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

[Dr Blake Bloxham]

Excellent growth thus far! You are way ahead of all the charts and references I listed before. Congratulations. And you still have worlds to go at only 4 months.

[robc]

Dr Blake,

 

thank you also for the informative post. I am almost at the 4 month mark 3/4/16 surgery.

The front hairline is advanced as you mentioned was usual, lot of budding and various stages in temples and crown.

 

"Wirey" type hair at this point. Natural hair is Lt/brown sandy color mixed with some gray.

 

New hairs are several shades darker than any other hair on my head and no gray?? You can see where the new hairline meets the old in the picture.

 

Any idea why? Hopefully this will blend eventually.

[Dr Blake Bloxham]

Rob,

 

Color and texture changes are unpredictable but very normal at this point. You still have a long road of maturation ahead.

 

Happy growing!

[bunsenburner]

Dr Bloxham:

 

I understand the percentage of penetrated hairs and maturation rate is very low at the 3 to 4 month mark. It follows logically that most patients would therefore see little change at this point. However, what is the most growth you have seen at this phase? Or what is the most change a patient could possibly expect 3 to 4 months after the operation?

 

For example: if a patient had a job interview or presentation approximately 100 days after the operation, is it possible they could look improved at this stage?

 

Thank you. Good information too.

[Dr Blake Bloxham]

Hi Bunsen,

 

I'm not sure if I understand your question 100%. But I think the gist of it is: What's the best you can look at 3-4 months? Right?

 

I'm honestly a little hesitant to even answer this. The reason why is because I do not want to create unrealistic expectations. The truth of the matter is that most patients see VERY little around this period. It's truly just the beginning of the growth, and -- like you said -- even the small number of hairs that have "popped" are still very immature (and immaturity during this phase means fine, wispy, and lighter in color).

 

Having said that, I do get a lot of patients who send me update pictures around 3-4 months. It is very exciting to see new growth at this time, and many like to update with the good news. So in response to your question, here are two patients who I think look about as good as you can at the 3 and 4 month mark respectively.

 

Here is a UK patient I did approximately 4,000 grafts on (FUT) 3 months ago. The "before" image is from the morning of surgery, and the after image is one he sent in (and I haven't touched either of them, just put them side-by-side and blurred out the face for comparison).

 

 

Tremendous difference for 90 days! The best one I remember from one of my patients.

 

Here's another patient 4 months after his 2,500 graft procedure. The patient sent these images in, so I haven't tried to standardize them for quality or anything like that.

 

 

Obviously not the best shot-for-shot comparison, but clearly he's had excellent growth for 4 months.

 

So that is about the "best" I think you could look. But as you can tell by the first post, this is NOT average and most patients should NOT expect to look like this at 3-4 months.

 

I also usually recommend that patients undergo surgery after these big events -- weddings, family parties, work presentations, etc -- because it's much less stressful!

 

Hopefully this is what you were looking for.

[bunsenburner]

Dr. Bloxham:

 

Correct. That was my question.

 

I would be very comfortable with an appearance like this 3 or 4 months after surgery. I understand this uncommon. I will take your advice and probably delay my own FUT to accommodate an important engagement. Though I must admit, I do hope to be early on the progression curve and look like these patients 3 to 4 months after surgery. However, I am sure almost all patients would prefer this.

 

Thank you for the response.

[Dr Blake Bloxham]

Bunsen,

 

Good, I hope it answered your question. Yeah, I almost always recommend just doing the procedure after the event. So much less stressful -- which is better for healing!

[voxman]

Yeah, I almost always recommend just doing the procedure after the event. So much less stressful -- which is better for healing!

 

Amen to that - I postponed mine because of a family wedding/gig/cruise that would have had me looking disastrous for those events. And it was tough knowing I had already waited a year but in the end - it all worked out. I am at 3.5 months now and the popping is definitely happening - very pleased with progress so far.

 

My wife tells me she like my hair when I comb it back, and I like it down, so I plan to compromise like the pic below. Problem solved!

[Dutchie]

The overall growth does seem to come in spurts

Dr. Bernstein also says the growth comes in waves, and not linear.

 

Watch video at 1:20:

 

My question to you dr. Bloxham, do you know approximately how many waves the average person has before the transplant is finished growing after 18 months??

 

I'm not asking for an exact number, and it probably differs for every person, I just wanted to know if you could give us a ballpark figure or a numerical range of waves.

