Welcome to Association of Hair Restoration Surgeons, India

Position Statement of AHRS-India on Recommended Types of Hair Transplantation

Hair transplantation is an operation that takes hair from the back of the head and moves it to the area of hair loss. The fringe (back and sides) of hair on a balding scalp is known as donor dominant hair which is the hair that will continue to grow throughout the life of most men. The transplantation of this hair to a bald area does not change its ability to grow. Donor dominance is the scientific basis for the success of hair transplantation. Dr. Okuda of Japan first described the use of transplanted hair to repair scarred eyelashes and eyebrows. Unfortunately, the outbreak of World War II prevented his valuable discovery from reaching the rest of the world for two decades. Dr. Norman Orentreich published the first widely read report on hair transplantation surgery in 1959 and the field of hair transplant surgery was born. Candidates for hair transplant surgery are those individuals with hair loss that have sufficient donor hair from the fringe of the scalp to transplant to the balding area. In the past, many bald patients were not suitable candidates for hair transplant surgery but modern techniques have advanced the art of hair transplant surgery so that many more men are candidates. Hair transplantation surgery has improved in leaps and bounds over the past decade. The days of the "plugs and corn rows" which were a consequence of punch grafting of yesteryears are gone and the age of single hair-, micro-, and mini- grafting has arrived. Perhaps the most common thing to watch out for is the doctor who uses plugs to refurbish the hair on scalp. This is an outdated procedure that leaves the client with a scalp that sprouts the same kind of hair that you see on a plastic doll’s head. (Beware!! since some physicians still have not done away with the old and ugly technique of punch grafting. Therefore the importance of asking the doctor in detail about the procedure as advised by our website) With each passing day, international consensus is shifting from single hair transplants to “Follicular Unit” Hair Transplants due to better results. Through the use of these variable sized hair grafts along with new and improved instrumentation, the accomplished hair transplantation surgeons can create a natural hair appearance that is appropriate for each individual patient. Single hair-grafts have the finest and softest appearance. Although they do not provide much density, they do provide the critical soft hairline that is the transition to thicker hair. Reconstructing a new hairline is a skill requiring surgical as well as artistic skill. It is critically important to get it right the first time and thus requires considerable forethought and planning. Examining the hairline of a nonbalding person will show the presence of numerous single hairs in the very frontal hairline. Micrografts are small grafts containing 2-3 hairs that are placed behind the hairline to provide a gradually increasing hair density. Follicular Unit hair transplantation, the commonest state-of-the-art procedure today can be done by the strip method or by FUE or Follicular Unit Extraction. The strip method utilizes a strip of skin from the back of the head from which grafts are dissected out under high magnification and the donor area is closed by a ‘stitchless technique’. Upto 3000-5000 grafts can be placed in one day utilizing this technique. The technique is cost-effective and is meant for people requiring large areas to be covered. FUE, which is costlier, can be used for those who need 500-700 grafts in one sitting. Otherwise, essentially, both the techniques are the same. There is different terminology and techniques used by many hair restoration surgeons of AHRS-India and those around the world. Although there are variations in the techniques of individual surgeons, the combination use of these grafting techniques provide the most natural and pleasing results.The side-effects of hair transplantation surgery are relatively minor consisting of mild pain and discomfort after the operation, swelling which may move down to the eyes, and the formation of scabs over the grafts which take approximately one week to resolve. Serious problems of bleeding, scarring, and infection are rare. Modern hair transplantation surgery is comfortable, predictable, and the results are pleasing to most patients.Hair loss, however, is a life long process, most men will develop male pattern baldness (due to male hormones) until approximately 40-45 years of age. After that, the aging process thins the entire head of hair. Progressive hair loss or the desire for more density, will require more transplant procedures. Modern techniques, however, allow hair transplant surgery specialists of transplant larger number of grafts, greatly reducing the number of procedures needed to complete the result. In cases with burns where good quality skin is not available, surrounding skin can be recruited by the technique of “Tissue Expansion” or by “Flap surgery”. However, these techniques may be used by some surgeons but do not give results superior to “Follicular Unit Hair Transplantation” in Hair Loss other than in burns.

Position Statement of AHRS-India on Synthetic Hair & their role in Hair Restoration

In the light of the evidence in contemporary literature which follows, a consensus position statement of AHRS is being made. AHRS India would like to state that available evidence is not sufficient to recommend the use of these fibres in patients of alopecia and therefore does not recommend their use. If any physician wishes to use them, the physician should be aware that the responsibility for a decision to use these fibres solely rests with him/her and hence should be aware of the possible legal complications that may arise in such cases . It should be done after fully understanding possible risks involved and should not be regarded as an easier alternative to the technically more difficult procedure of hair transplantation, in cases with sufficient donor area. Nor is this an alternative for medical treatment with minoxidil or finasteride, in early hair loss. Proper counselling is important before its use and informed consent should include specific information about the present ban by FDA . Further, patients should be advised about possible loss of 10-20 % every year and the recurrent costs involved . Possibility of erythema, contact dermatitis, infections, formation of sebum plugs should all be explained to the patient before performing the procedure.

