The Perils of Direct Hair Transplant DHT

The Perils of Direct Hair Transplant DHT
  • Aug 14, 2020

It has come to our notice that many patients have undergone substandard procedures in name of hair transplant.
In addition, their doctor or clinic told them that only 50 to 60% of the transplanted hair are expected to grow (something that is totally misleading and a lie).
Such procedures are sold with a the USP of Direct hair transplant (DHT) viz., that the grafts are extracted and then inserted into the recipient slits without examination under microscope and dissection of unnecessary skin (dermal, epidermal and subdermal) tissue.

In reality, DHT is of no benefit to the patient.
The only person to benefit maybe the doctor/clinic who does not wish to spend the extra effort and time required to perform all the steps of transplanting hair grafts.

The following pictures show some examples.

The correct method involves

  • Extraction of grafts, 
  • Examination of grafts & trimming of excess skin tissue under magnification, followed by,
  • Implantation of the graft in recipient slits.


  1. The graft should fit entirely and snugly in the recipient slit (not recipient hole).
    A needle slit is a 2-D structure which will best accept a well trimmed graft.

The pictures show that a part of the grafts in the so called DHT method stay outside the recipient slit (see picture below).

This often leads to poor growth as a part of graft that includes the stem cells (bulge area) is not inserted into the skin.

Even in the best of conditions, placing a 1mm cylindrical graft in a 2 – dimensional recipient slit creates cobble stoning as shown in the picture.

Conclusion: Examining and trimming of the grafts under magnification is an important, non removable step in hair transplant.

  • It is being skipped in some establishments.
  • This is a wrong precedent (and active disinformation to outright lying) on part of such clinics.
  • The hair grafts have the capability to stay outside body for a few hours before implantation.
  • Proper trimming of excess tissue and placing the graft entirely and snugly into the recipient slit ensures better yield/growth without any ugly cobblestoning.

So, my request to patients is to beware of 2 things:
1. Do NOT fall for the marketing gimmick behind DHT (direct hair transplant). Its, at best, of no benefit to the patient.
2. Look at ONLINE pictures (immediate post operative pictures) of the patients of the clinic.
Also ask to be shown your own recipient area pictures immediately after procedure and on subsequent days.
Take daily pictures post hair transplant.
If all goes well you should not notice the telltale grafts extruding from the recipient slits.
If you take all precautions (and tell the doctor you want correctly trimmed grafts to be placed snugly), AND PICTURES THEREOF, you shall not fall prey to this lie.

Please let me know if you have any queries.
Dr. (ex-Capt) Arvind Poswal

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