Hair Transplant in Guwahati and Northeast by Dr. P. J. Mazumdar

Hair transplant is a procedure for helping in hair loss

by transferring hair from the patient's own hair growing areas to bald areas. It is primarily used for male baldness but can also be used for female baldness, to reshape eyebrows, eyelashes, hair loss due to burns or trauma, etc

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Hair transplant is a procedure used to treat areas of hair loss by transplanting hair from one site of the body to another.

It is primarily used in male pattern baldness, but is also used in female pattern baldness, loss of hair due to trauma, burns, surgical incisions, etc.

Male pattern baldness forms the bulk of the cases, upto 95%. Balding persons of all ages can get hair transplant done. Age range of hair transplant done in Arogyam Hair Transplant clinic ranges from 14 years (a young girl with burn injury of the scalp) to a 72 year old male.

Hair transplant is a cosmetic procedure. It is a purely elective procedure and personal aspirations of the patient are the main driving force for having this operation. Benefits from this procedure can be immense. Baldness can affect both social and professional life of the people who suffer from it, and people who are sensitive to it can become very self conscious about this and are unable to interact confidently with other persons. A hair transplant can be life changing in these situations.

Male pattern baldness or Androgenetic alopecia is controlled genetically. The hair follicles are genetically programmed to stop producing hair at a certain age which is determined by hereditary factors. These genes are activated by the effect of testosterone. Hair loss is graded according to the Norwood scale and graded from 1 to 7.During the balding process, the hair does not fall off directly, instead the hairs start getting thinner and shorter and do not reach their full length. In this way the density of hair covering the scalp is decreased. Hairs which fall off and are seen on the pillow and during showers are not due to balding.

History

The first recorded cases of hair transplant began in the early nineteenth century when some surgeons transplanted scalp flaps and free grafts to bald areas. Hair transplant was also done in Japan around 1930 when hair was transplanted to replace damaged eyebrows. Modern era of hair transplant began in late 1950’s when Dr. N. Orentreich transplanted free donor grafts to bald areas. He demonstrated that hair longevity was ‘donor dominant’, that is, the lifetime of a hair was determined by the site in which it grew originally and not the site to which it was transplanted. Dr. P. Walter defined the ‘Safe Donor Zone’ which contained hair with the maximum lifetime longevity.

Surgeons continued to develop techniques to transplant smaller and smaller grafts. Initially punch grafts were taken, but this gave an unnatural appearance to the new hair. In 1990, Limmer developed the technique of using microscopes to dissect follicular hair units from strips. Since then, the follicular unit has become the gold standard for transplantation. In 2002, FUE with extraction of single follicular units was developed. Initially manual punches were used but since 2004, motorized drills have come to be used in FUE and this is the most advanced technique at present.

Methods:

The concept of ‘Safe Donor Zone’ is the basis of hair transplant. It will be noticed that even in the most bald and elderly person, hair is still retained in the sides and back of the head. These are the areas in which hair is genetically programmed to last throughout life. This forms the catchment area for hair transplant. Hair is taken from this area and then transplanted to the bald areas. Hair is basically like a plant and the skin is like the soil. When a hair is taken out with its root from any area of the body and planted in the skin in a different part of the body, the hair will continue to grow in that area just like a plant which is removed from one field and planted in another.The transplanted hair lasts lifelong and this is what makes hair transplant so valuable.

Hair transplant is done by two main methods, FUT and FUE. They differ only in the way hair is extracted, the plantation is done in the same way.

In FUT or Follicular Unit Transplantation or Strip Method, a strip of skin 1 cm wide is cut out from the occipital and temporal regions. Technicians then splice this strip into individual hair follicles. These follicles are then transplanted into the bald areas in the second stage.

In FUE, in the modern method, a drill of 1 mm size or smaller is used to carefully remove each individual hair follicle containing 1 to 4 hairs. Small round holes are left behind which form only minimal tiny round scars.. 1 out of 4 hair follicles are drilled out and the resulting slightly lower hair density is not noticeable at the donor site. The plantation method is the same.

The basic method of plantation is to create a small incision and then insert the hair follicle into it. The incision can be made with a small scalpel or a needle. Recently, customized transplanters like Choi implanters have been developed which makes the procedure faster and easier. Plantation is usually done by assistants.

Both the methods are done under Local Anesthesia. The patient remains fully conscious and injections are given in the skin to make the skin numb so that there is no pain during the procedure. FUE has the big advantage that it is much less painful postoperatively and it does not leave behind a scar.In FUT, the patient has a stitch at the back of the head which can cause discomfort for months even after the incision is healed, besides the scar. Maximum of 2000 grafts are done in a day. Usually a session on a single day will last about 6 hours but large sessions will last 8-9 hours. Breaks for lunch, toilet breaks, etc can be taken at any time without any problems. The patient can go home after the session and come again next day for the second session if needed. Typically FUE is more expensive than FUT because the surgeon has to spend more time.

Pre- operative

Before the procedure, the patient has to be assessed psychologically. His needs are to be understood and the possibilities and limitations of the procedure explained. The patient needs to be explained that he should not expect a miracle like a complete return to his original hair pattern but only camouflaging by obtaining a natural hair line and increased hair density is to be expected. The amount of hair to be transplanted is decided based on factors like the amount of hair loss, costs, the expectations of the patient etc. Patients can go for a small transplant initially and then come back for further implants after 3 years or so as more of the original hair is lost.

For plantation, the surgeon has to decide the look of the hairline and then draw it out. The amount of hair planned to be transplanted, the age of the patient, the possibility of further loss of original hair, natural look, the density of hair planned, etc are all factors which need to be considered. Drawing of the hairline is more an art than science.

Results

After the procedure is completed, the patient has a bandage at the back of the head but the transplanted area is kept free. Minimal precautions like avoiding rubbing the transplanted hair, etc are advised. Patient can wear a cap to cover the transplanted area from the next day. Shampooing of hair is advised after 4-7 days or earlier to wash out scabs.

Final results in hair transplant will take 6 to 9 months to show. After the transplant the hair will initially appear to be growing very nicely after 10 to 20 days. After that about half the hairs will fall. Only the outer portion of the hairs fall and the roots remain inside. This occurs because some of the hairs go into the telogen phase. At the end of one month about half the hairs will be growing and so only half the desired density will be visible. There will be no change for the next three months and it is common for patients to become anxious or depressed in this period. The roots of the hairs which have fallen off will start growing hairs again by the fourth month and the new hairs will start appearing. Almost all the fallen hairs will have appeared by 6 to 9 months and that is why full results should be expected only by 9 months. However, even after 9 months, for upto 1 and a half year, a few hairs will continue appearing and the existing hairs will also grow thicker and darker, and hence results will continue to improve till 1 and a half year.

