Shravan Kumar’s family at their home. Eight years after he started losing hair, he had gone in for the transplant. (Express Photo by Amit Chakraborty)
The Chaudharys say they never realised Shravan Kumar’s despair at his fast-receding hairline. “It’s in our genes. His father, my father, they all went bald. But it never bothered us,” says first cousin Shiv Karan, at his office on the second floor of a building in Andheri East, Mumbai.
By 40, five years after he had started losing his hair, Kumar had started wearing a wig. By 43, he had gone in for a hair transplant. In March this year, hours after he had had the procedure, Kumar died. On November 28, the matter reached Parliament, with Hanuman Beniwal, the MP from Nagaur, Rajasthan, seeking a CBI inquiry into Kumar’s death, besides a crackdown on the “mushrooming hair transplant business” in India. Kumar’s family, which runs a domestic and international courier service with 35 offices across India, traces their origins back to Nagaur.
Kumar had received hair follicular unit extraction implant in a 12-hour-long procedure on March 7 at a clinic in Chinchpokli, South Mumbai. Within an hour, he developed shooting pain on the right side of his neck, followed by swelling in his face and shoulder. He passed away on March 9.
Dermatologists and cosmetologists say death from a hair transplant is rare. In another case in India, a 22-year-old medical student had passed away in Chennai in 2016 after hair transplant. But the salon he went to was illegal, with no operating theatre for such procedures.
In Kumar’s case, the Sakinaka police has registered an accidental death report and is awaiting medical opinion for the next step.
The hair transplant market in India is seeing a surge, spreading now to smaller clinics. As per a report last month by Global Market Insights, a marketing research provider, the industry would grow from $6.5 billion in 2018 to $31 billion globally by 2025. While the Asian demand is driven by a desire for looks, in Africa and the Middle-East, it is more a factor of hair loss, the report said.
Dr Shubhangi Parkar, head of the KEM Psychiatry Department, says every six months she gets a patient fighting depression due to skin colour or hair loss.
Follicular unit extraction, that leaves less scarring, is a relatively new technique, dating to 2005. A 0.7 mm-1 mm-thick needle is used to extract hair follicles from a part of the body, for planting on the scalp. Each follicle can grow two to three hair strands. A specialist can undertake 500 to 3,500 follicular grafts, depending on the scalp area, in one sitting.
The dermatologist-cum-cosmetologist who treated Kumar — who refuses to be named, saying he is being hounded — says Kumar’s was a ‘Grade 7’ case, requiring transplantation over his entire scalp. Hence, Kumar underwent 3,700 follicular grafts, that could help grow over 9,000 hair strands. The doctor claims to have followed the same standard operating procedure in 1,100 procedures over the past seven years.
His Chinchpokli clinic though is only a year old, spread over two floors, with one operational bed for transplant. Depending on the patient flow, the doctor sometimes conducts procedures overnight, like in Kumar’s case. The controversy following the case hasn’t hit demand at his clinic, but according to him, this might follow.
Kumar, who was also trying to lose weight, first tried out a wig, inspired by his friend Umed Singh who wore one. Singh, who works in Bollywood, says he provided Kumar his first wig, for Rs 40,000. However, Kumar wasn’t satisfied and kept changing the hair piece.
Two years ago, Singh says he saw an advertisement and underwent a hair transplant. “Kumar liked my hair. Last year, I introduced him to my dermatologist.”
Kumar pondered for a year before deciding to go ahead, without telling his family.
Now they know that he visited the Chinchpokli clinic a day after he had returned from the Kumbh Mela in Uttar Pradesh. Wife Seema, who had accompanied him to the Mela, says he took Rs 2 lakh with him (Singh claims the doctor had asked Rs 1.5 lakh for the procedure). “Shravan said he was going to get new hair. I thought he meant a new wig,” Seema, 43, says.
Around two hours after Kumar had reached the clinic, the procedure started. He was given a local anaesthesia, Lignocaine, that lasts an hour or two. Then, over the next 12 hours, the doctor, operating alone, extracted hair follicles from his chest and transplanted them on his head. Transplanting each follicle can take a minute or two.
