Thank you for your question.
You submitted your question without a photo. You describe in your question that you’re
5 months out after undergoing hair transplant. And you state that your observation that there
was descent hair growth after 3 months. But then 5 months out, a lot of the hair that
was transplanted has shed and you have bald spots. And you’ve been looking on forums
and it appears that it’s not a typical situation so you’re looking for some guidance.
Well, in the absence of more details of your surgery and of at least an image, I can give
you some general understanding of what I think about when I hear a story like yours. A little
bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island
for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers. This
is regenerative medicine technology to help men and women with genetic pattern hair loss
using a material called Acellular matrix and platelet-rich plasma (PRP) which was actually
derived from work we did to help patients heal better after hair transplant.
So it is certainly understandably distressing to see more of your scalp being revealed after
transplant when things appear to be going well. And it is a challenge from just hearing
the story of what is an explanation for this. The questions that would arise from me are
were these transplants next to a lot of existing hair? Are you essentially experiencing something
comparable to shock loss of your existing hair? Are you dealing with hair loss progression
or is it that the grafts are certainly being compromised from whatever reason? There are
certainly a lot of possibilities and it’s actually too early to draw any conclusions.
When you look at any hair transplant healing process, it is not unusual for people to look
a lot worse before they look a lot better. Now we certainly have experienced and I don't
want to certainly frighten you but we have patients who underwent mega session transplant
surgery and had lost 90% of their grafts. And there are a lot of variables that come
into play.
When we were doing a lot of transplants and we wanted to get better healing of the donor
area, we wanted to get better outcomes and survivability of the hair grafts, we used
something called platelet-rich plasma (PRP) and Acellular matrix. And what was a nice
side-effect which we’ve ultimately resulted in developing a whole new system and management
of hair loss is that thinning hairs became thicker. Now move the clock forward, over
the past 7-8 years, we’re actually helping patients around the world, men and women with
different levels of genetic pattern hair loss.
In addition, we’re actually helping men and women who have undergone transplants.
And the window that appears to be the most impactful for patients who have had transplant
is within the first 3 months. And so we’ve had patients come within that window and from
our experience doing transplants, we’ve seen the grafts healing sooner and growing
faster as well as existing thinning hair looking thicker. And I always tell the patients that
it actually makes your hair transplant surgeon look better because you actually have a better
coverage when you have two modalities: the grafts and the regeneration of thinning hairs.
So that aside, you’re now at this window where if you aren't taking any other drug
like finasteride to help manage your hair loss, you have no choice but to just wait.
I think it is tough for patients to wait but I think it’s important that you continue
communicating with your doctor about what you’re going through. No one knows your
scalp better than your doctor, the doctor who did your surgery. And a lot of times when
someone comes who’s concerned about their situation, even a microscopic examination
can help a patient understand how things are going. But when there is a certain degree
of shock loss early on and there’s a window of hair not growing, it can certainly be very
distressing. We’ve had patients who even look worse in a year and then looked better
at 18 months. And so, there is a range certainly and it depends a lot on a lot of variables.
The more advanced the hair loss, the more tenuous the situation is with existing hairs
and other variables which occur during surgery and surgical healing and the way a person
heals all impact the outcomes of hair transplant.
You know it’s no surprise that people in our specialty are continuously challenged
to get the best outcome when you are dealing with a wide range of variables, some of which
are intrinsically part of the genetic pattern of that individual patient and some has to
do with just the healing process. Generally speaking, most people who do hair transplant
surgery do a very good job. If they’re doing a lot of transplants, they’ve got their
systems down and they have good technicians and good process. It’s really about how
that individual heals that ultimately determines the success of the procedure.
So if you aren't on a drug like finasteride then it’s worthwhile discussing this with
your doctor because that’s at least something to manage your progression. I would say that
in a situation like yours, when people like yourself come to our practice, I often say
that I don't want to do any treatment like a treatment like Hair Regeneration until after
6-7 months or longer has transpired because that window of the first 3 months are already
behind you. And I don't think that it makes a significant impact that we can predictably,
with reasonable certainty, have predictability about. So I just wait until the one year and
beyond period so that the grafts have grown and we can look at what is the true inventory
before helping patients with using regenerative medicine technology.
So I hope that was helpful, I wish you the best of luck and thank you for your question.