I have had a fairly lengthy and frustrating battle with hairloss and hopefully my story will help a few patients in their research on finding the right solutions to address their hairloss.

My hairloss dates back to 1997, when I first started noticing hair loss in my second year of medical school.

Having walked into medical school full of life and vigour, the thought of losing hair and looking ridiculous in my 20's was a very bitter pill for me to swallow. From being exceptional at football and also being very active with the Latin ballroom society, I became a bit of a recluse and was inventing excuses not to hang out with my mates. I did try a few products to no avail.

It was not until my final year in medical school, that I realised that there were some safe and effective medications to battle with my genes. I was prescribed Minoxidil and Propecia and although I was a high Norwood 3 by that time, it did halt progression and I gradually accepted my receding hairline as surgical outcomes in those days were extremely poor.

It was about 10 years ago when I bumped into an article about FUE and how it was progressively becoming more acceptable as a viable alternative to strip surgery. But having done a bit more research, it became apparent that FUE was still in its early days and that the outcomes were very poor and it was best avoided at this stage.

A few years later, I became aware of a clinic in Europe who claimed to have pioneered a new technique which had far better results than FUE. Having come from an NHS background, wherein you are counselled by professionals who have your best interests at heart, I jumped at the offer of having to fly and get operated by a so-called master surgeon.

It appeared to me that it was precisely FUE that was being performed and having had a background of Strip surgery, I felt the surgeon would have my best interests at heart and I had no hesitation in paying €15,000 for 1000 grafts.

The post operative period was uneventful and I was back operating within a week. However, only towards the third month, it had dawned in that I had a huge gap between the area that was transplanted and my existing hair. When I examined under magnification, it appeared that I had suffered significant shock loss due to the trauma associated with the surgery. On calling up the clinic, I was reassured that it was a common event and that it would reverse overtime.

However at the end of nine months, not only had the shock loss not reversed, but also the transplanted follicles looked shockingly weak and wispy.

To add insult to injury, it appeared that my donor area was ravaged and there were very few good follicles left behind to do any meaningful correction surgery. So technically I had to learn to live with a poor surgery. I did consider legal action, but having spoken to a few peers, it appeared that I had little recourse for legal action as the surgery was not performed in the UK.

My result after 9 months

I believe this unfortunate event shaped my entire career. I immersed myself in hair restoration surgery and had an opportunity to meet ethical surgeons all over the world and better my skills in hair restoration in general and FUE in particular. A few years of persistence and under the guidance of some great surgeons, I can safely say that my results are comparable to the best in the industry and also I have managed to assemble a highly motivated and ethical team.

The entire process made me realise the trauma someone has to go through when subjected to a poor hair transplant and my team and I always strive to ensure that no patient is disappointed in our hands. I believe this is partly responsible for us having some of the highest satisfaction rates in the industry.

After eight years of having to stick to ridiculous hairstyles and bucket loads of Toppik and other concealers, I had a corrective surgery supervised by my team and applying the principles of Third Generation FUE we have mastered over the past seven years.

Hi Dr Reddy, can you tell us a bit more about your background in medicine and hair restoration?

I qualified in 1999 with a Bachelor in Medicine and Surgery and went on to pursue Masters in Surgery in West of Scotland Deanery. Following this, I trained in Dermatology. It is during my days in medical school, that I took a keen interest in hair loss and hair restoration as I was battling with hair loss and was exploring all options available.

How did your hair loss affect you in your teen years?

In hindsight it does seem a bit silly. But when you are 17 and losing hair it does feel like the end of the world. I became a bit of a recluse, wearing caps all the time and having weird hairstyles to hide my hair loss. It had reached a stage where I had almost every excuse under the sun, not to socialise and go out partying. When I turned 19, I met a dermatologist and he prescribed me Propecia and Minoxidil. They did seem to halt progression of my hair loss, but compliance with Minoxidil was an issue as my hair was constantly greasy.

I understand you underwent surgery yourself. Can you tell us a bit more about your experience?

I have had a very interesting experience with hair restoration surgery. The first surgery was a disaster by all means. This was when I was in my final years of surgical training. I had very little time to do my research and purely went with what was mentioned on the website as I believed every word and what the consultant promised me.

What do you reckon went wrong?

I come from an NHS background wherein every employee is ethical to the core. When I met the consultant, I had no reason to doubt her and just went in and had the surgery done. Little did I know that medicine in the Private sector has a lot of caveats attached to it and the consumer has to be very wary contemplating to get surgery done outside the NHS.

What did you learn from your experience?

The biggest lesson I learnt was that you ought to do a lot of research before contemplating any form of cosmetic surgery. I believe that the outcomes in hair restoration surgery are dependant a lot on the surgeon and it is of paramount importance for any prospective clients to meet the surgeon and the team performing the surgery.

On a positive note, my bad experience has led me to push the boundaries and achieve results, which are considered the best in the industry, and on top of that I have managed to accumulate a team who share a similar vision to me.

Can you tell us a bit more about the Third generation FUE?

When I started performing FUE, I observed that we had a very high rate of transection (cutting of follicles unintentionally) and this in turn affected the surgical outcomes as the hair looked a bit wispy and we had to take a lot of extractions in order to get the desired number of grafts with the desired number of hairs.

This process was not very efficient. It took a lot more time to extract the follicles and because of the wastage of hair, there was less hair available for future surgeries. This I believe is the primary reason that is making FUE a less desirable surgery, as a lot of surgeons performing it have not mastered the technique of minimising wastage of hair.

