Growth Potential

It’s a minor consolation that even the rich, powerful, handsome and famous can’t prevent balding. Narendra Modi, Salman Khan, Sourav Ganguly, Ranbir Kapoor, Kapil Sharma, Sanjay Dutt, and Gautam Gambhir have all bowed their head before the surgeon’s knife to bolster their barnets. It’s not just about vanity or good looks. A 2013 study by Charité – Universitätsmedizin Berlin, a European university hospital, found that hair loss was an “enormous emotional burden” that could lead to low self-confidence. In extreme cases, it could lead to depression or body dysmorphic disorder, in which people suffer acute anxiety about their looks.

Hockey star Sreejesh Raveendran, who got a hair transplant last December, is a classic case of how thinning hair undermines confidence. He says: “I’d hear that I look 35 years old. I would get conscious when I had to face the media. Senior player Prabhjot Singh got a hair transplant, and he looked good, so I followed suit. Now, I don’t have to wear my hair short, and can experiment with hairstyles.” Remarkably, Raveendran is only 27 years old.

His is no one-off case. Sanket Shah, CEO of Advanced Hair Studio (AHS) India, a hair replacement company, says 80 per cent of his clients are 20 to 40 years old, compared to the 1980s and ’90s, when 70 per cent were 40 to 60 years old. He says: “Increase in stress, improper lifestyle, pollution, hormonal imbalance have led to… the onset of balding at a young age, for men and also women.”

The problem is growing (no pun intended), and so is the demand to fix it. Thanks to international exposure and higher disposable incomes, people are more conscious about their appearance, and willing to spend to look good. A 2015 survey by the International Society of Hair Restoration Surgery (ISHRS) shows a 76 per cent jump in the volume of hair restoration procedures worldwide from 2006 to 2014, especially in the Middle East, Central and South America, and Asia.

“People come to our clinic not only to treat hair loss, but also to improve their hair’s health and undergo cosmetic procedures… to add zing to their personality,” says Shah of AHS. He says the number of clients increases by the day.

In India, hair restoration is a Rs 632-crore industry, according to market research firm Frost & Sullivan. The unorganised sector — mainly doctor-owned centres —accounts for 80 per cent of the market. The rest is dominated by corporate chains and multi-speciality tertiary care hospitals.

Surgery and Alternatives
Transplants aren’t for everyone. Akshay Batra, Managing Director of Dr Batra’s Positive Health Clinic, says: “Factors such as age and balding pattern matter. For instance, we don’t recommend hair transplant to clients who are 23-24 years old, as at this age the progression is fast... But someone who is 40 will go bald in 10 to 15 years. So we recommend surgery to only 20 per cent of people who approach us.”

Here’s how surgery works. Hair loss generally occurs in the front and top of the head, so in the strip excision harvesting method, doctors take hair from the back of the head and transplant it to the bald spots. The other common method is follicular unit extraction (FUE), in which individual follicles are transplanted.

Ajay Bansal, CEO of Direct Hair Implants (DHI) India, says his company pitches its FUE procedure as “lunch-hour surgery”, because it is stitchless, and requires no overnight stay. The cost depends on the number of follicles transplanted, and ranges from Rs 1.5 lakh to Rs 4 lakh.

However, Manoj Khanna, founder and chairman of the 21-year-old Enhance Clinics, says 67.5 per cent of hair transplant surgeries worldwide are done by the strip method. He says he used this method for cricket commentator Harsha Bhogle.

In cases where hair transplant is not possible, there are cosmetic alternatives. Shah of AHS says: “For 80 per cent of our clients, we do a combination of procedures if the bald area can’t be filled with hair transplants.” One cosmetic method is where the clinic prepares a skin patch with hair fused to it that matches the client’s hair type, and glues it on. The client has to visit the clinic every three to five weeks to get it glued again, says Shah.

Last year, Dr Batra’s Clinic launched Instant Hair, in which microfibres are attached to the scalp for natural-looking coverage as a temporary solution that lasts until the hair is washed. DHI offers a scalp micro-pigmentation process, which adds colour to the scalp to give the impression of hair follicles and makes for a fuller look.