 

Thanks in advance

[Dr Blake Bloxham]

Hi Dutchie,

 

Just saw your PM. Sorry for the delay!

 

Waves! I like that. Basically saying the same thing as "spurts."

 

The exact number is a good question. I don't think it would be standardized for each patient, but I agree with the idea that it comes in waves or spurts like this. If I had to break it down, I would say there is probably 2 big "popping" spurts between months 3-5 and then another around 7-9. And then a maturation spurt around month 6-7 and then one around month 9-12. But this is going to be very patient dependent. I think the important thing to remember is that it does come in spurts. So don't be worried if you aren't seeing linear popping, growth, and maturation like you mentioned above.

 

Hope this is what you were looking for!

[Dutchie]

Hi Dutchie,

 

Just saw your PM. Sorry for the delay!

 

Waves! I like that. Basically saying the same thing as "spurts."

 

The exact number is a good question. I don't think it would be standardized for each patient, but I agree with the idea that it comes in waves or spurts like this. If I had to break it down, I would say there is probably 2 big "popping" spurts between months 3-5 and then another around 7-9. And then a maturation spurt around month 6-7 and then one around month 9-12. But this is going to be very patient dependent. I think the important thing to remember is that it does come in spurts. So don't be worried if you aren't seeing linear popping, growth, and maturation like you mentioned above.

 

Hope this is what you were looking for!

Yes, thanks for answering. Thats exactly the way it seems to be going with me.

 

One major spurt around month 3 to 4. But I'm now at month 6 almost and it seems to have completely stopped popping, but the maturing is still happening. So hopefully I still have 2 more major spurts to come.

 

So to summarize: 3 major popping spurts. And 2 major maturation spurts

[Dr Blake Bloxham]

Hi Dutchie,

 

Good. Glad it helped. I think you'll probably have another 2 popping spurts and 2 different phases, spurts, waves, etc, of maturation left to come. Sounds like you're right on target!

 

Keep us updated.

[Dutchie]

Thank you.

 

Cheers

Edited July 27, 2016 by Dutchie

[Dutchie]

Dr. Boxham, could you please tell us approximately how long it takes for a single hair to fully mature from the day it sprouts out of the skin, to the day it has fully matured.

 

Are we talking 4 weeks or so, or many months??

 

(thanks in advance)

[voxman]

Dutchie, interested in Dr. Bloxham's answer, but here's my take - a hair 'grows' or lives about 6 years - so from the pop to the drop, I would figure at least 6 months, and maybe more like a year to fully mature.

[Dutchie]

Holy crap, thats way too long.

 

Somebody needs to invent a hair speeder-upper

[mosd]

so if one hair grow at month 9 it would take until month 15 until its matured?

[voxman]

Guys, the grafted hair is growing once it emerges - It is getting fuller, thicker, assuming it's coloring, deciding it's sexual identity, and getting longer.

 

Once it matures, it continues to grow about 1/2 inch a month average.

 

If you never cut it, it will grow to about 3 ft long before the body sheds it. YMMV.

[Dr Blake Bloxham]

Dr. Boxham, could you please tell us approximately how long it takes for a single hair to fully mature from the day it sprouts out of the skin, to the day it has fully matured.

 

Hi Dutchie,

 

Interesting question. So you're asking: How long does it take for a single hair to fully mature from the day it sprouts to the day it's fully matured?

 

I'll start by giving you my favorite answer in all of medicine: it depends.

 

Annoying, right? But please, do read on ...

 

So let's take a step back and look not at the hairs maturing, but the follicles that produce the hairs maturing -- and how this affects the maturation of the hair.

 

There is a specific reason why most transplanted follicles don't start growing hair until 3 months after they are transplanted. When follicles "rest" and don't grow hair, they are said to be in the "telogen" phase. Basically, follicles stop functioning in this stage and don't produce hairs. Telogen can occur for a variety of reasons: as part of a normal hair cycle, as the permanent end result of androgenic alopecia, or as part of post-surgical trauma. But regardless of why it happens, it usually lasts 3-4 months.

 

So transplanted follicles start growing hairs around 3-4 months because they are basically traumatized into a telogen state. They recover from this shell shock and eventually wake up 3 or so months after your transplant and begin growing hair.

 

But again, it's not that simple.

