mountain top, the density is lesser. Hair transplant is creating an illusion of density. We can never match God’s creation. With minimal grafts we can make the bald spot look denser. Its also common sense- when the crown/vertex area looses around 30,000 grafts before becoming bald, how can we create the same density with 5000 grafts alone!
- The density in the crown area is 30 per sq cm while that at the hairline is 55-65 per sq cm. The density has to progressively decrease as we go back towards the crown otherwise we shall run out of grafts just midway to the crown.
These are the reasons why hair transplant surgeons are never as gung-ho about the crown area.
The over 3 decades old oligopolistic hegemony and overpriced marketing of hair transplant just gave way to a rational and practical approach. This was not possible without the advent of FUE as a viable alternative to FUT in early 2009.
The higher oligopolistic pricing was maintained by various machinations till 2016 when global prices crashed.
A once luxury service had suddenly turned into an affordable commodity.
However the Hair Transplant Wars are real and still raging.
For example, the marketing of the Robot is an attempt to steer the identity of the hair transplant industry and prevent it from cannibalising FUT hair transplant industry completely.
It can be compared to the gifting of the Trojan Horse ostensibly as a gift to the goddess Athena. It was however, as we all know, a subterfuge in which the Greeks were well versed. It may seem too audacious a battle strategy but the FUT surgeons are fighting tooth and nail with their backs to the wall. Their own errors by omission and commission have led to the emergence of a whole technician driven service industry in Turkey and elsewhere. And all ethical doctor-run centers the world over are suffering.
Had FUE been recognised as a legitimate procedure way back in 2009 when it became popular, more legitimate surgeons would have picked up its nuances and been fully prepared to take on the deluge of patients. However it was not to be. FUT surgeons who hitherto had controlled world opinion had an axe to grind. They discouraged fresher doctors and biased them against FUE learning and mercilessly tried to suppress the occasional voice that wanted a change in stance of the key Societies controlling the minds of young surgeons aspiring to a glorious career in hair transplant.
Many today sport blinkers though they are aware that this is a David & Goliath battle that the Old School of thought is destined to lose.
The take home message for all from this ongoing undecided Battle would be that a rock-solid premium marketing strategy in cohorts with an oligopolistic market posturing can overwhelm any concept of what legitimate and rational pricing should be for years together.
This is what I keep telling my patients- priorities keep changing with evolving fashion trends and also with age as you mature.
Procedures done on a mere whim mostly are repented when you grow wiser!
The best way to fix FUT scars to my mind is FUE with SMP.
However you wish your previously implanted facial hair to be used.
I would like you to know that-
- Removing planted hair is not an accurate process since they are not always linearly aligned due to resultant scarring howsoever minimal.
- Being a blind procedure with an acceptable transection rate (TR) of 2-5 %, FUE cannot predictably remove planted hair without a higher transection rate of upto 30%. So these hairs will grow back.
Also some hair will be in telogen phase (dormant phase).
- These telogen hairs will be missed when we harvest. They will soon grow and hence you will need multiple sittings for complete removal.
That brings us to the moot point that FUE is not the best technique for hair removal.
You should try Laser hair Removal for the facial hairs and SMP with or without FUE for the FUT scars.
Its not a good idea to get sunburnt 7 days before the procedure.
However you can do it before 9 AM and after 3 PM when chances of sunburn are less.
Sunburn causes changes in the skin and healing follows which can cause increased bleeding during the procedure.
At Darling Buds, we have worked very hard to establish a reputation that transcends international borders. One of the ingredients for this reputation is the creation of standards. Standards allow us to ensure consistency and excellence while not forgetting value, which also must have a standard.
If we start to lower our standards for our procedure or for what our procedure is worth then a domino effect can take place. If we lower our fee then the value of what we do is diminished which can have a negative impact on the whole team. My staff enjoys hearing from our many patients how great the value is that our service represents and to lower our price substantially disrupts this value. Value must be appreciated on both sides, by the customer and those that provide the service. I hope you understand my position on this issue. If you have further questions I am at your service.
