In a tragic incident, two engineers lost their lives after allegedly undergoing hair transplant surgeries at a private clinic in Uttar Pradesh’s Kanpur. The deaths directly associated with hair transplant surgeries have triggered concern and panic among the public.
Dr Kashish Kalra, MD, Dermatologist and Hair Transplant Surgeon, Head of Department, Dermatology, Max Smart Hospital, Saket, New Delhi weighs in on how this could have happened.
Q: How is death possible from a hair transplant?
A: The possibility of death in this scenario, is basically due to the excessive use of local anaesthesia and the wrong injection technique. When the injection was given, it probably went deep into the venous system and punctured a vein. Usually, local anaesthesia is given in the subdermal layer where the hair root is present. It is not given in depth. In this case, it seems the injection depth and technique were wrong.
Post-hair transplant care is also important. Patient has to take certain antibiotics for five days and certain other medicines for five more days. Maybe these medicines were not taken and it also appears that a sensitivity test was not done. Many other things could also have gone wrong as the doctor was not qualified.
Q: What are the possible fallouts of a hair transplant?
A: Hair transplant is one of the safest possible surgeries imaginable. The problem here is that the transplant was done by a dentist. As per the National Medical Council, only dermatologists, plastic surgeons or general surgeons who have training in hair transplant are allowed to perform the same.
The problem with hair transplant industry is it is seen as a beauty procedure like a facial. So patients are unaware that they have to go to a specialist. The guidelines are not very strict either. These two deaths have really shaken the system and I am sure the guidelines will now be followed.
In order to prevent any fallouts, a pre-anaesthetic checkup is very important. This includes various blood tests in which we see vital markers such as coagulation time. If bleeding takes too long to stop, we don’t proceed with the surgery. Also, transplants are not performed on those who have uncontrolled diabetes or hypertension. Some cardiac tests are also conducted as the drugs used for local anaesthesia can cause some cardiac issues as well. So, if the patient is above 35 years of age the protocol is to do an ECG. If the patient is above 40 we also do a treadmill test.
These are some of the critical factors a doctor must consider before proceeding. A hair transplant is not just about extracting follicles from the back of the scalp and implanting them in the desired area. It involves a comprehensive evaluation of your overall health to determine whether you are a medically suitable candidate for the procedure.
Q: Who is an eligible candidate for a hair transplant?
A: An eligible candidate is one whose overall health parameters- such as sugar levels, blood pressure and heart function are within the normal range. The second aspect to consider is whether you are likely to get good results from the procedure. That depends on your donor area (the area from which hair follicles are taken): whether enough follicles can be safely extracted, your hair texture, and the thickness of your hair. These considerations help determine the outcome and success of the transplant.
Q: Is medication used during transplant also a cause for concern?
A: Medications that are a concern are the ones used for local anaesthesia. Before we start a hair transplant, we do a sensitivity test and observe the patient for a day or two. If there is no adverse reaction only then is the patient a suitable candidate for local anaesthesia. Usually, two to three drugs are commonly used during a hair transplant procedure. The most frequently used is Lidocaine (also known as Xylocaine), followed by Bupivacaine. It is important that a qualified anaesthetist is assigned to handle the administration of these medications to ensure patient safety, even though it is not a general or spinal anaesthesia procedure.
Q: What should one look out for in terms of safety when going in for a transplant?
A: I would really like to highlight some points. Do not look for the cheapest option as this might come with considerable risks. In this case, as reported by the media, the hair transplant was done for around Rs 40,000. This amount is definitely far below the typical cost of a hair transplant, which usually ranges from Rs 1 to 2 lakhs. The price depends on factors such as the number of grafts being implanted, and each doctor sets his fees based on his expertise and skill.
Many clinics conduct hair transplants with the procedure being carried out solely by technicians. However, it must be performed by a dermatologist or a plastic surgeon. There are specific steps in the procedure that only a qualified doctor can handle. Therefore, when you go for a hair transplant, it’s important to ensure these standards are met. Hair transplants are the domain of dermatologists and plastic surgeons, not dentists, yet this field is being exploited by some in the dental profession.