x

Faq - Hair Transplant

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.

Absolutely not!
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-

  1. 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!
  2. 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?

48 hours.

3. How many days will it take to get rid of any signs of surgery?

2-3 weeks.

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)

5-6 months.

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?

Please read-

http://www.regrowhair.com/hair-loss-blog/extraction-vs-insertion-what-is-the-most-important-stage-in-follicular-unit-extraction-fue-hair-transplantation/

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-

Anagen Phase:

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.

Catagen phase:

A short transitional phase, this lasts 10 days when the hair falls off and the hair enters the resting phase

Telogen 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.



 

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-
top-6-ways-to-mislead-a-potential-hair-transplant-patient


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)" style="fancy"]

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 .... ?

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.

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

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.

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.

Please see-

https://darlingbuds.com/celebrities-videos

https://www.facebook.com/Celebrityhairtransplants/?ref=bookmarks

https://www.youtube.com/user/dearbhatti/videos

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.

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.

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.

There is no proven scientific evidence yet regarding PRP use.
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.

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-

  1. The doctor-centric doctor-administered Clinic
  2. The technician- centric doctor-administered Clinic
  3. The technician centric-entrepreneur administered clinic
  4. 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-

  1. 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.
  2. 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.
  3. 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-
1. Harvesting
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-
http://www.regrowhair.com/hair-loss-blog/extraction-vs-insertion-what-is-the-most-important-stage-in-follicular-unit-extraction-fue-hair-transplantation
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-

  1. Uncontrolled diabetes
  2. High blood pressure
  3. 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.

If you are offered a Free consultation, take it!

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.

We use this technique in selected patients but never for the hairline.

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.

Every medicine has side effects like all things in life- food, air, love, etc!

However they occur rarely.

The benefits are immense and hence I will recommend them.

Most of my patients do not have any side effects.

If they do, I tell them to stop the medicines.

The reasons are threefold-

Caucasian hair is compact in follicular units and hence can be extracted with ease and low transection rates since all hair units are parallel to one another.

Punch size used is smaller since follicular units of the graft are compact and the cross section diameter is lesser

The contrast between skin color and hair color is low.

For more information and to see results visit several videos related to caucasian hair transplants at-

https://www.youtube.com/playlist?list=PL369T6qyYsuGzUqqHgMAsICgekPq88_Et

That is not true with our Clinic. Dr Bhatti has a such a varied clientele from various ethnic groups, and various socio-economic subgroups from all corners of the world. Also the Bollywood and Pollywood industry is so demanding that he cannot have just one hairline for all ! To see our hairline design and how we suit the hairline to the facial structure, ethnic group and many timesunder duress 🙂 for the glamor industry. To learn about our hairlines see this Playlist on YouTube for Bollywood celebs and decide for yourself-https://www.youtube.com/playlist?list=PL369T6qyYsuGUpQgdWANQrsJAHbEjQ9JR

When done alongwith the hair transplant-

  • It aids in healing
  • Anesthesia is already given for the hair transplant and PRP procedure will be painless.

Firstly, you will never be able to replicate the density of a weave that is more than natural density by twice the amount.

 

With a hair transplant we can give you 50% of natural density in the first session.
However this looks like natural since the placement of grafts is done in a manner that lesser grafts look a lot more.
Hair transplant simply stated is an illusion to the eye.
This illusion disappears when you wet the hair or trim your hair real short.

Thank you for your question. I cannot discuss the cases that you reference as this would be breaking patient confidentiality. However, I can address the issue overall by saying that not all patients can receive equally high density in one session as some would like. It comes down to the patient tissue. When we are dense packing we have to place each incision close together but the challenge lies in that some patient's tissue is brittle and breaks down more easily than that of other patients. This "bridge" , if you will, simply disintegrates and creates a wound that can be three times bigger than the intended size of the original recipient site so when this happens we must back off of the desired density and come in at a lower density, with additional adjustments.This is a physiological issue alone and is not dependent on tools or doctor skill. If anyone tells you differently then they are not experienced with density or they are not admitting to the issue that challenges every hair transplant doctor worth their diploma.

