Author Bio: Dr. Sanusi Umar MD is the author of this article.
Following a hair transplant procedure, most patients experience the growth yield they had anticipated without much difficulty. But others wait the expected 5-6 month timeframe, hoping to see the first signs of new hair only to realize that their grafts did not grow. And in the end, they must come to terms with disappointing coverage. In this Q&A video, Dr.Umar discusses the causes for low growth yield following a hair transplant procedure.
Is Your Progress Aligned With a Normal Hair Transplant Timeline or Poor Hair Transplant Growth?
Hair transplant results take time to manifest. And without a basic understanding of the average course of events following a procedure, it becomes easy to mistake the slowness of normal growth progress for hair transplant graft failure. An understanding of the basic timeline for hair transplant growth will help produce more clarity on whether or not a patient should come to terms with the possibility of poor hair transplant yield.
In the first couple of weeks following a hair restoration surgery, patients will notice redness and the formation of scabs which then fall off as the skin heals. Within the first two months after surgery, the hair shafts that were present will also fall out. Many people also mistake this for graft failure. But in truth, this is a very normal and positive sign that new hair is forming.
Signs of new hair sproutings become evident between two and four months. The growth initially looks patchy and even, but will start to appear more uniform over time. More desirable looking results start to manifest between the seventh to tenth month. In some cases, patients may not see growth even at ten months past their surgery. This still is not necessarily an indication of failed grafts. Some late bloomers are able to achieve the results they wanted in the end. Dr. Umar recommends that patients wait until month 12 before considering the possibility of poor hair transplant growth.
Causes of Failed Hair Transplant Growth – What Los Angeles Patients Need to Know
Hair implants, or grafts, are not able to produce growth if they have been severely damaged. Each follicle is essentially a tiny organ, much like the heart or liver. Damage to such structures will impair or even destroy their ability to perform normally.
Many factors can lead to low growth yield following a hair transplant. However, there are still a common set of causes that can be attributed to most cases of low growth following a hair transplant.
Poor Selection of Follicular Unit Grafts
Most patients who undergo hair restoration procedures do so because they suffer from androgenic alopecia. This means that their hair loss and thinning is caused by hair follicles that have miniaturized and can no longer produce normal hair as they did before. Those who qualify for hair transplant surgery where head hair is used will have follicles that have miniaturized as well as a supply of non-miniaturized follicles that can produce long term growth.
Surgeons must be careful to only select grafts that have not been affected by miniaturization. But errors can still happen when it comes to choosing the right grafts. If miniaturized follicles have been included in the donor pool, patients can end up with poor growth yield.
Poor Handling of Hair Transplant Grafts
Dr. Umar emphasizes that the extraction and overall handling of the follicles need to be as gentle as possible, avoiding factors that will affect the survival of the graft, such as pulling, tugging and use of force. Follicular damage due to harsh handling is perhaps the most obvious cause of low growth yield following a hair transplant.
Mechanical Damage From Surgical Instruments
When using general cylindrical Follicular Unit Extraction (FUE) punches, common forms of damage may be inflicted on the follicular unit grafts. A few examples include:
Punch Misalignment with Hair Follicle Orientation
This type of damage can occur when the surgeon has to guess the location and positioning of the hair follicle beneath the skin. With the basic FUE punch, they must rely on the visible hair shaft to make these determinations. But it is possible to make inaccurate assumptions and cause damage to the graft by misaligning the punch.
Inaccurate punch alignments may also occur if the patient is moving, making it harder to safely encompass the grafts.
Torsional injuries may occur when the follicle ascends into the punch lumen and adheres to the internal wall of a rotating punch. The graft becomes stuck and rotates with the punch, as the lower portion is still attached to the skin. This results in a broken graft.
Lack of depth control
Follicular units, which define individual hair transplant grafts, may consist of more than one hair follicle bundled by a tissue sheath. In many cases, the ends are splayed or spread at beneath the skin. If the surgeon advances the punch too deeply, there is the risk of severing these endings.
With wider follicular units (due to having multiple hair follicles), it is possible for grafts to become stuck or impacted within the interior of the punch once they are fully extracted. The surgeon often has to use forceps to retrieve them. When used with excessive force, the grafts can then become damaged.
