Can I Lose My Transplanted Hair?

One of my favorite aspects of interacting with the public is answering questions on Reddit during an AMA (Ask Me Anything) session. It allows me to chat and answer questions from those that want to learn more about hair restoration but might not be sure how to begin the hair transplant process. I conduct an AMA session every three months and my latest AMA took place this past week.

Each AMA session contains interesting questions from people across the country. I’d like to share one of the most interesting questions that was asked during our last Q&A. Keep reading to learn more about the possibility of hair loss after a hair transplant procedure and check out one of my videos on the topic:

Reddit AMA – Question About Hair Loss after a Hair Transplant

A patient who had two hair transplants in the past was questioning whether the transplanted hair is always permanent as he has lost a lot of hair two years after the first surgery. He mentioned that he thought the hair loss was not grafted hairs but native hairs that were susceptible to further loss.

Once he received his second hair transplant, he thought that he started to lose grafted hairs in the frontal hairline from both procedures. He mentioned this was a year after his second surgery, so it was not like the grafts fell out prematurely. The transplant worked and then, a year later, his hair started to fall out. What could be the cause of grafted hairs falling out a year after surgery?

As I said earlier, this is one of the most interesting questions as it is a topic that is on the mind of many patients who visit our office for a hair transplant consultation. They want to know if there is a possibility that they will lose hair on their scalp anywhere from immediately after the surgery to a year (or beyond) after the procedure.

Here are some of the causes of hair loss after a hair transplant, that I shared on Reddit, in greater detail:

• Losing Native Hair in the Area:

We certainly don’t expect the transplanted hair to fall out. There are different conditions that may contribute to the loss of your volume of hair after a hair transplant. As the patient mentioned, he may have lost the native hair that was present before transplantation.

• Asynchronization of Hair Growth Cycles:

Scalp hair is always going through different phases like growth and resting. On average 15% of our scalp follicles are always resting. That means we lose hair shafts on those follicles until they start to grow again. After a hair transplant, we lose hair shafts on all grafts after the first month which means we artificially induce a resting phase. At the one-year mark, we usually see 100% growth since all the hair is out and all of the follicles are in the growth phase. After the first year, the cycling of hair starts to become asynchronized which means some of the transplanted hair may go to sleep. The amount could be as high as 15% of the hair. These grafts are not gone, but the hair has entered the resting phase. As these hairs grow back in 4-6 weeks, others may fall out, so it can be expected to see a decline in volume after the first twelve months.

• Cicatricial Alopecia:

In rare cases, other skin conditions like cicatricial alopecia may cause hair loss. If this is a possibility, the patient should be evaluated by the operating physician with a scalp biopsy and proper treatment can be started for the condition.

• Senile Alopecia:

There is another relatively rare condition, seen in older people with male patterned baldness, where the donor hair gets thinner. This senile hair loss could happen everywhere including the areas that are used as donor hair for transplantation. If someone has the gene for senile hair loss, the transplanted hair may start to thin out the same as the native hair, but this condition does not happen until an older age.

• Other Causes:

People may lose hair for a variety of reasons like scarring, autoimmune disorders, skin conditions like alopecia areata, excess manipulation, or the hair being pulled in certain hairstyles. In general, normal hair and transplanted hair are not immune to these factors.

Hair Transplant – Are the Results Permanent?

The first thing to know about a hair transplant is that the results are permanent in the area of the scalp treated by the surgeon. There is a general possibility of hair loss in the scalp after a hair transplant, but this does not include the area of the scalp where the hair transplant was performed. The other areas of the scalp that were not treated by the placement of hair grafts in currently visible thinning or balding sections can continue to lose hair. In addition, there might be sections on the scalp that were not treated in the past that could show hair loss in the future.

This does not necessarily mean that additional hair loss will occur after a hair restoration procedure, but it is something that patients need to keep in mind as they consider the possibility of surgery. Plus, as mentioned in my answer on Reddit, there is a chance of a skin condition causing hair loss in the future. This hair loss cause might not be evident (yet) while examining the scalp during the consultation appointment for the initial hair transplant.

Does it sound like we might be going back and forth on the answer? We are certainly not trying to “have it both ways.” It is simply important for patients to know that the results of any type of medical procedure are not 100% certain. However, between the diagnosis made during the consultation appointment and the hair transplant surgery, our team of experienced and board-certified surgeons are ready to provide long-lasting results that are natural in appearance.