How safe is a second transplant on a previously transplanted area?

[SeanT1]

 

Hi everyone, hope you all are enjoying your evening.

I'm close to eight months P.O at the moment from a transplant on my hairline, 
I'm not happy with the density.  I understand that it may be too soon to judge but to be honest I do not think any more hairs will sprout.
I simply can't get away with my hair in the sun, it ends up looking way too thin.

How safe is a second transplant on a previously transplanted area?
Could this cause damage to follicles from the first transplant?

Any ballpark number of grafts in mind to increase density on my hairline?

Thanks.

 

s

 

 

[Future Hair Doc]

This can be done but you're still early at 8 months. It can take up to 1.5 years to see full results. Also, you shouldn't get another hair transplant surgery for at least 1 year after your prior surgery. Are you on finasteride and minoxidil? They can both help

[SeanT1]

Just now, Dr. Suhail Khokhar said:

This can be done but you're still early at 8 months. It can take up to 1.5 years to see full results. Also, you shouldn't get another hair transplant surgery for at least 1 year after your prior surgery. Are you on finasteride and minoxidil? They can both help

Hi, on Finasteride yes.
Thinking of taking a leap and trying SMP for density.

Edited April 18, 2022 by SeanToman

[BDK081522]

It's very safe if you go to a reputable and highly skilled surgeon. They implant in between native hair on a regular basis without permanently disrupting. Your newly transplanted grafts may get shocked out due to surgical trauma but they will grow back. I would guess 500-700 grafts should get you where you want to be. 

Edited April 18, 2022 by BDK081522

[SeanT1]

10 hours ago, BDK081522 said:

It's very safe if you go to a reputable and highly skilled surgeon. They implant in between native hair on a regular basis without permanently disrupting. Your newly transplanted grafts may get shocked out due to surgical trauma but they will grow back. I would guess 500-700 grafts should get you where you want to be. 

Thanks, my biggest worry was damaging existing grafts.  I'm only 26 years old you see.
Might be considering SMP to improve density but I'm unsure how natural that will look.

Edited April 19, 2022 by SeanToman

[Gatsby]

SMP would be a good option but you must wait at least 12 months since your last surgery before going ahead on this. You also want to wait 12 months at least to see what you you have to work on. At 26 though I wouldn't be a rush to make it 'perfect' (though I get your thinking at 26). I would really want to see how much finasteride is actually stabilizing your current MPB before going forward on anything. From 26 to even just 36 your hair loss and donor condition could change dramatically. You really want to be focusing on how your hair will look over the lifespan. Trust me. I'm 55 and you will care as much about your hair at 26 as you will at 56! Why do you think I'm going back to Thailand in 10 days? 🤣😉👍

[SeanT1]

4 hours ago, Gatsby said:

SMP would be a good option but you must wait at least 12 months since your last surgery before going ahead on this. You also want to wait 12 months at least to see what you you have to work on. At 26 though I wouldn't be a rush to make it 'perfect' (though I get your thinking at 26). I would really want to see how much finasteride is actually stabilizing your current MPB before going forward on anything. From 26 to even just 36 your hair loss and donor condition could change dramatically. You really want to be focusing on how your hair will look over the lifespan. Trust me. I'm 55 and you will care as much about your hair at 26 as you will at 56! Why do you think I'm going back to Thailand in 10 days? 🤣😉👍

Great answer, thanks Gatsby.
I've been excited for your progress also.

Been on Finasteride for two years now I think, 1mg a day.
Have their been reports of others that take this yet hair loss continues over 10 years?

As you say, being young you want your hair to be as perfect as possible when you're in a room full of people the same age with zero MPB.

 

[BDK081522]

You can continue to recede in the hairline while on finasteride but it usually holds the crown very well. I would stay away from smp in the hairline. It can look fake if not done correctly. I think your best bet is to go to a reputable clinic and have them add some density via more grafts. 

[Rahal Hair Transplant]

Sean,

In order to evaluate the density of the hair transplant, we really need to see other angles of the scalp. For example I posted a picture of the hairline which is great but a picture showing a 45 degree angle from the front and a picture of the top would certainly be helpful.

At eight months postop, you are not fully grown and the hair could still look thicker in the next several months. That said, I agree that it likely won’t be a substantial difference between now and then and will likely need additional density. Did the surgeon explain that you would likely need a second hair transplant? Or do you feel that you didn’t have adequate growth?

it is perfectly safe to get a second hair transplant in the same area as long as you’ve given the hair transplant a chance to fully mature. In my opinion, give it another 4 to 8 months to grow out completely and then undergo another procedure if you still feel it is necessary.

in the meantime, I suggest contacting your surgeon, expressing your concern and asking about density and whether or not he feels you had adequate growth.

it would also help if you post preoperative and immediately post up pictures so we could see where the grafts were placed and what the growth looks like to date.