Despite all this, customer forums are full of disgruntled clients, but companies such as DHI claim hair transplant success rates as high as 99.6 per cent. Shah of AHS says his company gives a “100 per cent guarantee to give a head full of hair… using clinical and non-clinical procedures”. So the problem, perhaps, is that clients have unrealistic expectations and clinics don’t explain procedures and outcomes well enough.

Shah of AHS says, “What brands can do is tell clients in black and white that no one can regrow a dead follicle… Moreover, no one can predict the result of hair transplant surgery. Each body reacts differently.”

Sometimes clients’ expectations are too high. Today many celebrities are open about getting hair transplants. Anurag Kedia, Director at the RichFeel chain of hair and scalp clinics, says: “Clients see celebrity endorsements or before-and-after images in advertisements, which is the norm for advertising in this industry, and set their expectations high. They feel their result will be same as that of the people in the ad, which might not be true, so they feel cheated in the end.”

But brands continue to use before-and-after images of celebrities in ads. Shah of AHS says, “We have 225 brand ambassadors, such as Shane Warne, Ricky Ponting, Gautam Gambhir, and Jacques Kallis, and none of them are paid.”

Anil Madan, founder of advertising agency Aqua Design & Communications, says, “There’s nothing wrong with using celebrities to promote a brand.” However, he adds that companies should use only celebrities whom they have treated, and not those who are paid to endorse. He adds: “Before-and-after images is a norm in health care, because everyone wants results.” He points out that ads for products like Eno and Vicks do this too. But, he adds, companies should not claim customers will get their hair back in two or three months, as individual results may differ.

Regardless of disgruntled clients, the hair restoration business is growing 20 to 25 per cent year-on-year, according to Frost & Sullivan. DHI’s Bansal says his company plans to add five branches this year, in cities such as Visakhapatnam, Ludhiana, and Indore. A quarter of RichFeel’s centres are in small towns.

It’s not just the big names; small clinics are cropping up everywhere. It is common to see newspaper classifieds advertising hair transplants for as little as Rs 10 per follicle. Enhance Clinics’ Khanna, who is a past president of the Association of Hair Restoration Surgeons (AHRS) India, says he has proposed to the government to regulate this industry.

“This is a lucrative business, with the cost per sitting ranging from Rs 80,000 to Rs 5 lakh,” says Khanna. “Due to this, I have seen self-taught dentists or nurses open hair restoration centres for quick money, but the biggest loser is the patient.”

And Now the Hair-Raising Part
Narendra Patwardhan, current president of AHRS India, says the Medical Council of India (MCI) permits only allopathic professionals with proper training in hair restoration to perform the surgery. However, enforcement of the law is a problem in India, he adds.

A hair transplant is not a complex procedure, but it’s still surgery, and there are risks involved. Patients may suffer from scarring or swelling, or shock loss, in which the body doesn’t accept the new hair. Also, doctors need training to understand natural hair growth and hairline patterns.

“We get a lot of cases to rectify where men get women’s hairlines after the transplant,” says Bansal of DHI. “Other common bloopers are when the hairline is set too low, or it looks artificial, or the direction in which the hair is implanted looks unnatural.”

In a botched case, the damage is sometimes irreversible. Malpractice victims can sue their doctor in the consumer court or lodge a complaint with the MCI. If found guilty, a doctor could get a warning or lose his or her licence to practise, says Tejinder Bhatti of Chandigarh-based Darling Buds Hair Transplants.

Some in the industry have proposed the implementing of regulations similar to those of the International Society of Hair Restoration Surgery, which permit only qualified doctors to perform hair transplant surgery. However, implementation may take some time. Until then, Khanna suggests that people seeking surgical treatment thoroughly research their doctor’s credibility. After all, a botched procedure is worse than baldness.

sonal@businessworld.in
@sonalkhetarpal7

(This story was published in BW | Businessworld Issue Dated 30-11-2015)