Dr Tejinder Bhatti

Thanks NaMo, for your interest. I just uploaded the video-

Thank you for the appreciation. The patient is not a case of male pattern baldness. He is suffering from Sikh pattern traction alopecia in which DHT blockers are not required. TIPS TO PREVENT TRACTION ALOPECIA IN SIKHS- SIKH PATTERN TRACTION ALOPECIA - Darling Buds Hair Transplant Center

Thank you, Mr David, Look forward to meeting you soon.

Mr. Moritz, Good to meet you here. How have you been? Looking forward to your next visit to Darling Buds !!

Hi Questionmark, Thanks for the Qs! He received at the present time 1506 grafts for the region just in front of the previously planted crown area which had become bald and which he covered with a parting on to the left. At this moment most of his scalp is planted hair. In case his crown begins to expand (which it will in good time) I think he has another 800-1000 grafts left. Moreover, he has a good supply of beard and chest hair which we shall recruit for his future surgical hair restoration whenever the time comes and he feels the desire to have this done. I do not feel he shall need another procedure now till 4-5 years. But its just my guess.

fisher4man I am only a Legal Beagle. Ask the ISHRS why it thinks so and you shall get an exhaustive answer out of the ISHRS' collective wisdom- Qualifications for Scalp Surgery Speaking for myself- I do all the harvesting myself- 100%. I follow ISHRS orders and the Law..

Thank you for the Qs fisher4man. And thank you for your interest in the philosophy of hair transplant particularly that of FUE technique for which alone I can answer since I am 100% dedicated to this technique which works well in my hands. If you mean to say by your above quoted remark that there is more wastage in FUE grafts, you are wrong. FUE transected roots grow back and live to be harvested again from the donor. However, FUT grafts on the other hand get transected out of the body. Yes ofcourse FUE grafts by nature are slender, and devoid of the cuff of surrounding protective tissue which renders them to be more fragile. This is an inherent drawback with FUE technique. However if the grafts are implanted with good speed by a team of rotating technicians, the viability of the FUE grafts is comparable to that of FUT grafts. I would say there is no difference in plantation when we compare the 2 techniques. They are just different harvesting techniques which produce comparable results. I believe that all stages of hair transplantation- harvesting, slit making and plantation are equally important and one without the other 2 can lead to failure. Lastly, hair transplant is team work and its strength is in its weakest link.

Hi "Options", That's a nice discussion following your questions and I could not resist sharing my thoughts. A cohesive skilled Team is the key variable to a successful modern day hair transplant where mega-sessions are the norm. If one accepts this fact, it would be clear that a team has to be assigned duties for efficient completion of the task at hand. The second important variable by which outcomes are determined is the speed with which harvested slender fragile FUE grafts devoid of protective covering and so more prone to dessication need to be returned back to the body (recipient area). It is only one person who can possibly harvest at one time. While harvesting requires skill and constant practice borne out of many months of relentless practice, slit creation is an art that needs to take into consideration the patient’s long term hair restoration goals, his/her hair styling preference (location of parting line for side parting hair styles, slick backs, spikes, etc.) which will determine the angle and planned strategic density variation in various esthetic locations in the bald scalp. The light and shade effect also plays a large part in determining where to place more slits than another. Where harvesting is a skill, slit making is an art. It is my personal opinion, and I think that of many leading FUE surgeons today, that a doctor who doing all steps including plantation in today’s times is either an itinerant hair transplant surgeon who cannot afford a team or a poor leader. For a physician doing plantation after harvesting the grafts cannot do more numbers than roughly 1000 in a 8-10 hour session. After all maintaining a great team is a daunting task and calls for inherent leadership acumen. Reputed doctors with successful leading practices the world over devote their precious time to various stages other than plantation since the latter requires speed to accomplish and this can only be done by a team which keeps rotating. Plantation is a repetitive exhausting process which needs a keen eye, stamina, and skill. I cannot see myself maintaining my stamina and hand eye co-ordination under high magnification after I have spent 2-3 hours with a patient harvesting the grafts. Not only is it difficult for even young eyes to be in bright light for long periods but it is impossible even for nimble fingers keep their stamina and dexterity required to densely pack grafts 55 grafts inside a centimetre squared. I always rotate my staff in pairs for grafts greater than 1500. I fail to understand how a doctor can do all steps himself. Since speed is of the essence once the grafts are out, planting them by a single person who has been through the fatigue of harvesting would be the weakest link in the chain and needs to be condemned. However, some patients fail to understand this fact. In a field where attrition rates are high due to poaching, I for one continue to better my harvesting skills while continually training back-up nurses for only plantation, for though I can train a planter in 3 months, a good harvesting technician/ physician can only be trained in 2-3 years. Moreover, it is illegal for technicians to do harvesting since they are technically incising the skin which is a qualified registered surgeon’s job. Plantation is the only step legally authorised to non-doctors. It would be pertinent here to read the ISHRS advisory on who can perform harvesting- Qualifications for Scalp Surgery

