Thank you for your question.
You submitted two photos, one preoperatively and one at the point you’re at. You state
that you’re 38-years-old and you had hair transplant done 4 months prior in the widow’s
peak area. You’re expressing concerns about existing hairs breaking or shedding resulting
in what you feel is a bald spot. You contacted your doctor and you were advised by staff
to use Rogaine. You further described in your question that you were never told about Rogaine
as being part of the routine post operative procedure and you’re asking if your hair
will still grow back without Rogaine.
Well, I can certainly share with you this type of issue which does occur fairly often
when it comes to hair transplant. And I think there is an opportunity to at least go over
some basic principles and how I apply them in my practice.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I am also the founder of TrichoStem™ Hair Regeneration
Centers. This is a system we developed over several years based on a non-surgical hair
restoration concept that we discovered during hair transplant. And it was used to help people
with male and female pattern hair loss. I have been practicing in New York and Long
Island for over 20 years and hair transplant has also been a significant part of my practice.
That being said, I think it is part of essentially routine preoperative counseling that there
is something that occurs often with hair transplant with native hairs as well as transplanted
hairs and that term basically covers everything. It’s called shock loss. And shock loss is
a temporary shedding of hair which goes into what’s called an early telogen phase. There
are 3 phases of hair growth: anagen, catagen and telogen. Anagen is the active growing
phase. Telogen is the resting phase.
When you have a procedure like hair transplant, it’s fairly traumatic to the scalp. And
multiple placements of hair require multiple injections or I should say incisions whether
it’s with a needle or with a blade. When that occurs, my interpretation is there’s
a lot of inflammation, there’s a lot of vascular compromise and existing hair can
go into a temporary shedding phase. So it’s not unusual for someone to look worse before
they look better.
Now looking at your photo, it appears that you are doing this to basically fill what
you perceive is a gap in the widow’s peak area. It doesn't appear that you have female
pattern hair loss. I think that it is likely that your hair, not being in a thinning process,
will naturally grow in a timely way.
In our practice, speaking of what we do to help people after hair transplant, we developed
this treatment called Hair Regeneration which evolved out of hair transplant where we noticed
when using this material called Acellular matrix and platelet-rich plasma (PRP) that
thinning hair became thicker after transplantation. And further, the hair grafts actually grew
in faster. It’s actually now fairly often that we see patients who have had hair transplant
done elsewhere who’ll come in within the first 3 months to have our injection to expedite
the healing process and further, it seems to expedite the regrowth.
Now that being said, I think that the spirit of what the medical staff at your doctor’s
office wanted to assist you with was the use of minoxidil to try to see if it could expedite
regrowth. Minoxidil is a pharmaceutical. It’s applied topically and is generally well tolerated
and it may have some potential value in helping stimulate the regrowth.
The answer to the last part of your question: will your hair growth back without the minoxidil?
As long as the hair is intact, the hair follicles that are native or the hair follicles from
the grafts, the answer is yes. They will grow back. There is something called collateral
loss that can occur and this is not intended to further increase your anxiety but there
is trauma that occurs to existing hairs in situations where there is a certain amount
of density that results in some what is often referred to as collateral loss but it’s
too early to draw that conclusion. Generally speaking, the full expression of the complete
healing of the transplant and the growth of hair, native and transplanted hair takes about
a year to 18 months. There are some people who are slow growers and it does take that
long. But generally speaking, it is a standard in our field to say at about 12 months that
you will have the regrowth.
A lot of patients will use a topical fiber to help blend that area. This may or may not
be useful to you but it is something that can be used to help people transition through
this challenging period when there is often less hair than when you started.
Again, going back to this concept of Hair Regeneration and what it is able to do, we
are essentially always trying to help our patients whether it’s with transplant or
with progressive hair loss reactivate resting hairs. And so, your doctor may essentially
be trying to help you with Rogaine. There can potentially be a value with PRP but that’s
also something that is up to your physician and your physician’s experience. I would
say that it is probably that if you allow yourself to see through this process until
the 12th month point, you can at least allow for all of the growth cycles to become back
in alignment so the growth of your transplanted hair and your existing hair will combine to
improve what you have preoperatively.
So I hope that was helpful, I wish you the best of luck and thank you for your question.