Using FUE, surgeons are now able to use body hair also from the chest, back, arms and legs. Body hair is permanent but remains shorter in length. Using such hair, transplants upto 10,000 hairs have been done. But this is only for the very concerned patient who wants high density; for the average patient transplants of 1000 to 2000 hairs are usually satisfactory. This can be done in multiple sessions also over the years.

Conclusion

Hair transplant along with all other cosmetic procedures is growing in popularity in the present times. As people have more luxury and time to spare, no one wants to be left behind in the race for success and happiness. About 100,000 hair transplants were done in the US and about 280,000 worldwide in 2010. It is growing very fast in Asia since the last three years, and India also is showing a rapid growth. Not just male baldness but female hair loss and procedures for eyebrow and eyelash transplantation are also becoming increasingly popular. As with all cosmetic procedures it is a personal choice. For those who feel their baldness is a limitation, hair transplant has emerged as a safe and effective procedure with minimal side effects or drawbacks.

Arogyam Hair Transplant clinic has now been started in Downtown hospital to bring the advantages of this procedure to the people of the North-East. The latest FUE technique by motorized drill is used in the center. The aim is to provide the latest technology at an affordable cost and thereby benefit the people of this region. More than 500 patients have been operated till 2017 and many thousands more have been treated medically. The latest techniques and fully surgical safety is ensured to provide the best and safest results to the patient at a standardized cost.

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What happens on the day of the procedure

Previous day

• There are no work restrictions for the previous day and no diet restrictions. Patient should have healthy normal diet.
• Alcohol must be avoided on the day prior to procedure and restricted for 3 weeks prior to 90 ml per day or less.
• Smoking should be stopped completely from 3 weeks ahead for best results, if this is not easy then it should at least be restricted as far as possible. Smoking hampers best results.
• Patient should shampoo his hair the day before the procedure with normal shampoo.
• If some portion of hair is greyed (whitened), then there is no need to dye the hair as only the black hairs will be taken. If majority of hair is greyed or whitened, then it is preferable to dye the hair so that hair can be taken easily. Ask your doctor whether or not to dye the hair if you dye hair regularly.
• Cash for payment must be readied. Payments have to be made in cash and in advance before the procedure starts. There will be no time to take it out from the ATM on the day of the procedure. Patient must have the cash ready when he reaches the OT the next day.
• If installment payment is being planned, then patient must sign the agreement for installment payment on the day prior to the procedure. The patient must go to the Hospital on the day prior to the procedure and take required documents along with him which includes salary slips, photostat copies of identity proofs, cheque book, etc. Please check the page cost in hair transplant for the requirements for installment payments.
• All investigation reports which are advised for the procedure must be readied if they have not already been reviewed. If investigations have been done in Downtown hospital or Arogyam, the reports can be collected by our staff. If they have been done outside, the reports must be collected and checked against reference values to see whether they are normal. Reports must be produced before the procedure starts.
• Attendants (accompanying persons) are not a must for the procedure. Most patients come alone for the procedure. However it is desirable that an accompanying person should be there with the patient which helps to reduce stress for the patient. Attendants should be told beforehand to be ready at the proper time. Attendants need not wait outside the OT during the procedure as it will be a day long procedure, after initial discussions with the doctor the attendant can leave for his own work and can remain in contact over the phone. If there is no attendant, an emergency contact number of someone in Guwahati should be arranged for the day of the procedure.

Day of the procedure:

• Patient must have full normal breakfast on the morning of the procedure.
• He must carry with him a cloth cap to wear on the way back.
• He must take along the investigation reports with him.
• He should also have ready the cash payments as discussed.
• He should wear a buttoned shirt rather than a T-shirt which may cause problems while putting on after the transplant.
• Food or drinking water need not be taken along as these will be available in the hospital.
• Patient is required to reach Downtown hospital, Building no 1 at 9 AM sharp.
• If registration in the hospital has not been done previously, then registration must be done at the reception. Registration fees is Rs 100.
• Pt is then directed to the OT which is on the 2nd floor.
• Patient's weight is taken, BP is measured and sensitivity test is done.
• A gel is applied in the area of the transplant.
• Patient is also asked to take 2 painkiller tablets and a tablet for acidity. This will be supplied by staff.
• Patient must then sign the consent form. General consent form of hospital OT is supplied and no special consent is required for hair transplant.
• Patient then changes into the OT patient dress.
• The doctor and patient then again review the plan for the transplant. The number of grafts to be transplanted, the area where the hairs will be planted, general line of the hairline, etc are discussed.
• Patient then makes full payment according to the number of grafts that are to be done. Full advance payment must be paid as agreed upon prior to the procedure. Payment should be in cash. This is the hospital protocol. Procedure will start only after payment is made.
• Photographs of the patient's bald areas from a few different angles are taken. These photographs are only for patient record and are required by law for all cosmetic surgery. They will not be published in media or online.
• Then comes the all important task of drawing the hairline. The patient reviews the hairline and only when both the patient and the doctor are satisfied with the hairline, it is finalized. The grafts will be given according to this hairline.
• Patient's hair is then trimmed. Hair is trimmed to 3 mm which is the approx length at which army people keep their hair.
• The patient then lies down on his back and the plantation area is scrubbed with antiseptic solution. Local anesthetic injections are then given in the front and other areas where the hair is to be planted. This completely anesthesizes the skin and the patient will not feel any pain during the procedure.
• Slits are then made in the areas where hair will be planted. Slits are very small and hardly visible to the naked eye. The number of slits is equal to the planned number of grafts. The surgeon makes the slits according to the plan of the transplant. They are directed according to the natural direction of hair.
• Once slits are completed, the patient lies on his stomach. A gel pillow is used to place the head and face. The donor area at the back of the head is then scrubbed. Local anesthetic injections are then given at the back of the head. The surgeon the begins the process of FUE. The number of grafts that are taken out at one time depend on the number of grafts to be done during the day. If 2000 grafts are planned for the day, for example, usually 1000 grafts will be taken out at one time.
• The patient then again shifts his position and lies on his back. The grafts which have been taken out are immediately planted into the slits by the staff assistant. This minimizes the out-of-body time.
• Working lunch is then served for patient and staff.
• In the afternoon, the same routine of taking out grafts and then plantation is followed to complete the process of transplant.
• Once the process is completed, the area is then cleaned and a bandage is given at the back of the head.
• The patient then changes back into his normal clothes. The patient can now wear the cap he has brought so to cover the signs of the procedure on the way back.
• The doctor now explains the medicines to take and protocols to follow. Antibiotics and painkillers have to be taken for 7 days. The patient can bathe from the next day and wet his head also but shampooing is to be started after 4 days. No dietary restrictions but smoking and alcohol is to be avoided or restricted. No other special precautions are needed.
• The patient can then go back home.
• He can join work from the very next day.