Hi Tigerkat, Though I have no significant experience with this approach of giving a uniform thin look, I would like to say that it is easy to achieve if the patient wishes. The grown hair in the recipient area would match the native hair at the back and sides if done in the same low density like in this representative patient. Yes, even the side temples would look pleasing when buzzed down to the same hair length. It is a good approach to my mind in a patient who wishes this look knowing he has a low/ depleted bank of donor hair. Thanks for being part of the conversation started by KO. Best.

Hi KO, Sorry for the delay in responding to your thread. You are right- many people like to just have the feel of a vague hairline from a distance. with low density. This when enhanced by scalp pigmentation (SMP) can look very effective. However, in Indians there is a premium attached to long hair and in the geographical location where I practice, a person would much rather have a comb over than a buzzed look. I have not had the instance of treating patients wanting a low density spread out coverage.

On completion of his 9 months post second procedure he can walk into my clinic and I shall shoot an HD video of his result and post it on this thread for all to see. (with a signed statement that Toppik was not used ) I am sure it shall be an excellent result despite the poor quality of grafts utilised.

When you deal with a patient having potential low yield the hair are not evenly distributed all over the scalp. This is the technique of “strategic placement”. The patient is advised that a particular hair styling method be done to get a good result with minimum grafts available. In this particular patient’s case we had reached an agreement as per records available with me that he agreed to part his hair on the left with a flick to the right till he got the second procedure when he could go in for any styling he chose after more grafts were added to the right side. This is the reason why the density was low on the right side in his case; and also in some other similar cases in the past which were corrected in the second procedure with more grafts. However, the case of “Shane13” is different. He was noted to have a localized flaky skin lesion the size of a coin where grafts did not grow. This was rectified with minimal grafts and he is a very happy patient today. Please refer his thread. ‘eternaldenied’ had no Toppik on when he came for his second procedure just before which the pictures were taken. All patients come after a shampoo scrub. None of my patients in all my results on this forum or my website FUE Hair Transplant India - Darling Buds | Dr. Tejinder Bhatti are with Toppik on. There are better ways to ask for subsidised procedures than attempting to arm-twist through a thread on HRN. When you do such large number of cases, it is natural that a few dissatisfied clients will always result. However, we never abandon them like we did not abandon "eternaldenied". And as I said, this is a lovely thread where I shall keep referring my clients with unrealistic expectations.

This is a set of pictures taken just before the commencement of the second procedure. To my mind, given the complexities of the case where we had to take a large number of body grafts along with poor quality scalp grafts on the insistence of the patient after due counselling I feel this is a satisfactory result. There is no reason to believe that the result after the second procedure shall be even better. Unhappy patients like these even after due counselling devoid of hard sell do teach the hair restoration surgeon a lesson- to be careful in future while accepting such cases.

Pictures of the patient before the procedure. He was extensively counseled regarding the meager supply of grafts available for him and towards realistic expectations since his body hair was limited in quantity.

This patient’s result is quite educative for the potential balding client seeking a hair transplant. I often refer the link to this thread to some customers so that they have realistic expectations of possible outcomes in situations like this. The present patient had a meager quantity and sub-optimal quality of donor hair due to which, consequent to the patient’s inability to accept his balding, a procedure was done. As you can see this is the donor area at the time of the first procedure and the second picture (shaved) is the donor area just before commencing the second procedure. Very few good quality grafts were available for the first stage and even lesser for the second. Hence the first procedure was supplemented by body hair from the beard. In the next post I shall show you the balding area and thereafter during the latter half of the day we shall discuss his result all based on pictures taken in the clinic.

Dear Fujita, Yes it is very obvious that HTIndia has business interests with me. He is my old patient and now a dear friend and business partner too. He has a counseling office in the United Kingdoms. When the previous post was made by him, the business plans had not yet firmed up and we very occasionally talked. However, HTIndia was at that moment of time in the process of making his website. By the way I have several of my past patients around the world who send me new clients- for word of mouth works better than advertisements. However, Fujita, none of my business partners will ever be seen posting on this Forum.

