What is the difference between hair growth at 12 months and 18 months after hair transplant surgery? How much more hair growth can I expect?
This hair loss question was posted directly to Dr. Raymond Konior of Chicago, IL, who is a member of the Coalition of Independent Hair Restoration Physicians. See his professional answer below.
In my experience the final result for hair density following follicular unit grafting is seen around the one year mark. This is especially true for healthy first-time hair restoration patients who have the benefit of excellent blood circulation. Patients who have had prior procedures, especially those who have undergone minigrafting or old-fashioned hair plugs, tend to have more scar tissue and compromised circulation in the previous graft zones. These patients may take much longer to reach their peak density, in which case the 18 month result could look better than the 12 month result.
Another example where one may see a distinct difference between the 12 month and 18 month result is in those patients who develop a texture change in their hair during the early hair regrowth phase. The reason that a hair shaft assumes an altered texture following hair transplantation is poorly defined, but I believe it is related to the healing dynamics between the follicle and graft insertion site. Insertion openings for follicular unit grafts are typically less than 1 millimeter in length. Although this very small opening appears to heal very quickly, one has to understand that scar formation still occurs between the follicle and the scalp. After all, it is scar tissue that mends all soft tissue injuries. Even though the graft insertion site is a very small wound, the scarring process has the capacity to alter the physical characteristics of the follicle for some patients, in which case the result is a kinky or highly textured hair shaft.
Wound healing via the formation of scar tissue is actually a very complex process. The initial sealing of a wound with scar tissue is just the beginning of a much longer physiological event. Scar tissue undergoes a maturation process lasting months, and sometimes years, after the repair process is initiated. Larger scars in other parts of the body are often initially recognized as being hard and pink. The long-term maturing phase of healing is commonly appreciated by progressive softening and lightening of the immature firm, pink scar. It is not at all uncommon to see continued softening and color improvement in some scars for many years following the initial injury.
With respect to hair replacement surgery, the healing process between the follicle and the scalp is nearly complete within several months of the procedure for the majority of patients. Uneventful healing with insignificant scar interaction results in normal looking hair following the procedure. On the other hand, those patients who do develop a more aggressive healing response with a prolonged scar maturation phase may require well over a year for their hair texture to return to normal. Kinky hair is usually a concern for those hair transplant patients who started out with perfectly straight hair, but fortunately it tends to resolve with time for most of those who experience it with their early hair regrowth. The time it take this textural change to resolve varies from patient to patient, but it is possible for it to persist beyond the 12 month mark.
Raymond Konior, MD
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