Can a Hair Transplant Fail?
That is – after a successful hair transplant, can you then start to lose your transplanted hair?
This question is interesting because, excluding the normal hair loss that occurs after surgery (i.e., 1 to 4 months), a hair transplant is designed to last a lifetime. Hair transplants are permanent under the principle of ‘donor dominance in androgenic alopecia:’
Is there such a thing as hair transplant failure?
If a graft is taken from an area destined to be permanently hair-bearing and transplanted to an area suffering from male patterns baldness, it will, after an initial period of effluvium, grow hair in its new site as long as it would have at its original site. This is the scientific basis of hair transplantation surgery. (Manoj Khanna, Indian J Plast Surg. 2008).
Due to post-surgical stress and shock to the scalp and follicles, transplanted hair can initially fall out a few months after surgery, but this is both normal & expected. The most common type of hair loss after surgery is called “shock” effluvium, a condition where some of the transplanted follicles go into a premature, but temporary, rest phase. After a while, they’ll start producing hair again. A smaller number, however, won’t survive the transplant. Hair transplant surgeons, however, are aware of how much transplanted hair is normally lost after surgery, and they compensate for this by making sure they transplant enough hair to offset any reasonable expected loss.
Hair Transplant Failure or Telogen Effluvium?
Losing transplanted hair years after surgery however can’t be attributed to post-surgical stress and shock factors. If this happens, is this a case of straight up “hair transplant failure?” That’s highly unlikely.
In the vast majority of cases where a patient’s transplanted hair begins to fall out years after a hair transplant the most likely cause is “Telogen Effluvium,” but – fortunately – it is a temporary condition. Essentially, around 90% of your hairs are in what’s called an active “anagen” state where they are producing hair. It’s why your hair gets longer over time. However, at any one time, 10% are on a break, i.e., they’re in a rest (or “sleep”) phase called “telogen.” This phase lasts about 4 months, and for those follicles, the hair stops growing. Telogen Effluvium is simply a condition where more than 10% of your hairs are in a resting state.
Telogen Effluvium is a poorly defined condition with a myriad of causes ranging from illness & medications to simple excessive nervousness and stress. Paradoxically you’ll first notice Telogen Effluvium as it ends, i.e., when more then 10% of your hairs are in a sleep state and then suddenly “wake up,” you’ll notice a lot of your hair falling out — but that’s only because those hair follicles are now pushing out the old hair shafts to make way for new hair.
In short, hair transplant failure is extremely unlikely.
(Rare) Hair Transplant Problems
While a transplant failure is extremely unlikely, that does not mean it is impossible. While hair transplants are permanent, there are rare conditions that can cause a hair transplant to “fail.”
For example, “lichen planopilaris” is a condition that can permanently damage hair follicles no matter where they are located in the scalp. There have been rare cases of patients having ichen planopilaris and then undergoing hair transplantation only to have their hair transplant fail. Fortunately a simple biopsy can detect this condition before undergoing a hair transplant.
Another cause of poor hair transplant outcomes, and even outright failure, is a diffuse form of Alopecia Areata. This condition nullifies the principle of ‘donor dominance in androgenic alopecia,’ and the newly transplanted follicles will succumb to eventual damage just as surely as the follicles they are meant to replace. Again, fortunately, biopsies can detect this condition before undergoing a hair transplant.
Other Concerns About Hair Transplant Failure
Additionally, the surgeon could also accidently harvest follicles from a donor area that is unstable in the sense that the early stages of alopecia areata could be affecting a high proportion of the follicles in at least part of the donor area. In this case, the transplanted follicles will eventually succumb to alopecia areata and permanently stop producing hair. However, a sufficiently trained and highly experience hair transplant surgeon will avoid making this mistake.
Another cause of hair transplant problems and poor outcomes is that certain scalp and hair characteristics make some hair loss sufferers poor candidates for a hair transplant: see “Reasons Why a Hair Transplant May Not Last or Have a Poor Outcome.” Again, a sufficiently trained and highly experience hair transplant surgeon will be able to tell you if you’re a good candidate for hair transplant surgery.
Finally, hair transplant problems can be the result of human error rather than nature, i.e., the surgical team performing the transplant may not be experienced enough, or careful enough, or the supporting transplant technologies may be subpar. The best way to avoid this problem is to consult with many doctors before making your decision to make sure you’re going to be working with the best surgeon and surgical team possible. Remember, a hair transplant is a big-ticket non-fundable item, so thoroughly check your doctor’s credentials, experience, patient testimonials / reviews, and any before and after hair transplant pictures.
By Dr. John Frank, M.D. – IAHRS, ABHRS,ISHRS, AHLA, XM Radio: ‘The Bald Truth’, NYC, OHIO
© 2022 John Frank, M.D.