This led me to gradually make amendments to my practice and introduce a series of manoeuvres whereby the transection of follicles is almost zero. On top of this, we have improved the way we replace the grafts and also the handling process has been improved. This has led to significant improvements in surgical outcomes.

When I presented my findings to my peers, I was advised to name the process Third Generation FUE, as Dr Rassman had introduced FUE 2.

What can a patient expect from a hair restoration surgery?

With improvements in techniques, I believe there has never been a better time to undergo hair restoration surgery. Provided the patients do the right kind of research and have reasonable expectations, I see no reason why there should be any undesirable outcomes.

How do you counsel your patients when they come for a consultation?

One of the things I have always believed is the fact that the consultation phase is the most important aspect. I insist on seeing all my patients and counselling them appropriately.

I believe client selection is very important as very few clients are suitable for surgery and it is important that they understand the limitations and have reasonable expectations. On average, I qualify around 10% of my clients I consult for a surgery.

What are the limitations with hair restoration surgery?

With what I perform, I am comfortable in assuring my clients that more than 90% of the transplanted hair survives. But the difficulty we face today is obtaining the desired number of hair.

On average, a human head has about 100,000 hair follicles. You can imagine if someone with a Norwood VI hair loss would need close to 40,000 hairs to be moved from the back of the scalp to have the same density as that of someone who has not lost their hair. In reality, the best number that can be moved is 1/3 of the hair left in the donor area. The very fact that we are unable to replicate hair in a lab with available technology, rules out a lot of clients for a hair transplant.

Could you describe the process involved on the day of the surgery?

A typical FUE surgery lasts 6-8 hours. On the day of the surgery, we give the client a light breakfast and take pictures of the scalp, once the client has consented to go ahead with the surgery.

I always give the client an option of trimming the hair a bit short. I believe the surgical outcomes are better with short hair and also the healing time is much quicker.

The first step is the extraction process whereby the client lies head down on a table and we pick the grafts individually from the permanent zone at the back and sides and store it in Acell. The second step involves the design of the hairline and making the incisions. The last step is where all the extracted grafts are placed into the incisions created.

The client goes home an hour after the surgery and can carry on with normal activities from the very next day.

Sounds like a fairly straightforward surgery. Is it a very painful surgery?

It is indeed a straightforward surgery.

The only pain a patient would notice is when the anaesthetic is administered at the back of the scalp and at the front. My patients have described the sensation of the anaesthetic similar to having a blood test.

Till present, no client has ever complained of post-op pain and has been pleasantly surprised by how relatively pain-free the whole process is.

Sounds interesting. Surely there must be things that can go wrong?

Like with any surgical procedure, we counsel our clients extensively about the things that can go wrong.

There is always a small risk of an infection, for which we prescribe a course of preventive antibiotics. There is a small risk of some swelling on the forehead, which usually resolves with a course of mild steroids. And there is an element of post-op pain, for which we recommend Paracetamol.

Most of the undesirable adverse effects are aesthetic. Fortunately, the industry is getting better and poor surgical outcomes are not very common. However I perform a lot of corrective procedures and I end to see a lot of poor hair restoration surgeries being performed.

Some of the things I get to see are:

1. poor angulations of hair;
2. poor density;
3. grafts being damaged in extraction and placement, resulting in unnatural look and feel;
4. significant scarring at the donor sites, both with strip and FUE surgery;
5. scarring and necrosis of recipient area due to poor placement techniques;
6. unacceptably poor growth of hair.

The list is not exhaustive, but it gives you a fair idea of how damaging a bad hair transplant can be.

That does sounds scary. What advice would you give to patients in order to avoid the pitfalls of having a bad hair restoration surgery?

My only bit of advice for the client would be to do extensive research whilst trying to find a hair restoration surgeon. I firmly believe good teams need to be rewarded fairly and hence a very cheap surgery might not always turn out to be very desirable.

It is a good idea to see as many visuals as possible of the procedures performed by the doctor you are consulting. I also recommend meeting some of the patients the doctor has worked on.

If someone says they are good, they should be able to demonstrate that with a variety of before and after visuals.

You are so right. Is there an age limit for having a hair restoration surgery?

I don't believe there are any problems performing surgery in the elderly, as long as they are medically fit. However, I am a bit reluctant to perform surgery in clients under the age of 30.

Is there a reason why you would advise young clients against having a surgery?

Performing a hair restoration surgery on a young client can turn out to be disastrous for various reasons:

1. Firstly the hairs that are replaced with a hair restoration surgery are permanent. This being the case, if a client has unstable hair loss and undergoes a hair transplant, he has to live with an island of hair in the front as the rest of the hair undergoes progressive thinning.
2. Younger clients desire lower hairlines. This might turn out to be a bad decision, both on the part of the surgeon and the client, as hairlines change and mature naturally with age.
3. Younger clients have a lot more hair per square centimetre. Despite significant improvements in dense packing, it can be hard to achieve natural density of 90 hairs per sq cm with one transplant procedure. This can be rectified by further sessions. However we need to bear in mind that we are depleting donor hair for future transplants.

Finally Dr Reddy, what do you reckon the future holds for this industry?

We as a scientific community are very excited about cloning. If and when cloning becomes commercially available, we might be able to offer hair restoration surgery to a wider clientele with no limitations associated with current techniques.

I also believe, with better understanding of hair loss, we might be able to develop better medications to prevent hair loss.