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Surgical Therapy

Hair Transplant Implant Transplantation Surgery

Not everyone with hair loss requires hair transplant/ transplantation/ implantation surgery. Many cases of advances hair loss also can be treated with medical therapy and medication treatments. A good hair loss doctor/ trichologist will assess the causes of hair loss, including hormonal balance in the body and then precribe the best treatment, whether surgical or non-surgical. There is a lot of advanced hair growth medical research also like the QR 678 and stem cell hair injections and you should choose a dr who has knowledge of these as well. However, if you do need hair transplant surgery, please make sure you go to a plastic & cosmetic hair surgeon who is aware of follicular unit hair transplantation (FUT), follicular unit hair extraction (FUE) and Direct hair implant (DHI) so that your surgeon can suggest the best option for you.Hair Transplants—follicular unit grafts and multi-follicular unit grafts
Modern techniques of surgical hair transplantation can restore lost hair and replac`e or re-shape your hairline with your own natural, growing, permanent hair, which needs no more care than the ordinary washing, styling, and trimming you have always done. Transplantation can be done today so well that often a barber or stylist cannot even tell that grafts have been placed.

Philosophy of follicular unit micro grafting
Hair naturally grows, in clusters of one, two, three, and sometimes four hairs, these clusters are called “follicular hair units. This procedure imitates nature by relocating these naturally occurring “follicular hair units” from the donor area (i.e. the back and the sides of the head) to the recipient site (balding area).

It has been shown that when single-hair micrografts are generated from breaking up larger follicular units, their growth is less than when the follicular units are kept intact, demonstrating the fact that “the whole is greater than the sum of the parts” and supporting the concept of the follicular unit as a physiological entity.

Hair Transplant - Implant Surgery

Hair Transplant Implant & Transplantation Surgery

The follicular unit grafts are trimmed under magnification and have a better hair /skin ratio. This allows the surgeon to keep the recipient sites small and space them closer together, while at the same time maximizing the amount of hair that can be placed into them. A large number of grafts, up to 2000 grafts can be transplanted in one session. Once the hair growth starts these transplanted follicular unit grafts are indistinguishable from the natural groups of hair in the nearby area. Practiced by an experienced and skilled hair restorative surgeon, Follicular unit transplantation can produce a look that is undetectable and completely natural, making full use of the patient’s donor supply in the least number of sessions.
Candidates for follicular transplant surgery
Anyone who has experienced permanent hair loss may be a candidate for hair restoration surgery, including:

Men with male pattern baldness

Women with female pattern hair loss

Men or women who want to restore or change the shape of their hairline(advancing the hair line).

People with areas of scarring from injuries or “scarring” skin diseases, and also patients who experienced some hair loss after surgery, such as face lift procedures

People who want to thicken or restore moustaches, eyebrows, eyelashes, and beards

Men and women who want hair in an area where they have little or no hair

How do I know if I am a good candidate for hair restoration surgery?
The elements that Dr Shome assesses to determine whether you are a good candidate include such things as: your general state of health; hair’s texture—fine or coarse; the contrast between the your hair color and skin color; the density, i.e., the number of hair follicles per square inch of the hair in the donor area; the size of the area to be covered; the size of the area of donor hair; whether or not previous grafting procedures have been done; and your goals and expectations. Making an accurate diagnosis and making treatment recommendations require an examination by doctor and a frank discussion of possibilities between the patient and the doctor. Dr Shome will also give you a realistic estimate of the total cost of the planned procedure or procedures. One must understand that transplantation redistributes existing hair follicles and cannot create new hair follicles.

What happens during a hair transplant procedure?

Hair transplantation surgery is considered to be “minor out-patient surgery.” Hair transplant procedures can take from 4–8 hours and are usually performed using local anesthesia on an out-patient basis, occasionaly with some supplemental oral or IV medication. Patients are awake as usually no sedation is used. There is typically little discomfort during the surgical procedure. The donor areas, where the grafts have been harvested, are usually closed with sutures. These are usually removed in 7–14 days. Dissolvable sutures may occasionally be used in order to eliminate the need for you to return for suture removal. The recipient sites, where the grafts are placed on top, are essentially small, superficial needle holes or slits in the skin of the scalp. A typical follicular unit transplant as done by Dr Shome proceeds as follows:
After a light breakfast you are expected to report to the hospital by 7.30 am. A staff of the Hair Restoration team at Apollo Hospitals will receive you. All the necessary paper work and formalities will be completed at this time. By 8.00 am Dr Shome will meet you and review the plan for your hairline and discuss the number and placement of the grafts.

