Hair Transplant- Who should do?

Well this is a topic very less discussed openly, but this a fight among various streams of doctors who claim that hair transplant should be done by some specific specialties of medicine.

Here I am to present the current scenario worldwide and current law status in India, so as to understand the controversial debate. While general allopathy question eligibility of doctors practicing dentistry (BDS, MDS etc), at the same time Dermatologist and Plastic Surgeons questions the eligibility of other allopathy streams like MBBS, ENT Surgeons, General Surgeons, Opthalmologist, Maxillofacial Surgeons, Anaesthesiologists, Orthopedicians, Gynaecologists etc.

Actually there is no official form of certification for hair transplant in most parts of world including USA, so any doctor who is MBBS or equivalent should be eligible to perform hair transplantation surgery with training under a good hair transplant surgeon. In most of the countries including India there are no specific law or MCI, or DCI guidelines so as to lay down eligibility criteria for hair restoration and even lasers and other cosmetic procedures like Botox, Fillers etc. As per a talk in Facethetics 2017 by a senior doctor who is practicing law, as per then rules and laws, dental specialist whether BDS or MDS can perform hair transplant surgery, provided he / she has undergone some kind of hair transplant training before practicing hair transplantation. In fact there is no law yet in India which stops dental specialist to perform hair restoration surgery. When we talk about alternative medicine doctors like homeopathy or ayurveda or unani, then its clear that they are clearly not eligible to do hair transplantation surgery.

When it comes to plastic surgeons, then there is no question regarding eligibility for hair transplantation. But when it comes to dermatologist, many other specialty doctors question, how can they perform hair restoration surgery when they are just physician and not surgeon.

So the Hair Transplantation eligibility is full of controversy and as per my understandings following things are to be considered before deciding eligibility for hair transplantation –

1. Hair Transplantation is a minor and office procedure with good outcome –

No doubt here as many books on hair restoration have mentioned very clearly that hair transplant is minor or office procedure. Hair restoration surgery (HRS) is a very promising and sought after aesthetic procedure with very few complications. Thorough preoperative evaluation, skillful surgical techniques, good communication and postoperative follow-up go a long way in giving satisfactory outcome with fewer complications in HRS.

List of Complications – Click here

HT Office
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HT OFFICE 2
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2. Hair Transplant is done under Local / Regional Anaesthesia

Hair transplant is done under local / regional anaesthesia and thus this part should be very safe with medical specialties in which local and regional anaesthesia is a routine practice like Anaesthesiologists, Plastic Surgeons, ENT Surgeons, Ophthalmologists, Dental Surgeons, General Surgeons etc.

3. Blood loss in Hair Transplantation

Surgeries can be categorized according to blood loss as bellow –

  • Minimal tissue trauma : 2-4 cc/kg/hr
  • Moderate tissue trauma : 4-6 cc/kg/hr
  • Severe tissue trauma : 6-8 cc/kg/hr

Being minimal invasive FUE hair transplant is with minimal tissue trauma and thus blood loss is minimal. Suppose a patient of 70 kg (mostly man in 20- 40 year age group) with 8 hours of transplant loose 1000 ml of blood volume then its just 1.78 ml/kg/hr of blood loss which is considered as very minimal and hemodynamics is usually maintained in this case very well. Also blood loss can be easily stopped with pressure against skull. One should always note history of delayed coagulation and Bleeding Time, Clotting Time and PT-INR should be routine before hair transplantation. Presence of Anaesthesiologist will increase safety perioperatively. Also incidence of blood loss in hair

4. Knowledge of anatomy and physiology

As per my knowledge anatomy and physiology of all body parts is a subject that is taught in first year of both MBBS and BDS. So as far as this part is concerned both general allopathy with MBBS or higher and Dentist with BDS or higher should have good understanding of anatomy and physiology. But yes they should refresh their knowledge and in fact update it related to procedure they are going to perform. Also proper training of procedure or surgery should be done prior to the treating patients.

5. Medicines Used in Hair Transplant

Very few medicines are used in Hair Transplant like Xylocaine with or without adreline, Bupivacaine, Antibiotic to prevent perioperative infection, and medicines like betadine, alcohol etc to provide aseptic environment. All doctors who have completed MBBS and BDS usually have knowledge about these basics of medical science.

Where as FUT is an invasive procedure and involvement of plastic surgeon or general surgeon should be preferred.

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