Q: Does donor area hair thin with age? – T.W.
A: Hair taken from the donor zone is considered to be permanent and should resist changes related to androgenetic alopecia also known as genetic patterned baldness. In other words, it will not be lost. Through the natural aging process, hair diameters may decrease over time making the donor area appear thinner.
Q: Does minoxidil play any role in the survival of the grafts after a Neograft/FUE procedure? — J.W., Philadelphia, PA
A: When a doctor performs a hair transplant, the hair should be taken from the permanent zone so, by definition, that hair is not affected by medication (i.e. does not need to be maintained by either minoxidil or finasteride). If the doctors using Neograft are suggesting that minoxidil increases survival, then they are probably harvesting hair outside the permanent zone. To clarify, I use the ARTAS robotic system for our FUE procedures, not Neograft, as the former is a far more accurate device for harvesting.
Q: After my hair transplant procedure I had some shock loss, and then after about 4 1/2 to 7 months I had tremendous growth — really thick. I was amazed actually. Now, at 8 months it has thinned again, quite a lot compared to the growth I had before. I just wondered if this was a normal growth pattern and whether further growth could be expected? — N.T., Brooklyn, NY
A: This is not the most common situation, but should not be a cause for concern. The newly transplanted hairs are initially synchronous when they first grow in — i.e. they tend to all grow in around the same time (with some variability). This is in contrast to normal hair, where every hair is on its own independent cycle. Sometimes the newly transplanted hair will shed at one time before the cycles of each hair become more varied asynchronous.
For continued discussion of this topic, visit our page on hair growth and the growth cycle. Or read posts in the topic of Growth after a Hair Transplant.
Q: I understand that seeing the result of a hair transplant is a process – what can I expect? — L.L., Highland Park, T.X.
A: It generally takes a year to see the full results of a hair transplant. Growth usually begins around 2 1/2 to 3 months and at 6-8 months the hair transplant starts to become comb-able.
Over the course of a year, the hair will gain in thickness and in length and may also change in character. During this time, hair will often become silkier, less kinky or take on a wave, depending upon the original characteristics of the patient’s hair.
In subsequent hair restoration procedures, growth can be slower.
Q: It has been over a month after my hair transplant procedure and I am starting to get nervous. When can I expect to see some growth? — J.N., Winnetka, I.L.
A: Transplanted hair begins to grow, on average, about 10 weeks after the procedure, although this number can vary. Hair tends to grow in waves and occasionally some new hair may start to grow as long as a year after your procedure. In general, growth is a bit slower with each hair transplant procedure, although the reason for this is not fully understood.
Q: Hi! I wanted to ask if after hair restoration surgery the transplanted hair will eventually fall out? Because the surgery is to restore hair mainly for people with genetic hair loss which results from DHT, won’t the DHT make the new follicles implanted fall out as well? — B.C., Stamford, C.T.
A: Hair loss is due to the action of DHT (a byproduct of testosterone) on hair follicles that cause them to shrink and eventually disappear (the process is called miniaturization). The follicles on the back and sides of the scalp are not sensitive to DHT and therefore don’t bald (miniaturize).
When you transplant hair from the back and sides to the bald area on the front or top of the scalp the hair follicles maintain their original characteristics (their resistance to DHT) and therefore they will continue to grow.
Q: It had been 5 months since my hair transplant. I only see minimal growth of maybe a few hundred fine hairs. My transplant consisted of 2,217 grafts. Could you give me your opinion if this is normal or is it a failed hair transplant? — L.D., Miami, F.L.
A: It is too early to tell. Hair grows in very gradually with great variability from person to person.
Some patients only have a little fuzz at five months and then have great growth by one year.
You really need to wait the full 12 months to evaluate the success of the hair restoration.