Hair Transplant - Implant Surgery Close UpYou will be asked to change into medical gown/hospital clothes and a shot of premedication is given to you. The hair in the donor area is trimmed and you will be asked to have a head wash with a medicated scrub. After drying your hair you will be seated in a chair that is very similar to the dentist’s chair. Your vital signs (pulse, blood pressure) are checked. An IV line is secured. For the initial part of the procedure the chair will be completely flattened and you will be asked to lie with your face down.

Hair Transplant & Implant Surgery Close upAfter making sure you are comfortable Dr. Shome will inject the local anaesthetic on to the prepared area on the back of your head. In all likelihood, the injection of the local anesthetic is the only part, in which you will feel an occasional sharp but tiny pain. By now the back of your head would feel numb and after confirming this Dr Shome would proceed with next step of the surgery. Using a scalpel a strip measuring 1 cm – 1.25 cm wide by 15 cm long (on an average) is removed from the donor area. Because the strip is so long and thin, the donor defect is not wide, so closure is possible with very little tension.

The donor area is closed with stitches, in two layers, an inner layer of absorbable sutures and an outer layer of non absorbable sutures, which would need removal. Dr Shome uses the method of Trichophytic closure, a method by which the scar will not be hair less and hence better concealed. What is done is that 1-2mm of the top edge of the donor defect is trimmed off. This transects a row of 1-2 follicular units, which then grow through the eventual scar, thereby dispersing its obvious linearity.


Hair Transplant - Hair Growth Close up Hair Transplant - Implant Post Surgery Concealed Scar

Hair growing through the scar in the Trichophytic Closure

Well Concealed Scar

Throughout this part you would not have felt any pain. The suture line is well covered by the hair around it and is not visible ordinarily and in time, would be virtually impossible to detect it even if one were to look for it while combing. At this point you will be allowed a break and you could take some refreshments and generally relax.

The donor strip will be divided into slices or slivers, maintaining the integrity of the follicular units. Dr Shome himself does this important step using magnification. These slivers are then handed over to trained assistants, who separate the slivers into follicular micro grafts, which contain 1, 2, 3 or 4 hairs. It requires several trained assistants to prepare on average 1500 – 2000 grafts

While the assistants are preparing the grafts, Dr Shome will start the anesthetization of the recipient area. You will receive a couple of shots over the front, above the eyebrows and some over the top. Again these needle shots may give you a few sharp pains but only temporarily. Once the anesthesia takes effect your scalp will be completely numb.

Hair Transplant - Implant Surgery Close UpThe recipient sites are made with 18G, 19G or 20G depending on the size of the grafts. Dr Shome makes the recipient holes and places the graft simultaneously in a manner quite similar to putting ones foot into the shoe using the shoehorn. Care is taken to match the direction of the graft insertion with that of the surrounding hair. Spacing and the natural pattern is maintained. All through this you will not feel the pain of the needle pricks.

The size of the grafts allows Dr Shome to place the grafts as close as it is possible with minimal injury to the scalp. Graft placement will take 2-4 hrs depending on the number of grafts. You can spend this time listening to some light music. During this period if need be you may take a break and have some refreshments.

Hair Transplant - Implant Post Surgery Close UpBy 2.30 pm all the grafts will be in place and after reviewing the grafts you would be sent out from the hair restoration room. There is no dressing on the grafted area. A small dressing is kept on the donor area for the first 48 hours to soak any collected blood and prevent soiling of the pillows. You may wear a lose cap with prior approval from Dr Shome so as to prevent the grafts from sticking to the cap. You will receive a painkiller before you leave the hospital premises. You will be advised to take antibiotics for five days to prevent infection of the grafts. Painkillers may be required on the first few days. Cold compresses over the forehead are helpful.

After changing into your clothes, by 3 pm you will be ready to go home. Though it is possible for you to drive, it is not recommended and it is better to have someone pick you up and drop you home.

