By the time you spot thinning in the mirror or a part that’s suddenly wider, the damage has been brewing for months. Maybe years. That’s the problem plastic surgeon and clinician-scientist Dr Debraj Shome wants to fix. His pitch: stop treating hair loss after it happens. Start assessing it before it shows. Also read | Tired of ‘home remedies for hair fall’? Nutritionist Kiran Kukreja shares easy moringa biotin laddu recipe
The problem: We wait too long
According to him, most people only walk into a clinic after the volume is gone. “That’s the biggest limitation in hair medicine today,” Dr Shome, research mentor at QR678, said in an interview with HT Lifestyle. “By the time thinning is visible, the biology of the follicle has often been deteriorating for a long time,” he added.
The old model was basic: look for a receding hairline, more hair on the pillow, a wider part. By then, he says, you’re late.
Treating hair health like a chronic condition
Dr Shome argued hair needs the same approach as other chronic conditions: structured risk assessment, not just a mirror check: “Today, there is growing recognition that hair health should be assessed more like other chronic medical conditions, using structured risk assessment rather than visual observation alone.”
That means looking deeper:
⦿ Genetics: family history and predisposition
⦿ Shedding patterns: progressive density loss and persistent fallout
⦿ Hair quality: shaft strength, texture, cuticle integrity
⦿ Inside factors: hormones, nutrition, systemic inflammation
To make this measurable, he shared a patent-pending diagnostic framework. Instead of ‘it feels thinner’, it uses a 12-item ‘hair ageing index (HAI)’ to generate a ‘hair biology score’. Also read | Hair fall decoded: Trichologist explains the difference between stress-shedding and hormonal hair loss
The goal isn’t one-size-fits-all. He explained that the protocol sorts patients into biological profiles based on what’s actually driving loss:
⦿ Follicular signalling decline — disrupted growth signals and cell communication
⦿ Excessive shedding — telogen phase acceleration, hair falling too fast
⦿ Structural damage — weak shafts and cuticle breakdown
⦿ Refractory changes — complex cases that resist standard treatments
Risk assessment, not crystal ball predictions
According to the surgeon, spot the driver early, and you can address the root cause — not just the symptom. Dr Shome also clarified, “The objective is not to replace clinical judgement, but to give clinicians a standardised framework to evaluate hair biology and track changes over time.”
He added that this isn’t a crystal ball. It’s closer to cardiology. “Identifying risk is different from predicting certainty,” Dr Shome said, adding, “Like heart disease risk scores, structured hair assessment helps identify who may benefit from earlier monitoring and personalised intervention — before significant loss becomes evident.”
Dr Shome highlighted that the shift is simple but big: from fixing bald spots to protecting what you still have: “The future of hair restoration will move beyond simply treating visible hair loss.”
Dr Shome concluded. “With a better understanding of follicular biology, structured assessment can help us catch subtle changes earlier, personalise treatment, and ultimately shift the focus from hair restoration to hair preservation.”
In short: check earlier, treat smarter, keep more of what you’ve got.
More about Dr Debraj Shome
He is a celebrity facial plastic, cosmetic and reconstructive surgeon. Over 20 years, Dr Shome has built a career centred on surgical precision while advancing aesthetic medicine through research, innovation, medical education, institutional development, and global training.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