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Mesotherapy - Does it work?

It is primarily used in male pattern baldness, but is also used in female pattern baldness, loss of hair due to trauma, burns, surgical incisions, etc.

Male pattern baldness forms the bulk of the cases, upto 95%. Balding persons of all ages can get hair transplant done. Age range of hair transplant done in Arogyam Hair Transplant clinic ranges from 14 years (a young girl with burn injury of the scalp) to a 72 year old male.

Hair transplant is a cosmetic procedure. It is a purely elective procedure and personal aspirations of the patient are the main driving force for having this operation. Benefits from this procedure can be immense. Baldness can affect both social and professional life of the people who suffer from it, and people who are sensitive to it can become very self conscious about this and are unable to interact confidently with other persons. A hair transplant can be life changing in these situations.

Male pattern baldness or Androgenetic alopecia is controlled genetically. The hair follicles are genetically programmed to stop producing hair at a certain age which is determined by hereditary factors. These genes are activated by the effect of testosterone. Hair loss is graded according to the Norwood scale and graded from 1 to 7.During the balding process, the hair does not fall off directly, instead the hairs start getting thinner and shorter and do not reach their full length. In this way the density of hair covering the scalp is decreased. Hairs which fall off and are seen on the pillow and during showers are not due to balding.

History

The first recorded cases of hair transplant began in the early nineteenth century when some surgeons transplanted scalp flaps and free grafts to bald areas. Hair transplant was also done in Japan around 1930 when hair was transplanted to replace damaged eyebrows. Modern era of hair transplant began in late 1950’s when Dr. N. Orentreich transplanted free donor grafts to bald areas. He demonstrated that hair longevity was ‘donor dominant’, that is, the lifetime of a hair was determined by the site in which it grew originally and not the site to which it was transplanted. Dr. P. Walter defined the ‘Safe Donor Zone’ which contained hair with the maximum lifetime longevity.

Surgeons continued to develop techniques to transplant smaller and smaller grafts. Initially punch grafts were taken, but this gave an unnatural appearance to the new hair. In 1990, Limmer developed the technique of using microscopes to dissect follicular hair units from strips. Since then, the follicular unit has become the gold standard for transplantation. In 2002, FUE with extraction of single follicular units was developed. Initially manual punches were used but since 2004, motorized drills have come to be used in FUE and this is the most advanced technique at present.

Methods:

The concept of ‘Safe Donor Zone’ is the basis of hair transplant. It will be noticed that even in the most bald and elderly person, hair is still retained in the sides and back of the head. These are the areas in which hair is genetically programmed to last throughout life. This forms the catchment area for hair transplant. Hair is taken from this area and then transplanted to the bald areas. Hair is basically like a plant and the skin is like the soil. When a hair is taken out with its root from any area of the body and planted in the skin in a different part of the body, the hair will continue to grow in that area just like a plant which is removed from one field and planted in another.The transplanted hair lasts lifelong and this is what makes hair transplant so valuable.

Hair transplant is done by two main methods, FUT and FUE. They differ only in the way hair is extracted, the plantation is done in the same way.

In FUT or Follicular Unit Transplantation or Strip Method, a strip of skin 1 cm wide is cut out from the occipital and temporal regions. Technicians then splice this strip into individual hair follicles. These follicles are then transplanted into the bald areas in the second stage.

In FUE, in the modern method, a drill of 1 mm size or smaller is used to carefully remove each individual hair follicle containing 1 to 4 hairs. Small round holes are left behind which form only minimal tiny round scars.. 1 out of 4 hair follicles are drilled out and the resulting slightly lower hair density is not noticeable at the donor site. The plantation method is the same.

The basic method of plantation is to create a small incision and then insert the hair follicle into it. The incision can be made with a small scalpel or a needle. Recently, customized transplanters like Choi implanters have been developed which makes the procedure faster and easier. Plantation is usually done by assistants.

Both the methods are done under Local Anesthesia. The patient remains fully conscious and injections are given in the skin to make the skin numb so that there is no pain during the procedure. FUE has the big advantage that it is much less painful postoperatively and it does not leave behind a scar.In FUT, the patient has a stitch at the back of the head which can cause discomfort for months even after the incision is healed, besides the scar. Maximum of 2000 grafts are done in a day. Usually a session on a single day will last about 6 hours but large sessions will last 8-9 hours. Breaks for lunch, toilet breaks, etc can be taken at any time without any problems. The patient can go home after the session and come again next day for the second session if needed. Typically FUE is more expensive than FUT because the surgeon has to spend more time.

Pre- operative

Before the procedure, the patient has to be assessed psychologically. His needs are to be understood and the possibilities and limitations of the procedure explained. The patient needs to be explained that he should not expect a miracle like a complete return to his original hair pattern but only camouflaging by obtaining a natural hair line and increased hair density is to be expected. The amount of hair to be transplanted is decided based on factors like the amount of hair loss, costs, the expectations of the patient etc. Patients can go for a small transplant initially and then come back for further implants after 3 years or so as more of the original hair is lost.

For plantation, the surgeon has to decide the look of the hairline and then draw it out. The amount of hair planned to be transplanted, the age of the patient, the possibility of further loss of original hair, natural look, the density of hair planned, etc are all factors which need to be considered. Drawing of the hairline is more an art than science.

Results

After the procedure is completed, the patient has a bandage at the back of the head but the transplanted area is kept free. Minimal precautions like avoiding rubbing the transplanted hair, etc are advised. Patient can wear a cap to cover the transplanted area from the next day. Shampooing of hair is advised after 4-7 days or earlier to wash out scabs.