What happens after hair transplant surgery?
Hair transplantation is a very safe, relatively minor surgical procedure. Significant complications are extremely rare. There is usually little or no discomfort in the grafted area. Most patients feel some “tightness” in the donor area for 1–2 days and are prescribed a mild analgesic to help cope with this. Patients may be asked to use moist compresses or sprays and to sleep in a semi-upright position for 2–3 days following the procedure to minimize swelling and bruising. Small crusts may form on each graft, and these can usually be camouflaged by any existing hair that can be combed over the recipient area, or with camouflage products such as HAIROUSE, DermMatch, Couvre, or Toppik. These crusts will flake-off by 5–14 days after the surgery, the smaller follicular unit scabs often falling off at 4–6 days and the multi-follicular unit scabs taking longer. The transplanted hair seen growing out of the scalp may initially be shed; however, the roots remain and will be dormant for 10–14 weeks, at which time the new hairs will all begin to grow. Numbness that may occur in the donor or recipient area usually disappears within 2–8 months following surgery.

As stated above, complications are rare. Minor inflammation can occasionally occur around a newly transplanted hair follicle, similar to an infected ingrown hair or pimple, and usually responds to simple warm compresses. The scar that occurs in the donor scalp as a result of the removal of donor skin is usually quite narrow and can be easily hidden by the surrounding hair. The graft sites in the recipient frontal area heal with almost no visible scarring and are covered by the transplanted hair. A minority of patients may experience mild swelling in the forehead area for a few days following surgery. It typically appears around the 3rd post-op day and goes away after 3–4 days. Infection in either the donor or recipient area is extremely rare. Many patients experience a small area of numbness above the donor scar and in the rear central scalp that gradually disappears after a few months.

In the overwhelming majority of hair transplantation procedures there are no complications. However, a number of side effects, risks, and complications can occasionally occur. For the purpose of putting these things in perspective, we will divide them into two categories: those that occur occasionally and those that occur very rarely and are included here for the sake of completeness:

Side effects that occur only occasionally:

Mild Swelling in the forehead, occurs in about 1 in 10 procedures

Mild “Shocking” (shedding) of Existing weak Hair causing them to drop out for 3 months, after which they grow back.

Epidermoid cysts,

Temporary numbness of part of the head,

Post-op pain or headache

Minor and trivial side effect: Itching in the area of the new grafts or along the donor scar may occur occasionally.

Side effects or complications that occur only very rarely:

Irregular or uneven or delayed hair growth

Discoloration of grafts

Elevation or depression of grafts



Dizziness or fainting

Allergy or reaction to anaesthetics or medications used: Medications are kept at hand to immediately treat any allergic reactions.

Failure to improve “quality of life

Infections: Very rare because of rich blood supply.

There is also the possibility that other effects or complications not presently known, recognized, or understood, may develop, now or in the future.


What is the difference between hair transplant and hair weaving, hair bonding and hair fusion?
Hair transplant is a surgical procedure in which permanent hair from the patient’s own head is transferred to the bald areas. Hair weaving, bonding and fusion are temporary procedures in which, external hair bearing devices are attached to the existing hair or scalp using weaves, micro clips, adhesives to achieve cover of the bald area. Hair transplant is a permanent and natural method to correct baldness
What is follicular unit transplant (fut)?
Hair grows in naturally occurring groups of 1,2,3 or 4 hair, a good transplant imitates nature and transfers these units as they occur giving a very natural and undetectable look. The older methods of hair transplant using punches, minigrafts (3-5 hair), micrografts (1-2 hair) that do not respect the follicular unit as a single entity, give a very unnatural look.Am I a candidate for follicular unit micrografting?
Age, grade of baldness, quality of your hair, a detailed medical history and physical examination will decide whether you can be a candidate for hair transplant. Being well informed regarding various aspects hair loss, restoration etc and having realistic expectations from the procedure, increase the chances you will be happy with the results.

How do I decide about the location of my hairline and number of grafts required for me?
The placement and quality of the hairline are important factors in determining the success of a transplant. Patient’s expectations, facial proportions, grade of baldness and generally accepted guidelines help in planning the hairline. In general it is advisable not to place a hairline too low, as it looks unnatural. Imitating the natural hairline in terms of density, direction of hair growth and gradual transition is as much a work of art as it is a science.
The number of grafts required is directly proportional to the extent of the bald area and depends on the available donor area.

What happens to the donor area?
After single strip harvesting, the donor area is closed with stitches and every effort made to keep the ensuing scar, thin and flat. Keeping the surrounding hair at least one inch long helps in hiding it. After 8-12 months it is virtually undetectable, even to the hairdresser.

