How Hair Transplants "Grow," "Mature," and "Pop!" - Dr Blake Bloxham, Feller/Bloxham

[Dr Blake Bloxham]

How Transplants Grow, "Mature," and "Pop!" (pictures, charts, and explanations below)

 

I wanted to take an opportunity today to go over how transplants "grow," "mature," and "pop." I also wanted to touch on how all of these factors influence the overall appearance of the hair transplant as it unfurls. I wanted to centralize all this information for those researching, and more importantly for those who are eagerly watching their transplants "grow-in" 3-12 months after surgery.

 

I think patients are sometimes concerned that their results are "falling behind," "not coming in correctly," or not matching what they see posted online. So I hope this review will help them understand how transplants evolve and remind them that they are likely right on track.

 

It is also very important to understand that this information is a rough and vague average, and all patients do grow, mature, and pop a little differently. And that a transplant shouldn't be fully "evaluated" until the 12 month mark (at a minimum). BUT, hopefully this helps patients understand the process, what to expect, and chases away some growth worries!

 

Enjoy:

 

Do hair transplants actually "mature?"

 

We always hear this online: "a hair transplant takes 12 months to fully 'mature.'" And in the beginning phases of hair transplant growth, it's pretty obvious that these fine, "wispy" hairs themselves are going to thicken, darken, and naturalize.

 

But no matter how many times I tell patients that this maturation truly does continue all the way up until the 12 month mark (and often times all the way up until the 18 month mark), I still frequently speak with patients -- both online and in person -- who think their transplant is "done" at the 6 month mark. Even if they don't fully say it, it seems like they don't really expect much change in these later stages of the transplant. I'm not sure if it is because we do often see impressive examples of early growth around 6 months online or if it's because it seems a little "strange" that the hairs will change after they have been growing for several months, but it absolutely does occur.

 

To both demonstrate this AND help those who may be concerned about their results around the 5-6 all the way up until the 9-11 month marks, I wanted to show a good example of this maturation and discuss the phenomenon a bit further.

 

Case:

 

The patient is a male with a classic NW VI balding pattern and a somewhat limited donor. We evaluated and decided to do an "as much as possible" or "AMAP" FUT procedure to re-frame his face with a conservative and age-appropriate hairline and fill as much thinning scalp as possible.

 

Here he is before the transplant:

 

 

We were able to obtain 2,500 grafts to achieve the above plan. He was very pleased and expressed the desire to continue working further back in the scalp after the results grew and the donor region healed.

 

He came back in 6 months after the transplant. He told us he was very happy with "the result," and we took some pictures. We were pleased he was happy, but assured him that 6 months was very early and he still had a lot of "maturation" left. He was hesitant to believe us and didn't think he would really see much change from this point forward. We told him to come back in a few months and we'd show him exactly what we meant.

 

Here is how he looked at 6 months:

 

 

 

Great coverage, but also a perfect example of transplants that are still very "immature." Note how a lot of the hairs have "popped" through the scalp, but still appear thin compared to his surrounding donor. Also note how the hair has much more of a "coarse" and "wavy" appearance compared to the donor.

 

3 months later I noticed the patient had scheduled another follow-up appointment. I saw him again at this 9 month mark and as we informed him, the maturation magic continued! We took some comparison pictures and put them next to the 6 months shots. He was extremely surprised how much it had changed in a few short months, and I think he's now definitely a believer in the continuance of maturation during the later months of a transplant.

 

Here's the comparison we showed him:

 

 

Here's a few more shots of how he looked at 9 months:

 

 

As you can see, there is a noticeable difference in: the thickness of each hair strand, the color of each hair strand, the softness of each strand, and the inherent "kink" or "wave" in each strand. Altogether, the hairs match the characteristics of the donor hairs in the 9 month shots much more compared to the 6 month shots. This is maturation!

 

He has also had more hairs "pop" through the scalp in general, but more on that later ...

 

Here's a close-up demonstrating the differences:

 

 

Maturation Timeline:

 

So now we see that not only do hair transplants "mature," but they really do continue maturing up until late in the game.

 

But what's the maturation "timeline" that patients can expect, and what will the transplant look like during these phases:

 

Maturation Timeline*:

 

 

*Please remember: this timeline represents an "average" estimation of where results will be at said time periods. Patients are unique and do mature at different rates. This has no real bearing on the final result. Please note that it often takes all the way up until 18 months to see the characteristics described around the 12 month mark in those who are "late maturers."