Saw Palmetto is an extract of the fruit of Serenoa Repens. It is rich in fatty acids and phytosterols. This herb has been shown to inhibit the production of DHT, an important androgenic hormone that can cause problems like balding and prostate enlargement. Because it blocks DHT it has been claimed to be effective along with 5% Minoxidil in the management of common baldness. However, proper medical studies to prove such a claim are lacking.
Saw Palmetto extracts have been claimed to have several effects:
1)Reduces DHT which causes baldness and prostate enlargement as stated above.
2) Corrects hormone imbalance both in men and women.
3) Helps build and strengthen tissue and increase metabolism.
4) Acts a diuretic which improves urinary flow.
5) As an expectorant, it relieves chronic bronchitis, asthma and chest congestion.
6) It has been tried in thyroid disorders.
7) It stimulates appetite, digestion and absorption of nutrients.
8) Acts as an aphrodisiac because it is said to increase libido and treat erectile dysfunction.
9) Reported to be of use in breast enhancement.
10) Has also been used in polycystic ovary disease.
TYPES: There are 2 kinds of herb palmetto supplements available in the market. One type is dried saw palmetto berries and the other type saw palmetto extract in the form of tablets.
Recommended dose is 160mg twice a day. However, it should be taken in consultation with your doctor.
SIDE EFFECTS: It has a low toxicity. The most common side effects is mild stomach discomfort which can be alleviated by taking it after food. The worries raised by some regarding possible prostate cancer by its interfering with PSA levels has been shown to be incorrect.
SCIENTIFIC STUDIES: Searching the literature, no double blind studies have been carried out to assess the efficacy of saw palmetto in common baldness either in men or women.
APPROVAL BY FDA:
Saw Palmetto has not yet been approved by FDA in alopecia androgenetica.
Considering its benefits in enlarged prostate and its effects on 5 alpha reductase enzyme, it might be an alternative in those patients in whom Finasteride causes significant sexual dysfunctions.

Position Statement of AHRS-India on Hair Weaving, Hair Bonding, Hair Fusion & Hair Extensions

These are temporary non surgical methods of using a wig or a hair piece to cover an area of hair loss or hair thinning. Useful for a social event, wedding, party, stage show, meeting old friends or making a short appearance. Unfortunately these are marketed as methods of permanent use which leads to the problems.
Hair transplant surgeons are upset on being asked if they do hair waving. Weaving is done in a parlor by your hair stylist, it does not require a doctor or a hospital set up.

The name has an implied meaning which makes the hair loss patients imagine that something closely woven and dense, natural looking, shall be replaced to relieve them of their baldness. Since patients are afraid that a wig will come off in public. A small wig of the size of the area of hair loss is prepared and is knotted to the surrounding hair with black silk thread running around the border. This method of fixing is called as hair weaving.

Beware of a weave pull out! The hair surrounding the area of baldness or thinning where the knots are tied for fixing the hair piece, tend to get pulled off in a few months, leading to traction alopecia and permanent loss of hair from the borders thus making the hair less patch larger and wider than before. Now a bigger wig or hair piece needs to be made and fixed. Under the hair weaving, scalp secretions, sebum, sweat, bath water, soap shampoo, tend to keep collecting unless you regularly visit the expert and remove it for cleaning. Removing and re fixing is charged and takes around 3 hours. There are recurring expenses and maintenance. Also, all remaining natural hair under the weave is lost in the next few months.

The name makes hair loss patients to imagine that some additional hair shall be bonded strand by strand to their remaining hair. However this is an alternative method of fixing a wig into the surrounding hair by using clips instead of silk thread knots. The clips can be undone for cleaning, bathing and refixed by the user. A double sided tape is used on the front border while clips are placed on the sides and back. Areas where the clips hold on to the hair cause traction alopecia and patches of hair loss. The wig makers try to keep rotating the placement of the clips to avoid permanent hairless patches. Any natural hair remaining under the area covered with the hair patch is lost.

Herein the scalp is shaved of any remaining hair and a hair piece is glued to the skin. It can only be removed by using a special remover solution for the water proof adhesive. Causes itching, eczema, allergic skin reaction and deteriorates the underlying skin as well as hair.

These are smaller hair pieces or locks of hair attached to clips, hair bands, used or tied in a knot along with natural hair to make it look fuller or longer as it is being set or styled. The extensions can be removed when you undo the hair style.

Finasteride (brand name Propecia®) is an orally administered medication for male pattern hair loss (MPHL). Several years of investigation and use by more than a million patients show that finasteride has long-term effectiveness and safety in treating MPHL in men of all ages and all ethnic backgrounds. Finasteride is sometimes used alone or in combination with minoxidil to complement hair transplantation. Finasteride is not recommended for use in women. Finasteride's effects in slowing hair loss and stimulating new hair growth work best for early to moderate degrees of hair loss. Men with extensive hair loss are unlikely to experience much regrowth with finasteride; these men are better candidates for hair transplantation or other surgical approach to hair restoration. Finasteride is most effective in stimulating hair regrowth over the crown of the scalp. It is less effective in stimulating regrowth at the front of the scalp-where hair loss is commonly called a "receding hairline". AHRS-India Hair restoration specialists may prescribe finasteride to prevent further hair loss by the patient, and carry out hair transplantation to provide coverage at the frontal hairline.