Failed Transplants

[voxman]

Being a Newbie here and reading voraciously just about every topic and discussion, I see now and then some less than glowing reports of a HT with a highly recommended Dr. that can only be described as a failure. A recently resurrected post about a 2nd HT that was a fail has me shaking my head and feeling really bad for the fellow.

 

Given that the human body is subject to different genetics and stresses and environments and we all heal and react differently, is there such a thing as a head that just wont take a HT?

 

I'm 10 weeks in on my own HT and it's boringly normal based on what I've read and seen and experienced so I am not worried about my own mane, just curious.

[Spanker]

Yes, there is a small group of people, I think it has been estimated by some doctors as about 3 percent that just don't yield well, given all other variables are constant.

 

Sometimes it's techs, a doc, or post op care, but every great once in a while, you just pull a bad card. I don't know of any preventive test that you can do to see if you are one of these few.

[Blake Bloxham]

Vox,

 

Yes, there are instances where patient physiology is solely responsible for poor yield. Like Spanker said, this is a very rare occurrence and it is usually difficult to distinguish from human error.

 

When it is not caused by an external error, a hair transplant that simply "won't take" is usually caused by post-transplant lichen planopilaris (LPP). LPP is an inflammatory scalp disorder that results in patchy alopecia. According to the literature, there have been at least 17 cases of LPP that developed within 4-36 months after surgery. 17 reported cases out of the thousands of hair transplant procedures performed each year is a very small percentage of alleged LPP caused failures.

 

Frankly, these percentages are low and theoretical in nature. This makes worrying about something like this occurring probably unnecessary.

[napavalley]

I've had LPP for 40 years and 2 failed HTs. Now working with Dr Konior and hair and scalp dermatologist Dr Mirmirani in California I will beat this. Dr. Konior has been my best supporter in this journey.

[ZeoRanger]

When you say you've had it for 40 years, do you mean you've been diagnosed 40 years ago? Knowing this, did you take any measures prior to the HTs?

[frogger]

Vox,

 

Yes, there are instances where patient physiology is solely responsible for poor yield. Like Spanker said, this is a very rare occurrence and it is usually difficult to distinguish from human error.

 

When it is not caused by an external error, a hair transplant that simply "won't take" is usually caused by post-transplant lichen planopilaris (LPP). LPP is an inflammatory scalp disorder that results in patchy alopecia. According to the literature, there have been at least 17 cases of LPP that developed within 4-36 months after surgery. 17 reported cases out of the thousands of hair transplant procedures performed each year is a very small percentage of alleged LPP caused failures.

 

Frankly, these percentages are low and theoretical in nature. This makes worrying about something like this occurring probably unnecessary.

 

Is the transplant the cause or trigger of the LPP? Or is LPP something that person would already have?

[Dr Blake Bloxham]

Frogger,

 

Normally the patient has LPP before, it is misdiagnosed as standard androgenic alopecia (male pattern baldness), and a transplant is performed. If the LPP is still "active" the new grafts will be attacked just as the native follicles are, and permanent scarring hair loss will occur in the transplanted follicles.

 

However, it can occur the other way as well. Inflammatory conditions like scarring alopecia often fluctuate between periods of "flare ups" where the condition is bad and dormant periods where the condition is inactive. Sometimes people can have dormant LPP that is set off by a hair transplant procedure. Like I said previously, this is quite rare; but physiologically possible.

 

Here's a video I made about cicatricial alopecias (which includes LPP) and hair transplant surgery. It may be helpful to those researching. Remember that scarring alopecia does not automatically preclude one from hair transplant surgery, but it does make the entire process much "trickier." And it's important to understand that there are many instances where patients with inflammatory scarring or cicatricial alopecias simply are not good transplant candidates.