Final results in hair transplant will take 6 to 9 months to show. After the transplant the hair will initially appear to be growing very nicely after 10 to 20 days. After that about half the hairs will fall. Only the outer portion of the hairs fall and the roots remain inside. This occurs because some of the hairs go into the telogen phase. At the end of one month about half the hairs will be growing and so only half the desired density will be visible. There will be no change for the next three months and it is common for patients to become anxious or depressed in this period. The roots of the hairs which have fallen off will start growing hairs again by the fourth month and the new hairs will start appearing. Almost all the fallen hairs will have appeared by 6 to 9 months and that is why full results should be expected only by 9 months. However, even after 9 months, for upto 1 and a half year, a few hairs will continue appearing and the existing hairs will also grow thicker and darker, and hence results will continue to improve till 1 and a half year.

Using FUE, surgeons are now able to use body hair also from the chest, back, arms and legs. Body hair is permanent but remains shorter in length. Using such hair, transplants upto 10,000 hairs have been done. But this is only for the very concerned patient who wants high density; for the average patient transplants of 1000 to 2000 hairs are usually satisfactory. This can be done in multiple sessions also over the years.

Conclusion

Hair transplant along with all other cosmetic procedures is growing in popularity in the present times. As people have more luxury and time to spare, no one wants to be left behind in the race for success and happiness. About 100,000 hair transplants were done in the US and about 280,000 worldwide in 2010. It is growing very fast in Asia since the last three years, and India also is showing a rapid growth. Not just male baldness but female hair loss and procedures for eyebrow and eyelash transplantation are also becoming increasingly popular. As with all cosmetic procedures it is a personal choice. For those who feel their baldness is a limitation, hair transplant has emerged as a safe and effective procedure with minimal side effects or drawbacks.

Arogyam Hair Transplant clinic has now been started in Downtown hospital to bring the advantages of this procedure to the people of the North-East. The latest FUE technique by motorized drill is used in the center. The aim is to provide the latest technology at an affordable cost and thereby benefit the people of this region. More than 500 patients have been operated till 2017 and many thousands more have been treated medically. The latest techniques and fully surgical safety is ensured to provide the best and safest results to the patient at a standardized cost.

Continue reading

Top 30 Questions You Need To Ask About Your Hair Transplant Doctor and Clinic in Guwahati Assam

All hair transplant customers in the region try to find the best hair transplant doctor and clinic in Guwahati, Assam and the Northeast.  Hair transplant experts are doctors who are specialists in hair transplant surgery. Guwahati, Assam is the most popular destination for medical procedures like hair transplant and there are 5 hair transplant clinics in Guwahati itself out of which choosing the best can prove difficult for those who do not know the right things to ask. 

Given here is a list of THE TOP 30 questions that YOU need to ask before choosing the best hair transplant doctor and clinic in Guwahati and the North East, 10 questions each about the Doctor, Clinic and the procedure itself.

10 questions to ask about your hair transplant doctor / specialist

10 questions to about your hair transplant clinic /hospital

10 questions to ask about your hair transplant procedure

10 questions about the hair transplant doctor/specialist in Guwahati

1. What is the qualification of the doctor?

It is vital to know the qualifications of your doctor. Many unqualified persons like MBBS doctors, Ayurvedic or Homeopathic graduates and even techinicians can be found doing hair transplant in India and also in Guwahati. This is specially true of clinics which are branches of big chains of clinics and have roaming teams to do the transplant. Such clinics, and also some consultants, will gather all hair transplant patients till a number is reached and then call the team with which they have contact. These teams most often do not have qualified doctors - a qualified doctor does not need to go to patients, patients come to him. Such doctors are often anonymous and the consultant cannot even name them properly and may also give unverified 'degrees' which are dubious.

Dr. P. J. Mazumdar is the highest qualified doctor in the North East – he is the first and only US Board certified hair transplant specialist being a Diplomate of the American Board of Hair Transplant Surgery. This is the highest qualification in Hair transplant and there are only about 20 such qualified hair transplant specialists in India.

2. What is the experience of the doctor? How many cases has he done?

The experience of the doctor is the most important element in the success of hair transplant. In clinics with roaming teams of doctors/technicians, although the clinic chain as a whole may be experienced, no one can be really sure about the experience of the individual doctor/technician who is going to do the procedure. These roaming teams keep rotating their doctors /technicians bringing in new faces to cut cost

Dr. P. J. Mazumdar is the most experienced doctor in FUE Hair Transplant in the North East. He did the first FUE transplant in the North East in 2012 (the actual procedure of motorized FUE was invented only in 2006 in the US by Dr. Sam Harris). Since then, he has been performing the highest number of FUE surgeries in the North East each year and this number has been steadily growing.

3. Will the doctor whom I have consulted do the procedure itself or it it somebody else?

In many clinics the person who does the initial consultation is not the operating surgeon and merely kept there to convince the patient with vivid descriptions but is unable to provide the actual information. The operating person sees the patient only just before the procedure. This is both dangerous and totally unsatisfactory, as the best results cannot be obtained in this way.

In Arogyam Clinic, Dr. P. J. Mazumdar himself will examine the patient right from the first consultation to the end of the procedure ensuring that the patient is well informed about all the steps of the procedure.

4. Will the doctor do all the steps of the procedure?

In many clinics, the doctor does not do all the steps of the procedure. He may do only the initial hairline or a few extractions leaving the rest of the procedure to the technicians. This is dangerous and illegal.

In Arogyam Hair Transplant Clinic, Dr. P. J. Mazumdar himself will do all the steps of the procedure from initial consultation to hair line drawing to follicular unit extraction to slit making, as per the norms of the AHRS and ABHRS.

5. Will the doctor do the aftercare of the patient?

In clinics with roving teams of doctors / technicians, the person doing the aftercare is different from the persons who did the procedure. This is an unsound practise and can lead to problems for the patients.

In Arogyam Clinic, Dr. P. J. Mazumdar will always be available for aftercare himself.

6. Will the doctor be available for post operative care?

In case of chain clinics and some consultants who bring in operating teams from outside, once the operating person has completed the case, he leaves the state itself and goes back to his hometown. The patient cannot locate his operating doctor any more and has to depend on advise from someone who does not know how the procedure is actually done. Take care to ask if the operating doctor will be available for post operative queries.

Dr. P. J. Mazumdar will be stationed in Downtown hospital and is always available for all queries of the patient in the post operative period, which is very important for the patient.

