Do Hair Transplants Thin Over Time?

[Melvin- Admin]

Calling all hair transplant veterans, this topic comes up from time to time. It seems to be hotly debated, even amongst us our community. Some say that they will thin if you don't use finasteride. Here is my thing, if that were true, wouldn't someone like Dr. Phil have a thinning donor? Everyone's hair thins with age, even women. Thoughts, rebuttals?

 

Do Hair Transplants Thin Over Time?

@BeHappy @JohnAC71@Tao all you guys who had a hair transplant over 10 years ago. 

[Westview]

This is a really good question.  The answer is hairs that are transplanted from the DHT safe zone should be good for the rest of your life.  In other words they shouldnt fall out under normal circumstances.

What does happen however is that as you age each individual hairs can thin in diameter over time.  This is especially true for grey hairs.  So lets say your hairs have a diameter of 70 microns when you're 25.  By the time you hit 40, 50 or 60 those hairs might then only be 40 or 50 microns thick.  This is why some people feel their hair transplant is thinning.  The hairs arent actually falling out, each individual hair is just getting a bit thinner (which gives the illusion that some of your transplanted hairs may have fallen out).

There are supplement you can take that will help minimize this, and I'll post them later today when I have time

Edited February 5, 2021 by Westview

[Britanium]

Absolutely agree everyone’s hair will thin over time. Some people more than others. And yes it happens to both women and men. 
For me personally though my hair isn’t really thinning too much. And I will be 50 later this year. I’m lucky enough not to have too many grey scalp hairs yet. 
As I would be flat out Norwood 6 without my hts and started my journey over a decade ago I think I would have noticed any transplanted hair falling. And it honestly hasn’t. Yes I get sheds etc but I can honestly say what has been transplanted has stayed. The reason I am still seeking a 6th ht is because my mid scalp has always been weak. The “hair illusion” isn’t good in this area. 
It’s not because I have continued to lose native or transplanted hair. 
And I do not take Fin either. Interestingly I have recently seen quite a few long time members come back and post there current results. To be honest a lot of them actually look better ! 
 

Edited February 5, 2021 by JohnAC71

[aaron1234]

Do HT's thin over time?  Possibly for some, though many men get HT's in regions with thinning native hair.  When that region thins over time are you able to detect whether it was the transplanted hair or native hair that thinned or died out?  I think it's very difficult to say.  I will say that I've had to address my frontal third over the course of 7 surgeries.  Is that because my first strip was taken too high (as determined by both Dr's Ron and Paul Shapiro)?  Or is it because I have a mild case of retrograde alopecia?  Or did I just lose more native hair?  Impossible to say. 

[ciaus]

There are probably some hair follicles even in the donor that check out as we get farther into our senior years at the margins, part of the general falling-apart of the aging process, but nothing on the scale that recent, less than sincere IMO, topics want to suggest.

I think alot of the heat in this debate is actually coming from a much smaller source, people creating multiple user accounts/posts. I feel for those that are sincere and were probably burned by a bad doc/procedure that took hair outside of the safe zone, or that have some undiagnosed medical condition causing the loss. But I have no sympathy for the trolls doing this that just get off on causing drama.
 

And there are too many excellent, highly intelligent HT doctors out there who could be working in other specialties in the medical industry making great money, etc. If HTs really only lasted a few years before falling out, it makes no sense that so many of them would risk compromising themselves ethically, financially and legally. 

[Melvin- Admin]

2 hours ago, ciaus said:

There are probably some hair follicles even in the donor that check out as we get farther into our senior years at the margins, part of the general falling-apart of the aging process, but nothing on the scale that recent, less than sincere IMO, topics want to suggest.

I think alot of the heat in this debate is actually coming from a much smaller source, people creating multiple user accounts/posts. I feel for those that are sincere and were probably burned by a bad doc/procedure that took hair outside of the safe zone, or that have some undiagnosed medical condition causing the loss. But I have no sympathy for the trolls doing this that just get off on causing drama.
 

And there are too many excellent, highly intelligent HT doctors out there who could be working in other specialties in the medical industry making great money, etc. If HTs really only lasted a few years before falling out, it makes no sense that so many of them would risk compromising themselves ethically, financially and legally. 

