Abstract
<title>Abstract</title> <p>Hair transplantation, especially by follicular unit extraction (FUE), has become increasingly popular worldwide, with India witnessing a significant increase in medical tourism. Local anesthesia with lidocaine, often combined with epinephrine, is the standard practice for such procedures. While lidocaine is generally safe when administered appropriately, excessive dosing, inadvertent intravascular administration, or rapid absorption from highly vascular areas can cause Local Anesthetic Systemic Toxicity (LAST), a rare but potentially fatal complication. We report a case of a 45-year-old healthy male who died during a hair transplant in New Delhi. Although the first session was uneventful, the patient developed sudden onset of breathlessness during the second session (the next day), followed by collapse. While postmortem examination revealed pulmonary edema and minimal coronary artery atherosclerosis, the toxicological analysis detected lidocaine in visceral organs and blood. After ruling out other causes, the cause of death was given as myocardial insufficiency due to systemic lidocaine toxicity. This case is, to our knowledge, among the first reported fatalities of LAST during hair transplantation. It highlights the medicolegal implications of inadequate perioperative documentation, the need for strict adherence to established anesthetic safety protocols, and the importance of emergency preparedness in cosmetic surgical settings.</p>