Daniel J. Lee, MD, FACS, FISHRS

It often takes 12 - 15 months for all of the newly transplanted grafts to grow a hair. While most people notice new growth 4 months after a transplant some take longer. So at 10 months I would not consider another transplant. Wait 12 - 15 months before determining the final result.

How long ago was your transplant? It is not uncommon that for the first 3 - 4 months after a transplant the hairs in the transplanted follicles will fall out. The follicles start growing a new hair from the 4th month onward but it usually takes 12 - 15 months for all of the transplanted follicles to grow their new hairs. Your loss is not related to you brushing your hair.

It appears that your hair loss started suddenly in September. One possibility is a condition called Telogen Effluvium. This is where a lot of hair in the "growing" phase is pushed into the "dormant" phase. At the end of this phase (about 1 - 2 months) the hair sheds. Normally a small number of hairs are in the dormant phase and we shed about 100 - 150 hairs per day. Telogen Effluvium can be caused by many factors including a stressful event such as pregnancy, a serious illness, emotional stress, etc. The good news is that the hair most often returns after 6 - 8 months after the stress is gone. Your ferritin is 27 which is at the low normal for a female so is likely not related to the loss. In addition it is unlikely that the loss is due to the finasteride. In my practice, however, I prescribe 1 mg of finasteride.

As someone in their early 20's exhibiting significant hair loss, it is vitally important to begin a committed plan to prevent further loss.  You are a bit too young for a transplant at this point and it would be important to document the slowing or stopping of continued loss.  Once you are undertaking a vigorous prevention program for a year or so then you would be able to consider a restoration procedure.   There are several modalities that have been shown to prevent and possibly reverse your hair loss.  These include the use of topical minoxidil, oral finasteride, PRP (platelet rich plasma) injections and the use of low level laser therapy (LLLT). Minoxidil (Rogaine) is a compound that increases the blood flow to the scalp after it is applied topically.  This is thought to help the folllicle cells produce stronger and healthier hairs  It should be applied to the scalp in the areas of loss once a day. Finasteride (Propecia) is a medication that decreases the formation of the compound dihydrotestosterone (DHT).  DHT is produced from the metabolism of testosterone by the enzyme 5-alpha reductase.  It promotes hair loss in genetically susceptible people.  Finasteride blocks the enzyme and thus prevents DHT from being formed.  DHT blood levels in those taking the drug are markedly decreased.  Thus with less DHT at the site of the follicle, there is less hair loss. PRP treatments involve injecting a concentration of platelets into the area of hair loss.  Platelets have compounds called growth factors which are used by every cell in the body to help them carry out their functions.  By providing these growth factors to the follicle, it is felt that hair loss is prevented and stronger hairs are produced.  In a treatment, a vial of blood is collected from your arm and spun in a centrifuge.  This concentrates the platelets into a specific layer of plasma (liquid portion of blood) which is then injected into the scalp in the areas of loss.  The entire process takes from 30 to 45 minutes but the actual injections are done in about five minutes.   LLLT is a treatment in which light of a very specific wavelength is emitted from a laser cap.  The light is then absorbed by mitochondria in the follicle cells.  Mitochondria are the energy factory of the cell and produce ATP which is the energy molecule of the body.  The laser light helps the mitochondria produce more ATP. This energy molecule is used by the follicle cell to produce stronger healthier cells. Therefore in those with hair loss, especially younger people, prevention is so important!  Get on a prevention regimen and be persistent with it.  These modalities will slow/stop your hair loss and in some people even regrow stronger, healthier hair.

Six months after a transplantation not all of the new hairs have begun to grow.  During the first three months three quarters of the transplanted hairs will fall out.  This is most noticeable soon after the surgery.  The new hairs don't start to grow until the fourth month.  Each month thereafter more new hairs will grow.  This will continue until the 12th to the 15th month.  That is when all of the transplanted hairs that are going to grow will be growing.  So at six months I feel that it is too early to make a judgement on what the final result will be.  But if you do have concerns it would be best to go back to the surgeon who performed the procedure to discuss it further.  

Being hypothyroid will definitely contribute to hair loss.  As long as your thyroid levels are normal (blood tests need to be done regularly) the PRP's should help stop the progression of your hair loss.  They have also been shown to actually reverse the miniaturization process in some people.  But it would still be important to have a complete evaluation with an experienced hair restoration surgeon.

At four months the wind will have no effect on your grafts.  By a week the grafts have incorporated into the surrounding tissue of the scalp and will not come out.

The PRP done at the time of the restoration procedure was to help the viability and growth of the newly placed grafts.  The question is not whether one worked better than the other.  PRP's are often done separate from a transplant as it has been shown that the growth factors that are delivered to the follicle in a treatment will help prevent further hair loss.  And in some instances will help reverse the miniaturization process.  

Minoxidil, which is felt to increase blood flow to areas where it is used, should be applied to the areas where hair loss is present.  It won't be beneficial being placed in areas where there is no current loss.

It is hard to determine what may be causing your hair loss without more information.  The best thing to do would be to see a hair restoration expert and have a full evaluation including a history and physical exam.  In addition certain blood tests should be done. This information will help determine the best course of action for you. Some non-surgical options for hair loss include the medication spironolactone, platelet rich plasma (PRP) injections, and low level laser therapy (LLLT).