I agree, I think there is a percentage that thins out, as we age less hair becomes active on our head. I don’t expect to have the same amount of hair at 70, 80, or 90.

[ciaus]

14 hours ago, Melvin-Moderator said:

Calling all hair transplant veterans, this topic comes up from time to time. It seems to be hotly debated, even amongst us our community. Some say that they will thin if you don't use finasteride. Here is my thing, if that were true, wouldn't someone like Dr. Phil have a thinning donor? Everyone's hair thins with age, even women. Thoughts, rebuttals?

I've always wondered about Leno, think he's one of those guys like John Kerry that goes big with a bold grey skull cap hair piece.

 

[asterix0]

I have done some research into this and have even made a thread about it.

It seems to be a combination of things. Senile alopecia is just the generalized reduction in overall density as we age, which is different than male pattern baldness. This plays a part in it potentially.

However, donor dominance, where the donor hair maintains its characteristics when moved to the recipient area, is still inconclusive. Actually, you will see that beard hair and body hair transplants will have the hair change in texture and type when it is transplanted. So complete donor dominance has already been refuted.

In some patients though, even completely healthy hair in the donor area will become thin and begin to fall out if the patient is not on finasteride or other anti androgen. Each individual patients threshold is different in this case.

If you want to be sure and protect your transplanted hair and your donor hair, finasteride should give you that peace of mind, assuming you can tolerate it.

It is important to note that you don't need to have DUPA to have this happen. Your recipient zones just need to be sufficiently androgen sensitive such that they even overload the more resistant donor hairs.

Edited February 5, 2021 by asterix0

[Melvin- Admin]

2 hours ago, asterix0 said:

I have done some research into this and have even made a thread about it.

It seems to be a combination of things. Senile alopecia is just the generalized reduction in overall density as we age, which is different than male pattern baldness. This plays a part in it potentially.

However, donor dominance, where the donor hair maintains its characteristics when moved to the recipient area, is still inconclusive. Actually, you will see that beard hair and body hair transplants will have the hair change in texture and type when it is transplanted. So complete donor dominance has already been refuted.

In some patients though, even completely healthy hair in the donor area will become thin and begin to fall out if the patient is not on finasteride or other anti androgen. Each individual patients threshold is different in this case.

If you want to be sure and protect your transplanted hair and your donor hair, finasteride should give you that peace of mind, assuming you can tolerate it.

It is important to note that you don't need to have DUPA to have this happen. Your recipient zones just need to be sufficiently androgen sensitive such that they even overload the more resistant donor hairs.

I disagree that donor dominance is inconclusive there are several HT patients who had their HT’s over 20 years ago. If the hair wasn’t DHT resistant it would’ve thinned by now. @Pat - Community Publisher the founder of the forum had his first HT in 99. His hair looks just as good as it did back then. He doesn’t take fin either. 

Now, I will concede, it depends on the person and where the hair is taken. As @aaron1234 pointed out, hair may be taken from an area for example like the nape which is not resistant to DHT. That could cause the hair to thin. But only slightly.

[Melvin- Admin]

But I like this discussion guys, I knew this topic would be debatable. I love to hear different points.

[asterix0]

1 hour ago, Melvin-Moderator said:

I disagree that donor dominance is inconclusive there are several HT patients who had their HT’s over 20 years ago. If the hair wasn’t DHT resistant it would’ve thinned by now. @Pat - Community Publisher the founder of the forum had his first HT in 99. His hair looks just as good as it did back then. He doesn’t take fin either. 

Now, I will concede, it depends on the person and where the hair is taken. As @aaron1234 pointed out, hair may be taken from an area for example like the nape which is not resistant to DHT. That could cause the hair to thin. But only slightly.

This is the point I trade to make in the other thread though. The burden of proof is not upon an individual to find a case where the transplant succeeded. 

Just one case, taken from the universally accepted safe zone, so only the strictest Norwood 7 area, where it then failed in the recipient area, would be enough to dispute the donor dominance theory. 

