Survival Rate of Hair Following Transplant

[gettinghair]

My understanding is that it is normal to have shafts of transplanted hair fall out within weeks or a month, and that they will (hopefully) grow back after 3 to 4 months.

 

I realize that not all heads are created equal but, on average, if there is such a thing, what is the per cent of transplanted grafts that will continue to grow after transplanting without without falling out first?

 

Maybe it would better ask if it is common to have hair grow without falling out, or is it completely unheard of?

 

Thanks.

[Maxxy]

Welcome gettinghair,

 

I have read of cases where the vast majority of grafts have not fallen but generally most, if not all the hairs will shed - some may have a few survivors.

[Dr. Michael Beehner]

Your impression is correct, in that the great majority of the hairs that are transplanted (most of which are only 1/8th inch long) are shed during the first few months, before the "real" hairs appear 3-4 months post-operatively. They usually shed in one of two ways: some fall off with the scab at the 6-10 day point, while others just "sit in place" in the skin, even though down deep in the skin they are literally disconnected from the follicle (the living part of hair), which shrivels up and hibernates for that time period. These short stubs then can sit there for weeks or the can fall off at anytime. The best way to tell a "disconnected," non-growing one from one that is going to grow is to simply look at it a couple of weeks later. If it is longer, then it is growing. Simple as that.

I find that around 5% of hairs keep on growing from the day they are transplanted, and in some patients, this percentage is even much higher, but they are definitely the exceptions.

The other issue you alluded to was what percentage of the hairs that are transplanted actually survive and grow. Many studies have been done to look at this, some with tiny boxes out in the middle of bald skin, and others deep in the center of a thousand other sites, and the averages are somewhere around 90% survival for all FU's, and around 99% for MFU grafts (DFU's and TFU's). The FU studies range from the high 70's to even higher than 100% (due to hidden telogen stage hairs that later grow). The percentage you receive from your doctor will depend on the skill of him/her and the staff more than anything. In two research studies I conducted, 1-hair FU's did not survive as well as 2-hair FU's. Again, the probable reason for this is the same as for why MFU grafts survive better - namely, because of the extra protection and buffering against the elements of drying and trauma that the extra tissue between the follicles provides.

Mike Beehner, M.D.

[rpachigo]

Thank you Dr. Beehner for those hard numbers of which I've been hard pressed to find on PubMed.

[gettinghair]

This may sound ridiculous but,assuming a highly skilled transplant has occurred, is there any reason to believe that the number of hairs that are shed can be reduced by scrupulous, delicate, loving care of the transplants?

[Dr. Michael Beehner]

We give our grafts fairly loving and gentle care but haven't been able to change those statistics. In talking with my colleagues over the years, that is the usual experience. I would be interested to know if any of them have one that is different.

Studies have been done using finasteride and/or minoxidil to try and change them, but I am not aware of any appreciable influence on preventing transplanted hairs from going through that "hibernation" stage before growing.

Mike Beehner, M.D.

[transplanted]

Originally posted by Mike Beehner, M.D.:

Your impression is correct, in that the great majority of the hairs that are transplanted (most of which are only 1/8th inch long) are shed during the first few months, before the "real" hairs appear 3-4 months post-operatively. They usually shed in one of two ways: some fall off with the scab at the 6-10 day point, while others just "sit in place" in the skin, even though down deep in the skin they are literally disconnected from the follicle (the living part of hair), which shrivels up and hibernates for that time period. These short stubs then can sit there for weeks or the can fall off at anytime. The best way to tell a "disconnected," non-growing one from one that is going to grow is to simply look at it a couple of weeks later. If it is longer, then it is growing. Simple as that.

I find that around 5% of hairs keep on growing from the day they are transplanted, and in some patients, this percentage is even much higher, but they are definitely the exceptions.

The other issue you alluded to was what percentage of the hairs that are transplanted actually survive and grow. Many studies have been done to look at this, some with tiny boxes out in the middle of bald skin, and others deep in the center of a thousand other sites, and the averages are somewhere around 90% survival for all FU's, and around 99% for MFU grafts (DFU's and TFU's). The FU studies range from the high 70's to even higher than 100% (due to hidden telogen stage hairs that later grow). The percentage you receive from your doctor will depend on the skill of him/her and the staff more than anything. In two research studies I conducted, 1-hair FU's did not survive as well as 2-hair FU's. Again, the probable reason for this is the same as for why MFU grafts survive better - namely, because of the extra protection and buffering against the elements of drying and trauma that the extra tissue between the follicles provides.

Mike Beehner, M.D.

 

Thanks for the info..

Is it depends on the FINAX we use? Wat if we are not using, whether the hair re-growth starts or not?

 

Please put some light on this issue.

[Dr. Michael Beehner]

I think your question was regard to whether or not using finasteride helps prevent the "effluvium" or dropping out of the newly transplanted hairs for the 3-4 month period. My answer would be that I have not seen any convincing evidence that finasteride (Propecia/Proscar) or topical minoxidil has much effect on whether or not this happens.

I think it's a great thing to be on finasteride if you are having a transplant, because there will be an increase in hair mass for a few years due to the medication, and that increase, along with the gain of the transplanted hairs, will look a lot more impressive on top than if the patient only gets the transplants but allows male pattern baldness to cause his remaining "native" hairs on top to drop out.

Mike Beehner, M.D.

[transplanted]

Thank you for the info doc.

My Question was about- FINAX's effect on newly transplanted hair.

What I understood from your reply is-

we are using FINAX to avoid the male pattern baldness.But not for the transplanted hair growth. right?

[transplanted]

I mean, Is FINAX attributes to the growth or increase in hair mass of the transplanted hair.

[Dr. Michael Beehner]

Your assumption is right. The finasteride helps the non-transplanted hair that is still present on top, but is susceptible to male pattern baldness. It indirectly helps the transplant, simply because everything looks a lot fuller several months down the road if the native hairs aren't dropping out around the newly transplanted ones. The surgeon ends up getting credit for both, even though the medication is responsible for one of the two positive effects. On the other hand, we often get blamed when a transplant fails to meet the patients expectation for additional density, sometimes not because the transplanted hair didn't grown in great, but rather because of the gradual thinning of the ones that were there to start with.

Mike Beehner, M.D.