Thank you for your question.
You submitted a photo showing the area where you’ve had the hair transplant harvested
from with a question stating that you’re 20 days after having follicular unit transplant
or FUT or strip surgery for hair transplant, 1200 grafts. You’re on Propecia and that
you are noticing, what you describe as shock loss in this area. And you want to know if
there’s anything that can be done to help this area regrow the hair.
Well, I can certainly give you my perspectives on this situation. 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.
Hair transplant has been a significant part of my practice. In fact, I’m the founder
of TrichoStem™ Hair Regeneration Centers, a system of non-surgical solutions for hair
loss using Acellular matrix and platelet-rich plasma (PRP) essentially for men and women
with thinning hair. We developed a process that can regrow, thicken hair and actually
work as an alternative to surgical hair transplantation. And this system was derived from doing hair
transplant.
To begin with, just to give you an overview of what you’re going through and the journey
ahead and I’m sure you’re transplant surgeon discussed this with you, you have to understand
that when you harvest from this area at the back of the scalp, basically the goal is to
take out as many hair as you can in order to transplant to get the best coverage in
the areas where you had hair transplanted. But for the surgeon, there is a balance that
has to be achieved. And what’s that balance? The balance is to minimize the degree of tension
on that incision so that it is closed very well so that the scar heals well. And for
the future, to close it in a way so that there’s minimal tension so there isn’t permanent
loss of hair. So it’s a balancing act. And so when we talk about numbers of grafts and
then the length of the strip of hair and the width, that’s basically the global intention.
And sometimes colleagues have been very aggressive, myself included, where a patient needs a lot
of hair and you try to push the limits. Now I’m not saying that’s what happened here,
but that’s just to understand what the concept is of doing a strip surgery which has been
the goal standard for many years.
In our practice, to help facilitate the healing of this area as well as to deal with problems
such as what you’re experiencing like shock loss, we started using a material called Acellular
matrix which is a material derived from pig bladder to help stimulate the stem cell activity
to facilitate healing. Now this doesn’t mean that you absolutely have to use this
but this is to describe what we did in our practice to help ensure maximum healing.
That being said, this is an area which has a long time ahead to heal and chances are
that the hairs that are lost from shock loss which is referred to as telogen effluvium
scientifically, where hair in a given area may temporarily shed but the roots remain
and then the hair regrows but it grows 3-4 months typically.
Hair transplant, there are a lot of phases that you’re going to be going through and
understand that really the final result takes about a year and in some people, it takes
even longer. So this is an evolution and process. So as far as the possibility of facilitating
regrowth, if someone comes to me and says to me, “Okay, I’m 20 days out of my hair
transplant and I want to facilitate regrowth”, I would probably say that there’s some potential
value and at least no harm in applying just a little bit of topical minoxidil although
it’s unlikely that it’ll make an impact but that maybe really there is no harm in
doing that. As far as other options such as platelet-rich plasma (PRP) injection, platelet-rich
plasma (PRP) with Acellular matrix, I think that there’s probably some potential value
but I would caution you because I think that, this is an area that’s already an area that’s
relatively well covered. If you grow your hair long enough, it’ll just flap over.
So in patients who come to us who have had hair transplant done elsewhere and they want
to maximize their yield, we do Hair Regeneration injection treatment which is a combination
of Acellular matrix and platelet-rich plasma (PRP) which I developed over several years
and what I’ll do is I’ll inject in the area where they’ve had the grafts placed.
And generally speaking, if we do it in the first 3 months or so, there are certain types
of value that can be derived from that benefit in the area of the grafts. I can’t say that
we’ve already have that much call for treating the donor area so I can’t say specifically
that well, we’ve treated this many donor areas and they healed that much better. I
think it’s kind of a tricky thing to really establish what would’ve been natural healing,
what would’ve been healing with some type of stem cell-based technology.
I would also say that if this was you first hair transplant, this is probably going to
be the best yield as well as the area of the skin will have the least tension. So I think
it’s alright to just leave it alone and just let it grow. There’s always time to
do some kind of potential scar revision or if you undergo a second transplant to revise
the area. But as far as shock hair loss is concerned, I think you have 3-4 months just
to allow regrowth and chances are, you may not even realize that there’s been regrowth.
Before you know it, it’s going to be as good as it can be. But again, you’re looking
at a wound healing process that’s going to be months to about a year. So pace yourself
is probably the take home message. You know, it is natural to examine areas which have
been treated but to really look at something so critically probably would be more exhausting
than fruitful. It’s appropriate to ask these questions but I think you should seek the
guidance of your operating surgeon as to what to do because no one’s going to know this
area than the doctor who did the surgery and that is also an important thing to understand
is that anyone who gets a second look can certainly give their perspective from their
clinical experience but the doctor who performed the surgery is naturally going to do the best
job they can to get the best results they can from their clinical experience.
Again to summarize, likely from just this one photo and this question, I would say,
doing nothing would likely result in just whatever hair that should grow, will grow.
Allow a year for the full expression of the transplanted hair as well as the full maturation
of the donor area. And of course, continuously follow-up with your doctor to get a sense
of how you are progressing and if there’s any intervention that your doctor feels would
be useful for you.
So I hope that was helpful, I wish you the best of luck and thank you for your question.