7. Will the doctor follow any ethical standards in his advice?

Today there are many different types of people doing hair transplant even in Guwahati. Many persons are quite ready to cheat patients using the patient's lack of knowledge of technicalities. The commonest method is to quote 'follicular units' for 'hairs'. One follicular unit contains 2.5 hairs on the average, and price should ethically be quoted in terms of FU (follicular units), but many clinics will count hairs as FU. Clinics also do not give any option to the patients to verify the number of FU received, and give much less than the promised number. Also unrealistic boasts like '5000 FU in one day' are common for such clinics. Prospective hair transplant customers should be aware of these false claims. The highest number of FU that can be done in a day as per International norms is generally 2500 FU, and that too is a high figure.

Dr. P. J. Mazumdar, being a Diplomate of the American Board of Hair Transplant Surgery, and also a member of the Ethics Committee of the Association of Hair Transplant Surgeons of India, is duty bound to follow all ethical guidelines and customers can be assured that they will receive true facts at Arogyam.

8. Will the doctor follow the latest technological advances in hair transplant procedure?

Hair transplant is a rapidly advancing field and many new developments are taking place in this field. It is necessary to remain upgraded with the latest knowledge to take advantage of these developments. Professional money minded clinics generally will not invest in new technologies in order to maximise their profits.

Arogyam Clinic updates its procedures regulary and Dr. P. J. Mazumdar is a regular at all national and International conferences in order to acquire the latest instruments, technology and knowledge to achieve the best results in hair transplant.

9. Does the doctor belong to the requisite professional bodies for hair transplant?

Clinics relying on fly by night doctors are unable to give a full account of the qualifications of their doctors, and such doctors are often unqualified and untrained, and sometimes there are even technicians masquerading as doctors. Membership of professional bodies is a tool to ensure that your doctor is fully qualified and all potential customers must make this quer.

Dr. P. J. Mazumdar is a Diplomate of the American Board of Hair Restoration Surgery which is the highest body of hair transplant surgeons throughout the world. He is also a member of the Association of Hair Restoration Surgeons of India and is member of the the Ethics Committee of the AHRSI.

10. Where has the doctor been trained?

Besides qualifications, it is important to know where a doctor has been trained. Most clinics with roving doctors are unable to give this information as the doctor or technician has not received adequate training.

Dr. P. J. Mazumdar received his initial training under Dr. Vasa and since then has attended numerous workshops where he has been trained under the best International and National experts like Dr. Sam Harris, the inventor of the modern method of FUE, the motorised FUE, Dr. Farjo, Dr. Besham and many others.

10 questions about the hair transplant clinic in Guwahati

1. Is the clinic a well extablished hospital or a small rented establishment?

Most hair transplant clinics in Guwahati at present operate from small rented establishments which are not at all fit to be operating rooms. A medical establishment with operating rooms where surgical procedures are going to be done has a huge number of requirements and cannot just be set up by renting a few rooms. Hence it is very important to ensure whether all the norms have been met, which is virtually impossible in a rented extablishment, often with many other shops, restaurants and bars nearby.

Arogyam Hair Transplat Clinic performs all its procedures in Downtown Hospital, the largest private hospital in the North East, and the procedures are done in the Main OT Complex of Downtown Hospital, thus ensuring that patients are assured of receiving the best of care.

2. Is the clinic well reputed?

It is also important to enquire whether the clinic is a well reputed and established one. Many clinics are set up as fly by night projects which have no prior reputation and are set up mainly to make profits.

Arogyam Hair Transplant Clinic and Downtown Hospitals are both well established Institutions which have a long list of achievements to their credit and enjoy a strong and well earned reputation as the best in their field.

3. Is the clinic well experienced in hair transplant?

It is also important to ask how much experience the clinic has in hair transplant. Although the chain clinics may have experience overall, the particular branch at Guwahati will have done only a few procedures till date. The overall experience of the clinic chain cannot compensate for the lack of experience of the clinic as it is the experience of the staff, etc which will count in the success of the procedures and also in any emergencies.

Arogyam Hair Transplant Clinic has the highest experience in FUE Hair Transplant, performing the first FUE hair transplant in the region in 2012, only a few years after motorised FUE was started in the US in 2006. Since then, it has been the most popular FUE clinic in the North East performing the highest number of procedures in a year and this number has been growing steadily over the years.

4. Is the OT of the clinic made all the norms required of an OT?

This is an important question to ask as small rented establishments cannot fulfil all the norms that are required of an OT before a surgical procedure can be done there. An inadequate OT exposes the patient to several risks and also acts as limitations to the success of the procedure.

Arogyam Hair transplant clinic performs its procedures in the Main OT Complex of Downtown Hospital which is built according to all the latest norms and standards required of an Operating Room and ensures full safety of the patient and helps to reach the greatest success of the procedures.

5. Is the OT equipped with all emergency procedures?

This is a crucial question to ask about the hair transplant clinic. Proper emergency backup is a must to ensure safety of the patient. Although hair transplant is considered a very safe procedure, it is still ultimately a surgical procedure and risks can occur because of untoward reactions of the patients to drugs used during the procedure. This can be easily tackled when the clinic has the required emergency equipment and backup, but if these are lacking the patient can be in serious danger.

No other clinic in the North East can claim the emergency backup of Arogyam Clinic. All procedures take place in the Main OT of Downtown Hospital with its full array of Emergency backup including Emergency Anesthesiologists and all necessary equipment, staff specially trained in Emergencies, and even ICU nearby if necessary. All other clinics in the North East are stand alone clinics in rented rooms with no emergency backup.

6. Is the OT equipped with all sterilization facilities?

Proper sterilisation is a must for all procedures. Sterilization requires a umber of important steps which must be performed correctly, such as autoclaving of instruments and clothes, liquid disinfectants for sharp instruments, regular fogging of the OT room, use of disposable equipments, etc. Such procedures are difficult to ensure correct performance and small stand alone clinics are likely to have gaps in their sterilization procedures.

Downtown OT complex has all the necessary equipment and procedures to ensure full sterilisation of each and every case. All procedures of Arogyam Hair Clinic are performed in Downtown OT.

7. Is the OT equipped with all the latest instruments for hair transplant?

Success of hair transplant requires that the best and most modern instruments are used for the transplant. This ensures optimal results of the procedure. It is important to enquire whether the clinic is using the latest technology.