Thank you for sharing your pictures. You are clearly heading for extensive baldness.
You will be able to appreciate from the pictures you have provided that even the neck area shows reverse balding, severely constricting the safe zone of hair transplant.
The safe zone is the area where the hair are free of DHT receptors and this makes them unique. Unique since they are permanent hair and will stay lifelong in most cases.
I will advise that you wait till 27 years for me to know whether you will be a candidate for hair transplant or not. Since hair transplant is not for all kinds of baldness and all age groups.
I hope you will understand. There are other solutions available, like hair pieces, SMP, etc. Even cloning will be in the market soon so there is no need for despondency in this regard.
1. How many days would I need to come to Chandigarh for?
You need to come the evening before and stay for one more night after the procedure. Usually people stay for 3 nights- one night before and 2 nights after.
2. What happens after the surgery?
You return to the hotel.
Do I need to revisit the clinic?
Yes the next day at 8 AM for change of dressing and instructions for care.
What is the resting time before I can travel without any bandages?
3. How many days will it take to get rid of any signs of surgery?
4. In how many days would I have a full head of hair even if they are short? (I just don’t want to look bald as I use a hair line system at the moment to hide my baldness)
Complete result at 9-12 months.
5. I am planning to keep my head shaved until all the existing as well as new hair begin to grow. Would I appear bald in the area of new hair till they begin to grow?
Yes till 4 months.
6. Will there be any visible scars from the surgery?
No. Not with hair length at #1 in the donor area. Scars at planted area are usually not visible even on slick shaving.
7. Is one surgery going to resolve the issue of baldness forever or would I need to do it multiple times?
Hair transplant is not a cure for baldness. We only fill in the bald spots. If you bald more, you will need more coverage.
8. I understand the need of involvement of technicians to perform the surgery, but it would be helpful if you could let me know what part of the surgery would be done by yourself? for example who would perform the grafting and incisions?
No one I know does more work in FUE on the client in this industry!
9. Are the results guaranteed?
There are no guarantees when dealing with the human body and biological tissues. However I assure you that you will get a result and if God forbid there is poor growth due to some reason, will do whatever possible to arrive at the result we set to seek. Getting a good result is as much important for my practice as it is for you.
10. Would the orientation of the hair be taken care of during the surgery?
Yes ofcourse. We do this all day long 6 days a week for the past 12 years! So we know what we are doing. Rest assured.
Your hair grows around half an inch a month, and faster in the summer than in winter. The growth phase, or anagen phase, lasts an average of 3-5 years, so a full-length hair averages 18 to 30 inches. The anagen phase is genetically determined and can last even longer.
Xie Qiuping, a girl from China has the enviable Guinness Book Record of the longest hair- 5.627 meters. Clearly her anagen phase is very long. Rapunzel’s though was even longer! However, there is no scientific record of Rapunzel and she likely is only a creation of Fairy Tales- due to girls’ desire for long hair.
Hair cycyle of growth has 3 phases-
Hair grows around 1mm a day (half an inch a month). The anagen phase is also called the growth phase and it typically lasts 2.5-5 years. Therefore full length hair on average can go upto 30 inches in the best case scenario if your genes are optimally endowed for hair growth. The growth phase can be as much as 7 years especially in Asians.
A short transitional phase, this lasts 10 days when the hair falls off and the hair enters the resting phase
This is the resting phase and lasts only 3 months when the root grows a new hair.
When your growth cycle gets disrupted, hair loss and thinning become apparent. This can be triggered by androgenetic alopecia, metabolic imbalance, illness or nutritional deficiency.
In all honesty, I consulted with other surgeons in Turkey, India and Thailand.
I was advised by 80% of them that it would be around 2,500-3,000 grafts to fill the crown area alone.
