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My understanding is that it is normal to have shafts of transplanted hair fall out within weeks or a month, and that they will (hopefully) grow back after 3 to 4 months after the hair transplant procedure. I realize that not all heads are created equal but, on average, if there is such a thing, what is the percent of transplanted grafts that will continue to grow after transplanting without falling out first? Maybe it would better ask if it is common to have hair grow without falling out, or is it completely unheard of?
Your impression is correct, in that the great majority of the hairs that are transplanted (most of which are only 1/8th inch long) are shed during the first few months, before the “real” hairs appear 3-4 months post-operatively. They usually shed in one of two ways: some fall off with the scab at the 6-10 day point, while others just “sit in place” in the skin, even though down deep in the skin they are literally disconnected from the follicle (the living part of hair), which shrivels up and hibernates for that time period. These short stubs then can sit there for weeks or they can fall off at anytime. The best way to tell a “disconnected,” non-growing one from one that is going to grow is to simply look at it a couple of weeks later. If it is longer, then it is growing. It’s as simple as that.
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After 2 hair transplants (800 and 2000 grafts), I never experienced hair loss in the donor area, but I did this 3rd time after 2600 follicular unit grafts. I was wondering if anyone else had similar issues.
Unfortunately, there is no test we can perform to determine who will get hair loss (telogen effluvium) due to shock and who will not. I have had several hair transplant patients over the years with similar stories to yours. They had multiple procedures but only had donor shock loss after one of the procedures. I am happy to say that in all those cases the patients eventually had full recovery in the donor area.
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Regarding hair transplant scars, I would like to add some scientific insights in this context.
The width and thickness of the hair restoration surgical scar depends on the following factors:
1. Nature of the patient’s scalp.
2. The physician’s surgical technique.
3. The surgeon’s skill.
The nature of scalp (skin) varies from person to person. No two patient’s skin will be identical in every parameter. In 50-70% of the skin’s nature, irrespective of the surgical technique used and skill of the surgeon, the wound heals very well leaving a negligible scar. But some skin textures are too lax or too tight. Thus, some unpredictable skin conditions will definitely produce a visible scar regardless of the surgeon and whatever technique is incorporated. This accounts to 5-10%. If the scalp is very thin and very lax, it tends to produce a wider scar. Scalps of African type / Black scalps produce thicker scars even leading to keloids. Some scalps can be very tight and become difficult to approximate. They also appear wider after healing.
All these wider and thicker scars account for less than 10% of cases. More than 90% of the patients will be happy with minimal evidence of scarring. That is the reason why even the earlier versions of hair transplantation gave beautiful scars without adapting the trichophytic closure or any other state of the art techniques.
I’m on my 3rd week post hair transplant. Doctors at the clinic I had my hair transplant at gave me their own shampoo to use. However, it’s running out now. What shampoo should I start using now? I was considering Nanogen shampoo, but I’m not sure. Any guidance would be appreciated.
My belief is that it doesn’t make any difference what shampoo you use after surgical hair restoration. All shampoos are simply soaps. Consumer Reports has done two extensive analyses of shampoos over the past ten years and published them, and their conclusion was exactly what I stated above. At our clinic we give out a “courtesy” gift tube of Nexus Therapy shampoo to each patient, but not because we believe it superior to all others, but simply as a gift. It has a slight nostalgic value to me also, since that is what the clinic gave out back in 1982 after each of my first three transplant sessions and I loved the way it smelled (have since lost most of my sense of smell and don’t enjoy that aspect of using it).
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Your impression is correct, in that the great majority of the hairs that are transplanted (most of which are only 1/8th inch long) are shed during the first few months, before the “real” hairs appear 3-4 months post-operatively. They usually shed in one of two ways: some fall off with the scab at the 6-10 day point, while others just “sit in place” in the skin, even though down deep in the skin they are literally disconnected from the follicle (the living part of hair), which shrivels up and hibernates for that time period. These short stubs then can sit there for weeks or they can fall off at anytime. The best way to tell a “disconnected,” non-growing one from one that is going to grow is to simply look at it a couple of weeks later. If it is longer, then it is growing. It’s as simple as that.
Unfortunately, there is no test we can perform to determine who will get hair loss (telogen effluvium) due to shock and who will not. I have had several hair transplant patients over the years with similar stories to yours. They had multiple procedures but only had donor shock loss after one of the procedures. I am happy to say that in all those cases the patients eventually had full recovery in the donor area.