To give an analogy with gravity. It isn't proof to drop 100 apples and say, hey they all fell to the ground, so gravity must be true. Only one apple that didn't fall would be sufficient evidence to disprove it. Unfortunately, there are several studies and individual patient cases regarding hair transplants, to continue the analogy, that sometimes the apple indeed does not fall to the ground. 

These cases are many years after the fact, so it is not as if we can say the yield from the 12-18 month settling period was poor.

For these individuals, I believe, and I am obviously not a doctor nor a researcher in this area, that their recipient area's affinity for androgenic alopecia exceeded the resistant of their individual donor grafts. 

However, I have yet to see, and if anyone has a case I would like to see it, where a patient on finasteride or dutasteride then had a failed transplant many years down the road. I do believe that finasteride + the added inherent resistance of donor hair should be sufficient protection for 99.99% of non DUPA patients. Even for DUPA though, Dr. Lorenzo has video accounts of patients with DUPA getting strengthened donor areas and better transplant results. These videos are public on youtube and are open for everyone to view. So I don't think even a DUPA patient is completely out of luck when it comes to hair restoration.

But it is entirely a case by case basis. Some guys have very quick hair loss on top yet very strong donors. Some have weak donors. Everything is a spectrum. The stronger one's donor is and the weaker one's androgen susceptibility is on top, the stronger the chance of a successful transplant.

 

Edited February 6, 2021 by asterix0

[asterix0]

I am also not a finasteride advocate by any means. It is just unfortunately the best weapon in the arsenal we have at the moment. I'm optimistic about new treatments such as CB-03-01, perhaps samumed, septipitrant, but if someone wanted to ensure their best possible transplant outcome, I would advise them to use finasteride, at least on a reduced, M-W-F scale if they cannot tolerate the daily dose.

[ciaus]

13 hours ago, asterix0 said:

The burden of proof is not upon an individual to find a case where the transplant succeeded. 

Just one case, taken from the universally accepted safe zone, so only the strictest Norwood 7 area, where it then failed in the recipient area, would be enough to dispute the donor dominance theory. 

To give an analogy with gravity. It isn't proof to drop 100 apples and say, hey they all fell to the ground, so gravity must be true. Only one apple that didn't fall would be sufficient evidence to disprove it. Unfortunately, there are several studies and individual patient cases regarding hair transplants, to continue the analogy, that sometimes the apple indeed does not fall to the ground. 

 

Confirming that an apple hits the ground, if only hair loss in humans had one cause like gravity. Your analogy is terrible.

Aside from dht and the currently known genes involved in hair loss, there are almost certainly other unknown genes directly and indirectly involved, molecular level chemistry, individual environmental and lifestyle factors, immune system malfunctions, diseases known and still unknown, the aging process, etc. The root causes of hair loss can be ridiculously complex and we'll probably never fully understand all of them.

And any one or combination of those would be enough to choke out a donor hair where it currently lives or after you move it. 

 

Unlike the other discussions started on this, I can honestly say Melvin's comes from good intentions. To the small minority of you that aren't trolling my advice would be to do the doomsday speculations somewhere else until there's a strong body of evidence and studies to support them. Guys coming to this forum are often in a vulnerable place, desperate, even paranoid, willing to do and try things that could seriously compromise their health trying to hang on to their hair. There's a burden of responsibility we all have and should appreciate, because how and what we post can make the difference in whether these guys get to a better or worse place when it comes to their hairloss. 

[asterix0]

5 hours ago, ciaus said:

 

Confirming that an apple hits the ground, if only hair loss in humans had one cause like gravity. Your analogy is terrible.

Aside from dht and the currently known genes involved in hair loss, there are almost certainly other unknown genes directly and indirectly involved, molecular level chemistry, individual environmental and lifestyle factors, immune system malfunctions, diseases known and still unknown, the aging process, etc. The root causes of hair loss can be ridiculously complex and we'll probably never fully understand all of them.

And any one or combination of those would be enough to choke out a donor hair where it currently lives or after you move it. 

 

Unlike the other discussions started on this, I can honestly say Melvin's comes from good intentions. To the small minority of you that aren't trolling my advice would be to do the doomsday speculations somewhere else until there's a strong body of evidence and studies to support them. Guys coming to this forum are often in a vulnerable place, desperate, even paranoid, willing to do and try things that could seriously compromise their health trying to hang on to their hair. There's a burden of responsibility we all have and should appreciate, because how and what we post can make the difference in whether these guys get to a better or worse place when it comes to their hairloss. 

