NMC guidelines for Hair transplant

Dr Rohit Billowria
Now is the time for strictly adhering to the National Medical Commission’s guidelines for any kind of aesthetic surgery and hair transplant procedures which should to be undertaken by a properly trained and licenses Registered Medical Practitioner i.e practitioner of Modern Medicines. The Ethics and Medical Registration Board of the National Medical Commission has clearly spelt out guidelines for such procedures in the interest of the persons undergoing such surgeries.
Preoperative Diagnostic Evaluation, Surgery Planning, Surgery Execution including donor hair harvesting hairline design, recipient site creation and management of other patient medical issues and possible adverse reactions and Post-operative care have been listed as aspects of hair restoration surgery which should only be performed by Registered Medical Practitioners as per the National Medical Commission.
It is unethical for a RMP to train an individual to perform, assist in surgery who is not an accredited health professional licenses to do so.
Any procedure involving a skin incision for the purpose of tissue removal from the scalp or body, or to prepare the scalp or body to receive tissue, (e.g incising the FUE graft, excising the donor strip, creating recipient sites) by any means, including robotics, is a surgical procedure. Such procedures must be performed by a properly trained and licensed Registered Medical Practitioner (RMP) i.e practitioner of Modern Medicine. RMPs who perform hair restoration surgery must possess the education, training and current competency in the field of hair restoration surgery like adequate knowledge in hair physiology, pathogenesis of scarring and non-scarring alopecia, anatomy and physiology of scalp including scalp vasculature and nerve supply, adequate clinical skill to identify patients who are candidates for hair transplant surgery and contraindications for hair transplant including active scarring alopecia, adequate knowledge and clinical skill pertaining to the medical treatment of alopecia and pre and post-transplant medical care, acquired basic knowledge and skill base in surgeries pertaining to skin and its appendages, adequate training and knowledge pertaining to medical issues and possible adverse reactions that can arise during the hair transplant surgery including basic life support and resuscitation measures.
The hair transplant should preferably be undertaken only by those who have surgical grooming like formal surgical training such as MCh/DNB Plastic surgery, MD/DNB Dermatology with adequate grooming in dermatological surgical procedures. It is also noted that the above- named specialities have Hair transplantation as a core topic in their curriculum.
The following aspects of hair restoration surgery should only be performed by a RMP:
* Preoperative diagnostic evaluation
* Surgery planning
*Surgery execution including: Donor hair harvesting, Hairline design, Recipient site creation and Management of other patient medical issues and possible adverse reactions
* Post operative care
It is unethical for a RMP to train an individual to perform/assist surgery who is not an accredited health professional licensed to do so.
Minimum requirements in a hospital/clinic performing hair transplant surgery
The day care theatre should be equipped with facilities for monitoring and handling emergencies including stocking of emergency drugs, Boyles machine, intubation sets and ambu bag. A plan for handling emergencies should be in place and all nursing staff should be familiar with the emergency plan. It is ideal to have a standby anaesthetist.
Anesthetic Procedures :
Aesthetic Procedures should be undertaken only by those RMPs who have adequate training to do these procedures as per their curriculum.
So, curriculum of various specialities should be guiding principle for all RMP’s while undertaking any procedure including aesthetics and hair transplant procedures.
Aesthetic Procedures including Hair Transplant :
Aesthetic Procedures including Hair Transplant as with any other surgical procedure, may have complications and requires skills and training in appropriate patient selection, differential diganoses and surgical techniques and appropriate post procedure care to optimize outcomes. It is suggested that anyone who wishes to perform these procedures should be adequately knowledgeable and trained and should ensure that they have adequate infrastructure and manpower to manage any issues that may arise due to procedure performed.
Aesthetic Procedures including Hair Transplant are not an Emergency Surgery, and hence there is no case for allowing any untrained person to do it under the pretext of “Exceptional Circumstances”. Para 6 of the Judgment mentions “Hair transplantation being an aesthetic surgery needs to be performed by RMPs like qualified dermatologists or trained surgeons”.
* It may be noted that watching in workshops or on You Tube or similar platforms is not adequate training to start Aesthetic surgeries including hair transplant.
* Assistants or OT technicians; should be from a medical background, such as nurses, lab technicians, pharmacists. However, they need to be provided structures, systematic, and proper training (responsibility will lie with the RMP) in all aspects of both aesthetic surgery and disinfection, sterilization, patient communication etc.
* Surgical assistants/technicians should perform tasks only under the supervision of a RMP.
The RMP should have an anesthesia back up in the form of presence of the anesthetist in the operation room area with all the requisite resuscitative equipment and drugs in place.
The RMP should ensure that the patient undergoing such a surgery should have adequate preoperative clearances from the medical specialists and the anesthetist.
The RMP should have a well-equipped postoperative recovery room with facilities for monitoring of vitals and adequate record keeping.
There are other guidelines as well with regard to Manpower and infrasturcture.

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