Edmond Griffin, MD

What you are experiencing is not uncommon, and may even be only temporary. At any given time, from 6% to 8% of the hair follicles on the scalp are naturally in the telogen or “resting” phase, which usually lasts for about 100 days. Various factors, like accidents, illnesses, and significant hormonal shifts, can disrupt this cycle, forcing a disproportionate amount of follicles into the telogen phase at once. When this occurs, the effects are not necessarily noticeable right away, and patients may not experience widespread shedding until up to three months after the initial disruption. Once the underlying problem has been dealt with the hair follicles will usually resume their natural growth cycle, so hair that is lost as a result of telogen effluvium will most likely regrow by itself over the course of the next year.

This assumes, of course, that the underlying medical issues have been addressed. Platelet rich plasma works primarily by accelerating the transition of the hair follicle from the dormant telogen state back to the actively growing anagen state, so if your hormone levels have stabilized PRP therapy may definitely help. However, if you are still having thyroid problems, any change resulting from PRP will be minimal. I would recommend that you make sure your hormone levels have stabilized and wait to see whether your hair begins to regrow by itself. Telogen effluvium does not result in permanent damage to the hair follicles, so PRP will still be a viable option at that point.

Although it is very rare for complications to occur when your hair transplant surgery is performed by an experienced, board-certified dermatologist, it is important to note that every patient is different so a comprehensive, in-person consultation will be necessary in order to determine how many grafts you may need and what your specific health considerations may be. During that consultation, there are basically four extremely important questions that you should ask:

Are You Board Certified?  Although any licensed physician can attempt to perform hair transplantation surgery, only a doctor have with certification in an appropriate specialty, like dermatology or plastic surgery, will have the years of additional experience and training that you want.  Because dermatology specializes in the hair, skin, and nails, it is particularly applicable.

Do You Have Hospital Privileges?  Making sure that your doctor has surgical privileges at accredited, state-licensed, or Medicare-certified surgical facilities ensures that they can properly address any problems or emergencies that may arise.  Hospitals will only grant privileges to surgeons with a well-established track record.

Can I See Examples of Your Work?  The best surgeons will be more than happy to supply you with before and after hair transplant pictures and testimonials that will give you an excellent indication of the kind of results that you can expect. An extensive “portfolio” will show you that a doctor has experience with the procedure and can give you a better idea of what you should expect.

Who Will Be Performing the Surgery?  Some doctors may find it faster or more convenient to rely on technicians working under their supervision to complete part or all of a surgical hair transplantation procedure.  No technology can substitute for surgical skill, and only a highly experienced surgeon can place and angle each graft so that it blends seamlessly with the existing hair, providing natural-looking hair restoration results.

One of the most difficult challenges of transplant surgery is to avoid damaging the follicles, particularly when using the follicular unit extraction (FUE) technique. Because it is impossible to see the orientation of the individual follicles underneath the skin during FUE harvesting, each cut must be made blindly, and so even the most proficient and experienced surgeon may damage some of the follicles during the procedure. Additionally, after the cut has been made, tension must be applied to remove the follicles from the scalp, placing additional stress on the grafts and potentially causing further injury. This means that after harvesting there are often several follicles that are not suitable for transplantation, and so these must be discarded.

It may also be the case that, during implantation, your surgeon decided not to overcrowd the transplant area, since trying to force too many grafts into a small area can compromise blood flow to the scalp and place the health of every follicle in jeopardy. Still, assuming that all of the follicles that were implanted thrive in their new location and start to produce new hair, 3,800 out of 4,000 grafts would be a 95% survival rate. Although we routinely achieve higher survival rates by using the follicular unit grafting (or strip) technique, that percentage is actually very good for an FUE procedure and not a reason to be concerned.

Every individual case is different, and without a closer examination it is difficult to determine whether any damage might have been done. However, I do not think that you have anything to be concerned about. Most people don’t realize that even clear glass will naturally block most ultraviolet wavelengths, and glass that has been specially treated to block ultraviolet light (like the UV protective windows you mention) will block virtually all of them. The visible and infrared light that is able to pass through a window has virtually no chance of damaging your grafts. In fact, certain wavelengths of focused, red-spectrum (low frequency) light have even been shown to increase the energy production around the hair follicles and wake the cells from dormancy into an active growth phase. I often prescribe red light laser therapy to patients who have recently undergone hair transplant surgery to help maintain the hair on the head, prevent further thinning, and stimulate regrowth.

Although it is impossible to make a definitive diagnosis without examining your scalp personally and going over your medical history in greater detail, it sounds as though you may be experiencing shock loss, a relatively common complication that may arise from hair transplantation surgery. Follicular unit grafts that are packed too densely into a small area can potentially overtax the existing blood supply, impairing the growth of the hair follicles that are already in that location. Certain patients may even experience shock loss regardless of the amount of care taken during the procedure, but in such cases the effects are usually only temporary.

In our practice, we have found that non-surgical hair restoration treatments like platelet rich plasma and red light therapy can help improve circulation to the follicles and so can help to alleviate some forms of shock loss. However, it is also important to remember that most forms of hair loss are progressive, so it is not at all unusual for hair follicles that were healthy and vital at the time of the surgery to eventually start to show signs of deterioration. That is why we always recommend that our patients carefully adhere to a post-surgical hair maintenance plan that minimizes future hair loss.