Arogyam Hair Transplant clinic can justifiably claim to be using the latest technology in the field of hair transplant from 6X Heinz loupe, Blunt Titanium punches, Choi Implanters, Graft counters, etc.

8. Is the OT fully staffed?

It is important that all staff should be fully trained and qualified. Even a single under qualified nurse or staff can be the weakest link in the chain and can cause the whole procedure to fail by not doing his or her work properly. Most clinics use a number of staff who are not qualified and have no theoretical knowledge and learn their work at the clinic itself by observation.

All staff in Arogyam clinic are fully qualified staff nurses who are trained in emergency procedures.

9. Are all the required legal and ethical procedures followed in the clinic?

There are a number of legal requirements for maintaining a medical clinic and full documentation is a must for all procedures. This is necessary for ensuring the safety of the patient and for standardisation of procedures.

Arogyam Hair Transplant Clinic along with Downtown Hospitals maintains all records and documentation and meets all legal requirements according to ISO 2002 standards. This ensures the highest level of standardisation. All taxes including GST are paid in full and strict documentation of all cases is ensured, and complete patient confidentiality is maintained.

10. Does it have all the support like lab, blood bank, ICU, etc?

Supporting facilities like pathology lab, Blood Bank, ICU, etc ensure full safety and backup for the patients. Stand alone clinics do not have any of these facilities and would require the patient or attendants to run around for simple requirements, and this can be a disaster during emergencies.

Arogyam along with Downtown hospitals have all these facilities thus ensuring a safe and convenient procedure for the patient.

10 questions about the hair transplant procedure

1. Will the doctor explain the best procedure for me?

Hair Transplant in fact is not the only procedure for all bald patients. There are many cases of baldness where in fact hair transplant is not recommended, like unpatterned hair loss, alopecia universalis, etc. Hair transplant is to be avoided in such cases. Also in cases of young patients presenting with minimal loss, it is often better in the patients interest to delay the transplant. There are many other cases where the best procedure is not hair transplant but medicines or other forms of treatment. Advisers in small clinics do not have all the knowledge to determine when hair transplant is not the answer, and they are also driven by greed to suggest the highest number of follicular units that the patient can bear in all cases.

Arogyam Hair Transplant clinic follows all ethical guidelines of the American Board of Hair Restoration Surgeons and only the best and most appropriate advise is given to the patient. Patients who do not require surgery are prescribed other forms of treatment like medicines, hair patches, etc. Also only the most appropriate number of follicular units are advised and all factors are considered in determining this number.

2. Will the doctor take care of my long term needs for hair?

It is very important to understand that baldness can be a continuous process. A person who now shows baldness at the back only can soon start showing baldness at the front also. This is specially so in case of young persons whose baldness is at the initial stages. Hence proper counselling is a must for all balding patients to ensure that care is taken of the future needs of the patient also. This requires a genuine desire to see that the patient is benefitted in the long term also and not just do a maximal transplant in the first stage without caring what will happen to the patient some years later.

At Arogyam Hair Transplant clinic, care is taken in counselling the patient to ensure that they understand the nature of their hair loss so that only the best possible advise is given which will take care of the long term needs of the patient also.

3. Is hair transplant the only procedure?

Hair transplant is not the only treatment for baldness. Many other treatments like medical treatment and also Hair Pieces (artificial hair) can be given for baldness. Transplant is required in many cases but not in all. It is important to know all the choices available before making a decision.

4. What is the survival rate of the transplanted follicular units?

It is very important to know the survival rate of transplanted follicular units. Many clinics claim total or close to total FU survival to impress potential customers, but this is a false claim.

Internationally 85 to 95% survival rate is considered very good. Arogyam consistently achieves survival rate of around 92%.

5. How many follicular units can be done in a day?

It is also important to ask this question. Internationally a good clinic does between 2000 to 2500 follicular units in a day. This ensures optimal results. Some clinics even in Guwahati claim they can do upto 5000 follicular units a day, this is a false claim as it is simply not possible to do this number of FU in one day. Such claims prove that the clinic is cheating either by giving lesser number of FU than they show or counting hairs as FU..

6. How can I verify how many follicular units were actually done for me?

This is the step where patients are typically cheated in most clinics. No clinic has proper verification methods of the number of FU that they do. The patient is then left at the mercy of the clinic hoping that they have fulfilled their promises. But most, if not all, clinics cheat on this score and give lesser number of FU than promised. Sometimes clinics ask the patients or attendants to count the FU but this also is not a sure method as no one can possibly manually count all the FU within the short time at their disposal.

At Arogyam, a special verification method is used so that no patient has any doubt in his or her mind. Follicular Units are placed in special counting trays and patients are asked to take pictures of these trays which they can then then zoom in and count later if they wish. This ensures that no patient has any doubt in his or her mind about the number of FU that were actually done.Not just the number but the quality of the ollicular Units, whether they have been transected or are whole, the number of hairs per FU, etc can all be checked so that the patient is fully confident in what was done..
Is the counting done by follicular units or hairs? How can I verify thi?

Difference between follicular units and hairs is another way in which clinics will typically cheat their patients. A FU contains between 2 to 3 hairs on the average and ethically counting and pricing should always be done in terms of FU and not hairs. But many unethical clinics will count hairs as FU and thus cheat their patients, who have no way of verifying whether hairs or FU were counted.

At Arogyam, pictures are given to patients of the counting trays and this can be used to verify that indeed FU were used and not hairs.

8. What density of follicular units will I be given?

A well planned hair transplant requires that the density of hairs at different sites of the scalp is also planned beforehand and the implantation is done following this density. Thus for a successful result the correct density must be determined beforehand. The patient has a right to know what density has been planned for him and the doctor must be able to explain this. Hence it is important to ask this question beforehand, however many clinics do not have proper planning and cannot give this information.

At Arogyam, not only is the density planned but to ensure correct density, density stamps are used so that the density is given with precision.

9. Will all the advised steps of hairline be done as per International technical norms?

International research has continuously led to improved techniques and guidelines which ensure optimal results. It is important that this latest knowledge is used in the clinic and correct operational procedures are followed.

Arogyam Hair Transplant clinic follows all the latest technical guidelines and procedures as advised by the American Board of Hair Transplant Surgeons and ensures the best results for the patients.

10. Will any long term medicines be needed after the transplant?

Post operative care and medicines required should be ascertained before the transplant. Long term medicines are not needed after the transplant but sometimes medicines may be prescribed for existing hair in order to preserve existing hair.

