In view of the recent incident involving a hair transplant surgery having gone wrong, the Association of Hair Restoration Surgeons - India would like to inform the consumer about steps to be taken before choosing to opt for hair loss treatment.

Meet the Operating Surgeon:

It is important that, as a hair loss patient one should be evaluated by the doctor who is going to perform the hair transplant. At many centers, especially those that offer free consultation, one may not get to meet the doctor who is going to perform the hair transplant and as a consumer one should demand to meet him/her.This is very common with chain of clinics or franchisees where the patient usually meets the sales consultant and not the operating surgeon. Given the trend today (unlicensed technicians taking over as contract workers and performing the entire transplant) , it is important to ascertain that the doctor evaluating the patient is indeed the one who is going to perform the hair transplant surgery. Make sure to ask the doctor as to which steps of the hair transplant would be performed by the doctor and which partswould be delegated to the technicians.

It is imperative that the patient ask the following questions regarding the doctor:

Who will evaluate my hair loss and recommend a course of treatment? What is their education,training, licensure, and experience in treating hair loss?

The internationally accepted guidelines which are also endorsed by AHRS-India regarding role definition of a hair transplant surgeon, state that, the following aspects of hair restoration surgery should only be performed by a qualified hair transplant surgeon:

• Preoperative diagnostic evaluation and consultation
• Surgery planning
• Surgery execution including
• Donor hair harvesting
• Hairline design
• Recipient site creation
• Management of other patient medical issues and possible adverse reactions
• Post-operative care

Ascertain the Qualifications / Credentials of the Treating Doctor:

Today, doctors from diverse backgrounds and training are entering the field of hair restoration (Dentists, Homeopaths, Ayurvedic Doctors etc.) even though they do not have the education or the training for the same.

Technically speaking the specialties naturally associated with hair restoration by virtue of curriculum in the training are Plastic Surgery and Dermatology. Surgical specialties of ENT and General Surgery are associated with hair restoration by virtue of the surgical background. All these specialties need further specialized training to be able to be successful hair transplant surgeons. This would also involve attending conferences and workshops dedicated to hair restoration, presenting papers at conferences and publishing articles and books related to hair transplantation. All this is helpful in establishing the credentials and experience of the hair transplant surgeon.

AHRS-India in October 2015 has resolved that the only specialties eligible to become members of AHRS-India would be

• M. Ch. Plastic Surgery
• M.D. or post graduate in Dermatology
• M.S. or post graduate in ENT surgery
• M.S. General Surgery.

Ascertain the facilities in the hair transplant center

Hair transplant is an Out Patient procedure (Clean rather than sterile procedure) which is performed in a dedicated room. Sterile techniques as required in any surgical procedure should be followed. More importantly Hair transplant is surgery on a healthy patient under local anesthesia with a very high safety margin. Intra-operative complications or life threatening emergencies are extremely rare in hair transplant surgery. However, in spite of this the center should be equipped with standard monitoring and resuscitative equipment for this purpose. It is also imperative that the hair transplant surgeon be trained in ACLS (Advanced Cardiac Life Support) skills. If not, it is important to have a qualified person with the necessary training and skills (Anesthetist) to be present through-out the procedure.

Do not fall prey to misleading advertisements:

One would routinely come across advertisements in media and on the internet with claims like - `unlimited grafts for INR....` Or stamp paper guarantee` or `scar-less surgery` or `robotic surgery` etc. As a consumer one should know that hair transplantation as a procedure is limited by the finite donor area so the term unlimited grafts is false and cannot be achieved. Any incision which is created by a scalpel blade or the finest of rotating punches, will always lead to a scar. Hence the term scar-less surgery is a misleading claim. There has been an advent of machines in hair transplantation field. One must remember that these machines merely aid the surgeon in performing the hair transplant and currently no machine or robot is capable of performing the entire surgery without human inputs. Most clinics try and lure the patients by offering huge discounts. But whether they really stand up to their promises is a matter of concern. More importantly, with the advent of FUE, the field of hair restoration has become a number game. Advertisements claiming a single stage restoration using a large session of hair transplantation usually end up depleting the donor area in young patients without a concern to the future progression of hair loss. There is no such thing as a single hair transplant. As the hair loss progresses one would need additional sessions and this has to be factored in during the planning stage.

Ascertain whether the treatment advised is an approved treatment:

As the awareness for hair loss treatments increases so also the promotion of fake cures/treatment rises. The newspapers and the internet abound in promoting stem cell therapies, growth factor injections, various laser treatments, and nutritional supplements.

As a consumer it is very difficult to differentiate between such miraculous cures and genuine treatment. The following questions when posed against such treatments will reveal the truth.

• Does the treatment claim to be FDA (or US FDA) approved or tested in ethics committee/FDA approved clinical trials. The package insert of these medications should mention the FDA approval. If the proof is anecdotal or based on company generated data, then you can sure that the product would not be as efficacious as claimed.
• Do the promoters of such treatments claim - `complete regrowth`, `quick results`, miraculous treatments etc. Again such claims would be misleading and not true
• Ask about the adverse effects from the treatment. If it is claimed that there are no adverse effects you can sure that the product would not be effective either or not tested adequately.
• Oral Finasteride 1mg and topical Minoxidil for men and topical Minoxidil for women are currently the only drugs/medications approved by the US FDA for Male and Female Pattern Hair Loss.