I have yet to determine if this is due to environmental factors such as nutrition or genetic factors but it is indeed an issue that exists for some patients. Others do not have this problem and where higher densities are indicated they are met without problems or complications. Be warned. No doctor can guarantee that you will not need a second pass for additional density. If they do, you should walk away as this is simply a fact of hair restoration surgery. Sometimes the desired density cannot be realistically met, either due to the inherent limitations of hair restoration surgery or the unrealistic, uneducated expectations of the patient, or both.

I hope this helps.

Yes they are healthier in the hands of FUT surgeons like FUE grafts are healthier in the hands of FUE surgeons. Provided you choose your surgeon correctly.

Thank you for the mail with pictures of your type 3 pattern.

 

You have reverse balding from the nape of the neck upwards which is going to continue its upward ascent and reduce your scalp donor.
Any hair transplanted from this region will not be permanent and will shed over time.

I feel you should allow the balding to progress for another year and then send me comparative pictures in the same angles these have been taken.
You should be cautious in your approach since whatever grafts available are precious in your case and a misadventure will cost you money and emotions invested.

I look forward to following up with you in future.

I have not seen keloids appearing in the scalp donor or the recipient site ever even in patients with previous keloid formation and strong family history.

Keloids form in areas of tension (due to meeting of skin tension lines like 'fault lines') overlting bony prominences like the presternal region of the chest, front of knee and shoulder point.

Though the scalp lies over bone, the underlying bone is round and the skin is loose and mobile.
Theoretically keloids can occur over the occipital protuberance but we do not harvest from this region.
However, if keloid formation has occurred on minimal needle pricks before, it would be advisable to do a test procedure and wait for 6 months.

It is never a good idea to increase density in the crown. As they say it is the 'black hole of hair transplant'!
This is since the crown expands circumferentially with ongoing balding and this greatly increases the surface area that will need further plantation.
If it were to be filled with the same density as the hairline, it would consume all grafts available.
If we are to do a high density plantation presently as suggested by you, when the crown expands we will not be able to replicate the same density in the surrounding and it will give a halo effect since we would have run out of grafts.
I strongly caution you against high density for the crown.

Most people coming from outside like to choose the premium package due to car transfers. Also the new punch gives lower transection rate.

This is of advantage only for extensive balding where we need greater yield. Even a 2-3 % higher yield is important.
Otherwise there is no difference in result.

Yes, there is a direct non-stop flight to/from Chandigarh.

All hair should go in within 6 hours of harvesting.
We do 3500-4000 scalp and body grafts almost every other day and have never exceeded the out of body time for grafts.

However if there is difficulty in harvesting and it is taking long, I will myself do the remaining procedure on the subsequent day.

Yes most likely there will be shock loss. It can be mitigated by starting Propecia in the dosage 1 mg a day atleast one month before the procedure.
However, even without Propecia, shock loss will happen only within the crown area and not around.
The thinning hair may permanently be lost but then why would you wish to preserve them since, as it is, they are on their way out.
We can avoid going too close to them but this will alter the overall result which will be less dense and when these thinning hair which are in the balding zone fall off, theer will be loss of density.
Propriety lies, therefore, in ignoring the thin hair and planting in optimal density.

Since you have already got an FUT done, I will suggest you again go for an FUT procedure since the prime advantages of going for an FUE is now lost. You now have a linear scars. Another FUT procedure will not give you 2 scars!
Once the FUT procedure is done and when the scalp due to resulting tightness will not allow another you can contact me for an FUE procedure. This will be optimal utilisation of the scalp donor given that you already have a linear scar.

Other advantages of FUE in isolation are:

  1. Less downtime
  2. Less postoperative discomfort

That will not be possible since your counseling has to be done, blood tests have to be carried out and you are to be given medication the night before the procedure.
We would also like you to digest overnight the points discussed during the pre-consultation so the next day there are no surprises!

Also, I have seen that clients who come in the same day have anxiety and due to which we have had to on occasion cancel the procedure due to elevated BP.
One gets a procedure done once or twice in a lifetime and so I do not wish that you spoil your best chance to a great result by being careless with timings wherein if you reach late due to a traffic jam (or any other reason) we rush to finish your case against a time deadline.

Firstly, afrotextured hair on the scalp has a very low density. if other racial groups (Caucasians, Asians, Arabs) have 100 hair per cm sq, Africans have a mere 15-20 per sq cm

and that too in those who are well endowed. Therefore it is impossible that in an African any doctor can take out more than 1200-1500 scalp grafts in one sitting using FUE technique. Further harvesting may not be possible since 'skin show' may result.