How painful is hair transplant?
Usually the only pain (tiny, sharp) you would feel is during the injecting of local anesthetic. Some patients report a painful discomfort towards the end of the procedure which gets relieved by the pain relief medication. Many patients report no pain whatsoever.

What are the pre operative preparations? What care is required after the transplant?

Follicular unit transplant is a planned surgery and it is in the interest of the patient to confirm the date of the transplant at least three weeks in advance, the idea being to start pre operative preparation. Depending on the type of hair, Dr Shome may advise medication for improving quality of the donor hair and to reduce postoperative shedding. If flaking or scaling is present you may advised to use medicated shampoo for a couple of weeks before the transplant. If you are using Minoxidil it should be discontinued ten days before transplant.

If you are on any blood thinners like Aspirin, Clopidogrel, Heparin, Warfarin etc, vitamin supplements, anti depressants, these should be discontinued atleast a fortnight before the transplant. Any long-term medication you are taking should be discussed in detail with Dr Shome in the first consultation. Any major illness or episode of fever in the recent past should be disclosed to Dr Shome.

Smoking or tobacco in any form delays wound healing and should be stopped a fortnight before surgery and if possible discontinued permanently as it may play a role in hair loss. No alcohol 48 hours before surgery.

Do not cut your hair (before the transplant) without prior discussion with Dr Shome, as you need to have hair, at least one inch long in the donor area. This helps to hide the operated area post operatively.

Report to the hospital at the scheduled time and make sure to have a light breakfast before your transplant.


Having got the transplant done, it is very important to review the postoperative instructions with Dr Shome before you leave the hospital. Read the instructions carefully and make sure you understand them properly. Following this advice will go a long way in insuring the best possible outcome of the procedure.

On the first night, sleep in semi upright position, taking 2-3 pillows or sleep in a semi reclining chair. Elevation of your head lessens the chance of swelling or bleeding. Make sure to take all the prescribed medications. The painkillers relieve mild painful discomfort, which is usually present for the first 2-3 days. Ice bags or cold compresses in the donor area and over the forehead (not over the grafts) will also help in pain relief and reducing the swelling.

Do not wet hair for 72 hours after the transplant. You may shampoo in a limited fashion after this. Dr Shome will give detailed instructions regarding this to you after the transplant. Tap the grafts dry, do not rub the graft sites until ALL the scabs have fallen off. Ten days later, you may gently massage the hair in the grafted area and two weeks later, you may resume normal shampooing. Scabs/crusts form, which cling to the grafts during the healing phase. These will fall off in 7-10 days. DO NOT pick at them. After 14 days, gentle massaging while shampooing will speed their removal. The odd graft may be dislodged accidentally and fall out. This is not a matter for concern and will not significantly affect the overall result of your hair transplant.

Avoid strenuous activity and exercise for three weeks. Do not bend or lift heavy weights as this may cause bleeding from the transplanted areas or increased swelling. It is better to avoid exercise and swimming for three weeks. Do not expose the scalp to direct sunlight, use a loose fitting cap.

There will be some mild swelling and this is quite normal. It usually starts over the grafted area and tracks down over the forehead, 2-4 days after the transplant, which may in another day or two cause swelling and bruising on the lower eyelids. Elevation of the head and limiting activity, will reduce chances of swelling occurring around the eyes, but if it does occur it will last generally for 24-36 hours, before disappearing.

Some slight bleeding occurs occasionally. Elevation and compression will generally stop the bleeding. Ice packs may be used on the back of the scalp (donor area) but not over the grafts. Normally with these measures it stops but if it does not then you can call Dr Shome.

Sutures used are usually of absorbable type, so do not require removal, but if non-absorbable sutures are used then they are removed by 12th day.

Minor symptoms like itching, decreased sensation (mostly on the top of the head), infection (rare), scarring etc may occur but rarely are a problem. Dr Shome will prescribe an ointment to reduce the itching if it is troublesome. Decreased sensation corrects itself in 6-12 months.

Shedding (telogen effluvium) or mild “Shocking” of nearby existing hair occurs when there is weak existing hair in the transplanted areas of the scalp. This effect, in general, is noticed in about 1 in 10 patients and is seen anywhere between 2-4 weeks to 3-4 months post transplant, after which the hair grow back along with the new hair. If a particular hair that is “shocked” was on one of its last life cycles, then it may drop out permanently. It is important to realize that surgery does not stop further loss of non-transplanted hair.

