Dr. Bisanga - Will My Hair Transplant Last?

[Raphael84]

Will My Hair Transplant Last?

 

 

 

[Britanium]

Yes 🙌 exactly this ! Thanks for posting @Raphael84 this has been asked often over the last few months. Good to hear a Drs explanation! 🙏

[Navthedon]

So this is exactly what is happening to me at the moment, the hairline I had transplanted is now thinning (after four years). I have been told this might have something to do with seasonal 'shedding' but im not so sure - does that even exist? My question to you now is this...do I go for another transplant or get back on the meds and see if they help? Or will PRP help? Thanks 

[TorontoMan]

2 hours ago, Navthedon said:

So this is exactly what is happening to me at the moment, the hairline I had transplanted is now thinning (after four years). I have been told this might have something to do with seasonal 'shedding' but im not so sure - does that even exist? My question to you now is this...do I go for another transplant or get back on the meds and see if they help? Or will PRP help? Thanks 

Every hair on your head has a life cycle. The anagen phase, which is the phase in which your hair grows , has a cycle about 3 years on average. Each hair could be in a different cycle at any given time, thats why some hairs shed and others don't, the hair that shed was coming off its anagen phase after many years (if it is healthy hair, minaturized hair have smaller cycle times). What ends up happening when you have a hair transplant is the hairs from your donor are being extracted, they are automatically forced into a telegon phase, this is just simply due to the shock of the surgery, and that is the reason why you have a typical 3-4 month "ugly duckling phase" or recovery, because all these hairs have been taken out of the anagen phase due to shock and put to sleep in the telogen phase. Post surgery after a hair transplant, when these hairs start to grow again they have all started a new anagen phase, in which they will grow for 3-4 years and then enter a new cycle of sleep again, the problem here is that all these transplanted hairs have started a similar anagen phase at the same time, meaning they are synchornized. So when time comes that your hair goes into the telegen phase, which it will always, you will notice most of your hair transplanted hairs fall at the same time due to this shed, and then you'll panic and think your hair transplant is wearing off. Dr. Bisanga in this video is describing general thinning, which should be accepted by every man, while we are cheating our nature and genetics with hair transplants, we cannot yet cheat simply getting old and aging, at some point even men with out MPB should understand that your cells degrade and you will thin naturally. 

Look up anagen synchornization, a few doctors have made videos about it online, including dr. Sethi. 

Edited March 15, 2021 by TorontoMan

[Ajamilo]

48 minutes ago, TorontoMan said:

Every hair on your head has a life cycle. The anagen phase, which is the phase in which your hair grows , has a cycle about 3 years on average. Each hair could be in a different cycle at any given time, thats why some hairs shed and others don't, the hair that shed was coming off its anagen phase after many years (if it is healthy hair, minaturized hair have smaller cycle times). What ends up happening when you have a hair transplant is the hairs from your donor are being extracted, they are automatically forced into a telegon phase, this is just simply due to the shock of the surgery, and that is the reason why you have a typical 3-4 month "ugly duckling phase" or recovery, because all these hairs have been taken out of the anagen phase due to shock and put to sleep in the telogen phase. Post surgery after a hair transplant, when these hairs start to grow again they have all started a new anagen phase, in which they will grow for 3-4 years and then enter a new cycle of sleep again, the problem here is that all these transplanted hairs have started a similar anagen phase at the same time, meaning they are synchornized. So when time comes that your hair goes into the telegen phase, which it will always, you will notice most of your hair transplanted hairs fall at the same time due to this shed, and then you'll panic and think your hair transplant is wearing off. Dr. Bisanga in this video is describing general thinning, which should be accepted by every man, while we are cheating our nature and genetics with hair transplants, we cannot yet cheat simply getting old and aging, at some point even men with out MPB should understand that your cells degrade and you will thin naturally. 

Look up anagen synchornization, a few doctors have made videos about it online, including dr. Sethi. 

thanks for a really good answer
Just wondering: after the new cycle will it come back again or start to miniaturize?

[Navthedon]

Thanks, That was a very detailed  reply. How long does this “telegen” phase last. This is how my hairline looks at the moment : only the front peak of the hairline was done and that is what has “thinned”. 

how long do I have to wait for it to go back to “normal” and will it thicken up again? 

