As with all surgical procedures, results from hair transplants can’t be guaranteed. It’s possible that some or all of the transplanted hair may fail to grow (this occurs in less than one percent of cases). Every effort will be made to give you the maximum yield from your transplanted hair.
Alopecia Areata (AA), or spot baldness, can in rare cases exist in a diffuse form that resembles genetic balding. The diffuse form of this disease, when it occurs, is more frequent in women than in men, and can be a cause of a transplant failure if your body’s immune system attacks the hair follicles (<0.1 percent chance). AA can be diagnosed by multiple biopsies.
Failure of the transplants to grow can be caused by other factors such as technical failures by the surgical team, due to inexperience and/or sloppy surgical methods. We call this the H (human) factor. As this surgery is a team effort, the team is only as good as its weakest member. Inexperience in the surgical team is the most probable cause of graft growth problems.
On rare occasions, the grafts may not all grow, even though your surgeon and the surgical team do everything perfectly. The hair transplant industry has called this the X factor, which simply means that there’s no identifiable cause for the problem.
Clearly X factor is an additional set of factors beyond the patient’s scalp condition or the surgical team. The chances of failure to grow from X factors should be less than one percent in the hands of an experienced surgical team.
When hair fails to grow, it may be helpful to biopsy the scalp in the areas where the failure occurred, but because this type of failure is so unusual, biopsies are not recommended in advance of the transplant.
Hair loss after the surgery
Hair loss can occur at both the recipient site and the donor site. For men, hair loss at the recipient site is related to genetic induced miniaturization of the existing hair and minimized by taking finasteride (1 milligram daily). This drug is effective fairly quickly (in the first 24 hours).
Young men are at greater risk for post operative hair loss so a daily dose of finasteride is important to prevent what is referred to as shock loss or accelerated thinning secondary to the genetic balding process. (The next section explains shock loss.) If you’re a man under 35, planning hair transplant surgery, you should talk to your doctor and begin taking finasteride at least two weeks prior to the procedure.
Men over age 35 have less chance of shock hair loss after a hair transplant because their genetic hair loss has usually slowed by that age.
When hair loss occurs in the recipient area in a young man with genetic hair loss who has not been on finasteride, the loss may be permanent. This type of loss usually occurs in the first six months post surgery. When hair loss occurs in women in the recipient area, the loss is rarely permanent, but it may take four to six months for hair to regrow in the recipient area.
Hair loss can also occur around the donor area; this is most often the result of a wound closure that’s too tight. When hair loss occurs in the donor area, it usually starts at about ten days after surgery and completes its course over the following six weeks. When hair falls out in the donor area, it usually re-grows over the ensuing four to eight months. The hair that is shocked is forced into its sleep (telogen) phase, but will usually recover.
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