 

When normal follicles wake up from telogen, they begin growing pretty normal hairs. Normal color, thickness, character, etc. But this isn't what happens with a transplant. As we know, the hairs come in differently and then "mature."

 

So, why does this happen? Well a few different thoughts and theories, but I think it basically comes down to several factors:

 

1) The "hair matrix" at the bottom of the follicle that is in charge of providing a lot of the initial, inner protein of the hair shaft may still be a little "shaken up" from surgery, and may not be putting out the same amounts of hair shaft ingredients that it will be as things normalize.

 

2) The inner portions of the follicle (specifically something called the "inner root sheath") is still very jumbled up and distorted from surgery, and this makes the shape of the hair shaft itself odd. This normally results in a hair shaft that looks a little "wiry" or "kinky."

 

So now you're 3 months out of a transplant and you just start growing these hairs. They are coming in a little light in color and thin because the hair matrix of the follicle isn't quite "up to par" yet, and the shape/texture of the shaft is a little off because the inner parts of the follicle are still jumbled around. As you start reaching the 9, 10, 12, etc, month marks, this begins correcting. It obviously starts closer to the bottom of the scalp because this is where the newest part of the hair shaft is, but this maturation really starts to take effect by this point.

 

So, is that the answer? 12 months? Well not for everyone. We make generalizations based upon where most people fall in the "normal curve." But this doesn't mean people don't mature at different rates. And if you go back to the above information, you'll start to understand why.

 

What if the lower portions of your follicles where the hair matrix lies were particularly sensitive? Then maybe your follicles will "wake up" later than others and you won't see maturation until closer to the 18th or 20th month mark. What if the central portion of your grafts distort easier than some patients, and your inner root sheaths take longer to correct themselves? Well, then you may be looking at more "unmanageable" hairs until the later months.

 

This scenario or any variation of this scenario could result in later maturation for you.

 

So, cutting all of this aside: what's the longest I've personally seen maturation take?

 

Honest answer -- and one you probably don't want to hear: basically 24 months. I can think of one patient in particular who looked so immature when I saw him at 12 months, 18 months, etc. His hair shafts were still lightly colored and thin compared to his donor. And this was a guy who did everything he could to minimize graft trauma -- IE FUT with a big staff trained -- and watched VERY carefully -- in handling grafts. When I saw him at 24 months, it had finally matured to the point where I thought it would at 12 months.

 

And probably for the same reasons above. So hopefully this overly detailed -- and probably somewhat boring -- explanation will explain how and why patients can mature late. I also hope it instills the idea that later maturation is not unheard of, especially in regions further back in the scalp. Not making any comments on any specific cases here, but it is possible and you very well could be a late maturer.

 

Hope this helps!

[Dutchie]

Wow, thats interesting. I had no idea the range of time could be that different for each individual patient

[voxman]

Nice explanation Dr. Bloxham.

 

All I know is that after 30 years of watching it go and being 'the man', I'm getting my fuc*&%ing Rock Star Hair back!!

[Dr Blake Bloxham]

Vox and Dutchie,

 

Thanks! Hope it was helpful.

 

And glad to hear the "rock star" hair is coming back in, Vox!

[Alundra]

would I be at risk at being one of those who takes extra long to have the hair mature? I had my hairline completely restored as it was virtually gone, I have lighter hair and light skin and at 7 months now I see quite a bit of hair but it is incredibly think and transparent looking. Is this because I have light hair to begin with? I have noticed on cloudy days and looking at a car window for example I can clearly see the hair better than any light or mirror

[Dr Blake Bloxham]

Hi Alundra,

 

I know we see a lot of big transformations around the 6 month mark or so online, but remember that the 6-7 month mark is still very early in the grand scheme of things. Still seeing more transparent hair around the 7 month mark isn't really out of the ordinary. Especially if you have lighter hair to begin with. And, of course, you may be a little slow/behind on the maturation scale in general.

 

Altogether, I wouldn't be concerned at this point. It's difficult to state whether you're at "risk" of being a slow maturer, but what you describe really isn't out of the ordinary for 7 months.

 

Hope this helps!

[HairShadows]

Glad I used the search function. Your posts are extremely insightful Dr Bloxham, thanks for taking the time to share.

Love your terminology.

I had an explosion of popping at week 11 but although maturing has continued, haven't seen anything new come through at all for the last 3 weeks. I was worrying, but do feel more assured now.