How to deal with hair loss after a hair transplant

In this episode, we’re going to tackle hair loss or continued hair loss after having a hair transplant surgery.

Welcome to the Hair Loss Show! Dr. Russell Nudson and Dr. Vickram J Aash discuss issues relating to hair loss and the medical and surgical treatment of hair loss in both men and women.

Hey everyone, thanks very much for joining us on the Hair Loss Show. Please remember to like and subscribe to the channel. In today’s episode, I’m going to answer a question that was actually emailed through, and I thought it was worthwhile making this the topic of an episode because I think it highlights some interesting and important points that could be educational for everyone out there.

So, I’m going to paraphrase an email that was sent through. Basically, I’ve had two hair transplants in the past—FUE surgery in 2015 into the crown and 2016 in the front. I was satisfied with the results, and in 2018, I started to notice that my hair in the crown was getting thinner and the density was decreasing. But I didn’t care since the front looked great. In 2019, I started to notice the same symptoms in the front transplanted area—thinning and losing density. Now the front is a mess. I’ve been to many doctors without getting a straight answer. Some say you’re losing hair from your original hair, not the transplanted ones, which is not true. And some say that the hair taken from the back for transplanting was taken from the wrong area and recommend I take finasteride. I’ve been on it for 6 months now without noticeable progress. I don’t care what the problem is now, but the issue is, I’m planning to have another hair transplant to fill the gaps in my hair, and I’m afraid of losing it again after 2 years as before. Please advise.

Look, I think that’s—I mean, thank you very much to the person who sent in that question. I’d like to use it as a teaching point for everyone. I don’t know how old this individual is, but they’ve had two hair transplant surgeries in a short period of time and are continuing to lose hair. For me, the most upsetting aspect of this is that from 2016 until relatively recently, there was no discussion of medication. So they had a hair transplant surgery without trying to maintain the existing hair.

Again, I’ve not seen photos, so I can’t speak specifically to this individual. But from what I can gather, it seems more than likely that the transplanted hairs are still in place, but it’s the existing hair that has fallen out due to male pattern hair loss. That’s why the area looks thin again. This individual has spent a lot of time, effort, and money, had two procedures, and has not achieved the required or expected outcome. Now, they’ve been put on medication and have said specifically, “I’m not happy with the progress.”

Well, first of all, what is the expectation of what the progress should be? Starting on finasteride is not going to make him grow new hair. It’s actually going to hopefully just try and stabilize things and limit the progression.

Another point of concern is that this individual wants to go and get another hair transplant, again. So this will be the third in the space of probably four years. I don’t know the graft number, but just looking at the email, saying the front was covered and the back was probably involved, you’re probably talking about quite a high number of grafts. The risk of over-harvesting in the donor area starts to become a reality for this individual. If they remain unstable despite being on medication and continue to lose hair, do they have enough donor hair for a fourth or potentially a fifth operation? We don’t know. I certainly don’t know, and I’ve not seen pictures—it’s not a direct patient of mine.

But the learning point here is that, please, please, please, if you’re having a hair transplant at a relatively young age, speak to your surgeon, make an informed decision, discuss medication, and discuss what the risks are of not taking the medication and what the long-term effects may be. I’d hate to see you potentially in a scenario where you’ve spent lots of money and still haven’t got the desired outcome, and you’re in a position where your back now looks unnatural as well.

So, to the person who sent this email, thank you very much. The key would be, from my perspective, speak to your surgeon. Find out what their thoughts are on your donor area—how deplete is that—and what they would do to judiciously use the grafts to thicken up the areas of most importance to you, so they minimize the progression. If you’ve only been on therapy for 6 months, potentially wait a little bit longer. Demonstrate that you can be stable for a little while before delving into having another surgery. Also, look at other alternate therapies. There are many regenerative therapies on the market—things like low-level laser therapy, minoxidil as well.

You’re going to need to take a holistic approach in managing this. It’s not a quick and easy solution. I hope you find this helpful. Thanks again for watching, and we’ll see you on the next episode. Take care.