[TorontoMan]

4 hours ago, Ajamilo said:

thanks for a really good answer
Just wondering: after the new cycle will it come back again or start to miniaturize?

Yes hairs grow back again when they enter the Anagen phase. Whether or not they will miniaturize depends on your MPB, so there’s no one answer for any particular person, it all depends on your genetics, whether or not you’re taking preventive steps etc. Typically, hairs that are transplanted will last longer without miniaturizing, because they’re often taken from a more “safe” and dht resistant zone. Most hair loss is due to mpb and it is progressive, unfortunately it is naive thinking to believe it will stop or “stabilize”, so over time most hair miniaturizes if you don’t reduce your androgens ahead of that process. 

 

4 hours ago, Navthedon said:

Thanks, That was a very detailed  reply. How long does this “telegen” phase last. This is how my hairline looks at the moment : only the front peak of the hairline was done and that is what has “thinned”. 

how long do I have to wait for it to go back to “normal” and will it thicken up again? 

Telogen lasts typically 3-4 months, could last longer in some individuals. Remember your hair in the donor isn’t dht proof, some individuals lose hairs even in the back and sides. While for you It seems to me you have just experienced a shed, and things should return, over time your best practice is to get on meds to maintain that hair. 

Edited March 16, 2021 by TorontoMan

[Navthedon]

Thank you again. I will be waiting with tension over this period

[TorontoMan]

58 minutes ago, Navthedon said:

Thank you again. I will be waiting with tension over this period

May I ask how old you are?

[asterix0]

@Raphael84 Could you please follow up with Dr. Bisanga and ask this question:

Imagine we extract only grafts from the safest Norwood 7 donor area.

Does Dr. Bisanga advocate that the lifespan of these grafts will be the same if they are transplanted into the recipient area, compared to if they were never transplanted at all? If I understood his video correctly, this is what he said, but I wanted to double check that he is claiming this. 

Further, does he find this universally to be true, or is it dependent on individual patient androgen sensitivity? Meaning, do some patients still need to take finasteride because their DHT sensitivity in the recipient area will still harm the "safe" donor grafts over time?

 

[Navthedon]

Of course. 45. 

[Raphael84]

Great comments and conversation here which is great to see.

@TorontoManhas provided some great insight.

18 hours ago, Navthedon said:

I have been told this might have something to do with seasonal 'shedding' but im not so sure - does that even exist?

Seasonal shedding is a real thing, and I have been in contact with several patients over the winter period who have reported real concern with increased shedding, and they have since explained that it became more controlled almost overnight. Seasonal shedding is generally reported in the colder winter months, there are a few speculative explanations as to why. Having said that, a seasonal shed would likely be experienced more generally as opposed to just your transplanted hairline. This may be the case but you may not be aware other than in your hairline unless you are really paying attention throughout and/or notice more hairs on your pillow, in the sink etc.

18 hours ago, Navthedon said:

My question to you now is this...do I go for another transplant or get back on the meds and see if they help?

Without knowing anything specific about your case, but having seen the photo that you have since shared, based on the frontal hairline image you appear to have a great head of hair, especially at 45 years old. Im not sure what may be happening begin your hairline.
Medication is a personal decision as we all know, and so you will have your own preferences and reasons why you are not currently using medication. Hair loss is progressive and will likely continue to evolve to some degree without a regimen in place.
With your current concerns, the last thing that you want to do right now is jump into another transplant. At 45 with your current hairline photo, there would be an argument if you even needed a further procedure, but that would be down to your own feelings, but certainly give it some time to see how things may recover over the next months, and depending where you may be located, revisit the clinic for consultation to assess levels of miniaturisation throughout your scalp including your donor area, and that would then provide further details allowing a more informed decision regarding the possible "need" for medication.

11 hours ago, asterix0 said:

Does Dr. Bisanga advocate that the lifespan of these grafts will be the same if they are transplanted into the recipient area, compared to if they were never transplanted at all? If I understood his video correctly, this is what he said, but I wanted to double check that he is claiming this. 

Further, does he find this universally to be true, or is it dependent on individual patient androgen sensitivity? Meaning, do some patients still need to take finasteride because their DHT sensitivity in the recipient area will still harm the "safe" donor grafts over time?

