Introduction : Hair transplant means surgical hair restoration. The term hair transplant is actually a misnomer. It is not a transplant in it's true sense. Hair cannot be transplanted from one person to the other simply because hair is not a life saving organ. It's importance is only cosmetic. So technically the procedure is microfollicular grafting that is extracting hair roots from one area of abundance to the area of deficiency or to the area of hair loss.

More than 90% of cases of hair loss are due androgenetic alopecia. Male androgenetic alopecia has been classified by Norwood into 7 grades depending on the extent and area of miniaturisation. Female androgenetic alopecia is more of a thinning pattern has been graded by Ludwig as grades 1,2 & 3 depending in severity of thinning.

Donor zone : Sensitivity of the follicles to DHT dihydrotestosterone is localised only from the front hairline to the vertex. This sensitivity is inherited.  Patterns of alopecia develop only in this sensitive zone. The temporal and occipital scalp areas are devoid of this sensitivity . These hair hence grow permanently with the same quality. So this is the donor area for hair grafting. Follicles from this donor zone are extracted and implanted in the balding zones. These implanted follicles then grow new hair permanently. These hair once grown do not require any medical maintenance.

Limitation :  The total number of hair follicles in the scalp is always constant. So once follicles are extracted from the donor zone, they do not regrow or multiply. Whatever number extracted from the donor zone is subtraction from that area and addition on to some other area where they are implanted. So this concept of limited availability of donor follicles is the most important limitation of hair restoration. We do not have an unlimited supply of hair for transplantation. This is the main reason why normal hair density is not achievable in any surgical hair restoration.
Other donor zones : Hair follicles see also available for extraction from areas other than the scalp. These are
1. Beard
2. Body hair
3. Pubic hair

But these are not the donor areas of first choice for extraction. The reason is that body hair has different genetic characteristics compared to scalp hair. Body hair can never grow long after transplantation. So these areas can be targeted only after the donor scalp is exhausted of hair roots and that no more hair follicles can be extracted from the scalp. So follicles in these areas are used generally as fillers to improve the already achieved density after 2-3 sessions of hair transplantation provided anyone desires for improvisation of hair density.

Other limitations of hair grafting :
1. Waiting time: once done, it takes approximately one year to see a full result of the transplant.
2. There is a limit to the number of grafts that can be extracted in one session of micrografting. Maximum 2000 upto 2500 follicle unit grafts can be extracted in a single session depending on the donor hair density.

Methods of hair grafting :
1. Strip method also called FUT
2. Single follicle extraction also   called FUE
3. Combination technique with both strip and FUE for extensive coverage.

Strip method. FUT :  in this method, a full strip of donor scalp skin is extracted with whatever maximum length from temporal to temporal area on the other side which is usually more than 20 cms in the average scalp. Width is the limiting factor here with not more than 1 to 1.5 cms facilitating easy scalp closure. Strip once extracted is divided into multiple slivers and then individual follicle unit grafts followed by implantation.

Advantages :
No hair cut or head shave needed
Lesser operative time 4
Stitch line remains concealed.

Disadvantages :
Stitch pain is more compared to FUE
Stitch line leaves a permanent line scar visible only in full head shave.

FUE : in this method, individual follicle units are extracted by using micro punches, 0.8, 0.9 or 1mm  depending on the size of hair and units.

Advantages :
Relatively pain free as no stitch line.
Punch scars are not predominantly visible compared to the line scar.

Disadvantages :
Mandatory full head shave required for procedure
Longer operative time
Percentage of follicle damage is higher as punch extraction is a blind procedure.

Anaesthesia : Hair transplant is a purely local anaesthesia procedure.

Post operative recovery. : Minimum down time of 4-5 days. Head wash can be safely started from 3rd or 4th day. Antibiotics and pain killers may be required upto 5 days. In case of strips, the stitchs can be removed after 12 days to 2 weeks. All scabs of implantation generally fall off by 2 to 3 weeks followed by initial shedding of all implanted hair.
New hair growth from implanted follicles starts by 12 to 16 weeks and then gradually improves over one year following surgery.
Hair transplantation is a wonderful aesthetic procedure and the results are pleasing provided one understands and accepts it's limitations. Cosmetic hair density that can be achieved by this surgery is not even 50% of normal hair density but it is sufficient enough to give a good profile change as per one's own desire.
Success rate is very good overall with an average graft survival rate of 80-90 % which means that out of 100 implanted follicle grafts 80 to 90 grafts survive, 10-20 % grafts may not survive due to technical and physiological reasons which is accepted worldwide.

Caution about false advertisements :
There are a lot of false advertisements floating in the media and give wrong concepts about hair transplantation like quick results, scarless hair transplants, non surgical hair transplants, no touch technique, unlimited hair grafts and multiplication of hair, stem cell therapies, 100% success and guaranteed results, robotic transplans, etc. These claims are not true.
Hair transplant cannot give a quick result. It is a physiological process which cannot be altered by any means to give quick results.
There is no concept of non surgical hair transplant. It is a proper surgical procedure which will leave definite and permanent scars whether strip or fue. These scars cannot be treated or made to vanish by any means.
The concept of no touch technique does not exist. Any surgery cannot be without handling of body tissues.

Claims of unlimited grafts cannot be true as there is a limited donor zone available for extraction and hair follicles cannot be multiplied by any means. Also claims of stem cell therapies giving hair growth and multiplication of hair follicles are completely false.

Claims of 100% graft survival and guaranteed results are also not practically true because 100% of implanted grafts cannot be claimed to survive. Also any surgical or medical procedure done for any purpose cannot give any guaranteed results and such claims are not true.
There have been failures if the procedure is not done properly.

Also there are a lot of unqualified clinics doing hair transplant procedures all over the world and not just in our country. There are a lot of clinics which appoint technicians to do the procedure without any qualified medical supervision. So before choosing the clinic it is extremely important to know who is the operating surgeon and the doctor's qualification.

Advertisements about robotic hair transplants are also not practically true as it simply cannot be a robotic procedure. A machine can be used to ease the procedure but it simply cannot replace the skill of a human hand and the brain behind it. Hair transplantation is an art, an extremely skilful job and requires competent hands along with an intelligent brain working behind the hands.

Conclusion :
Hair transplantation is a very safe good cosmetic surgery which gives pleasing results if done properly and in good qualified hands.