Hi, It takes an FUT scar 18 months to become supple. This would be the best time to fill it with FUE grafts and disguise its straight line. If done earlier, graft take is certain to be less than optimal. In response to your second Qs, 6 months is a long enough wait before we can go in again for a second harvest from the same donor area. For filling up a previously planted area, 9 months is a reasonable wait period. Best wishes.

Dear Jayukdht, I would not like to place promotional material here. We would have shifted completely by end March. You are most welcome for the inauguration.

Hi Jayukdht, This is in regard to your query on the sizes of punches. Well, I use the Harris dull punch- sizes 8 and 9. The actual cutting diameters of these punches are - 0.75 and 0.85 mm respectively. The other punches available in the market are marked as per internal diameter. Well, in most cases I use 0.75 mm since it allows me finer grafts which can be packed closer together for greater density in contrast to grafts harvested with the 0.85 mm punch. But it is not that all cases are necessarily candidates for a smaller punch! In around 15% of my clients who have larger follicular groupings, I do use 0.85 mm alone. I mostly first use the 0.75 mm punch avoiding larger follicular groupings and come back again to harvest the latter with 0.85 mm punch. On average 80% and above work can be done in most cases with the smaller punch. I have never had the occasion to use sizes bigger than 0.85 since the past 4 years after I picked up the wonderful FUE technique. I hope I have answered what you had asked.

Hi, I shall post more pictures after 3 months once I have shifted to my new location and things get orderly. The shifting is taking place at the moment and is consuming most of my time.

Hi GNX1, I have seen (and this is just my impression without any established available scientific data to quote) that beard and chest hair gray faster than scalp hair and hair from other parts of the body.

Hi Midnightio, We worked on your hair transplant within the following clinical constraints - 1. Low density of donor area 2. Thin hair with more 1s and 2s than 2s and 3s 3. Gross Tramline FUT scarring which you sought to be disguised The grafts available were distributed strategically to make optimal utilisation of meagre resources. As you correctly alluded to, hair transplants are a visual illusion wherein without achieving natural density, we seek to give natural looking results. Your final result will be satisfactory. It is too early to see results yet. The FUT scar was discussed with you and leftover grafts were transplanted. You would remember that it was not the primary goal for your procedure. If we were to transplant more hair during your next visit, the scars would barely be visible. I would advise around 800-1000 body hair to disguise the scar completely so even with size 1 or 2, we would barely be able to discern the tramline scars of FUT. Revising the tramline will not be possible since after 2 procedures, your scalp has become tight and there would be scar creep which definitely shall make your scar wider than it presently is. However, SMP (scalp micro pigmentation) is emerging as an adjunct in such cases as yours. You might like to explore this too.

Yes you are right when you state that beard hair goes gray faster than scalp hair. Once transplanted, unfortunately, it shall retain all its native characteristics and nothing will change except that baldness will be cured! Beard hair is 3 times thicker than scalp hair.

Dear Friends on Forum, Midnightio has just completed 30 days after the procedure- FUE hair transplant. He is progressing well. The hair shall now continue to grow till 6-8 weeks when around 60% of the growing hair shall start shedding. Why the shedding you would ask?- The growth that Midnightio is witnessing in most planted hair is not the hair which are growing but the root underneath that is sprouting a new hair. This hair is pushing the old shaft outwards. The new hair just about reaches the surface at around 6-8 weeks- the time when the shedding takes place. The remaining about 40% grafts continue to grow since they do not get disjointed from the root. In response to theMidnightios other queries- Also, can you also describe variables such as hair thickness and skin color/complexion and how this affects and influences hair transplants in general? I know that I have thin hair and a fair (white) complexion which may present some challenges. Ofcourse the thicker your hair is, the better the result after a hair transplant. However, Midnightio's hair is blondish and since there is not too much of a contrast with his fair skin, he should still have a satisfactory result in within the next 4-8 months. One other question -- Since grafts (besides body hair grafts) are harvested from the rear of the scalp, is it correct that this hair is genetically programmed to continue to grow through my lifetime? Is this always true? Or is this hair also subject to changes due to aging? The hair at the back of the head does not have receptors to DHT and hence it is widely believed that it is permanent in nature. However, since thinning of even this hair occurs in those in 70s and 80s, the transplanted hair will mirror this change whenever it occurs.

You can read about the autoclave at- http://en.wikipedia.org/wiki/Autoclave