 

Take a look:

 

[napavalley]

Immediately after the plug HT the inflammation scaring occurred right above the donor area in the crown. The way that I first knew there was a problem was from the blood on towel after showering. people are predisposed to carry LPP and something triggers it. I'm blonde, now grey, very light skin had allot of scalp dandruff oily skin issues when I was young. 40 years ago LPP was not understood. The only thing that helps is liquid steroid. I'm still on first stage treatments have not needed steroid shots. I hope that dr Mirmirani will start a more aggressive approach. When I had 2nd HT about 2 years ago did not know that LPP was active in right temple. I had 1,543 grafts in the two temples and a few test grafts in the scared temple. I must say that I'm lucky that my scarring area, after 40 years, is only the size of a silver dollar. Out of the 1,543 about half survived. I have now changed HT Doctor to Dr Konior thanks to this Forum. He found me dr Mirmirani, who is only an hour from me in California. Dr Mirmirani worked with Vera Price on research for hair and scalp issues. To say that their is now allot of interest in this area now she has a waiting time of between 4 to 6 months but I'm happy to wait, I've waited 40 years to find an answer. I'm new to posting, but have read this forum for years. I appreciate the comments and it proves a great service, thanks.

[esrec]

When creating the incisions and recipient site, is the tech or operating surgeon able to detect anything that would indicate the candidate may have a poor outcome?

 

Even something as trivial as excessive bleeding, or maybe a skin type that's resistant to implantation---is there anything basic that complicates the process to the degree that the "unique skill" of the surgeon can be the difference to compensate for a "less quality" patient? It can be even be something that's annoying that requires a ton of patience. Just curious.

[napavalley]

Great Question. In my circumstance it was only through a biopsy on the right temple area did I know that the LPP was also there. The graft appear to be OK on the left temple area. We knew that the crown had the disease because of the scarring. Obviously, the doctor did not think that the right temple had LPP or he would not have transplanted grafts. It was not until I started working with Dr. Konior that he made sure we took biopsies in all areas including donor area. All areas came back positive for LPP. This was when I started to become more proactive in fighting this scalp problem. Dr. Konior found me a renown hair and scalp specialist that is only an hour from where I live in California. I have to wait 4 to 6 months for an appointment but I am very existed. The doctors on this forum will hopefully answer your question but I think it is only through observation and biopsy that LLP can be determined. I think that the individual can be aware of some of the key things to watch out for. For me it is a burning sensation in the frontal hairline and the redness of my skin on both the scalp and face. Once I get this under control I will definitely go back to Dr. Konior for a HT but I will continue monthly visit to my dermatologist for maintenance purposes.

[napavalley]

Sorry, I forgot to finish, I know that I can beat this but until Dr. Mirmirani (the hair and scalp researcher) gives me the go ahead, and that she will be willing to monitor me after the HT I will not get another HT. It's just too discouraging to see those limited donor grafts just vanish. Without Dr. Konior, I would have never thought that I could be a candidate. Following his suggestions and recommendations, I know that I will be ready the next time to be successful. He has been my biggest supporter on the journey.

[ZeoRanger]

Thanks for your detailed post. I hope it'll get better for you.

[napavalley]

I'm interested in helping anyone on the Forum that has encountered LPP and has been discouraged with results. Like the doctor said it is uncommon and that's exactly why there is very little interest in curing this disease. It is uncommon and thus no money to be made thus little money going into finding a cure. Just give him some more steroid lotions and some more antibiotics and lets just keep controlling this forever. The old conventional thinking, the old conventional way of doing things. I guess I can stand around and continue to have this diseased just "controlled", or do I believe that I can make a difference. I will continue to update the Forum of any new advances in this area, thanks.

 

All the below is from NIH Public Access

Author Manuscript

From Arch Dermatol, 2009 December

Paradi Mirmirani, MD and Pratima Karnik, Phd.

Lichen Planopilaris Treatment With a Peroxisome Proliferator--Activater Receptor y Agonist

 

A recent publication

 

1

showed the relative rarity of LPP, which has an incidence rate of only 1.15% to 7.59% in all new patients with hair loss seen annually in 4 tertiary hair research centers in the United States. Thus, any drug having an indication for LPP would be eligible for orphan drug status by the US Food and Drug Administration. Given the experimental evidence for the role of PPAR-γ in LPP and the positive clinical and histologic effects of pioglitazone in this patient, studies evaluating the efficacy of thiazolidinediones, either orally or topically, may be advocated for LPP.

Dr Mirmirani has received research funding from the Procter & Gamble. Drs Mirmirani and Karnik have applied for a patent for the use of PPAR-γ to treat cicatricial alopecia.