Just like any other form of hair transplant surgery, follicular unit extraction (or FUE) is NOT a “scarless” technique and will result in some degree of scarring, regardless of what you may have heard. Whenever an incision is made in the skin some degree of scarring will always result. While it is true that an FUE procedure does not produce a single linear scar like follicular unit grafting (or FUG), it will produce dozens of tiny, circular scars throughout the donor area which can potentially be even more noticeable. One of the most important elements of any successful hair transplant procedure is making sure that those scars are as small and faint as possible, and this requires a surgeon with a great deal of skill and experience.

Fortunately, most scars do gradually fade over time, but every patient heals at their own rate, so it can be difficult to tell whether your case is atypical without a thorough examination. Even though recovery time after hair transplantation is usually minimal, some patients do experience redness and itching two weeks or even a month after their procedure. The symptoms you describe are typically signs that the scalp is healing, but it is difficult to know for sure based solely on the pictures that you have provided. I would recommend that you reach out to the surgeon who performed your procedure to make sure that you are not experiencing a mild post-operative infection, such as common folliculitis. As with any form of surgery, I would also encourage you to attend all post-surgical follow-up visits, take all prescribed medications, and carefully adhere to the hair maintenance plan that you formulated with your doctor prior to your procedure.

First, I want to commend you on taking steps to address your progressing hair loss in the early stages. Too many patients are under the mistaken impression that a surgical hair transplantation procedure is all that they will need, but this is not the case. I always stress to my patients that male pattern hair loss is progressive and only a preventative maintenance program tailored to the patient’s individual needs can fully minimize hair loss. Although you may feel as though minoxidil has had no effect, it is highly likely that your hair loss would have been even more extensive if you had used nothing at all.

That being said, in the forty years that I have been treating hair loss, I have come to believe that using minoxidil alone is NOT enough to stop the progression of androgenetic alopecia (genetic pattern hair loss). I usually recommend, at minimum, that my patients adhere to a regular regimen that includes 5% minoxidil (in the form of topically applied Rogaine®) along with finasteride (in the form of an oral dose of Propecia® or Proscar®.)  In some cases, patients who are uncomfortable taking oral medications can even benefit from custom blended topical solutions. However, as with all medical treatments, it is important that you consult with your doctor to find out what combination of treatments is right for you.

Given that is has been less than a week since your hair transplantation surgery, I would recommend being cautious about applying any chemicals to the healing grafts. At our practice, we recommend that our patients wait at least one full month after their procedure before they color, perm, or chemically treat the hair in any way. However, since cosmetics are specifically formulated to be applied to the skin, they can be safe to use as soon as your incisions (both at the graft and donor sites) are fully healed, which may be as soon as three days after your transplant. Still, as with any surgery, it is important that you discuss your concerns with the doctor who performed the procedure, either over the phone or at your next post-operative visit, before making any alterations in your recovery plan.

Intriguing question! While you are correct that stress does cause the body to produce additional adrenaline, it also increases the production of the hormone cortisol, which actually blocks the activity of testosterone, so it is unlikely that it will exacerbate the progression of genetic pattern hair loss, or androgenetic alopecia, directly. The hair loss that you are experiencing is far more likely to be the result of telogen effluvium, which most often occurs when the body’s natural hair growth cycle is disrupted by a significant change in the body’s chemistry.

Hair follicles on the scalp do not continuously produce hair.  Instead, they progress through a regular growth cycle consisting of three stages: anagen (growth phase), catagen (transition phase), and telogen (resting phase).  During the anagen phase, new hair is formed and gradually grows from the follicle. Eventually, the hair progresses into the telogen stage, when it loosens in the follicle and subsequently falls out.  Normally, only about 15% of the hair follicles are in the telogen stage at any given time, and so a healthy scalp sheds anywhere from 50 to 100 hairs each day, a negligible amount that is easily replaced by newly growing hair.

During extremely stressful situations, however, the body can trigger a disproportionately large number of hairs to move into the telogen phase all at once.  This means that the hair begins to shed in significantly larger amounts than usual, causing diffuse thinning over the entire scalp. Anything that can cause a shock to the body can potentially cause telogen effluvium, from physical trauma, such as being in a car crash or undergoing major surgery, to crash dieting that starves the body of necessary proteins.  Even significant emotional stress, like the death of a loved one or a divorce, can prompt changes in eating and sleep patterns that the body can interpret as dangerous stress, resulting in the same symptoms. 

Fortunately, the hair loss from telogen effluvium is usually temporary, especially if you suffered no physical damage from your accident.  Unlike the hair loss that occurs as a result of androgenetic alopecia, the hair follicles are not permanently or irreversibly damaged; there are simply more hair follicles in a resting state than there should normally be.  Once the external cause of the stress is over, the hair follicles should return to their growing state and start producing new hair fibers within six months.  However it is extremely important to remember that your underlying genetic pattern hair loss is a progressive condition and that that you must continue post-transplant maintenance treatments and/or medications in order to keep additional shedding from occurring.