Hair Loss One year after a HT

[mikeey]

hi guys ,

 

as the title suggest , one of my close friends , Aged 42 had a HT last year at a leading clinic which has now shifted to Madrid , although he was very happy just a few months back , Now at exactly 14 Months post his HT , it seems he is Loosing the Density ( which was very good ) at the Hair Transplanted sites , it is NOT the Native hair which seems to have Lost its Bulk , BUT the Hair that were Transplanted .

 

He is Obviously Not happy , I wanted to Know if anyone here has / had the same Issues ?

 

how did they fix it ? Any valuable input is welcome and thanks in advance .

 

Also please note that he had from the beginning Never taken any medication ( Propecia or Rogaine ) ,

[Dr. Alan Feller]

What you are describing sounds like graft miniturization. In strip surgery it is rare. Maybe one in 500 patients. In FUE cases it appears to be much higher and is usually to a greater degree.

 

When a transplant is performed, FUE or FUT, grafts are removed from the donor area and placed into the recipient area. The body's healing system is then activated and new blood vessels are created to nourish and sustain those grafts. The new grafts and the new vascular system are, in a sense, balanced. That is, the graft gets the blood supply it needs and no more; and the new blood supply gives the graft the vascular supply it wants and no more. In most patients this "arrangement" becomes stable and the hair will return to its normal growth cycle and produce a hair every bit as thick as it used to be when it was in the donor area.

 

However,

 

In some patients, the process of healing and metabolic homeostasis is NOT complete before the second year. Not stable. Something happens, although we don't know exactly what, where the graft just decides to stop producing a thick hair shaft. I believe it's because the recipient area is actually OVER vascularized by the body during the first 18 months, and then the new extra blood vessels are withdrawn, inadvertently leading the graft into "thinking" it is suffering a deficit of oxygen and nutrients. As such it responds by lowering it's metabolic output and thinning the hair.

 

Think of this as having scaffolding around a building and then removing it. Difference here is that by removing the scaffolding, some of the "support vasculature" goes with it. Thus the graft has to move to a lower "hair producing" level to sustain itself and get back into homeostasis.

 

OR, the other way around:

 

It may also be that the graft itself just decides it is better off producing a thinner shaft and the blood supply is adjusted after the fact. The graft is a living thing that was just traumatized so it's reaction can be unpredictable.

 

It may also be that the healing and scar tissue formation in the recipient area is resulting in a small "choking off" of the blood supply, which is why it is key NOT to implant grafts TOO densely. This is the same phenomenon that literally kills follicles in the recipient area after FUE where the skin is brutally scarred throughout after FUE megasessions.

 

See this youtube video:

 

I believe the more fragile the graft is naturally (thin, short, wispy type follicles) the more prone it is to this "miniaturization after the fact" phenomena. In FUT there is very little direct trauma to the graft. But in FUE there is tremendous trauma by comparison, thus not only higher rates of miniaturization after the fact, but greater chance of miniaturization from the start.

 

It is a disappointing problem, but one that can not be predicted. One may, however, perform another transplant using the following protocol:

1. If the HT was FUE, switch to Strip (FUT). This will provide the most hardy and uninjured grafts

 

2. If the HT was FUT, lower the density of the new recipient sites as they are placed between the surviving prior transplants. I did this in a patient who used to post regularly on this site ten years ago and it worked like a charm.

 

Best of luck to your friend, and to all patients whose ultimately goal is just to improve their looks and confidence.

Here's a YOUTUBE video of a normal patient grown out post op:

 

 

And here is a YOUTUBE a patient who experienced the opposite of your friend. He was thin for a slightly longer period than is considered "normal" but then bulked up.

 

 

Dr. Alan Feller

Feller and Bloxham Hair Transplants

Great Neck, NY

516-487-3797

 

 

 

 

[mikeey]

Thanks Dr. Feller , the way you explained was terrific , although I am not a science guy by a long margin , but i fully understood your calling.

 

My friend has also read your Answer , and surely it was FUE and Not FUT ,, so in all it was not any fault of the surgeon , who in this case happens to be the Best in FUE around the world .

 

I hope any other FUE Doctor who reads this can please present his Point of view ,

 

Learning is Never and should never be Limited , so I urge all to please participate in this discussion .