Best wishes,

Rahal Hair Transplant

[SeanT1]

5 hours ago, BDK081522 said:

You can continue to recede in the hairline while on finasteride but it usually holds the crown very well. I would stay away from smp in the hairline. It can look fake if not done correctly. I think your best bet is to go to a reputable clinic and have them add some density via more grafts. 

Hi, does this also include transplanted hairs?

Can clinics add density without a full head shave down?

Edited April 20, 2022 by SeanToman

[SeanT1]

4 hours ago, Rahal Hair Transplant said:

Sean,

In order to evaluate the density of the hair transplant, we really need to see other angles of the scalp. For example I posted a picture of the hairline which is great but a picture showing a 45 degree angle from the front and a picture of the top would certainly be helpful.

At eight months postop, you are not fully grown and the hair could still look thicker in the next several months. That said, I agree that it likely won’t be a substantial difference between now and then and will likely need additional density. Did the surgeon explain that you would likely need a second hair transplant? Or do you feel that you didn’t have adequate growth?

it is perfectly safe to get a second hair transplant in the same area as long as you’ve given the hair transplant a chance to fully mature. In my opinion, give it another 4 to 8 months to grow out completely and then undergo another procedure if you still feel it is necessary.

in the meantime, I suggest contacting your surgeon, expressing your concern and asking about density and whether or not he feels you had adequate growth.

it would also help if you post preoperative and immediately post up pictures so we could see where the grafts were placed and what the growth looks like to date.

Best wishes,

Rahal Hair Transplant

Hope you're doing well,

Everything is posted here (before operation, post operation, months of development.etc); 

 

[BDK081522]

12 hours ago, SeanToman said:

Hi, does this also include transplanted hairs?

Can clinics add density without a full head shave down?

No, the transplanted hair will stay. It may miniaturize slightly over the next decades due to natural thinning but it will not completely fall out as native hair would. As we age even our donor (DHT resistant hair naturally thins) so this process will continue into your elderly years. Clinics can add density while keeping the hair long however it is not recommended. It's technically harder to graft in between long hair. It's best to shave and give your surgeon every opportunity to ensure graft survival without transecting neighboring hair. Think long term. If you're going to spend the money, time, and effort to go through this again give yourself the best possible chance at a great result. The hair will grow back quickly so think long term. 

[MaximumMM]

On 4/19/2022 at 8:48 PM, Rahal Hair Transplant said:

Sean,

In order to evaluate the density of the hair transplant, we really need to see other angles of the scalp. For example I posted a picture of the hairline which is great but a picture showing a 45 degree angle from the front and a picture of the top would certainly be helpful.

At eight months postop, you are not fully grown and the hair could still look thicker in the next several months. That said, I agree that it likely won’t be a substantial difference between now and then and will likely need additional density. Did the surgeon explain that you would likely need a second hair transplant? Or do you feel that you didn’t have adequate growth?

it is perfectly safe to get a second hair transplant in the same area as long as you’ve given the hair transplant a chance to fully mature. In my opinion, give it another 4 to 8 months to grow out completely and then undergo another procedure if you still feel it is necessary.

in the meantime, I suggest contacting your surgeon, expressing your concern and asking about density and whether or not he feels you had adequate growth.

it would also help if you post preoperative and immediately post up pictures so we could see where the grafts were placed and what the growth looks like to date.

Best wishes,

Rahal Hair Transplant

Hi there,

 

Can you comment on why it's important to let the implanted hairs fully mature before implanting on them?

 

I'm considering a transplant somewhat overlapping transplanted areas (not much, the second will be to fill in the crown, the first was for the hairline and mid-scalp) and wondering why advice for the time you must wait varires between 6 to 12 months. Thanks.

[Sunset Dune]

On 4/19/2022 at 12:58 PM, SeanToman said:

Great answer, thanks Gatsby.
I've been excited for your progress also.

Been on Finasteride for two years now I think, 1mg a day.
Have their been reports of others that take this yet hair loss continues over 10 years?

As you say, being young you want your hair to be as perfect as possible when you're in a room full of people the same age with zero MPB.

 

There are very few 26 year olds that have “zero MBP”. Those who don’t are very lucky, gradual balding starts in the mid 20s

Edited August 17, 2023 by Sunset Dune

[Rahal Hair Transplant]

@SeanToman,

It is perfectly safe to get a second hair transplant in the same area as the first hair transplant. That said, it is advisable to wait between 8 to 12 months prior to transporting hair in the same area as previous transplant. This will provide the  transplanted hair from the first procedure to at least break through the scalp so the surgeon can see where to transplant the new hair.

