I have been in the hair transplant field for over 15 years. I was one of the first to start hair transplantation in Bangalore and India. During this time, the field of hair transplant has seen huge advances and changes. It is interesting to go over some of them and to understand where the field is today, and where it is heading.
Early beginnings – 1980s
The first time I saw hair transplantation was a large punch transplant, with profuse bleeding, and unimpressive results. I decided that I don’t want to learn this.
The turning point – 2001
A friend asked my opinion about his hairloss and his desire to undergo hair transplantation. I was not much aware of hair transplantation and I started reading about it. And I read and read- it was fascinating as the field of Hair transplantation was witnessing significant advances. And I thought of learning hair transplantation. The study revealed that in 1995 -96 , the concept of follicular unit transplantation had been used using the follicular unit as the basis. There were papers on the logic and mathematics , and the field of hair transplantation had transformed itself from an era of mini grafts in to a more accurate era of follicular unit transplantation. It was also changing from an era of few hundred grafts in to an era of mega sessions. Microscopic dissection was now an indispensable part of this process of hair transplantation.
Where to learn?
All this fascinated me and I then set out to undergo training- it was expensive, 1000 USD a day in USA. So I went first to Taegu in South Korea under Jung chul Kim. And then I attended my first meeting in Chicago ISHRS meeting.
The beginning of the practice: In 2003 I came back in India to start one of the first ever clinics for hair transplantation using steromicroscopic dissection. I also invited Dr Alex Ginzburg with his team of nurses to perform at our center and train nurses. And with this, we were set to start hair transplantation at Venkat Center Bangalore, then called Venkat Charmalaya.
Progress- Follicular unit transplantation (FUT): And we made rapid progress –soon we were operating almost daily with in two years and our team grew. We introduced trichophytic closure, which is where we suture the skin in such a way that the hair grows through the scar. Our emphasis was on quality and ethics based on best scientific principles. We soon performed mega sessions over 2500 grafts . We performed eye brow, beard transplantation .We published one of the first reports of body hair transplantation in an indian patient. Our best work soon got recognition across the world and we started training doctors from other parts of India and abroad. We also authored the first ever guidelines of care on hair transplantation in 2008.
Advent of Follicular unit extraction (FUE): By this time Follicular unit extraction got introduced – early on it was inefficient with high damage rate to hairs and we were skeptical. Over time, instruments got better, machines came to make it better and safer – damage rate or transection rate which was about 20% fell to less than 5%. And patients started asking and demanding FUE. Slowly the percentage of FUE kept raising. And in our Venkat center Bangalore, my son Dr Aniketh joined us and soon became an expert in FUE. Now venkat center is one of the few centers in India with a dermatologist and plastic surgeon performing all best techniques of hair transplantation.
Texbook, conferences: I helped start the association of hair restoration of surgeons of India, which became a strong force. We organized the Asian congress of hair transplantation in Bangalore and I was the president of the association. We then edited major text book of hair transplantation, along with other senior authors from India. This is now the standard reading in hair transplant.
Medical therapy: While there were many advances in hair transplantation, the field of drugs for hair loss made slow progress unfortunately. Minoxidil and finasteride remained the only drugs. Finasteride became the butt of many criticisms about possible sexual side effects, while evidence for side effects remained unconvincing. Patients were refusing to take the drug. Disturbingly, clinics were scaring the patients about this drug , thus pushing the patients in to surgery. Platelet rich plasma was accepted with great enthusiasm by patients, despite its inadequate evidence. Soon patients were demanding it. And were getting it every where – in beauty clinics and spas. Commercialization was setting in
Challenges
Soon there were other challenges- FUE being simpler, technicians could perform it even without adequate knowledge- Doctors trained technicians and hardly did the job themselves – Teams of technicians started going around clinics , with doctor nowhere in picture; black-marketing and ghost surgeons made their entry. Hair factories started advertising. Cheating on the number of grafts was common place. Extraction from nonsafe areas lead to poor results. Giga sessions of over 5000 grafts lead to over harvesting and severe disfigurement of donor area.
Fake websites, social media hype, exaggerated advertisements about “ no scar” unlimited hairs” all lead to confusion in the minds of patients as to who is genuine and who is not. With clinics mushrooming and hair transplantation being performed even in spas, unbelievable things happened- death after hair transplantation, blindness after transplantation. A patient died in Chennai after hair transplantation in a spa in Chennai!!!
Robotics, Stem cells
Robotic hair transplantation has been introduced, but is expensive. Hopefully cost will come down as it happens with all machines. Unfortunately some clinics advertise robotic hair transplant even though the robot has not come to India. Stem cells are still far away. Nanofat offers some hope but evidence needs to accumulate
What next for hair transplantation in Bangalore and India?
Hair transplantation has been a boon to patients – but its commercialization is turning in to a bane. We at Venkat Center strongly believe that;
- Hair transplantation needs to be practiced ethically, safely, transparently
- No single technique or modality should not be thrust on the patient; patient has to be informed about all modalities and then given opportunity and time to decide
- A combination approach of Drugs, Growth factors and surgery gives the best results
- Doctors need to be at the fore front- NOT TECHNICIANS and ASSISTANTS. ASSISTANTS CAN ONLY ASSIST- THEY CAN NOT AND SHOULD NOT DO SURGERY
- Moderation is of essence- what can be done and what can be expected have to be explained by the doctor and understood patients
- Patients need to be patient- hair is part of beauty; beauty is part of health ; and health is part of life. SO DON’T MAKE HAIR THE CENTER OF LIFE. No technique is perfect , no drug is perfect. Be reasonable in your expectations
- Social media is an untrained wild animal- it has to be used wisely , both by patients and doctors
- Hair transplantation is a cosmetic surgery- result and safety is important. Don’t sacrifice this for low cost. If you eat road side because it is cheap, then you are likely to get food poisoning.
This is where we stand in 2019 december- a field which has seen ups and downs- more ups than downs, but the future while being bright, there are dark clouds on the horizon. Black marketing, nonmedical people entering the field, lack of adequate regulations are worrisome features- but we at venkat center Bangalore march on based on our experience, ethical attitude to enhance our efficiency and deliver service to patients.