Thats correct @asterix0
The "lifespan" of the follicle would be expected to be the same regardless of it remaining in the donor area or being placed within the recipient area.

I will copy from a previous thread with a topic regarding the safe donor area that we previously discussed.

"We have not seen evidence to suggest that transplanted grafts become more DHT susceptible when placed in the recipient area. 
The entire idea of hair restoration is based upon the fact that follicles taken from the donor area, which is less susceptible to DHT, will maintain their genetic makeup (donor dominance) and resist DHT. If this was not the case, then would be likely that a much larger percentage of patients would experience thinning and loss of transplanted hair in the recipient area. This would then be a common phenomenon. Even patients who had surgery in the 80s and before, with old style hair plugs, have still maintained that transplanted hair today, some 40+ years later.

Whilst some high Norwood patients may have no or lower levels of miniaturisation in their donor area at the time of consultation/surgery, as you explained if they are not using medication, this will likely be the continued progressive nature of androgenetic alopecia that is causing miniaturisation in the donor area.
Also, many doctors are still not focusing on miniaturisation in the donor area, and are not assessing this and providing that empirical data."

This can be found at the following thread -

[asterix0]

Thank you @Raphael84. I guess the reason for me asking is many patients, especially high Norwood ones, already have "some" donor thinning. Now, maybe this hair will not fall out during their lifetime, but it is nevertheless weaker than, let's say a Norwood 2 donor patient who wants to just straighten out their hairline a bit.

High Norwood patients usually have some degree of DUPA as well, from what I have seen. 

However, their donor hair still doesn't fall out all the way like on the top, even though it is weakened, since donor area is inherently different than the recipient one, there is less damage via DHT, calcification of the scalp, fibrosis, poor blood flow, etc. 

So the question is, if you are headed toward a higher Norwood (5/6/7), how feasible is a transplant because your donor hair is already somewhat compromised? If you are young (under 40) I think it would be quite risky without finasteride, would you agree? Even if your "final pattern" is already somewhat evident. Since I think the younger you are, with aggressive baldness, the higher the likelihood your androgen sensitivity is higher, meaning without DHT reduction, your grafts will be under even more pressure from all the factors of mpb. 

I myself am one of these patients, with signs of DUPA that have been somewhat strengthened by my continuous use of finasteride. So because I am young (29), I feel that if I quit finasteride, my donor will not be stable enough, and my androgen sensitivity will be too high to risk getting a transplant. 

 

 

 

Edited March 16, 2021 by asterix0

[Melvin- Admin]

Excellent video and topic. Dr. Bisanga's YouTube is gonna blow up.

[Raphael84]

9 hours ago, asterix0 said:

Thank you @Raphael84. I guess the reason for me asking is many patients, especially high Norwood ones, already have "some" donor thinning. Now, maybe this hair will not fall out during their lifetime, but it is nevertheless weaker than, let's say a Norwood 2 donor patient who wants to just straighten out their hairline a bit.

High Norwood patients usually have some degree of DUPA as well, from what I have seen. 

However, their donor hair still doesn't fall out all the way like on the top, even though it is weakened, since donor area is inherently different than the recipient one, there is less damage via DHT, calcification of the scalp, fibrosis, poor blood flow, etc. 

So the question is, if you are headed toward a higher Norwood (5/6/7), how feasible is a transplant because your donor hair is already somewhat compromised? If you are young (under 40) I think it would be quite risky without finasteride, would you agree? Even if your "final pattern" is already somewhat evident. Since I think the younger you are, with aggressive baldness, the higher the likelihood your androgen sensitivity is higher, meaning without DHT reduction, your grafts will be under even more pressure from all the factors of mpb. 

I myself am one of these patients, with signs of DUPA that have been somewhat strengthened by my continuous use of finasteride. So because I am young (29), I feel that if I quit finasteride, my donor will not be stable enough, and my androgen sensitivity will be too high to risk getting a transplant. 

Thanks @asterix0and well said.
 

9 hours ago, asterix0 said:

especially high Norwood ones, already have "some" donor thinning. Now, maybe this hair will not fall out during their lifetime, but it is nevertheless weaker than, let's say a Norwood 2 donor patient who wants to just straighten out their hairline a bit.