Any reasons that I could use fewer grafts (which would be very ideal) to achieve my desired results (2,800 grafts for both hairline and crown)?
There is no way you need so many.
All our grafts grow and we are confident about it- hence we do not pack the area so much as others do.
You have to be careful about depleting your scalp donor which will not allow more than 5000 in a lifetime!
Also you have to be cautious since some doctors quote for number of hairs they put and you misconstrue that you have been quoted per graft.
This is a leading scam in some hair transplant clinics which offer huge discounts and make up in innovative ways.
Also, please read-
The beard donor in Caucasians in times of ‘extreme need’ can go onto the cheeks since due to lack of color contrast between scar and surrounding skin, there is no visible scarring.
This however is not the case in darker skin types where we restrict ourselves to the ‘shadow area’- the area under the chin and behind the jawline, above the neck.
We do this regularly since I am an advocate of BHT.
3000 beard grafts has been achieved in Caucasians.
In Indians and other dark skin types 450-500 is the optimal number harvested.
I have seen your other patients in YouTube videos with a larger thinning /scalp area but considerably they required lesser amount of grafts as compared to mine.
Why is that so ? I am just being inquisitive. Kindly address my query. The videos I am referring to are-
https://www.youtube.com/watch?v=lVxboKqfmE8 (Hair transplant video 2876 Scalp Grafts Darling Buds Clinic@Chandigarh, India)
https://www.youtube.com/watch?v=iVmaQihByQI (30 Year Old I Type 4 Baldness I 2017 at Darling Buds Clinic Chandigarh India)
https://www.youtube.com/watch?v=D2UVoI6G7MA (Hair Transplant for extensive balding Dr Bhatti @DarlingBuds Chandigarh)
That is a nice observation and congratulations for doing a diligent research for your upcoming FUE hair transplant procedure.
In the comparison with your situation, what you missed out is the comparison between their scalp donor density with yours.
Though I strive to give maximum density possible with more grafts, in may patients those many grafts are not available.
In your case they are available but if you wish lesser grafts still you will get the result as in the videos.
In theirs the constraint was availability of grafts, in your case then, it will be patient choice.
I hope I have put things in perspective for your further research.
If there are any further questions, I will be happy to answer them.
The best technique is the one which delivers best results. As a patient you should research more and not fall for an argument where there is no basis since the proof of the pudding is only in the …. ?
My picture of youth is attached. I spoke to another clinic in Delhi and they said they can easily replicate this hairline. Can you guarantee I will get this density?
I will say that real and true native density is a fallacy for anyone expecting it and certainly if anyone is claiming they can and do achieve it. Any density achieved with hair restoration cannot be maintained with very short hair lengths. In addition, no clinic has a perfect record with regards to final results and the mark of a very good clinic is how they deal with patients that haven’t reached full satisfaction. I and my staff always strive to make our patients happy and satisfied.
I would like to ask which procedure will yield more grafts and good results?
Thank you for the mail with pictures of your type 6 pattern.
Since you have got a FUT procedure, the crown area has expanded since a part of your skin was removed and edges were stitched. Though FUT does give more yield per session by 10-15% but it expands the crown area significantly, thereby mitigating the benefit of more grafts. FUE does not do the latter. Also, in the second session FUT can never rival the amount of grafts that can be harvested using FUE technique since the scalp skin is tight due to the stretch.
Lastly FUE allows body grafts to be harvested and this will determine your future course now onwards.
Simply follow the following steps-
(a) Save the picture on your PC/phone
(b) crop the picture so any text of the cheating company is removed
(c) copy the picture
(d) paste the picture in the Google Image Search Box- https://images.google.com/imghp?hl=en&gws_rd=ssl
(e) This is serious crime if the picture of a patient has been copied from another clinic’s website
It was a technician run company and I now feel cheated. What can I do to get my money back?
Firstly it is your fault to have fallen for allurement and not having done your research.There is no dearth of companies that advertise themselves on their website by self-glorification and achievements which are not true.