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Top 10 things you need to know about cost in hair transplant in Guwahati, Assam and the North East

Cost in hair transplant varies widely in different regions, and different people will be quoted different costs even in Guwahati itself. You definitely want the best results for your transplant, and it may be confusing to understand why different costs have been quoted for the same person. Cost in hair transplant depends on three main factors – the degree of baldness of the patient, the expectation of the patient and the rates of the clinic. Besides this, there are a number of other factors which influence cost in hair transplant in Guwahati. Because of the wide variation in costs that are quoted to the patient, you need to understand the factors which influence the costs, and also the right questions to ask so that you get the best results for your money. Here the top 10 things you need to understand about cost in hair transplant in Guwahati, Assam and the North East.

1. Degree of baldness is the most important deciding factor for cost. The more the baldness the higher will be the cost for you. A higher area of baldness means a greater area to cover and hence a larger number of grafts and more time, so cost also is more.
2. Your expectations and desires: this can often be the most important factor deciding the cost of the procedure. How much you want to do is your own choice, and you can choose to go for a larger number of grafts or a lesser number as per the amount you have earmarked for spending on your transplant. After all not everyone may want to go for the largest possible transplant – you might want just enough to make yourself presentable. Lesser number of grafts than the optimum can still be used to cover the baldness very effectively, either by lowering the density of grafts given or by covering mainly the front portion of the bald area and creating a nice hairline. Hairline and the 'tuft' area of the scalp, the mid frontal portion, is the main area for creating a look of normal hair and it is sufficient to cover this area with nice density to make you look young again.
3. The rate of grafts is the third most important factor in the cost of transplant. It is here that you have to be extra careful in your decision to make sure that you get the best results for your cost of transplant. A whole lot of factors decide what the rate per graft is for the particular clinic and you have to consider these factors very carefully. They are given in the following sections.
4. The experience and qualification of the doctor is the main factor determining the rate per graft of the clinic. You should look carefully into whether your doctor is qualified for hair transplant and whether he has sufficient experience. You should also look into whether he is a member of the professional bodies for hair transplant and whether he is in touch with the latest technological advances. A highly qualified professional will naturally charge more than a less qualified person. Chain clinics will usually have roaming doctors whose qualifications are dubious at best and who disappear once the procedure is over.

Dr. P. J. Mazumdar is the most qualified hair transplant specialist in the North East as he is the only Diplomate in Hair Transplant Surgery from the American Board of Hair Transplant Surgeons. He is also the most experienced as he started FUE Hair Transplant in Guwahati and the North East in 2012, and performs by far the highest number of FUE procedures per year in the North East.

5. The stature and reputation of the clinic is also very important in deciding the rate per graft. A well established and reputed clinic will naturally have higher standards to maintain and this increases the cost.

Downtown hospital is the largest private hospital in the North East and Arogyam Hair Transplant Clinic is the only clinic in the North East to be situated in a hospital. All other clinics in the North East operate from rented premises with their inherent disadvantages. Full safety and sterility is ensured as the procedure is done in the fully equipped Main OT of Downtown hospital.

6. Graft vs Hair also determines the cost. A graft consists of two to three hairs or more. Many clinics will confuse the patient by quoting prices for grafts whereas they mean hairs. Thus you may find a clinic offering you '5000 grafts in 1 day at just Rs 20 per graft'. This might seem attractive, but there are many pitfalls in this offer. First of all, it is impossible to do 5000 grafts in 1 day, internationally no doctor does more than 2500 to 3000 grafts in a day. This is a sure sign that the clinic means 5000 hairs, not grafts. Such large number of grafts quoted for a small area is a sure sign that they mean hairs, not grafts. Their price per graft would thus be around Rs 50, but by quoting hairs instead of grafts, they make it sound like Rs 20 only. Also, such clinics do not offer you any reasonable verification method so that you can never determine how much they have actually given.

At Arogyam, strict ethical standards are maintained and all costs are quoted in grafts, which is the internationally accepted norm. Also, full verification is given to the patient by using counting trays in which the grafts are placed and then giving photos of these trays to the patients on their mobile, so that they can later zoom in and see whether grafts or hairs are being used and also count them easily on the counting trays. Thus no room is left for doubt in the mind of the patient.

7. The level of instrumentation also determines the price. Highly sophisticated and advanced instruments are naturally more expensive and costs more. Hence prices would be more.

At Arogyam, we use the most advanced technique, Blunt Motorised FUE, and the best instrumentation like 6X Heinz loupe, Choi Implanters, Blunt Titanium punch, density stamps, counting trays, etc to ensure the best results for the patient.

8. Emergency services also increase the costs. Although hair transplant is an extremely safe procedure with a very low rate of complications, yet it is vital that full emergency infrastructure must be maintained for safety of the patient.

Full Emergency services are possible only in a hospital setting and at Downtown hospital, we have the entire range of Emergency services to ensure full support in case of any emergency.

9. Supporting infrastructure like pathology labs, blood banks, ICU etc are a must for any procedure. These also drive up the prices but are a necessary part of hair transplant.

Downtown hospital has all the necessary infrastructure to support any big surgery including open heart surgery, kidney transplant, brain surgeries, etc and hence you will be assured of full support.

10. Full documentation including GST taxes ensure that proper standards are maintained by the clinic and all legal and ethical standards are maintained.

Downtown of course ensures that all such documentation is maintained up to the highest standards.

Costs in Arogyam Hair Transplant Clinic are maintained according to the standards we provide. We are not the cheapest clinic in Guwahati or the North East, but we are not the most expensive either, our prices are in the middle range. But we can justifiably claim that we provide the best treatment according to all International ethical and technical standards and we do not compromise on quality.

Our price is Rs 35 per graft plus GST. This is in the middle range of prices in India and also in Guwahati for any Association of Hair Restoration Surgery registered clinic and doctor.

For a Grade 3 baldness, cost would be around Rs 30,000, for Grade 4 around Rs 40,000 to Rs 60,000 , Grade 5 between Rs 60,000 to Rs 80,000, Grade 6 Rs 1 lakh to Rs 1.2 lakh and Grade 7 more than  Rs.1.5 lakhs. This is if they want to cover the whole scalp with high density, but as explained before you can also choose to do a lesser number of grafts and thus your cost can be lower than this also.