Another type of shedding is that of the transplanted hair, most of which will fall out within the first 3 to 8 weeks ( anagen effluvium). This is perfectly normal and to be expected for 90% of the FU grafts. Growth starts at about 3-6 months after the transplant. In the initial phase of growth the hair are fine but as time passes by (8-12 months), they gain length and diameter. By the end of one year, the “new” hair should be as robust as the surrounding non-transplanted terminal hair and growing at the same rate.

You may shampoo in a limited fashion starting 48 hours after your transplant. Take a plastic container into the shower and use it to pour water over your head several times. Then put a couple of capfuls of the shampoo, a pH balanced shampoo, into the bottom of the pitcher or cup. Add a slight amount of water to make a sudsy solution. Pour this over your scalp and shampoo by working your hair between your fingers and thumb. You may shampoo daily in the limited fashion. On the fifth day following the procedure you may let the shower stream hit your scalp. After 7 days, you may gently massage the hair in the grafted area and after 10 days, you may resume normal shampooing.

When will the grafts start to grow?
Growth starts at about 3-6 months after the transplant. In the initial phase of growth the hair are fine but as time passes by (8-12 months), they gain length and diameter. By the end of one year, the “new” hair should be as robust as the surrounding non-transplanted terminal hair and growing at the same rate.

What are the side effects / complications of hair transplant?
In the overwhelming majority of hair transplantation procedures there are no complications. However, a number of side effects, risks, and complications are mentioned in the medical literature and these are quite uncommon. For the purpose of putting these things in perspective, you may refer to PRE AND POST CARE. If you are worried about any particular complications you could contact Dr Shome for detailed information on the same.

Can baldness be prevented or cured by using a form of gene therapy?
Genes play a very important role in causing androgenetic alopecia. Hence manipulating the genes responsible for hair loss will cure baldness. Dr Angela Christiano the founder of the gene responsible for a condition called Universal atrichia (total absence of body hair, usually at birth), is involved in ongoing search for the elusive gene causing baldness and feels that someday gene therapy will be used to treat hairloss.

What about cloning?
Hair cloning is a slang term for engineered hair growth. It involves isolation of a group of cells at the base of the hair follicle. These follicular cells are multiplied in a laboratory and they divide to create new follicles and generate new hair, which are then implanted back into the bald area. Early results are promising, but it will take almost a decade of further study, clinical trials and meeting regulatory requirements before cloning is widely available. This would be a boon for patients with limited donor area whenever it is available.

Any new treatment options?
Researchers in Japan claim to have isolated two genes responsible for androgenetic alopecia. They also claim to have discovered a plant-derived ingredient called 6-benzyl aminopurine which could help revitalize the two genes and restore hair growth. It is difficult to verify this claim till large-scale studies are conducted.

What are the available remedies for combating hair loss? What is efficacy of herbal remedies?
At present there are only two remedies approved for hairloss. In terms of topical applications we have Minoxidil or its derivatives and in the pill form we have Finesteride in 1mg strength, which are effective (either singly or jointly) in large number of patients.
Amongst the herbal remedies, Saw palmetto has been used as an anti androgen but there are no conclusive studies to show its effectiveness for male-pattern baldness. Other herbal remedies, for the most part, have little if any effect on scalp growth. Certainly there have been no conclusive clinical trials showing the effectiveness of herbal remedies.
Of course, the most permanent treatment for hair loss is hair transplantation, which is safe, effective, long lasting and cost effective. Hair transplantation has been refined over the last few years and now it gives a very natural result.

What about various treatment options advertised in media and the internet?
In general, for male-pattern baldness, scalp injections are not only not effective, they may actually inhibit hair growth. Other mechanical hoaxes consist of rubbing the scalp, applying electric current to the scalp, ultrasound treatments and light treatments (ultraviolet) which have never been shown to be effective in growing human hair. Aside from these treatments, there are numerous products available through the mail or over the Internet, which claim to stimulate scalp and hair growth – but in reality do little or anything. The good news is that most of these remedies will do little harm. The bad news is that most of the remedies will be a complete waste of money.

For more information on Dr. Debraj Shome’s work, click on:www.theestheticclinic.com/dr-debraj-shome.html


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