Umm, ok, so you're saying that any one of those factors can cause a hair transplant to fail.

Lifestyle in theory can negatively affect hair, yet we see homeless people who are certainly malnourished, diseased, yet have full heads of hair. Does that mean I disprove your other causes theory?

There are people other forms of autoimmune conditions, much more serious and potentially life threatening, yet they still have full heads of hair. Does that mean I disprove your other causes theory? 

It just doesn't make sense to say, well due to how complex the human organism is, that the transplantation process may fail due to many vague and nebulous reasons that "could" potentially cause it to fail. 

When you go to a consultation, did the doctor tell you: Your hair transplant will be permanent if taken from the absolute safe zone, and if you do not have any underlying auto immune conditions, have all healthy biological metrics such as blood pressure, good cardiovascular health, etc. Will any doctor tell you this? 

The doctor did a microscopic evaluation of your hair, found your donor thick and robust, confirmed you do not have DUPA, everything was done by the book. The transplant in fact yielded normally and well, yet 4-5 years down the road the hair began thinning and falling out again.

How could this be? 

The most likely reason is that hair, when transplanted from one part of the body to the other, is affected by the recipient area to some degree. This degree varies from person to person. In some people, the effect may be strong enough that without additional protection from drugs such as finasteride, the transplant will over time fail.

There is nothing nefarious in this proclamation. This site should be an educational resource for patients that allows them to make the most informed decisions possible, and that includes all stages of the process, not just picking a particular surgeon or the FUT or FUE method.

This includes giving patients the information that they run an increased risk of a failed transplant if anti androgens are not taken. Many surgeons will tell you this. Many others will not. One can only hope that despite what patient's hear from one source, they do their own comprehensive research to get all the facts about this entire process before taking a significant financial and emotional commitment to the procedure.

Edited February 6, 2021 by asterix0

[asterix0]

I don't get why there is any sanctity about this particular issue.

If we see an example of malnourishment causing hair loss, and another where it doesn't happen, then we come to the conclusion that it may be a contributing factor to hair loss.

If we see an example of auto immune disorders causing hair loss, and another where it doesn't happen, then we come to the conclusion that it may be a contributing factor to hair loss.

Yet when we see an example of a hair transplant thinning over a span of 4-5 years, and another case where it doesn't happen, we are too afraid to say that donor hair may be susceptible to the recipient site, yet we clearly see instances of it happening. Why is that? It isn't fair to patients who are expecting one thing, yet get devastated down the road because they were misinformed about the possibility. 

Having said all this, I still support hair transplants. I plan to get one myself. They are life changing procedures and have come a long way. All I am advocating for is open transparency and acknowledgement of all possible scenarios so that patients can make the most informed decisions that they can.

Edited February 6, 2021 by asterix0

[Melvin- Admin]

Dr. Shapiro’s response was pretty good, you guys should check it out.

https://www.instagram.com/tv/CK9jreCjv10/?igshid=efc2s4c8bmc9

[ciaus]

1 hour ago, asterix0 said:

All I am advocating for is open transparency and acknowledgement of all possible scenarios so that patients can make the most informed decisions that they can.

 

This is where we fundamentally disagree, this forum is not the optimal place for "all possible scenario" speculations, especially negative ones, to be endlessly debated. Its about practical knowledge and research substantiated with real results to help people improve their lives. Some of the vulnerable paranoid guys coming here looking for help may not have the clarity of thought like you to put all this into proper perspective, and instead may needlessly rule out getting a hair transplant, spiraling deeper into depression, trying crazy drugs and other unsubstantiated potions instead. 

 

 

43 minutes ago, Melvin-Moderator said:

Dr. Shapiro’s response was pretty good, you guys should check it out.

https://www.instagram.com/tv/CK9jreCjv10/?igshid=efc2s4c8bmc9

Melvin do you have plans to put this on youtube? I don't do social media and didn't find it when I just searched.

