For Sikhs in Punjab, where I practice, having a full beard is a matter of great pride. However all patients we see are not, across the board, offered a procedure without detailed counseling/psychotherapy.
Indians have darker skin types on the Fitzpatrick Scale- Grades 4-6:
Beard transplant should never be done in patients below the age 25 since they are emotionally and physically immature.
In young adolescent age, hormonal profiling should be done to assess the reason.
One also has to take the patient into confidence and since balding is as common as 62.4% in adult Indian population above 25, the fact that has to be impressed upon is that beard restoration should be considered only in select individuals who meet the following criteria in this subset-
1 . Patient does not have a strong history of baldness.
2 . If patient has dark skin type which is tough and oily, the chances of hypertrophic scarring are immense. These patients are an absolute contraindication.
However, they can be considered if they are counseled alongwith their parents/spouses and they agree to wear a beard all their lives. This needs to be recorded in writing.
When I started off my hair restoration practice 15 plus years back, I took up all such cases since I am situated in Punjab, where amongst the Sikhs, tremendous premium is attached to a full beard.
However I learnt the wrong way, that this treatment should be only offered to a select few and that too after intense counseling which at times should be done in consonance with a psychologist.
The danger with brown skin is that even very tiny dot like hypo-pigmented scars can be left behind. Scars being paler than surrounding darker skin, it can be embarrassing.
On the contrary, in light skin, pale scars are camouflaged by surrounding light skin and there is no contrast that will make the dots apparent.
The other danger is of hypertrophic scarring in a large percentage of Indian skin, especially over the jaw bone where grafting needs to be done in the anatomic beard area.
You can see the case of this popular Punjabi actor (Kuljinder Sidhu) who underwent a successful beard hair transplant and even shaves once in a while without scars showing.
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