Q: I had my first hair transplant of 1100 grafts five months ago. The hair has been growing in well and I am very satisfied with the progress, but the new growth appears to occur in different cycles. Some of the hair never fell out and started growing within weeks. At around three months, a lot more started to grow, and now there seems to be even more growth of new hair coming in its finer stages. Is it normal for transplanted hair to begin growing at different times? Why does some hair come in looking thick and other hair start off finer and then gradually thicken up? — E.R., Bushwick, N.Y.
A: You are describing accurately how hair grows after a hair transplant. After the hair restoration procedure, the transplanted stubble is shed and the hair goes into a dormant phase. Several months later, growth begins as fine, vellus hair that thickens over time. The hair usually does not have its original thickness right away.
Typically, growth occurs in waves so that initially some areas will have more hair than others. Over the course of a year the cycles will even out and the hair will thicken to its final diameter.
Q I had a hair transplant 15 months ago at a well known clinic in Manhattan. There were about 1000 grafts transplanted in the front hair line. At this point I am upset with my results. My guess is that only about 50 new hairs have grown. My question is what would cause this to happen? It seems to me that the hair transplant took longer than expected and my grafts died before they were placed! Please help! — B.E., Ithaca, N.Y.
A There are many factors that can contribute to poor growth during the hair restoration process including grafts that are left out of the holding solution too long or kept under the microscope for a prolonged period of time where they dry out.
Grafts can be injured in the dissection process or can be traumatized during the placing – if they are grasped too tightly or manipulated too much.
If properly hydrated, grafts can survive outside the body for many hours, so this in itself is generally not a problem.
There is no way to really tell what the exact problem(s) may be without watching the entire hair restoration procedure, since so many steps are involved that can affect the survival of the grafts. All of these steps must be carefully controlled to insure optimal growth.
Q: I have had some grafts implanted into a donor scar. How long does it take to see the final result? B.K. – Newport, Rhode Island
A: In normal scalps, growth is generally complete by 10-12 months. Grafts placed in scar tissue may often take longer to grow.
Q: Why can donor hair become frizzy and dry once transplanted? — G.F., Stamford, C.T.
A: Frizzing and kinkiness is a temporary phenomenon that is part of the normal healing process after a follicular unit hair transplant. During the healing process, the new collagen that forms around the grafts can alter their growth. Over time, usually within a year, this collagen matures and the hair quality usually returns to normal. If grafts have been excessively traumatized or grafts larger than follicular units have been used, these changes are more likely to be permanent.
Dry hair is felt to be caused in part by trimming follicular units too closely and thus removing the sebaceous glands which normally provide an oily film to the surface of the hair and skin. With grafts smaller than follicular units (i.e. with closely trimmed micro-grafts) the risk is even greater.
To prevent this, in the dissection phase of the hair transplant, one should isolate intact follicular units from the donor tissue and trim away excess skin, but not trim the follicular units “to the quick.” Excess trimming, besides removing the sebaceous glands, also makes the grafts more subject to drying, warming and mechanical trauma (particularly during graft placing).
Q: This is my second hair transplant and is seems like it is growing more slowly than my first. Is this normal? – J.D., Port Washington, N.Y.
A: It is common for a second hair transplant to take a bit longer to grow than the first, so this should be expected. It is also possible that there is some shedding from the procedure, or a continuation of your genetic hair loss.
Propecia may be helpful in this regard. It is important to wait at least a year for the transplant to grow in fully and to give a chance for any hair that was shed to regrow.
Q: Do you ever see poor growth from a hair transplant? What causes this to happen? — R.L., Edison, NJ
A: The situations where I have encountered poor growth are:
1) When hair is transplanted to areas of skin that has been thickened due to the prior placement of larger grafts or plugs (this is called “hyperfibrotic thickening”). Removal of the larger grafts can somewhat ameliorate this problem.
2) When hair is transplanted into a thickened scar.
3) When a hair transplant is performed into an area of severe chronic sun damage. In this case, a very modest number of grafts should be used in the first session and if these grow well, additional grafts can be added in a subsequent session.
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