Hair Transplant | My Transplanted Hair Is Falling Out, Is This Typical After a Few Years?

My Transplanted Hair Is Falling Out, Is This Typical After a Few Years?

I had a hair transplant about five years ago with a doctor who I thought was a reputable hair transplant surgeon. It now seems that some of my transplanted hair is falling out. Is this typical after a few years? I was told that the transplanted hair would last a lifetime.
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In my opinion the biggest challenge facing hair restoration surgeons today is that there is a “mismatch” between the larger recipient scalp, and the smaller, limited donor scalp. We can always use more follicles in our transplant procedures to cover larger zones in the recipient scalp. However, the nature of the donor scalp only allows us to remove a certain amount in a single transplant session and still obtain a cosmetically acceptable closure. Individual factors such as scalp laxity, (i.e. looseness), density of follicles per unit area in the permanent zone, hair caliber and hair curl all contribute to the perceived “density” that a patient obtains with their procedure. Some of the patients will require greater than one transplant procedure to obtain there expected goals for “density and coverage”.

Generally speaking the “permanent zone” where follicles are harvested to transplant are expected to grow hair for the life of the patient. Interestingly though, many hair transplant surgeons believe that if a humans life expectancy was longer, (like 150 years) even the “permanent” follicles would become susceptible to the effects of dihydrotestosterone, (DHT) and miniaturize the hairs growing out of them.

Several things could have occurred in your situation…

1) The scalp harvested from your donor zone was taken from an area that was too high, or too low, leading to follicles that are transplanted that could still be susceptible to the ongoing effects of dihydrotestosterone, (DHT). This is one concern that exists with the procedure known as follicular unit extraction, (FUE). In the FUE procedure the follicles are harvested individually over a much larger area of a patients “permanent zone”. If the patient experiences ongoing genetic hair loss, the follicles harvested “high” or “low” in the donor zone may not be permanent. Please note that this comment does not exclude FUE as an excellent option for certain patients. However, this is one big advantage for “strip” harvesting where the selection of the donor scalp can come from what is truly considered to be permanent.

2) If the patient presents with a “diffuse” pattern of hair loss, (seen in men, but more commonly in female patients) the hairs growing from these “permanent” follicles may continue to diffusely thin even after the transplant. This is why it is important at the time of your consultation, that your transplant surgeon assesses your donor zone with some sort of magnification to assess for miniaturized hair even in what is generally considered a “permanent zone”.

3) If the patient is not stopping ongoing hair loss with the use of Propecia, minoxidil, or low level laser therapy, it may be that their natural non-transplanted hair is actually being lost, and the transplanted hair is in fact permanent. As the patient continues to thin, they erroneously assume that they are losing hair from the transplanted follicles, when in fact the thinning is occurring from the natural non-transplanted follicles.

4) Certain medical conditions, (most commonly thyroid disorders) can contribute to hair thinning. By correcting the underlying medical condition, the hair may “grow back”. In this regard, I would recommend that you have a medical hair loss evaluation by a dermatologist that can check lab tests and possibly perform a scalp biopsy to rule out medical causes of ongoing hair loss.

In closing, I would also recommend that you visit with you hair transplant surgeon and discuss your concern. If your surgeon is recommended by the IAHRS, (www.iahrs.org) you can be assured that they are truly among the “best of the best” in the field, and will assist you in obtaining the very best possible result.

Best Regards,

Robert J. Reese, DO
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association