[asterix0]

@ciaus I don't think it anyone here has the time nor the will to endlessly debate anything. We are not medical researchers, we cannot perform any experiments, our resources are very limited. We can only provide information and hope that patients can use it wisely to make the best possible decisions for themselves. 

What is your response to these publications?

https://www.jcasonline.com/article.asp?issn=0974-2077;year=2020;volume=13;issue=4;spage=292;epage=297;aulast=Kumaresan

Abstract

Background: The longevity of the grafted hair follicles is still debated and there are limited literature available on this topic. Aim: To assess the longevity of transplanted hairs after follicular unit transfer (FUT). Materials and Methods: A total of 112 patients who had undergone FUT were included in the study and their results at the end of 4 years were compared with the 1 year post surgery results by standardized images. The reduction in the density of the grafted hair follicles was graded by a blinded observer in a grading scale. Results: Among 112 subjects 50.89% had grade 4, 46.42% had grade 5, 2.67% had grade 6 alopecia respectfully. The 4 year follow up grading of hair loss showed moderate reduction in transplanted hair density in 55.35%, slightly reduced density in 27.67% greatly reduced in 8.03% and no change in the density in 8.92% subjects. Conclusion: The hair grafts transplanted may not last permanently for all the subjects. Recipient site influence might affect the growth and long-term survival of the transplanted hairs.

 

Here are some more examples:

https://pubmed.ncbi.nlm.nih.gov/16931898/

Abstract

Pathogenetic mechanisms in androgenetic alopecia are not yet fully understood; however, it is commonly accepted that androgens like testosterone (T) and 5alpha-dihydrotestosterone (5alpha-DHT) inhibit hair follicle activity with early induction of the catagen. Thus, we investigated the influence of T and 5alpha-DHT on proliferation, cell death and bcl-2/bax expression in cultured dermal papilla cells (DPC) from nonbalding scalp regions of healthy volunteers. T and 5alpha-DHT induced apoptosis in DPC in a dose-dependent and time-related manner; in addition a necrotic effect due to T at 10(-5) M was found. Interestingly, bcl-2 protein expression was decreased in T- and 5alpha-DHT-treated cells, leading to an increase in the bax/bcl-2 ratio. In addition, T and 5alpha-DHT induced proteolytic cleavage of caspase 8 and inhibited proliferation of DPC at 10(-5) M. High concentrations of T and 5alpha-DHT were needed to induce apoptotic effects in DPC. These data suggest that DPC from nonbalding scalp regions do have the capacity to undergo apoptosis, but need a high androgen stimulus. The present study provides an interesting new pathogenetic approach in androgenetic alopecia.

Even Dr. Bernstein, a respected surgeon, raises suspicions about it with evidence:

https://www.bernsteinmedical.com/research/donor-dominance-revisited/

[ciaus]

49 minutes ago, asterix0 said:

@ciaus I don't think it anyone here has the time nor the will to endlessly debate anything. We are not medical researchers, we cannot perform any experiments, our resources are very limited. We can only provide information and hope that patients can use it wisely to make the best possible decisions for themselves. 

What is your response to these publications?

 

Its not just us laymen, even your medical researchers are very limited when it comes to resources and experiments. The Bernstein link is from almost 20 years ago with oddball transplants to eyebrows and legs. And the other link from last year is one study of only a 112 patients, from authors and patient subjects that look like they are from India, about as trustworthy as Turkey when it comes to getting botched transplants.

There's not enough evidence supporting this to be on the typical guy's radar thinking about getting a transplant. 

Edited February 7, 2021 by ciaus

[Westview]

There are a bunch of supplements you can take that will reverse thinning hair.

And by that I mean it wont stop or reverse hairloss, but it will thicken individual hairs in diameter.

 

1. Viviscal: 

2.  Dermaven: 

4. Hair, Skin and Nails: 

 

The reviews for Viviscal are excellent.  Here's some of them:

 

 

 

[asterix0]

14 hours ago, ciaus said:

 

Its not just us laymen, even your medical researchers are very limited when it comes to resources and experiments. The Bernstein link is from almost 20 years ago with oddball transplants to eyebrows and legs. And the other link from last year is one study of only a 112 patients, from authors and patient subjects that look like they are from India, about as trustworthy as Turkey when it comes to getting botched transplants.