Hair Transplant Graft Failure Due to Air Drying and Extended Time Out of Body
The time the grafts spend out of the body must be kept at a minimum. Dr. Umar recommends a maximum span of no more than six hours from the time the follicles are extracted until they are implanted into the recipient bald regions. This includes the amount of time after they are excised, placed in a fluid storage environment, and retrieved to be placed in the bald or thinning areas.
Since the hair follicles are very tiny structures, small amounts of water loss due to evaporation will have enormously detrimental effects. Once the grafts are removed from their original site, they must be hydrated right away and placed in a chilled aqueous storage medium, consisting of physiological fluid.
The time that lapses after they are removed from their storage environment and inserted into the recipient area must also be minimized. According to Dr. Umar, this should be no more than a few seconds.
Patient Mistakes That Result In No Growth After a Hair Transplant
Hair transplant grafts can also become permanently damaged due to a patient’s choices and actions.
The Risks of Wearing a Hair Piece After a Hair Transplant Procedure
Dr. Umar explains that hair pieces can exert an occlusive, frictional effect on the inserted grafts. This may be worsened by the use of adhesives such as tapes and glues which cause traction and pulling on the hair at the surface of the skin. Similar to how traction alopecia occurs, when tension is constantly applied to the hair, this may cause tears in the follicle which leads to permanent damage.
The Effects of Chemicals and Inflammation on Hair Transplant Grafts
According to Dr. Umar, patients need to avoid or protect their scalps of anything that might lead to irritation or inflammation of the skin until their hair growth yield has fully manifested.
One example includes the use of harsh chemical products such as dyes, bleaches, and relaxants which can irritate the surface of the scalp. The deeper penetration of these chemicals can harm the grafts. But the effects are often worsened when individuals are allergic to them.
Also, if patients are noticing the first signs of dandruff following their hair transplantation, it would be important to start following a dandruff care regimen recommended by their doctor right away. Dandruff is usually caused by fungus which the body tries to get rid of through inflammatory reactions to attack these microbes. However, these processes can also damage the implanted hair transplant grafts.
Unknown Causes of Poor Growth Yield After a Hair Transplant
In very rare instances, it is not clear what factors were responsible for failed growth. There are no obvious indications. Or the actual causes may have been outside the range of common variables described above.
Prior to choosing a hair transplant provider, patients must understand that these surgeries involve a high degree of skill and experience. The basic premise of these procedures may seem simple enough, as they only involve the transfer of hair follicles from one location to another. But there are many ways for them to face the risk of damage. It would be extremely important to select a doctor who has demonstrated a strong track record of successful outcomes on many types of patient cases.
Following the actual surgery, the implanted grafts are still vulnerable to being permanently injured or harmed through styling and grooming choices such as the use of toupees and harsh chemicals.
By understanding what causes low growth yield following a hair transplant procedure, patients are in a much stronger position to avoid these factors and experience the results they had planned for.
If you are in the Los Angeles area and would like to speak to Dr.U about repairing poor hair transplant growth from prior surgeries, submit your information through our complimentary online consultation form.
Frequently-Asked Questions About Poor Growth Yield Following a Hair Transplant Procedure
I had an FUE hair transplant procedure done a month and a half ago and all of the grafts have fallen out. What should I do?
There is no need to panic – this is simply the shedding away of the old follicles to make room for new growth once the grafts have fully established themselves in the recipient area.
What can I do to make sure my FUE hair transplant goes as well as possible?
Avoid disrupting the area where the FUE hair transplant was performed immediately following the hair transplant procedure. This can include wearing a hat or using harsh chemicals on the hair, such as bleach or dyes. Sun exposure is also discouraged during this period, as is getting the area wet while showering or bathing. Follow your hair surgeon’s instructions carefully – they will give you a rundown of best practices and ways you can make sure everything goes well in the wake of your FUE hair transplant procedure.
It’s been a year and the coverage achieved via FUE hair transplant surgery is less than what I want. Is a second procedure possible?
Of course. Many of our patients at the Dr. U Hair Clinic in Redondo Beach, California come in for second, third, and even fourth procedures in order to attain exactly the results desired. Such “touch-ups” are more than normal and pose no risk to the grafts that have already been placed.
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