Secondly, with FUE technique around 60% afrotextured hair is not favorably disposed for a procedure due to the s-shaped bend of the shaft under the skin.

FUE being a blind procedure, the transection may be very high.
The best way to make sure that FUE is suitable for people with afrotextured hair is to do a test grafting of 50 hairs.

FUT may be ther better technique for African hair. However, since keloids occur more commonly in your racial group, this may be a problem.

Overall, African hair transplant is a challenge.

We do 10-12 such cases each year.

I have seen that Eastern Africans (Somalia and nearby countries) have a far straighter hair direction than other Africans. However the hair density remains the same.

There is no medicine in allopathy that does not have side effects.
If the benefits far outweigh the benefits and if side effects occur rarely and are temporary there is good reason to take them.

1. Sudden stress.
2. Stopping of Finasteride and Minoxidil
3. Hair straightening, perming or hair spa.

65 per sq cm. However how many grafts should be placed will depend upon-
1. Availability of grafts and likely future needs since donor hair are finite.
2. Skin condition- though some skin type can accept high density, others will just not. It all depends upon whether the grafts will survive when placed so close together. This can be assessed only during the procedure. If pushed beyond rational density, no grafts will survive. This is where the surgeon's expertise and judgement plays a part. You must have heard of high density hair transplants with very poor eventual hair growth after 6 months?

Yes- PRP, SMP (scalp micropigmentation) and hair piece are alternatives.

Nothing is a substitute for a hair transplant where you get real hair and gives a natural look. Most other treatments are temporary.

Look out for Cloning which will be a big splash in the pond of hair transplant in the not so distant future.

FUE is a minimally invasive procedure and if done with due care. the scars are barely perceptible and definitely not if hair length is 1 mm.
Your condition can be due to any (or all) of the following reasons-

  • Overharvesting
  • Hypertrophic scarring- this happens in 0.5% individuals
  • larger punch size used

Scar tissue forms even if a needle pierces you.

The punch of an FUE system creates a 0.75 mm hole which heals by contraction and forms a pinpoint scar half the size of the original hole.

In fair skinned, it is difficult to detect even from up close.
The darker the skin, the more the contrast between the scar tissue and normal skin and hence greater the visibility.
However, with hair length 1 mm it is still not discernible.

I practice anagen selective hair transplant and with this technique I can cherry pick grafts that are of good quality. These hair once grown are thicker and they grow faster. They will cover the same area with the same result as would 2000-2500 scalp grafts taken by the strip technique.

The hair is preferebly shaved in the clinic so I have a visual assessment of how light and shadow plays on the scalp when the hair is long. This way I can strategically position the grafts for optimal coverage and utilisation.

Hi! If out of body time is more important to you than good growth, you might as well let your grafts remain where they are! The hallmark of a great hair transplant is Out of the World Result, not Out of the Body Time!!

With a few exceptions, the low graft harvest has more to do with inexperience than anything else. Also, manual means of harvest will yield lesser grafts since it is time consuming. But in my clinic though we harvest an average 3500 grafts a day, the yield is comparable to any other center of repute. Also in FUE you have to see whether the low speed doctor is offering FUE as a secondary procedure- his core competence being FUT which he offers as his primary procedure.

There is more to hair transplant than meets the eye; so I encourage you to take your time and do your research well and not leap blindly in good faith.

Any graft planted with due care in harvesting storage and plantation, whether from body or scalp, should grow with 95% survival.

It is not the low survival of body grafts but the late appearance of the result that may be of concern in the impatient patient.

Hair from the body have a longer growth cycle upto 18-24 months unlike 6 months for scalp hair.

As a patient it is the result which you should aim at and not the technique.
No, we do not have the Robot. No center in India has it yet.
I will, however, be the first to buy it when the Robot surpasses results which I presently give to my clients.
However, if you wish a Robotic transplant, you can search doctors who have the Robot at-

www.artashair.com/choosing-artas/find-a-physician

Wishing you the best in your hair transplant journey.

Yes we do.
If you choose to have a procedure with us, the fee charged for consultation shall be adjusted in the final bill. Once a patient is operated in the clinic, there are no future charges for follow up or consultation.

