Month: January 2023

Dear Dr.,

I had a hair transplant (840 3-4 follicular grafts) in February of 2009. The areas treated were the large crown and also throughout the temporal areas. I still do not see a drastic difference. I am not sure why. I am continuously also using Rogaine foam and Propecia. When under any bright lights, I see such thinning as to where the transplant was supposed to have worked. I am not sure if something went wrong, or everyone’s bodies are different; thereby it may look better within another year. Have you heard of my situation? Does a hair transplant take up to another year in order to see better hair density results?
Thank you!!!

Without knowing more about your case, it would be difficult to provide much precise information. Sometimes a thin look can appear under harsh lighting because of your hair color, hair character, thickness, etc. The Rogaine and Propecia are good to continue using, but after a year you should’ve seen results by now from the surgery. Everybody is different, every surgery is different, and every medical group is different, but it generally takes 6 to 8 months to see the beginning results of a hair transplant surgery. Either your surgery has failed or you continued to lose more of your native hair and what you are seeing is the lost native hair. I have seen transplant failures, and generally these occur because of surgical errors, inexperienced or sloppy teams or techniques, or rarely the presence of some associated disease like diffuse alopecia areata (though this is unlikely in men).

I’d discuss this with your surgeon to find out his/her take on why your grafts haven’t grown. Be sure to compare your current look to pre-operative photographs, because sometimes patients don’t realize just how bald they were before the surgery (the hair grows in gradually so its hard to notice if you’re not focused on it all the time).

See this recent post for more — If There’s No Growth a Year After My Hair Transplant, Should I Just Get Another One?

I’ve had 2 procedures with a prominent surgeon for a total of around 3700 grafts. My first was at age 51, second 54. I felt I was a good candidate since the hair on the back and sides of my head was thick. My first procedure grew-in nicely but I had a lot of dry, itchy, flaking scalp issues. I began to notice thinning hair in the transplant area about 1.5 years ago. The 2nd procedure is still thickening up but I suspect it will thin as well in a year or so. I think this is partially due to my age since all my hair is getting thinner.

I’m not convinced HT’s last as long as the hype would like you to believe. I’m really concerned for guys in their 20’s going through this procedure expecting it to last a lifetime.

There are many patients who undergo hair transplant surgery in their 20’s and 30’s that still have a full head of transplanted hair in their 50’s. There is a small minority of patients who were never properly diagnosed and perhaps do not have genetic androgenic alopecia, but rather have another type of balding (such as diffuse unpatterned alopecia), that underwent hair transplant procedures that were not permanent. Or it’s possible the grafts were taken from a non-permanent zone.

When patients have transplants into thinning hair, the results are generally good for the first few years until their original non-transplanted hair starts to fall out (as they would have without the surgery) and those initial results become less impressive. This makes them think that the transplanted hair is falling out, as patients do not see (or were not properly informed) that hair loss is an ongoing dynamic process. Even with the native hairs falling out, the transplanted hair should be enough to provide a better overall look to the individual, as long as there was a proper Master Plan made.

I am transgender male to female, and have male pattern thinning. I have been on hrt and antiandrogens for 2 years and Proscar and Minoxodil for 8 months. I consulted a hair transplant surgeon about transplants on the crown and top of my head, and after a video microscope evaluation he said that he cannot do transplants as there is no room for grafts. He stated that I have not really lost any hair and have great density, just that the calibre of the hair had diminished. Do you think given more time on hrt, antiandrogens, proscar, and minoxodil, that the miniaturized follicles may recover to terminal thickness and if not what other options do I have?

If your hair is miniaturizing, then the hormones and complex medications you are taking may be the cause of your problem. Hair transplants, where there are normal densities of hair, may not help solve your problem. I couldn’t tell you if more time will for sure help your hair.