I have read about the “ugly duckling stage” in several hair transplant patient experiences. It seems that during the recovery process most people lose the hair that is grafted area initially and also can lose some native hair due to shock loss. Does this occur in all cases or is it more of a random event? Is it a bad sign if the implanted hairs do not fall out?
Personally I am not too worried about the ugly duckling stage aside from residual pinkness/redness from the implants. I have shaved/buzzed my head for an 8 month period in the path to a very low grade, so it is something I would be able to not see as too big of a deal, but I am interested if this stage is something that everyone experiences.
Not everyone sheds after their hair transplant but it is something to be expected. If it doesn’t happen then consider yourself among the lucky few but it does not mean that something is wrong. The exception to this is if you are too careful with the grafts. Sometimes patients can be so paranoid that they will cause damage to their new grafts that they will refuse to touch them, or when they do, they do so with the slightest touch. This can in some cases cause problems down the road.
When a transplant is performed the hair typically goes through an unexpected interruption to the natural hair growth cycle. The hairs that we see are in the anagen phase but the hair restoration surgery induces catagen, where the follicle separates from the blood supply and then the telogen phase begins which is the shed and eventual dormancy. Hairs shed through normal everyday physical activity. The hair moves up out of the follicular canal and eventually falls out. But patients that are too careful, sometimes, will see these hairs remaining but they are still separated from the blood supply so the hair just sits there in the skin. Eventually the body can see these hairs as a foreign body and start the rejection process. The skin will remain pink and even start to look slightly inflamed and mild infections can manifest. This eventually causes micro-scarring as the body continues to try and expel the foreign body.
The above is very rare but it can happen which is why we always encourage our patients to wash their hair and to be thorough with cleansing. This helps to knock the hairs out that are supposed to come out and the scalp remains healthy.
I hope this helps.
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