 

"Maturation" vs "Popping?"

 

I personally think this is confusing subject, and it may be why patients sometimes don't believe that "maturing" actually occurs after the hairs really come through the scalp.

 

So "popping" is just that: it refers to implanted follicles actually growing hairs and when the new hairs first penetrate or grow through ("pop through") the scalp. Maturation refers to the changes of these new hairs after they pop.

 

This means the appearance or "overall growth" of your transplant is actually comprised of two different things: how many hairs have actually "popped" through the surface, and the maturity of these hairs. Unfortunately, timelines for "popping" aren't as well-described as they are for maturation. But here is one I saw Bill -- the Managing Publisher -- describe recently that I feel is pretty accurate:

 

"Popping" Timeline*:

 

-Month 3-5: Hairs begin popping through surface

-Month 5: 50% of hairs popped or penetrated surface

-Month 6: 60% popped

-Month 7: 70%

-Month 8: 80%

-Month 9: 90% - 100%; biggest changes in overall appearance from this point forward are usually do to maturation and not new popping.

 

*As with the maturation timeline, this is a rough estimate and no two patients will be the same. Being advanced or slow on this timeline also has no bearing on the final result and a hair transplant really shouldn't be evaluated in full until at LEAST the 12 month mark.

 

Overall Growth and Appearance of the Transplant?

 

So, now we know that maturation all the way up until the 12 -- and sometimes 18 -- month mark is a real thing; we know these hairs have to "pop" through the surface to even begin "maturing;" and we know that these both occur on different time tables.

 

But what does this mean for the overall growth and appearance of the transplant?

 

"Overall Growth" or "Overall Appearance" = Number of Hairs "Popped" + "% Maturation" of Said Hairs

 

The way your transplant looks as it is growing-in is a combination of these two very important factors. If you have a lot of hairs that have "popped," but these hairs are still very immature, the over all growth and appearance still appears fine and thin. You may look like you have a "haze" of "peach fuzz" hair on the head at this point. On the opposite end, if you have few hairs that have "popped," but these hairs are more matured, then the hairs themselves will be more noticeable, but the density will look thinner. Slight differences, but the outcome is the same: the overall growth or appearance of the transplant will appear thin. And:

 

It takes both a good percentage of popped hairs and an advanced maturation of said hairs to really get the full effect of a "fully grown" hair transplant.

 

This is a little harder to put into a chart, but I think about "overall growth" as 2 very distinct points in time: 6 months and 12 months.

 

I always tell patients that at 6 months, your hair transplant is only about "half way done." Based on the previous charts, we know that 6 months means approximately 60-70% of hairs have popped through the scalp and these hairs are approximately 40% matured. This means for every 10 "hairs" implanted, 6 of them have grown and they still appear thinner and a bit more kinky, wavy, or wiry than the native hair.

 

Altogether, I think this results in an appearance that is approximately 50% of the density, fullness, and naturalness of the "finished" results (12-18 months). In other words, the result is roughly "half done" at 6 months. By this explanation, you can extrapolate and infer that this means the 12 month result is -- on average -- "done."

 

Again, this is variable! However, it makes it nice and easy to look at overall growth as a summation of popping + maturation and know that the appearance of said growth will be overall "half way done" at 6 months and "pretty much done" at 12 months (with 18 months still being completely normal). And the in-between months means you'll be somewhere in-between.

 

____________________________________

 

Well, I hope this was helpful! I know it's a lot of information but I do think it may be useful for those in the doldrums of hair transplant growth. Feel free to contact me or reply with any specific questions or recommendations for updates!

[Dolph1969]

Great article Blake.

[Dutchie]

Very informative. Thanks for posting

[ontop]

Great post Blake very informative so that others can gage there jouney.

 

Blake from what you have experienced do you see in your patients that the crown area takes a lot longer to mature like 12 to 18 month's plus? If so would it be a good guess this is because of the blood flow through this area?

Your thoughts or experiences in this

 

Thanks good post again well done.

[Dr Blake Bloxham]

Thanks everybody!

 

Ontop,

 

You are absolutely correct. In my experience, the crown usually takes the longest to grow -- both pop and mature. And I think you're right about why this occurs as well: blood supply. The crown generally has very good blood supply from the back and sides of the scalp, but this is temporarily disrupted with donor harvesting. So I think it gets a lot of its blood supply from the front during the growth period, and, therefore, grows slower. Even in non-crown cases, I almost always see the transplants nearest to the "front" pop and mature faster.