There's not enough evidence supporting this to be on the typical guy's radar thinking about getting a transplant. 

These are insufficient data points that I provided, that is surely true.

But there are many patient accounts scattered across forums that also corroborate this. Not enough to be a majority by any means. But enough in number that suggests it can happen. Will it happen to you, to the moderator, or the majority of patients? Probably not. But we don't really know.

Due to this I feel the risk is too high for me, and I will continue to take finasteride to maximize my chances of a successful transplant outcome for the long term, at least until a better treatment comes along.

Edited February 7, 2021 by asterix0

[Al - Moderator]

@asterix0 The first study with 112 cases, it looks like all of them were bad hair transplants to begin with. That's like one or two bad clinics performing 112 hair transplants and botching them all because they don't know what they are doing and then claiming hair transplants don't work because the hair doesn't grow well, so transplanted hair must not have donor dominance like we've heard for the past 50 years. They call it FUT, but I'm nearly positive it's actually FUE that they were doing. They called it Follicular Unit Transfer, Not Follicular Unit Transplantation. The Transfer word leads me to believe they are doing FUE punch grafts and implanting those.

Your real question should be how many people who have gone to well known North American clinics that have been doing FUT for over 20 years have patients that lost most of their transplanted hair over the years. Have you ever heard of a Hasson and Wong patient from years ago come here and say their transplant from 10 or 20 years ago all fell out? No. It doesn't happen. Why is it only happening recently? Why does it happen so much more with hair mill clinics that are doing multiple FUEs a day using primarily techs? Those are where the issues are. Bad extraction and implanting techniques. Some of the hair may grow for a while, but the follicles are too damaged and eventually die out. This was an extremely rare occurrence with FUT for many years. Why is that?

 

In your 2nd study it only claims the hair takes on characteristics of hair that grew or is growing in the area it is transplanted to. It doesn't say the transplanted hair develops a sensitivity to DHT. I sort of equate this to someone going to another country to live with a family who all have a peanut allergy or something. Eventually I will be eating more and more of the foods they eat, learning their language, learning their customs, but I'm never going to develop a peanut allergy that they have.

 

 

 

 

[asterix0]

@BeHappy Even Eugenix Clinic themselves, recommended on this forum and consistently posting fantastic results, disputes your claims:

https://www.youtube.com/watch?v=rJctY_jvd6U

Further, the number of patients posting on forums compared to the total number of transplanted patients is a very small minority. We also do not know how many of these patients are on finasteride.

How do you explain beard hair taking on characteristics of the recipient hair after being transplanted? There are countless examples of this, from posters here and other forums. You can ask a hair transplant doctor yourself who will mention that body hair will take on characteristics of your native hair (to some extent) when transplanted on top.

How do you explain such cases such as these?

https://www.hairlosstalk.com/interact/threads/transplanted-hair-permanent-or-not.127909/

Edited February 7, 2021 by asterix0

[asterix0]

However, that is only one yet another data point. And who am I, just a random person on the internet right? So just as I would recommend to anyone else, do your due diligence by contacting multiple, reputable hair transplant surgeons recommended on this website, and through your own research, yourself. 

Contact a reputable surgeon and present them with these questions yourself. Ask them have they or their colleagues seen this phenomenon in some patients? Ask them, just strictly medically and scientifically speaking, if they have not seen it, do they still think it happens in the general sense? Do they think surgeon expertise and a perfectly executed transplant can overcome this, by taking only the healthiest donor hairs?

A QA with Dr. Bloxham on this subject would be quite useful.

Even on his own website, he states:

Because hair follicles are taken from regions that are genetically resistant to hair loss during these procedures, for many patients, the newly implanted hair lasts forever.

https://fellermedical.com/how-long-will-a-hair-transplant-last/

He is considered one of the elite FUT surgeons in North America and I would imagine his opinion would be quite relevant.

It states further as a reason why your transplant may not be fully successful: 

• Experiencing other environmental and genetic factors

What are these other genetic factors he speaks of? Can one of them be an increased susceptibility to DHT in the recipient zone for some patients? These are worthwhile questions to ask. 

Edited February 7, 2021 by asterix0