Coloring if done days before is of no benefit since we need only a millimeter long hair. Due to this fact if coloring is done before 24 hours of the procedure, the root will grow and the base of the hair shaft will be without color at the time of procedure making the dyeing redundant. I usually color the hair the same morning of the procedure. This is also due to the fact that if there is color allergy, the color is washed off within 2 hours of the harvesting.

Any ingress into the skin by a sharp object howsoever small (even the smallest of all hospital syringe needles) shall leave a scar. However here we are talking only of scars that are not visible to the untrained eye and esp. when the hair grows back to even size #1.
FUT on the other hand leaves a linear scar.

The hair after a hair transplant seems to grow and then begin to fall. This fall happens between the 3-6 week period and is due to the fact that the root has begun to grow a new hair which continues to push the old hair outwards till it loose support and falls off. This happens in the vast majority of patients undergoing a hair transplant. However, a small minority continue to grow hair. The shedding phase does not happen in this fortunate subset of patients. Reasons for this are unknown. The hair once shed begins to show at around 4 months mark after which the results begin to show at a brisk rate getting better with each passing day till one year after the procedure. Most of the result, however, has set in by the end of the 9th months after the hair transplant.

The static electricity will make you look bald again very fast!
Also the thin new hair that grow at 3 months + mark will continue to get detached due to the strength of the strong electric charge emanating from your woolen cap..

There is no established study which proves this tall claim. The stem cell treatment is being unethically sold as the cure all for hair loss. However, a recent study of use of stem cells states those stem cells may actually cause cancer since we are too early in the understanding of how these work for various ailments. Whatever the benefits of taking injections of stem cells, genetic problems like genetic baldness can only be solved by changing the genetic composition to which there is no answer yet.

Hair transplant is not removed from the forces of the market. You pay more for a better product and less for a lesser product. A manufacturer of a product will never sell his at a lower rate if his product is good and will stand in the competitive market like hair transplant. Also be aware of whether you are paying per graft or per follicle! I hope you understand.

The beard grafts are not placed in the first few rows of the hairline and even where it is put; it is admixed in the right proportion to dull its seeming coarseness. It is surmised that after 2-4 years of plantation due to "donor co-dominance" the hairs take on the textural and linear characteristics of the scalp hair.

My thinking is that an average person can get 20% of his strands/grafts from the scalp donor area's safe zone during a lifetime. Since the strands (grafts) in an average male in this permanent region are around 20,000 we can take between 5000-5500 grafts in one lifetime without it showing! However, this can be 15-20% more or less depending upon-
1. Age
2. Density
3. Racial characteristics
4. Previous strip procedure
5. Dimensions of the head

Take a bowl of water and pour a cap full of baby shampoo creating lather.With one hand keep pouring this over the areas with crusts and with the other (while under the shower with a rapid strong jet) with gentle rotary movements of the forefinger and middle finger try teasing away the crusts. They shall go off in a day or two if the procedure is done properly.

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 folds-

1. 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. It’s 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!

2. 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.

We routinely do the "no shave" technique procedure for cases requiring an average 2000 grafts. The term "no shave" is a misnomer since it is a must to have hair awaiting extraction to be shaved down to 1 mm in length in order to accomplish an FUE procedure. However, these stripes (not to be confused with strips) are not visible due to overlapping of hair from above and hence the donor site looks the same after a hair transplant procedure. The common denominator for a "no shave" technique is long hair at the back of the scalp long- enough to cover the shaved stripes from where the grafts are going to be extracted. The following are the number of average grafts that can be taken based on given hair length over the donor area in an individual with 100 hair per cm sq- ½ inch length- 1000-1200 1 inch length-1200- 1500 1½ inch length- 1500-1800 2 inch length- 1800-2000 2½ inch length- 2000-2500 It is impossible to extract more than 2500 grafts in this technique since the hair lower down over the neck are spared and so are the thin hair bearing stripes which go untouched.This limits the extraction of greater number of grafts. If a patient with the same variables were to get a "full shave" FUE, up to 4000 grafts can be extracted.

The hair that are transplanted are neither someone Else's nor artificial. Since they are your own hair they will be treated in the same manner as your other hair. But during the first 6 months after the procedure there are some precautions that need to be taking. Please note that we are merely transplanting hair from one place to another. This does not change its characteristics like texture, curl, length, life, color, etc.

