What exactly are the reasons if transplanted hair does not grow?

[Jenova]

Over the last months I’ve read a lot of hair transplant patient reviews on forums, and I’m wondering why in some cases the transplanted hair does not grow? Like situations when the number of transplanted hairs and hairs that grow are way off.

 

[mister_25]

Faults from the doctor/technicians are the usual reason on poor survival rate like how long the hairs were handled outside the body and how they were handled. Other reasons can be on the patients side such as underlying scalp conditions.

I think its almost unheard of for every single graft to not take, you can be unlucky and have a majority but there are bound to be a few that survive.

[HappyMan2021]

Surgery/doc/tech error, or a physiological factor such as an undiagnosed scalp condition. 

99% of the time there is nothing a patient can actively do to negatively affect surgery results. 

Unless you are swimming in the gulf of mexico the day after surgery, or have some psychological issue where you are pulling out unsecure grafts, the patient has no impact on bad results. 

[Gatsby]

This is why surgery should always be a last resort. Apart from all the risks from going to the wrong surgeon there will always be that 'X' factor that cannot be attributed for.

[Melvin- Admin]

Most of the time it’s surgical error, but there may be underlying conditions that can affect hair growth. As well as x factor as Adrian mentioned. 

[mafpe]

Can't "exactly" tell you why, but there are several things that comes up to my mind as possible causes :

Patient factors :
- General health concern, from the skin, bodily function, blood flow, oxygen level.
- Recipient condition, scar tissue, skin condition, sickness/disease/genetic problem.
- Very aggressive balding / shock loss factor, etc that we have no real idea of.
- Lifestyle and diet.
- Medications
- Degree of movement done during operation, stress level which cause body to recover sub optimally.

Doctor / Tech factors :
- Transection of follicles.
- Poor graft handling, including and not only of squishing of the follicle, dehydration, temperature killing the grafts, bad solution coverage/content.
- Long time handling / grafts being out of the body for too long.
- Incision transecting existing hair leading to killing the native that is affected.
- Rough Implantation which might kill the grafts.
- Wrong depth on the implantation, leading to pitting / tenting.
- Wrong depth on the implantation, grafts unable to survive due to not enough blood/oxygen flow.

Post Op :
- Smoking post op, or any action that would decrease graft survivability / success rate.
- Lifestyle and diet.
- Graft handling, especially on the first and second week.
- Medications, possibility of infection / fungal infestation.
- Temperature and care toward the graft, example being if the head is exposed to sun or hot water / hot temperature in general.

 

There should be some more, but as of now those are the factors that comes to me immediately

[LookMaxx]

This explains well

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956960/

[Sammy_Brown]

FUE or DHI hair transplantation are meticulous procedures that require patience. However, many reasons such as the doctor's lack of experience, inadequate post-operative care, the person's not being a suitable candidate for hair transplantation, dishonest hair transplant centers can cause this. Therefore, it is most important to research the doctor, clinic and hair transplant well.

[Rahal Hair Transplant]

Jenova,

there are two main categories that the non-growth of transplanted hair  would fall into. These include surgical error and patient physiology.  Both of these categories can be further broken down why I worded it this way.

Surgical Error

Under the surgical error category, some of the reasons include 

* transection/damage to the follicles during extraction/harvesting

* damage/crushing of the follicle/bulb during implantation (this can be eliminated by using a no touch technique which is why implanter tools have been developed.  Of course there are pros and cons of using implanter tools as well which I wont get into here)

* Dessication/dehydration of the follicular units while they are outside of the body. This could be due to being outside of the body too long, not using enough for an appropriate solution, etc.)

- The above are usually a result of carelessness due to the improper handling of the fragile follicular unit grafts

Patient physiology

This one is a bit more complicated to break down because the truth is, nobody really knows why the patient’s physiology would reject a graft and cause it not to grow.  This is commonly referred to as the X factor. Unfortunately, this X Factor can’t be determined prior to surgery but simply put, there are some patients that for whatever reason, just aren’t good candidates and growth simply just doesn’t occur and they don’t grow.

It’s anybody’s guess at this point what the X factor(s) could be and I suspect there’s more than one of them. I would suspect that potentially some kind of condition(s) may be partly responsible, perhaps even certain medication‘s and the way they interact with hair growth, potentially hormones, etc.  it’s just not known so I’m throwing out what could be possibilities but aren’t necessarily the case.

Some think the so-called X factor is just an excuse to defend surgeons who are less than skilled or who may have made an error during surgery but it’s not.  While most of the time growth does not occur or is less than optimal, it is related to surgeon error, there is the very real X factor(s) that do come into play from time to time.  The only way to know for sure would be to go in for a second procedure either with the same or a different doctor and see if growth occurs the second time. If it does, it was likely search an error and not an X factor. But if growth doesn’t occur no matter which surgeon you go to, it is likely related to patient physiology a.k.a. the X factor.

i hope this helps.

Rahal Hair Transplant

[Vann]

- transection rate (either destroying the donor or [pre existing] native hair)

- collateral damage (putting hairs too close that it destroys a follicle nearby) aka permanent shock loss

- competitive blood supply (placing too many grafts close together)

- leaving hairs follicles out of the body for more than 2-3 mins without any solution. 

- Necrosis - skin/follicle death (dirty/unsanitized office, competitive blood flow, or viral/bacterial infection)

- high density of grafts added to a small area. 

- smoking/drinking/rubbing your head post surgery. 

some of these things relate to one another but remember most of this is due to the surgeons skill.

In general you should expect 10% of the grafts to not survive. So if you get 3,000 grafts expect 300 to not survive. Hopefully it isn’t your multiple grafts but realistically 10% is kind of expected in most cases. It doesn’t mean it will always be the case but there are many many factors that can influence your survival rate. 

[Jenova]

This was very informative, thanks a lot for the replies 🙂