In some websites, information loaded is taken from unreliable sources like Wikipedia etc which may be wrong. The consultants are fully responsible for information provided and for allurement and liable as per IT Act.
The planted hair will never shed. Even if they do like all normal hair, the root will always grow a new hair.
However while you were on Finasteride for the planted hair, the native thinning hair also benefited and were sustained and showed marked improvement in caliber by the medication.
Now that you have stopped it, all hair sustained by the medication shall fall off and revert to their original state when you started taking the medication.
You can either take the medication further in half dosage or wait for more hair to fall and fill in the balding area with few more grafts.
In this area, and noticing less density and itchiness within the area , is this hair loss typical based on symptoms and can I expect regrowth?
Yes Minoxidil does cause dryness and scaling which in turn cause itching and you scratch to gain relief. In this process a lot of telogen hair in the native thinning hair and also planted hair fall off, giving visible loss of density.
However planted hair being permanent will regrow.
The same cannot be said of the native thinning hair. They might not regrow.
Hence if the Minoxidl is causing too much itching, you can either lower its dose or stp it completely.
If you stop it, you can consider taking half dose Finasteride to avoid further progress of balding in the native areas that were not transplanted.
Firstly please understand that baldness is not a life threatening disease that everyone will go in for a hair transplant.
People opt for a hair transplant only when it affects their body image, affects their prospects in society or at the workplace or in love.
We have several celebrities who opt for hair transplant.
A famous celebrity from the Punjabi Movie Industry has been coming to me for the past over 4 years but cannot gather the courage to go in for a hair transplant since he has a morbid fear of needles.
A celebrity like Anupam Kher is firmly entrenched in all character roles in his bald look. Ever imagined what will happen to his career if he were to get a hair transplant!
People like Shahrukh Khan and Amitabh Bachchan wear a wig, not because they cannot afford a hair transplant, but because they have been wearing a wig for so long that the 6 months after a hair transplant without a wig will cause them great financial setbacks. Also, hair transplant look is not as dense as in a wig when you are suffering from extensive balding.
These are just some reasons regarding why celebrities do not always opt for a hair transplant.
Celebrities are human too and their choice of hair transplant is determined by the same instincts that we have. It is no different.
Oil is not required by hair.
The body produces its own oil for hair which contains growth factors.This oil gets suppressed when the source of lubrication is with coconut oil.
Also when you massage, telogen hair fall faster. After hair transplant the result will get delayed.
On the day of the procedure, contrary to what was told to him by the doctor, he discovered that the doctor had no role to play in the procedure except the slit making.
What course of action is available to him?
This practice is rampant not only in India but in many Western countries. The doctor does only the counseling and at most the slit making.
Most practices cover themselves up by getting consent signed after the patient has paid up the amount.
Some clinics also heavily sedate the patient.
The best course of action is to endorse in the consent form in your hand writing (and take a counter signature by the doctor) before making the payment that you will have recourse to legal action if the procedure is not done by the doctor as he claimed and that you shall be refunded the full amount in such an eventuality.
In fact this may be a case for criminal action by the police.
What I hope to get from this procedure is lowering my hairline as much as possible and filling in the temples to look in line with my hairline and with density, so I can have my hair combed up without being embarrassed with my naturally wide and big forehead and receding hairline.I have attached a picture of a model to show how ideally I wish my hairline and temples to be.This is my main goal that I wish to achieve from the procedure, but if possible, I am also interested in adding more hair to my thinning mid-scalp and crown area even with non-surgical procedures.
You are 26 and with obvious signs of ensuing extensive baldness.
Lowering the hairline is not in your best interests.
The hairline can be made but not like in the picture you have sent.
When you bald to type 5 or 6 which is very likely, a low placed hairline will look incongrous and therefore artificial, fake and un-esthetic..
Remember, the person you wish to copy does NOT have balding and therefore the hairline suits him.