There’s some discussion as to whether or not it’s a good idea to wait longer for the trash down here to mature, as people do row in a different rates. Personally, I don’t think it’s a bad idea to err on the side of caution and wait a full year to transplant hair in the same area as the previous transplant. But, generally speaking, waiting, eight months between hair transplants if you’re adding density to the same area as the previous transplant is prudent.

Best wishes,

Rahal Hair Transplant 

[SeanT1]

10 hours ago, MaximumMM said:

Hi there,

 

Can you comment on why it's important to let the implanted hairs fully mature before implanting on them?

 

I'm considering a transplant somewhat overlapping transplanted areas (not much, the second will be to fill in the crown, the first was for the hairline and mid-scalp) and wondering why advice for the time you must wait varires between 6 to 12 months. Thanks.

Hi, from my understanding we want our follicles to settle safely after surgery, allowing them to grow health and return to their normal state so a second surgery doesn't cause permanent shock loss. 

[MaximumMM]

9 hours ago, SeanToman said:

Hi, from my understanding we want our follicles to settle safely after surgery, allowing them to grow health and return to their normal state so a second surgery doesn't cause permanent shock loss. 

Thanks. This seems sensible. There's not much information about this online.

From what I read permanent shock loss is rare.

@gillenator you seemed to be quite knowledgable on a thread about permanent shock loss. I wonder if you have an opinion on whether, or how much, the risk of this might increase in a second surgery where the follicles are possibly not fully healed. In my case I would be having circa 3k grafts, possibly at 7.5 month mark, in a second surgery to be placed in the mid-scalp and the crown, with minimal overlap of existing implanted grafts (they are in the hairline and mid-scalp), although I imagine there would be some. 

Edited August 18, 2023 by MaximumMM

[gillenator]

MMM,

Please allow me to provide some feedback to your concerns with a second surgery and how shock loss could be a factor.

First let me make a distinction between 2 totally separate things: shock loss and transection…transection is the underlying damage to follicles that are caused by new incisions…these follicles under the surface cannot be seen by the surgeon and this is why doing a follow-up procedure too early carries the risk of transection…is 7 1/2 months too early?…yes it is…but you stated that there would be minimal overlap of the previous grafts, still if it were me, I would insist on no overlap.

Now lets discuss shock loss…while there is no damage to the follicles, this momentary cyclical loss of hair is caused by the related high level of trauma to the scalp caused by the surgery, mostly attributed to the recipient incisions and also injected fluids, etc…the traumatized follicles simply retreat into  a resting phase for approximately 3-4 months and then enter a new growth phase…hair that is in an advanced state of diffusion and very weak usually is permanently shocked…hope this makes some sense.

[MaximumMM]

Hi @gillenator. Thanks very much for your response. A couple of follow-ups:

Why would the risk of transection be higher with an early procedure?

In relation to shock loss: do you have any view on whether the risk of shock loss increases if a second surgery is done too early? I had some shock loss in my donor but now at 4.5 months it seems to be pretty much fully recovered.

[gillenator]

It’s all a matter of what cannot be seen under the surface of the scalp…why would the risk of transection in a previously grafted area be higher you ask?…it’s because the surgeon cannot see under the surface, he can transect what he cannot see and you paid lots of money for those grafts which are close to sprouting the surface, why would you risk damaging/losing some of them?…also, the outer surface of the scalp can look completely healed at 4 1/2 months post-up however what we cannot see is the level of trauma and inflammation under the surface and remember, it’s trauma and inflammation that induces shock loss…realistically, it takes a solid year for the  entire head to recover.

[MaximumMM]

18 hours ago, gillenator said:

It’s all a matter of what cannot be seen under the surface of the scalp…why would the risk of transection in a previously grafted area be higher you ask?…it’s because the surgeon cannot see under the surface, he can transect what he cannot see and you paid lots of money for those grafts which are close to sprouting the surface, why would you risk damaging/losing some of them?…also, the outer surface of the scalp can look completely healed at 4 1/2 months post-up however what we cannot see is the level of trauma and inflammation under the surface and remember, it’s trauma and inflammation that induces shock loss…realistically, it takes a solid year for the  entire head to recover.

Thanks. I'm still not clear on why the risk or transection would be higher *earlier* though (that was my question). I get why it's a thing in general. A surgeon isn't going to be able to see under the surface any better at 12 months than at 7.5 months. 

Nor am I really clear on whether the risk of permanent shock loss would increase if the procedure is done earlier. I appreciate it's difficult to quantify with any certainty, but I'm just trying to make an educated guess. If weak and diffused hair is more likely to permanently suffer shock loss, I'm not sure whether implanted hair which is firmly planted but still possibly healing (maybe inflamed) is also more likely to be permanently lost. Temporary shock loss is not a big concern. 

Edited August 22, 2023 by MaximumMM