5 min readJan 27, 2026 02:37 PM IST
First published on: Jan 27, 2026 at 02:36 PM IST
Written by Dr Abhishek Pilani
When Mitesh Matani, 44, came to see me, he had previously undergone three hair transplant procedures, two in India and one in Dubai, none of which delivered satisfactory results. Upon reviewing his medical and procedural history, one of the primary reasons for failure was that these surgeries were largely technician-driven. In one clinic, although a doctor was present, the most critical phase of the procedure — the implantation — was delegated to nurses and technicians. Yet we chase these procedures abroad and damage the chances we have.
So, what led to the botch-up?
On the face of it, hair transplants look simple. The surgical procedure involves relocating healthy hair follicles from dense areas (which we call the donor site), typically the back or sides of the head, to thinning or bald areas (recipient site). It is a permanent solution for male pattern baldness. But it is a precision-based surgical procedure that demands continuous doctor involvement, the doctor performing every follicle extraction and implantation himself.
In Matani’s earlier transplants, the surgeries were performed as single-day, bulk sessions using wider extraction instruments and a slit-based implantation technique. In this procedure, the surgeon, after harvesting hair follicles from the donor area, makes microscopic, slit-like incisions in the scalp, usually before placing the hair grafts. These slits are designed to be slightly smaller than the graft to ensure a “snug fit.”
Now patients like mine, who have a very weak, thin, or limited donor area (the back/sides of the head) may not have enough grafts to fill the area. The slit technique doesn’t work for them. It does not work if the scalp is too tight, fibrous, or scarred from previous surgeries.
Such methods significantly compromise graft survival, damage the donor area and often result in poor or no hair growth. Consequently, despite prolonged reliance on medications after surgery, the final outcome remained unsatisfactory for Matani.
Why hair transplants are easily botched up
Too many hair follicles are removed from the donor area, leaving it permanently thinned or scarred. Failing to account for future hair loss in other areas can result in an unnatural appearance over time. Lack of proper sterilization causes scalp infections, which can destroy hair follicles and lead to scarring.
How to ensure hair survival even in complex cases
My patient’s donor area was already severely depleted due to excessive over-harvesting in previous procedures. The donor area, once damaged, cannot be reversed or revived. It is a limited and non-renewable supply. For this reason, the operating surgeon must take complete responsibility for the procedure and should not delegate critical steps to assistants or technicians.
We, therefore, divided his corrective transplant into three to four smaller phases, each spread over 2–3 days, with shorter daily sessions of 3–4 hours. This phased approach helped minimise scalp trauma and significantly improved graft survival.
Ultra-fine micro instruments were used for both extraction and implantation, along with a simultaneous implantation technique. This allowed for precise graft placement and uniform, natural-looking density, even with limited donor hair. It helped ensure that no new scars developed in the donor area, which was already weak. Today, Matani has a full crown on his head.
How to keep hair transplants natural
Grafts must be placed at the correct depth to avoid unnatural popping or buried looks. Beyond depth, follicles are implanted at specific angles to mimic natural hair growth. They must be spaced adequately to ensure proper blood supply. The hairline design should be age-appropriate.
Why the care protocol is as important
The drill begins pre-op, beginning with stopping of blood-thinning medications, anti-inflammatory drugs, and aspirin. Follow all instructions regarding cleaning the scalp to prevent infection. Avoid touching or scratching the grafts for the first 24-48 hours to prevent dislodging them. Protect the scalp from sun and sweat, and avoid wearing tight hats.
Hair does regrow after a transplant, with permanent, natural-looking results appearing 12–18 months post-procedure. Following initial shedding (shock loss) in the first few weeks, transplanted follicles enter a resting phase before growing new, thicker hair.
(Dr Abhishek Pilani is a leading aesthetic dermatologist, dermato-surgeon and hair restoration specialist in Mumbai)
The donor area, once damaged, cannot be reversed or revived. 
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