The hair that have been planted are natural hair and will enter the hair cycle of anagen-telogen-catagen but whatever falls off shall grow back.There will be seasonal and stressful situations when more will fall than usual but unlike native thinning hair, they will always grow back.
The cost of hair transplant at any clinic is determined by market forces. If there is no-one to pay the amount we charge, the rates will obvious come down to Rs 36 as in other clinics or even lower as per the value determined by the client. Patients pay for the quality of work we do.
That is an unrealistic goal to expect and can never be met. Hair transplant is neither magic nor do we attempt to replicate God’s work.
Hair transplant is an illusion to the eye. Transplanted hair is usually no more than 50% of natural hair density.
After the result sets in you have to continue to groom your hair with the right shampoo and keep it long and blow dried.
If you wear the hair short or wet, this disparity between planted and native hair is evident and the illusion is lost.
Kindly reconcile your expectations.
PRP has no action on the operating surgeon or his staff. It only affects the patient’s growth potential.
Chest and scalp grafts are recommended for the crown since here the hair sit alongside the scalp skin and do not rise up much.
Beard grafts are solid grafts and will stand up and look weird since you will not be able to tame them.
Your condition arose since you got a procedure done at an early age when we cannot usually ascertain whether a person is a candidate for a hair transplant or not. We do not do a procedure before the age of 25 due to this very reason. Your dilemma seems to be that when you wear your hair long, the balding appears more prominent. Due to this you keep your hair short but then the strip scar becomes visible. On seeing your scalp donor, the grafts available are not encouraging at all since the hair are predominantly miniaturising. These hair will not withstand the transplant process and will not grow. Unfortunately even body grafts will not be able to hide the strip scar when hair is kept this short.
I will advise you to consider other options like SMP (scalp micropigmentation) and a hair piece.
Since the hair grew well till 6-9 months, the following reasons for the planted hair to fall off come to my mind-
(a) The FUT strip has been taken from very high up on the sides. This is the non-permanent zone which even in FUE we do not encroach upon
(b) There are a lot of miniaturizing hair. It could be due to this that the hair have fallen off.
(c) Sometimes doctors advise taking of Tab Propecia 3 months before to make the hair thicker. Once this drug is stopped, the hair that was miniaturizing and were sustained artificially due to the drug shall return to their original condition. Tis could have happened if this was the case with you.
(d) You should also rule out any skin disease. Kindly consult a dermatologist in your town.
The evidence of benefit is still anecdotal; but is increasingly being reported by many clinics of repute around the world.
Yes we offer it since a lot many patients do ask for the service.
Can you do this and how much does it cost for 5000 grafts from 1000 body hair grafts and 4000 beard and chest hairs... (all fue)
Though I have no pictures from you to base my advice on, I would like to advise that hair transplant using just body grafts is not a wise thing to do.
This is since body grafts do not match even closely those of the scalp in terms of texture, caliber or even color.
When used they are mixed with scalp hair in a given proportion so they lose their individual characteristics.
Let me know if I can help with further information.
It will be helpful to discuss if you can send me some pictures which I could study.
Following the success of pioneering clinics all over the world including India, FUE clinics have become extremely commonplace. It is estimated that in India alone, there are over 5000 FUE clinics operational. FUE clinics have a pecking order too like most health care delivery systems-
- The doctor-centric doctor-administered Clinic
- The technician- centric doctor-administered Clinic
- The technician centric-entrepreneur administered clinic
- The technician-centric technician-administered Clinic
The potential hair transplant candidate should do adequate research to determine the involvement of the doctor since the first hair transplant if improperly done can ruin his future chances of a successful hair transplant since the available donor gets depleted every time a procedure is done.
It is not solely due to steroid exposure though for a brief period.
The underlying cause is androgenetic alopecia which is inherited. The steroid exposure has only umasked it earlier. It would have appeared even otherwise.
You are going to bald quite quickly since it has happened at an early age.
Hair transplants done so early can often have their own unique problems.