The doctor says they took three breaks of half an hour each, with Kumar, who had been on a Keto diet for 15 days, getting his driver to fetch him spinach and beetroot juice. Seema says she called him up in the evening, and it was then that he told her about the transplant and said he would return by midnight.
The procedure finally wrapped up at 2.30 am on March 8. Soon after, Kumar felt a shooting pain in the nape of his neck.
The dermatologist says he gave Kumar a tablet and an injection for the pain. “When the pain didn’t subside, I realised he may need morphine or some other painkiller that I was not authorised to give,” the doctor says.
At 4.30 am on March 8, the doctor took him to Global Hospital, Parel. Kumar was not admitted there though (the hospital has refused to comment on the matter and police are yet to question them). Kumar was then taken to Dalvi Nursing Home, where an anaesthetist gave him an injection and asked him to rest.
Kumar’s friend Raj Kulhari says he reached the nursing home at 6.30 am after Kumar called him, and met the dermatologist. Kumar then slept for a few hours, before he was discharged. However, after he returned home, Kumar’s face and shoulder started swelling. “He could not breathe or speak. The swelling increased fast,” recollects nephew Sudhir.
At 4.30 pm on March 8, 14 hours after the transplant, Kumar was rushed to Dr LH Hiranandani Hospital. By then his face was double its original size, his eyes were squeezed almost shut and his airway was restricted. “Doctors found it hard to even insert a tube for oxygen support,” Sudhir says.
Dr Sujit Chatterjee, CEO of Hiranandani Hospital, says Kumar was suffering from a severe case of infection. “It was far advanced.”
On March 9, at 6.30 am, Kumar passed away. A preliminary postmortem indicated an anaphylactic or allergic reaction, causing swelling and uneasiness.
However, what caused the anaphylaxis remains a mystery. Dr Manjunath Shenoy, Vice-President of the Indian Association of Dermatologists, Venereologists and Leprologists — of which Kumar’s doctor is a member — says they have never had such a case. While both MP Beniwal and Kumar’s family have alleged that the doctor transplanted more follicles than safe in one sitting, the figure of 3,700 was well within the acceptable range.
Kumar’s doctor says that the anaesthesia he gave him, Lignocaine, should have also been safe as it is used commonly and Kumar had undergone a surgery in the past using it. “So I didn’t see the need for a patch test on skin, to check for allergy,” he says.
A four-member committee formed by J J Group of Hospitals to look into the case has asked the dermatologist why he didn’t conduct an ECG test before the procedure. The doctor has replied that ECG “was not essential”, and that they usually enquire about just the medical history and known allergic reactions of a patient.
In this case, it remains unclear whether Kumar was asked about his medical history or not, and if he provided all the details.
Dr Rohan Das, a Kolkata-based expert, says that while hair transplant is a simple procedure, a clinic must be equipped with a medical emergency trolley and intralipids for anaesthesia toxicity, and the physician should be trained for any emergency. “Anaphylaxis can happen in any patient. Once, a patient of mine suffered a reaction five hours into the procedure. We were able to save him as we were monitoring him constantly,” Das says.
The Chinchpokli dermatologist claims he didn’t leave Kumar’s side till the next morning. He says he next went to a medical camp and only heard in the evening that Kumar had been hospitalised in Hiranandani.
The doctor has submitted to police a list of the equipment his clinic has to handle emergencies, including an oxygen cylinder, an ambu bag, and intralipids.
As J J Hospital prepares its report — they have said they need another week — Kumar’s family has approached everyone, from transplant specialists to the police commissioner to the Maharashtra Medical Council, to politicians, seeking redressal. A complaint has also been lodged at the Maharashtra State Human Rights Commission and a petition filed in the High Court over the delay in filing the final autopsy and medical reports.
At the office of SM Express Logistics Pvt Ltd, where Kumar had been managing director since 1996, a photograph of him sits at the reception, smiling, with a wig on. Daughter Chandrika, 19, who sits across the office, suspects the genes have passed on. “Look at my forehead, it is getting broader,” she says.