There are at present 5 Hair transplant Clinics in Guwahati. Yes, there are 5 now! When we started we were the only clinic doing FUE Hair Transplant back in 2012. They are, in alphabetical order:

Arogyam Hair Transplant Clinic, Downtown hospital -owned by Dr. P. J. Mazumdar, MS, FICS, ABHRS Diplomate

Dr. Paul, Zoo Tiniali – part of a chain which started as a homeopathy clinic for hair.

DHI, Supermarket police point – part of a chain of clinics

HHY, Bhangagarh – part of a chain of clinics

Monjoven, VIP Road – owned by Dr. Porag Neog, MS. First hair transplant in the North East was done in Monjoven using strip method in 2010.

Prices, according to telephonic quotations, are:

Arogyam: Rs 35 per graft

Dr. Paul: Rs. 25 per graft

DHI: Rs. 65 per graft

HHY: Rs. 30 per graft

Monjoven: Rs 35 per graft

As you can see, we fall in the middle range of prices.

Each clinic has its own strength and weaknesses. Different patients choose different clinics as per their priorities. As a prospective customer, you should examine each clinic and determine which would suit you best.

Our disadvantages are:

• We cannot offer the cheapest prices. Our surgeon is the most highly qualified and with the longest experience in FUE in the North East, our instrumentation is of the highest standards, our OT is fully equipped to handle everything, etc. Our prices are not the cheapest but also not the highest either. If you are looking for the cheapest clinic, then we are not it, but if you are looking for the best, then please go through our information.
• Dates may not be readily available. All our dates are generally already booked well in advance, so you should book 2-3 weeks in advance to get the date of your choice.
• We do not have a high profile advertisement campaign nor sponsored celebrities, hence you may have heard less of us in the media. Being hospital based in fact, there was no advertisement at all in the initial years and it is only now that some internet advertising is being done at a limited scope. Majority of our patients continue to be referral patients from previous satisfied customers. Despite not having a high voltage publicity campaign, we take pride in the fact that we are the largest hair transplant clinic in the NE doing the highest number of transplants per year in this region.
• We do not offer highly glamorous facilities. Downtown hospital is one of the oldest hospitals in Guwahati, and the layout is not the most fashionable. The OT arrangement is geared towards sterility and efficiency rather than flamboyance.
• GST is a must. All our documentation is maintained legally and so we pay all our taxes.

Our advantages are:

• Arogyam Hair Transplant uses the best method of hair transplant, Blunt Motorised FUE, and the latest  instruments like Heinz 6X loupe, Choi implanters, Blunt Titanium punch, etc
• Dr. P. J. Mazumdar is the most highly qualified doctor in North East, as he is the only doctor in the region who is US Board Certified from the American Board of Hair Restoration Surgery as Diplomate in Hair Transplant, which is the highest recognition in Hair Transplant, and he is also the most experienced, having started FUE Hair Transplant in the North East in 2012 and doing the highest number of surgeries regularly since then.
• Arogyam Clinic follows all the ethical and technological norms established internationally by the American Board of Hair Restoration Surgery and the ISHRS (International Society of Hair Restoration Surgery) like ethical advise, cost quoted in grafts, hairline with multilevel graft placement, etc
• Arogyam Hair Transplant is situated in Downtown Hospital and all essential emergency services including full staff from anesthesilogists to emergency nursing care is available round the clock in case of any emergency.
• All advise and post operative care, etc is done by the operating surgeon
• All necessary steps of the transplant like slit making, extraction, etc is done by the surgeon
• Counting trays are used for full verification of the graft number and quality so that no doubt is left in the minds of the patient
• Full sterilisation according to highest OT standards is done in the main OT of Downtown hospital

Read up more here:

About Dr. P. J. Mazumdar and Arogyam Hair Transplant Clinic

Top 30 questions you need to ask about your Hair Transplant Doctor and Clinic

Know more about the American Board of Hair Restoration Surgery

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PRP in Guwahati Assam - Role of PRP in hair fall and hair weakness

PRP or platelet rich plasma is a form of treatment using the patient's own blood which is becoming increasingly popular in recent times in treating a variety of conditions including hair loss.

Platelets are a type of cells found in the blood of humans whose primary function is in clotting of blood. Platelets also contain a large number of growth factors which help in the stimulation of the healing process and it is these growth factors which are most useful for treatment of various conditions.

PRP is produced from blood. About 10 ml of blood is collected from the patient and this blood is then treated with some reagents and then centrifuged through a special double centrifuge method till a small volume, approx.. 1 ml of PRP is produced. The processing ensures that this small concentrated plasma is very rich in platelets. This is the PRP solution. This solution is then injected into the area to be treated so that the platelets release their growth factors at the site and cause healing.

PRP has become most famous for being used by various highest level athletes like Tiger Woods and Rafael Nadal in treatment of injuries. PRP injected into muscular and tendon injury sites speed up the healing process significantly and is thus used for healing. It is also used in various orthopaedic lesions like Osteoarthritis where it brings about healing.

PRP is also increasingly being used in hair loss lesions like Alopecia areata and also in Androgenetic alopecia or Male Pattern baldness.

Alopecia areata is an autoimmune condition where a small round lesion develops due to an autoimmune process. PRP injected into such lesions help significantly in promoting healing up of these lesions.

PRP is also increasingly being used in the most common type of hair loss, Male Pattern Baldness or Androgenetic alopecia. Although there were mixed results initially, various studies have now confirmed that PRP does work and gives good results in male pattern baldness. It is most effective in decreasing hair loss and has a minimal effect in growing new hair. In cases of progressive hair loss it helps to stop further increase in baldness. In cases of high hair fall and thinness/weakness of hair, it helps to stop further hair fall and also increases hair thickness and tensile strength. It is thus very useful for those who are having hair fall with chances of developing baldness, and also in those with hair thinness and weakness.

PRP is administered in Arogyam Hair Transplant and Cosmetic Clinic. The latest techniques are used for PRP and imported vials and reagents are used. The whole process takes 1 hour. Prior booking has to be done for the procedure. Please call at 7637089211/8811077011 for further details and to book an appointment.

PRP in Arogyam is done using the latest technology of needless injector. This is a special device where there is no needle and instead the solution is injected into the scalp at high pressure producing a painless PRP.

You can read up more on PRP in male pattern baldness in these studies:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622412/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134641/

https://www.karger.com/Article/FullText/477671

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