The question that I would ask is that if a patient (under 40 as your example) is a high Norwood and with some thinning and miniaturisation in their donor area, are they a good or even viable candidate for surgery? This will depend on many unique factors and ultimately what level (percentage) of miniaturisation that their donor thinning represents. Knowing that graft demands are high due to their higher Norwood pattern of loss, then considering surgery with patients with levels of miniaturisation may present risk in terms of potential yield and longevity of result. When miniaturisation may reach higher than preferred levels, then the risk/reward becomes unbalanced and surgery would not be an option, until the patient was able to potentially stabilise and improve levels of miniaturisation through using hair loss preventative medication such as finasteride and oral minoxidil.

Dr. Bisanga feels that any individual who is experiencing loss under the age of 35-40 would ideally consider medication. Whether they are a candidate for surgery without medication will depend on there personal situation in terms of age, pattern of loss, prediction of future loss, donor availability, family history etc.
I agree with your comment -

9 hours ago, asterix0 said:

if you are headed toward a higher Norwood (5/6/7), how feasible is a transplant because your donor hair is already somewhat compromised? If you are young (under 40) I think it would be quite risky without finasteride, would you agree?

Any individual with a higher Norwood pattern of loss under the age of 40 has experienced an aggressive type of loss. With this in mind and knowing that hair loss is progressive and will continue into our older age, then without medication the possibility of further evolution in terms of further dropping in the lower crown and lateral humps and potential thinning and miniaturisation in the donor is likely higher. Therefore not only may miniaturisation have an impact on longevity of transplanted hair, but the risk of further loss may result in transplanted hair on top becoming disconnected to native hair as the back and side further drop. This is why even individuals with extensive loss, can benefit from medication both in terms of slowing further loss and supporting a healthy donor if considering a hair transplant.

[asterix0]

Thank you @Raphael84. I guess since I have seen numerous cases of professional athletes (football players, tennis players who such as rafael nadal) who are probably not on finasteride due to performance and maybe doping regulations, who seemed to have lost transplanted hair over time.

Because they are young their hair loss is certainly more aggressive, but I would hope they went to a surgeon who did not extract miniaturized donor grafts. What I am hypothesizing that happened is because they may have higher DHT and testosterone, and young aggressive baldness, even their "safe zone" donor grafts may have been compromised without finasteride. Do you think this is possible?

 

 

[Raphael84]

This is absolutely possible. At the time of surgery, levels of miniaturisation within the "safe" donor area, may have been non existent or in the lower range meaning candidacy when considering all factors was acceptable. 
Surgery may have gone smoothly and performed to a high standard and all grafts extracted were strong and healthy without signs of miniaturisation.
Then potentially without medication and with the progression of hair loss, the donor area began to experience miniaturisation and due to the transplanted hair taken from within this same donor area expressing donor dominance and continuing in the same fate that it would have if it had remained in the donor area, the quality of hair begins to decline.

This is the reality of progressive loss and shows the importance of accurately understanding the donor area.

[Navthedon]

29 minutes ago, Raphael84 said:

This is absolutely possible. At the time of surgery, levels of miniaturisation within the "safe" donor area, may have been non existent or in the lower range meaning candidacy when considering all factors was acceptable. 
Surgery may have gone smoothly and performed to a high standard and all grafts extracted were strong and healthy without signs of miniaturisation.
Then potentially without medication and with the progression of hair loss, the donor area began to experience miniaturisation and due to the transplanted hair taken from within this same donor area expressing donor dominance and continuing in the same fate that it would have if it had remained in the donor area, the quality of hair begins to decline.

This is the reality of progressive loss and shows the importance of accurately understanding the donor area.

I am 45 - judging from my pics would you say this is miniaturisation or shedding (with the returning hair being the same quality as before)?

[Raphael84]

@Navthedon
To have an accurate and definitive answer, I would recommend contacting your surgeon and if feasible, schedule a follow up consultation. Your surgeon can then assess if you have any miniaturisation, the "health" of your donor area and compare density and hair count in your hairline/recipient area to your previous data. This would provide the most accurate and actionable feedback.