Dr Bhatti does one large case (3500 grafts) and one small case (1500-1800 grafts) on a typical day. This is so planned that the 2 cases finish by 7 PM. Dr Bhatti does the counseling, hairline design, trimming of hair, anesthesia, harvesting of grafts, anesthesia over the recipient site and slit making. The plantation is done only by his trained staff. The world over the best centers have planters who perform this part. If you say how much time Dr Bhatti is actually with the patient- A typical patient's case(3000 grafts) starts at 7.30 AM

7.30 AM- 8 AM: Counseling, hairline design, trimming (Dr Bhatti)
8 AM- 8.30 AM: Anesthesia (Dr Bhatti)
8.30 AM- 11.30 AM: Harvesting of grafts (Dr Bhatti)
11.30 AM- 12 noon: Anesthesia and 8Slit making (Dr Bhatti)
12 noon- 12.30 PM: Break
12.30 PM- 2.30 PM: Plantation (Team of Planters)
2.30 PM- 2.50 PM: Lunch
2.50 PM- 5 PM: Plantation (contd.)
6 PM- 6.15 PM: Dressing change and instructions for the evening ( Dr Bhatti)

It takes a linear scar one and a half years to mature and be amenable for a repeat strip procedure. However if he opts for FUE, the procedure can be done after 3 months since the donor area is removed from the scar. However after an FUE procedure if a patient wishes to get another FUE done, he needs to wait for minimum 6 weeks if the same donor area is to be harvested.

Every surgical assault on the skin leads to scarring. This is inevitable. However since scars are pale in color, they stand out more prominently in darker skin types than they do on white skin. In Caucasian white skin, it is difficult to make out any difference in the donor area even with head completely shaved. Non-whites (Indians, Africans, etc.) need to keep their hair minimum #1 length to look normal over the donor area. Manual or motor technique has no bearing on scarring which is determined only by the size of the punch and the skill of the surgeon.

Warranty/ guarantee is an illegal practice in medicine and we do not engage in commercial behavior like this. However if you research us well you will know where our clinic stands as far as hair transplant results and consequent satisfaction is concerned and where others who offer questionable "guarantee" do. If you wish you can name the surgeon and I will show you a host of his dissatisfied clients whom we have revised. I personally stand by all my results.

There is no difference. Climatic conditions do not play a role in the type of results you will obtain. A person from the Tundra region will obtain the same result as another residing on the Equator.

The donor area chose for a hair transplant contains follicles which do not have receptors to DHT a metabolite of the male hormone which when combines to the receptors shuts off the blood supply to the follicle making it wither away leading to baldness. These areas are the back of the scalp and side and body hair. Once these hairs are transplanted they are for life.

It depends upon what you are used to. I use motorised since I do wholly FUE and with the speed of a manual punch I can barely do 800 grafts a day. My transection rate if 4.75 at the present moment. Survival, though not assessed, seems to be above 95%.

During the procedure donor hair is taken from the "safe zone" hair of which are considered permanent in nature since their roots lack DHT receptors which is the root cause of baldness. Safe zone is found at-

Back and sides of the scalp
Body hair- chest, beard, underarms, groin, etc.

These hairs from the permanent zone when transplanted grow for a lifetime.

The salient criteria we at Darling Buds follow are:-

You should be above 21 years of age if you are suffering from male pattern baldness.

Your density in the recipient area (area of balding) should be less than 50% or else there might be a risk of shock loss.

You should have an adequate donor site and for this you need to take an online consultation.

You should have realistic expectations from a hair transplant.

Hair loss can be divided into:
1) Pattern Baldness
2) Non-pattern baldness
we deal with maximum number of pattern baldness (99.5%) and hence we shall discuss this malady. Pattern baldness is hereditary and if it occurs in the male it is termed as Male Pattern Baldness. Usually the gene comes from the mother's side of the family in 80% cases. To determine what pattern you are going to land up with if you have started to thin, you can see how the balding is with your maternal grandfather and maternal uncle. There is a high chance that yours shall be even more. Once a person is predisposed to balding due to his genes, the hair roots end up being born with DHT receptors. These receptors attract DHT ( a metabolite of the male hormone testosterone) which binds to the receptors and thereby cuts off the blood supply to the roots. This leads to decreased nutrition and the hair shaft begins to thin. Eventually it gets worse and the thin hair shaft looses length and eventually the roots disappear. This happens mostly over the vertex and not on the back of the head.

