Unregulated hair transplant practices in India: experts raise health and medical ethics concerns

Experts emphasise that only dermatologists and plastic surgeons formally trained in hair restoration should be allowed to perform these procedures, noting that hair transplant is a serious surgical intervention requiring thorough medical evaluation, sterile conditions and post-operative care

Hair transplantation in India is facing a troubling crisis -- not because of the procedure itself, but due to the concerning rise of underqualified practitioners operating in unsafe, unregulated environments. Although it is a serious medical procedure requiring expertise, sterile conditions, and thorough preoperative evaluation, recent incidents have shown how frequently these standards are neglected.

The outcomes, in some cases, have been fatal -- reports from Chennai, Delhi, Kerala and Kanpur reveal severe infections, toxic shock, and deaths, often linked to negligence, poor hygiene, or unauthorised personnel performing surgeries. These cases stress the urgent need for tighter regulation, as numerous clinics continue to operate without proper licenses or medical oversight.
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With the sector expanding rapidly, dermatologists and plastic surgeons across India are voicing serious concerns over the lack of enforcement, which not only endangers patients but also undermines the credibility of ethical medical practitioners.

Cases of adverse outcomes from improper hair transplant procedures

Several confirmed cases in recent years reveal the severity of the issue. In Chennai in 2016, a 22-year-old medical student, P. Santhosh Kumar, died two days after undergoing a hair transplant at a salon in Nungambakkam. The procedure was performed by doctors not qualified for such surgeries, and the salon lacked the necessary medical infrastructure, police investigations revealed. The cause of death was suspected to be complications from an allergic reaction to anesthesia.

In Delhi in 2022, a 35-year-old man died following a hair transplant procedure at a salon in Rohini, performed by unqualified technicians without medical supervision. The Delhi High Court expressed concern over such practices and directed authorities to take action against establishments conducting medical procedures without proper qualifications.

A recent incident in Kerala involved a patient developing necrotizing fasciitis, a life-threatening bacterial infection, after a hair transplant at a clinic that falsely claimed to have a dermatologist on staff. Investigations revealed that the clinic had been using the name of a dermatologist who had left years prior.

In Kanpur, two men, died following hair transplant procedures performed by a dental practitioner who was neither trained nor authorised to carry out such surgeries. The practitioner had promoted herself as a hair transplant specialist on social media platforms. Legal actions have been initiated, and the clinic’s registration renewal was denied due to non-compliance.
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Experts also shared several other cases where fake practitioners defrauded patients of large sums of money, operated multiple branches across major cities, and built a clientele that even included celebrities.

Hair transplantation procedure, related laws and systemic issues

Hair transplantation is often marketed as a simple, aesthetic procedure. In reality, it is a surgical operation that can last 6 to 8 hours and must be performed under sterile conditions with local anesthesia. A proper preoperative evaluation is essential to assess the patient’s medical history, medications, lifestyle habits (such as smoking and alcohol), and suitability for surgery. The condition of the scalp and hair loss pattern must also be analyzed to determine if surgery is even the right course of action.

Katheeja Nasika, consultant dermatologist, Rela Hospital, Chennai, explains that failure to screen patients or manage emergencies is a major reason for complications. “An emergency tray, anesthetist support, and a sterile OT (operation theatre) environment are mandatory. These are often missing in non-medical centers where the procedure is done simply for profit,” she said.

Sterility is especially critical. Instruments such as punches, scalpels, syringes, and gauze must be sterilised using proper medical protocols. Air quality in the OT must be controlled, and clinics should follow biomedical waste management rules. Clinics without these safeguards risk exposing patients to infection, including bloodstream infections due to the scalp’s high vascularity.

The National Medical Commission (NMC) has made it clear through its 2022 circular that only dermatologists and plastic surgeons trained in hair restoration are legally allowed to perform hair transplants. Similarly, the Dental Council of India has specified that among dental practitioners, only oral and maxillofacial surgeons (OMFS) are allowed to conduct such surgeries, and only under defined guidelines.

Yet, the line is frequently blurred. According to Avinash Pravin, dermatologist, member of the anti-quackery committee of the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL), many BDS graduates portray themselves as trichologists or cosmetologists. He describes the situation as a “deep-rooted, systemic failure” and confirms that public interest litigations have been filed in the Chennai and Mumbai High Courts challenging the dental curriculum’s inclusion of procedures outside its scope.
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He also flagged the issue of fake certificates and unrecognised foreign courses being used to mislead the public. “There are courses being marketed under foreign affiliations, but these have no recognition from the Indian medical system,” he said.

Misinformation, exploitation and the need for verifying medical credentials

Many clinics operate with aggressive business models, setting daily or monthly revenue targets. Dr. Pravin shared that in certain branded clinics, employees are assigned targets of up to ₹20 lakhs per month. Patients, often from modest financial backgrounds, are lured into signing EMI schemes for treatments that cost ₹60,000 to ₹80,000. Some clinics even convince patients to undergo procedures at home or in salons, where safety protocols are nonexistent.

False advertising is also widespread. Claims such as “hair regrowth in six months” and “100% success rate” are frequently made without clinical evidence. Brands often pay social media influencers to promote services and products, further misleading the public. Regulatory oversight for advertising in the aesthetic medical field is weak, allowing such misinformation to spread unchecked.

Sabyasachi Basu, consultant plastic, aesthetic and reconstructive surgeon, Narayana Health, Kolkata stresses the importance of education and formal training. “It takes 15 years to become a plastic surgeon -- MBBS, MS, and MCh. But many so called hair transplant ‘experts’ attend a two-week course and start practicing,” he said. “Even a technician with years of hands-on experience cannot manage emergencies, dosage calculations, or patient comorbidities without formal medical training.”

He adds that most small clinics lack critical care support such as ICU access, life-saving equipment, and anesthesiologists. “If a patient collapses, the setup is often not equipped to save them. This is a major risk.”

One of the central challenges is helping the public distinguish between trained professionals and unqualified operators. In Tamil Nadu, the medical council provides an online tool where patients can verify a doctor’s credentials using a clinic’s registration number.
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According to Dr. Pravin, the IADVL’s membership base maintains an internal standard for qualification verification, but even then, around 1–2% of listed dermatologists are believed to have questionable certifications. He urges patients to ask direct questions, check degrees, and look for registrations with recognised medical bodies such as the NMC, not just social media profiles or paid endorsements.

Call for urgent regulation

Despite numerous incidents and growing public awareness, concrete government action remains limited. Experts across the board are calling for a dedicated aesthetic practice regulation act, along with stronger enforcement of existing medical guidelines. Until that happens, dermatologists and plastic surgeons continue to push legal cases, raise awareness through social media and educate the public.

Dr. Nasika notes that ethical practice must begin with the practitioner, but the government must follow with accountability and enforcement. “Without proper action, unethical practices will continue to thrive. Patients should also play a role in protecting themselves by verifying qualifications and insisting on safety protocols.”
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The cosmetic and aesthetic medicine market in India is expanding rapidly. But behind the promises of transformation lies a troubling gap in regulation and oversight. Until the healthcare system can fully meet the growing demand, experts emphasise that patients may need to take an active role in verifying information, asking questions, and making informed choices about their care. A hair transplant, while elective, is still a surgical procedure -- and deserves to be treated with the same seriousness and caution as any other medical intervention.

from TheHindu.com