[ArochaHair]

There is also the possibility of the grafts transplanted not being immune to the effects of DHT. This can happen as well and is not dependent on the type of method used for placement (FUE or FUT). Hair can be taken from the middle of the safe donor zone and the hairs can still be DHT sensitive and so your friend's loss may simply be continuing unabated, since he's not using medication to halt further hair loss.

 

Dr. Rassman once had this to stay about this phenomenon:

 

This is highly unusual. after over 15,000 surgeries, I have seen this maybe 4 times. In the times I saw this, I examined the donor hair to see if the donor area had miniaturization. as senile alopecia could be a cause, but this was not the case in the 4 patients examined. A doctors in the community. a member of an email group that I belong to, asked that question to over 40 hair transplant surgeons about this phenomenon seen in one of his patients and this is what I said about it:

 

1- It could be senile alopecia, examine the donor area and see if the donor hairs are all healthy

2- It could be an autoimmune disease, so consider a biopsy of the recipient area

3- Count the donor density and see its comparison to your hair transplant density measurements.

 

One experienced hair surgeon from Australia who wrote one of the classic text books on hair transplantation, said that he saw this rarely (just as I said) and further stated that he believed that some of the hairs had a shortened hair cycle after a number of years and that might be the cause of it. But in reality, assuming that #1,2 and 3 are not identified, then no one really knows the answer to this.

[Dr. Alan Feller]

There is also the possibility of the grafts transplanted not being immune to the effects of DHT. This can happen as well and is not dependent on the type of method used for placement (FUE or FUT). Hair can be taken from the middle of the safe donor zone and the hairs can still be DHT sensitive and so your friend's loss may simply be continuing unabated, since he's not using medication to halt further hair loss.

 

Dr. Rassman once had this to stay about this phenomenon:

 

Absolutely true, and I have no doubt this happens from time to time. But I have also had patients whose donor area was exactly the same 20 months after surgery, thick as ever, but the grafts that came from there were beginning to miniaturize in the donor area AFTER having been obviously thicker.

 

It's as if there was full and normal growth, and then a retreat from this optimal state to a lesser state as evidenced by the thinner hair shafts.

 

Thankfully, another round of hair transplants did the trick, but those new grafts went through the same process even though they were from a different part of the donor area. Thicker at first, and then thinner. So we overcame miniaturization with numbers. Thankfully this is very rare and has a solution.

Best,

Dr. Feller

[Irry88]

Dr Feller, I might be having the same issue you described above. I will be coming up on the 2 year mark within 3 months, and i started shedding about 3 months ago.

 

Would using minoxidil on the recipient sites help this situation at all? Its a really crappy feeling to know that I might possibly be bald in the frontal zone again.

[Bill - Seemiller]

I really appreciate Dr. Feller chiming in and explaining this because to be honest, this is the first time I've actually heard or seen this posted on the forum. I would be interested to know where Dr. Feller got the statistics one out of 500 for Strip and more common during FUE ( please though, without turning this into a strip versus FUE debate).

 

Regrettably, I have heard about this kind of thing off more times then I would like over the years. And I would personally think if the receiving area is over vascularized that not all the grafts would grow in the first place rather than growing and then fizzling out. On the other hand, much like a garden that bears much fruit, if there is a problem below the soil, some of the fruit wi on the other hand, much like a garden that bears much fruit, if there is a problem below the soil, some of the fruit will want to be able to sustain healthy growth and thus, rot away. I suspect something similar maybe going on under the sc I suspect something similar maybe going on under the scalp.

 

The question is, what does a hair transplant doctor do if this is the case? If it is a case of over vascularization, I would hope the doctor would do something to compensate the patient since over vascularization is typically due to dense packing too many grafts in an area.

 

Since Dr. Feller has responded, perhaps she will be willing to share how his clinic handles this any event this happens in his hands.

 

Best wishes,

 

Bill

[Bill - Seemiller]

Also, I do encourage this patient to consult with his doctor and explain this problem in hopes that something can be done to help him.

[un13]

If it was for the dense packing then the hair wouldnt grow it the first place.

What your friend should do is to start taking finasteride , then you will get the answer. Most likely those follicles were affected by dht

Also this FUE vs. FUT is just not true. Funny to read about "the skin is brutally scarred throughout after FUE megasessions" when at the same time doc has no problems to do FUT megasessions which have the same effect on the recipient area.