[Dr. Scott Alexander MD]

Thanks for posting this Dr. Bloxham. It will certainly help many who have concerns or questions over their growth.

Dr. Scott Alexander

[ndubya]

Thanks for taking the time to post this.

[Rashid36]

yes thanks, when should a person get back to there doc if they have concerns ?

[ontop]

Thanks everybody!

 

Ontop,

 

You are absolutely correct. In my experience, the crown usually takes the longest to grow -- both pop and mature. And I think you're right about why this occurs as well: blood supply. The crown generally has very good blood supply from the back and sides of the scalp, but this is temporarily disrupted with donor harvesting. So I think it gets a lot of its blood supply from the front during the growth period, and, therefore, grows slower. Even in non-crown cases, I almost always see the transplants nearest to the "front" pop and mature faster.

 

Thanks Dr Blake & Dr Alexander very informative post here, which I always love to read up on & learn especially coming from you guys in the field.

[Dr Blake Bloxham]

Dr Alexander,

 

Thank you! I'm truly glad you enjoyed reading it.

 

Rashid,

 

Call them right when you're concerned. I think they would prefer to know sooner rather than later.

[hairmenow401]

This is a wonderfully written piece many will undoubtedly find beneficial. Well said.

[voxman]

Excellent piece, Blake!

 

I am 12 weeks this week and the 'popping' has begun in earnest.

 

Because my hair is both light brown and silver, it is difficult to see all the breakthrough with the naked eye, but closer examination shows lots of activity even as it is 'colorless'.

 

Definitely encouraging that it has begin! If I can get a good pic I will post it here as a 3 month popping example.

[Shera]

A very useful and informative article Dr Blake, thank you for making the effort.

[Dr Blake Bloxham]

Vox,

 

Glad to hear the magic is happening! I was very pleased when you received the official "green light" to go through with the second procedure. Definitely keep us updated! And yes, a good "popping" example would be very useful for the thread.

[Dr Blake Bloxham]

Thanks, Shera!

[voxman]

Blake - this just taken. The entire are was shaved for my HT so the long hairs (now about 1.5 in) have grown in since the procedure and the smaller ones are the new sprouts.

[un13]

why 9 month picture is taken with a different background . different light and different angle ?

Don't get me wrong but those factors could be a major factor in appearance

[Dr Blake Bloxham]

Vox,

 

Definitely looks like new sprouts "popping." Very exciting. And an excellent example of what hairs looks like when they first pop through, but truly haven't matured much yet.

 

Thanks for sharing, and keep us updated.

[Dutchie]

Another thing I noticed is my hairgrowth seems to come in sections and in stages. First my front parts started coming through, now that has apparently stopped, and now my midscalp and crown seem to be getting newly sprouted hairs.

 

I assume this is normal??

[Dr Blake Bloxham]

Hi Dutchie,

 

I see this in almost all my transplant patients. Very normal! This "front to back" pattern of popping, growing, and maturing has to do with the blood supply post-transplant. Everything will catch up by the 12-18 month mark, but this is definitely how they usually come in.

[Dutchie]

Hi Dutchie,

 

I see this in almost all my transplant patients. Very normal! This "front to back" pattern of popping, growing, and maturing has to do with the blood supply post-transplant. Everything will catch up by the 12-18 month mark, but this is definitely how they usually come in

So just because the frontscalp has stopped sprouting new hairs for now doesnt mean it can't restart again in a few weeks from now, right?

[Dr Blake Bloxham]

Hi Dutchie,

 

How far out are you now? If you're less than 9 months or so, then it should definitely continue sprouting.

[Dutchie]

I am exactly at 4 months and 3 weeks. My surgery was Feb. 3, 2016.

 

Thats good. That means I got another 4 months of new hairs that will sprout

[Dr Blake Bloxham]

At 4 months, you still have worlds of time to continue "popping." And yes, the overall growth does seem to come in spurts. So you're good!

 

Happy growing.

[Dutchie]

At 4 months, you still have worlds of time to continue "popping." And yes, the overall growth does seem to come in spurts. So you're good!

 

Happy growing

Thanks.

 

Just for reference, first 2 pics below were pre-op

 

 

 

 

---------------------------------------------------------------------------------------------

 

And this pic was taken yesterday (exactly 4 months and 3 weeks after surgery)

 

 

I'm already happy with my result up to now. Of course I want more hair though, but so far so good