We run the risk of putting too many grafts since only that would match your objectives as a young man- no contrast in density of planted hair to your natural hair density.
In so doing, we would be placing precious grafts in high density along the hairline.
If, God forbid, you develop extensive baldness, we would have erred since we would have prematurely depleted your scalp donor which is not infinite.
These same number could be better utilised in future with little lower density to cover extensive baldness.
I hope you understand.
However if this affects your psyche, I can offer to do a minimal number of 1200 scalp grafts to thicken the hairline.
The transection rate for harvesting planted hair due to scarring is almost 30%.
Also, you need to keep in mind that all hair roots reside under the skin and undergo cyclical shedding (telogen, catagen phases) only to regrow in the anagen phase.
Since some hair will not be visible over the skin when you come, it shall need around 2-4 sittings which is a cumbersome and costly process specially if you are traveling from abroad.
Scarring will not be visible after hair are transplanted back.
Every clinic has their own unique experience, ethics and commercial compulsions.
I can only speak for myself and for you. For you I can tell you, you will badly repent a hair transplant done so early.
All people will have different hairline designs with us and this will depend upon several factors-
- The availability of grafts in the long term if you are likely to become extensively bald. This can be assessed by current thinning pattern and/or family history of baldness.
- Every face is differently contoured and where a flat hairline is best suited for a rounded face, a more angular hairline will look more esthetic in a patient with a longish or square face.
- Africans have a straight and flat hairline with minimal indentations and the fronto-temporal angles are acute.
You have thinning but no significant balding at this moment.
However the condition will progress to baldness over time. How much time it will take cannot be predicted scientifically!
Unfortunately, in your present condition you are not a candidate for a hair transplant. Also we do not encourage hair transplants before 25 years of age.
I will also caution you against getting a hair transplant on a whim since this will be detrimental to your overall hairloss treatment plan in future.
In your present situation a hair transplant can be counterproductive since there is a great risk of “shock loss”. The appearance after shock loss will be far worse than it appears to you at the moment.
You shall have to be patient and wait.
Meantime you can follow the following advice-
1. Wear your hair longer- 1- 1 1/2 inches long
2. Use a mild shampoo like Johnson’s Baby Shampoo just thrice a week. On other days you can wash your hair only with water.
3. Sleep well and reduce stress in daily living to whatever amount you can.
3. Tab Biotin 5 mg at night.
4. In consultation with a local doctor you may be advised 5% Minoxidil and PRP treatment
5. Do not wear a cap for long. Let your scalp breath.
6. Apply hair thickening fibre like www.toppik.com in areas where there is seemingly less density
In India, as in the USA and other countries, the skin incision is to be made by the doctor alone. In hair transplant this entails the following steps-
2. Making of slits
All other processes can be delegated to trained assistants like plantation, dressing, etc under the doctor’s supervision.
My position is at-
Please read the ISHRS statement –
ISHRS LEGAL UPDATE October 2016:
DELEGATION OF SURGERY IN HAIR TRANSPLANTATION
The ISHRS shares, from time to time, legal developments on issues potentially affecting members. One such issue is the permissibility of delegating portions of hair restoration procedures to unlicensed personnel. In the United States, a physician’s authority to delegate to unlicensed personnel varies from state to state, and depends on each state’s regulatory scheme. Many states prohibit the delegation of surgery or medical tasks to unlicensed personnel.
The Florida Board of Medicine issued a Declaratory Statement in June 2016 that states that, “surgical excisions and incisions related to the transplantation of skin grafts goes well beyond the assisting of physicians.” The Florida Board of Medicine further explained Section 458.3485, Florida Statutes, did not authorize the petitioning physician:
to delegate the task of harvesting follicular units consisting of the excision of skin, subcutaneous tissue and hair follicles by use of a scalpel, micro-punch, motorized surgical extraction device or similar surgical instrument or device and incising the scalp for transplanting such grafts, to a medical assistant, or any other person who is not licensed as a health care practitioner and appropriately trained or otherwise experienced in the performance of such surgical procedures, in an office setting.
