Transplanted Hairs - Efluvium Resting

[Cowhorns]

Hi. Can someone clarify why that transplanted hairs don't all cyclically shed at the same time if they generally all enter resting at the same time following initial transplantation? Thanks

[gillenator]

For the most part, the transplanted hair follicles need to connect or establish themselves into an entire new area of blood supply. During the healing process, the hair follicles begin normal cycling once they have rested and then been rooted in their new environment. This does not necessarily happen concurrently but rather on an intermittent basis. The window period can be between three and six months for the most part.

 

Most of the follicles will survive in their new environment, some do not. If the grafts that transport the hair follicles are carefully prepared with minimal transection/damage, the yield should be in the upper percentile of regrowth. The blood supply are the "lifeline" of the hair follicles. Without it, they will perish.

[Cowhorns]

Thanks for this. I guess there could be an argument made that in some instances transplanted hairs growth / resting cycle could be closer together than non transplanted hairs ?

[gillenator]

I do not think there has been any studies done on this topic.

[hairshopeing]

Iv wondered about this? If say a mega session 10000 hairs are put in and survive, then roughly at the same point give or take a a year all would shed then regrow, so even if that was spread out over a year period if them 10000 hairs shed then lie dormant for 3 months then that would have a HUGE impact on the appearance of the patients hair for that period!!

[greatjob]

If this was true you would have hundreds of posts monthly of people freaking out because you would essentially loose all your transplant hair for a few months, that would be anything but subtle. A NW 6 for example that had say 6-8000 grafts moved, would go through a period of a few months where he would revert back to a NW 6, if that was the case I am positive we would have heard about it by now. I think the point when the hairs change phases is, like most things in nature, probably completely random and varied.

[agenteye]

Yeah, individual follicles enter hair growth stages at different times. Here is a better summary of the events that happen!

 

The growing (anagen) phase constitutes about 90% (1000 days or more) of the growth cycle of a hair follicle, while intermediate (catagen phase; 10 days) and shedding (telogen phase; 100 days) phases constitute only 10% of it. That is, at a given time, about 10% of hair follicles are in the intermediate and shedding phases; thus, not growing. These hair follicles, however, are randomly distributed over the scalp, so that no bald spots are seen.

 

 

90% of your follicles are growing at most all times.....which is why you don't see a mass shed of the follicles all at the same time. It would seem as though because you have all of your grafts transplanted at the same time, that they would mature and enter the three stages together at the same time.....but this just isn't how it works. The follicles all have a unique life, and therefore enter the different stages when they are (genetically) ready to do so!

[Cowhorns]

Hairshopeing - You have put into words very well what i was trying to say

 

 

Some good responses. Thanks

[gillenator]

The key is that they behave (growth cycle) on an intermittent basis. But everyone is different. Some HT patients do experience a more massive amount of their grafts shedding and going dormant. But the regrowth is subtle and again behave intermittently.

 

Some patients not only lose most of their grafts but they also experience shock loss of the native hair along with their grafts. Many of them do not put up pics and voice their frustration, some do.

 

Yet at one year post-op the follicles have had a chance to rest and re-enter their respective growth cycles once again.

[BaldingBogger]

Hi Gillenator,. At what point do you think that all grafts should have started growing again.?

 

Is it common to see a certain amount of grafts only emerge close to the 12 months mark after resting? Would that mean they were perhaps in a different cycle stage to the grafts that appeared earlier before they were transplanted?

[gillenator]

Generally speaking, a very high percent of the grafts should have sprouted by the nine month mark or so. There are always some exceptions like the slow bloomer. At 4-6 months post-op much of the regrowth is breaking above the scalp line which can be visually seen.

 

Then at 9 months post-op or so, most of the grafts have already shed, gone dormant for 3-4 months and then re-entered the growth phase. There can be some trailing growth and why at 12 months both the regrowth and some length have manifested.

 

So yes the follicles are at varying stages in their respective growth cycle and why it is at 12 months post-op that the regrowth, some length, and caliber maturation have taken place. We usually call this a "matured result".

[evil]

My 3000 grafts to the back of my head back at the end of Feb broke through my scalp about 2 1/2 months later and just sat there doing nothing until 2 weeks ago. So for me at 5 months the journey has only just started and from what I can see only around 50% of them are actually growing, the rest are still at the stage/growth they were at 2 1/2 months.

[scar5]

The cycles are unaffected by the HT. The hair falls out because of trauma. And so a hair can be shocked out post -transplant , start growing three months later and go into resting phase before it is barely even visible.

 

Also, follicles don't just go through cycles. I've seen magnified pics showing individual hairs within the same follicle in different stages of the cycle. So this means a 'two hair' follicle could actually be a three or four hair one.

Edited July 28, 2013 by scar5
Splleng

[gillenator]

Each follicle is in a given phase of the cycle. Sure there can be multiple hair shafts within a given hair follicle at varying lengths, but the follicle itself is either in the growing phase, the resting phase, or the shedding phase.

 

Shockloss occurs because of the related trauma, and the trauma does cause many of the hair follicles to retreat into the resting phase.

[Cowhorns]

I very recently read a post where a double hair was transplanted into the hair line which necessitated frequent plucking due to an unnatural apperance. It caused some debate as to how the hair got there with possibilities ranging from a moments loss of concentration from the techs to the the transplanted hair actually being a double however in resting phase and only showing a single hair in effect "fooling" the Dr to think it was a single.

[scar5]

... the transplanted hair actually being a double however in resting phase and only showing a single hair in effect "fooling" the Dr to think it was a single.

 

Exactly.

 

From a very well known (unmentionable) doctor.

 

quote starts here.................................

 

Most importantly, cosmetically, all too often surgeons and technicians do not realize the concept that the hair is in a cycle and do not notice that there is a telogen hair next to the anagen hair. So this picture is of a two (2) hair follicular unit. But unfortunately, untrained hair transplant teams assume that this is a one (1) hair follicular unit and implant BOTH hairs. This is not that big a problem unless it is implanted in the frontal hair line. Two hairs will eventually grow out rather than the preferred one (1) hair. If this happens often enough, the hairline will look less natural.

.....................end quote

[Cowhorns]

The one I read in part talks about doubles where 1 hair is resting and therefore mistaken for a single which can't be detected even under microscopes? That's what i think the post was stating, that all said I'm a little out my depth here if i'm honest

 

Here it is though....................

 

 

 

Doubles can and often are unknowingly implanted into the hairline by any doctor. Why would this happen? Explanation:

 

-When a multi-hair graft(2,3,4) is in the dormant(sleeping) phase, not all the hairs contained in the graft are necessarily dormant. One hair of a 3-hair graft may be dormant, 2 hairs out of a 4-hair graft may be dormant or 2 hairs out of a 2-hair graft etc. This can be misleading and cannot be detected even under powerful microscopes. So a 2-hair graft can appear as a single hair graft, and placed into the hairline.

 

This is often the reason why we see multi-hair grafts in the hairline. I have a triple hair graft which I pluck right at the very front. However clinic negligibility can also be a factor. Who is to say a tech wasn't busy thinking about their marital problems whilst separating the 1s from the 2-hair grafts for even 5 seconds? Truth is we will never really know which reason it is