To add salt to the controversies that exist regarding FUE, companies with commercial interests have vitiated its scientific climate and therefore amateur hair restoration physicians do not know which FUE system to choose. There are a host of machines some overly priced and some not worth their salt. Since there is no industry standard as far as an FUE System is concerned there is a plethora of companies associated with FUE surgeons across the globe innovating their version of the best FUE system. ARTAS is one of them. I do not think the robot is capable of achieving FUE harvest and plantation speeds equivalent to the human hand. The ARTAS today cannot harvest more than 500 grafts an hour whereas we at our center harvest more than 1200 on a routine basis in an hour's time. The James Harris system and its simpler variants shall soon be the industry’s standard tool and a semi-sharp variant of the dull punch would be most commonly used. However, the Harris FUE technique, being painfully slow, shall not last. Also,we do need to remember that it is not the machine which does the work in FUE. It is a mere tool in agile, discerning hands with an alert adaptable mind behind them. Remember the surgeon is not a slave in the hands of the tool he uses- it is the other way around. No magic wand exists in any field of medicine and hair restoration is not an exception.

The clustering of follicular units in an Indian graft is wide apart and hence a wider punch size is used to prevent transection.

0.85mm in Indians and 0.75mm in Caucasians.

NO. It’s too thick wiry and sometimes curls when used in that area.

If they don’t are they used as fillers. Beard hair is better than scalp hair for density and even the length is more. If you have ever been to a Gurudwara you would realise what I mean! However any other hair is less thick and will not provide good density. They are good for the crown if the patient otherwise is depleted. For other areas they are best used as fillers. Chest hairs soften the hairline best.

I do not believe in injecting. I have seen that if I store grafts in PRP the following are the advantages-

  • Less popping in tight packing
  • Better survival
  • Most grafts transplanted grow
  • Crusting is less
  • Shedding of grafts is lesser

Shedding of some of the patient’s existing hair in, and surrounding area of a hair transplant is a common occurrence post hair transplant. The mechanism is a normal response of the body to the stress of the hair restoration surgery as in site creation, adrenaline in the anesthetic etc. Using very small recipient sites and limiting the use of epinephrine may mitigate shedding to some extent. Shedding is a normal part of the hair transplant process and the risk is unavoidable.

Shock hair loss in FUE is common, but is generally not significant and should eventually completely recover. Yes it can be significant if hair is planted amidst a density of over 50%.

It works because hair removed from the permanent zone in the back and sides of the scalp continue to grow even when transplanted to the balding area in the front or top of the head. The reason is genetic predisposition to an inherited sensitivity to the effects of DHT. When DHT resistant hair from the back of the scalp is transplanted to the balding area, it will continue to be resistant to DHT in its new location and grow normally and progressively.

There is nothing delicate or fragile about transplanted hair. They can be permed, coloured or straightened. It is your own hair. You can engage in vigorous activities without fear of washing or blowing your new hair away.

Please avoid swimming in a pool (chlorinated water) or the beach for 3 weeks after the procedure. Remember there are acids, chlorine and bacteria in the pool or in the ocean. You might get redness and increased itching if you are not cautious.

No, it is not necessary that the recipient area be shaved, the incisions in the transplanted area can be made parallel to the natural growth of the hair, but this will definitely take more time. Please watch the video.

Patients having, hepatitis, blood disorders and cancer or uncontrolled diabetes are usually not taken up for surgery.

Since FUE does not restrict itself to the scalp donor area, there is no limit to the number of grafts one can harvest in a single session. An average FUT harvest gives 2500- grafts whereas in a similar person we can get upto 6000-10,000 grafts in the same sitting from scalp and body. However if the donor area is deficient grafts will be much lesser. In such cases they would be even lesser by the FUT technique.

In strip method sutures are put on the back of the head, so special precautions like sleeping in a particular position, refraining from strenuous work and exercise are required till the stitches are out. In FUE the patient leaves the clinic, reclines for a while and is free to continue his day to day activity. Even the bandage at the back of the head is removed the following day. There are no stitches which makes it minimally painful post operatively.

What is the time gap between individual sittings?

Enquire Now
darlingbuds