The Florida Board of Medicine’s Declaratory Statement is consistent with Resolution 16-130 adopted by the Florida Medical Association (“FMA”) in 2016. In particular, the resolution provided:
RESOLVED, [t]hat the Florida Medical Association oppose the use of unlicensed personnel and/or medical assistants to perform critical-to-quality steps of hair restoration surgery, such as re-distribution planning, donor harvesting of follicular units via FUE or strip methods, and creation of recipient sites; and be it further
RESOLVED, [t]hat the FMA oppose the use of unlicensed personnel and/or medical assistants to perform the diagnosis or treatment of hair loss conditions; and be it further
RESOLVED, [t]hat the FMA support legislative efforts to prohibit the use of unlicensed personnel and/or medical assistants to perform hair restoration evaluation, diagnosis, and/or critical-to-quality steps of hair restoration surgery, such as diagnosis of hair loss etiology, hair re-distribution, planning, donor harvesting of follicular units via FUE or strip methods, and creation of recipient site.
An earlier decision by the Virginia Board of Medicine is also consistent with the Florida Board of Medicine’s Declaratory Statement and the Florida Medical Association’s recent resolution. In 2011, the Virginia Board of Medicine instituted disciplinary proceedings against a physician who permitted unlicensed individuals to regularly incise the scalp and insert hair grafts without direct supervision, which the Virginia Board of Medicine concluded in December 2011, violated 18 VAC 85-20-29.A(1), a regulation that prohibits knowingly allowing subordinates to provide patient care outside of the subordinate’s scope of practice or area of responsibility.
The prohibition on the delegation expressed by the Florida Board of Medicine and the Virginia Board of Medicine are consistent with the ISHRS’s position on delegation announced in the ISHRS Position Statement on Qualifications for Scalp Surgery, available at http://www.ishrs.org/content/qualifications-scalp-surgery. These procedures should only be performed by a properly trained and licensed physician, or in countries where allowed, a licensed allied health professional within the scope of his or her license.
In addition to the foregoing examples from the United States, there are also recent international examples of charges being leveled against non-doctors performing hair restoration surgery. In September 2016, the Istanbul Attorney General’s Office charged two individuals with treating patients without a diploma following a police raid that allegedly revealed them performing hair transplant surgeries at a clinic without a doctor being present. As of this writing, the case against these two individuals is pending, and the Attorney General’s Office has requested prison sentences of 2-5 years.
The foregoing examples reinforce the importance of physicians, allied health professionals, and unlicensed persons involved in hair restoration to understand the legal restrictions on delegation in the jurisdictions in which they practice. Physicians, allied health professionals, and unlicensed persons involved in hair restoration surgery should carefully consider a number of factors in deciding whether delegation of a hair restoration surgery task is legal, ethical, consistent with the standard of care, and in the patient’s best interests, including, whether:
(i) The delegation is legally permissible, consistent with the applicable standard of care, and consistent with the codes of ethics to which the physician or allied health professional is bound;
(ii) The unlicensed personnel has adequate education, training, and experience to perform the delegated tasks;
(iii)The level of supervision a physician must provide to the individual to whom the task is delegated (e.g., direct, in the same facility, available by phone, none) is being met;
(iv) Malpractice insurance covers the physician and unlicensed personnel;
(v) The patient provides informed consent for the procedure, including the delegated portion of the hair transplant surgery; and
(vi) Delegation of a portion of the hair transplant surgery is in the patient’s best interest.
In summary, when deciding whether the delegation of medical tasks associated with hair restoration surgery is legal, ethical, and in the patient’s best interests the physician and other individuals involved need to research and consider a number of factors. Relying on what others do or the assurances of a sales representative puts all those involved, including the patient, at risk. Accordingly, the ISHRS encourages physicians, allied health professionals, and unlicensed persons involved in hair restoration surgery to research and understand the legal restrictions on delegation in the jurisdictions in which they practice.
Yes these shall be done one evening prior in our own lab in the clinic.
If you have not got a routine health check up done recently, it would be appropriate for you to get one done if you are traveling from a distance to avoid disappointment. We mostly worry about-
- Uncontrolled diabetes
- High blood pressure
- Bleeding disorders (also patients on blood thinners)
If I do not feel that density can be improved then I simply will not perform surgery in the area. It is a simple matter but from what I see in your photos improvements can be made. I wish to be crystal clear, there is always a chance of some shock loss from this procedure but there are two types of shock loss to be aware of. Permanent and temporary. Permanent is caused from transection of native hair during recipient site creation and this is what we wish to avoid. Shaving the recipient area allows me to better see the spaces in between your existing hairs thus it becomes easier to avoid these hairs and damaging them. Temporary shock however cannot be predicted accurately and it is simply a physiological response to the surgical trauma. The issue is usually resolved between three to five months post surgery.
These are normal concerns. Again, to be crystal clear up front, once the procedure is done and you see the final result it might have some indicators that YOU can identify as being a result of surgery but overall I feel that the result will look natural and will not be identifiable as being a surgical result by anyone around you. You will have increased coverage, higher density and a natural aspect. I am confident in my abilities based on my skillset and my experience but, as the saying goes, you can’t please everyone at the same time:) This is just a fact of life. I think this is one of the reasons why I’m successful with this speciality. I try to be honest with my patients and do the best work that I can. It is a simple thing, really, but apparently not so simple for most:)
I encourage this type of thinking because I feel that patients should recognize that this is an elective procedure and there are no guarantees. It is disingenuous, I believe, to make any promises other than the promise that I will do the very best job that I can. Anything more is asking for the impossible.
There is a lot of misinformation about FUE spread by some FUT only doctors due to reasons best known to them. The FUE long term result is the same as the FUT long term result provided you do not go to an FUT doctor for FUE and to an FUE doctor for FUT.
You need to come one evening before the procedure to Chandigarh at 3 M for a pre-consultation (except Sundays) and can leave the next day after the procedure- total 2 nights in Chandigarh. You can even return to North America which is a 25 hour journey ,rather safely. Our precision procedures allow you to travel the very next day since due to the controlled technique there is no facial swelling and pain post procedure.
Your expectations may be slightly off the mark.
A mohawk like the one shown as an example by you in your mail is achievable in patients who only have a good scalp donor site and do not have much advancing baldness. At most they have a type 2-3 pattern baldness. The mohawk can be achieved but in 2 sittings 6 months apart only in such select cases.
But always remember that there are no free lunches and more so in hair transplant. Honest ethical consultations will never be free since you are not being compelled into buying a product; it is only an opinion and assessment that the doctor will render. Free consultations are a trap laid for unsuspecting patients. Or else why would they be free. If a doctor has enough clientele, he will always charge like all other professionals do. Yes online consultations are mostly free since the doctor can reply back in his own free time.
At Darling Buds Clinic, of the many patents that approach me, just about 25% are candidates for a hair transplant. This number in 100% in clinics that value profit before patients. For being low cost clinics, they cannot afford to miss a single case. All 5 operating theaters need to be full all 7 days of the week for them to be profitable.
You get what you pay for.
There are many implanters in the market.
Most surgeons of eminence in FUE have started manufacturing their own implanter pen.
Examples- Sava, Lion’s planter, KEEP device, etc.
Ours is a modification of the Sava implanter but we do not use it for the hairline and temples since in this area heavy implantation density is needed and hence the slits are pre-made very superficially aligned to the skin surface( this cannot be achieved with a planter since it can only go upto 45 degree to the skin surface at maximum slant. Using the implanter here will not give a natural result.
Also all cases are not fit for implanter pen given varying skin thickness and complexities.