Why has my transplanted hair started growing instead of shedding? Is that normal?
Doctor Answers 10
Hair shedding following a hair restoration
Hair shedding from the transplanted area is normal. It typically occurs between 14 days and 42 days (2-6 weeks) following a hair restoration procedure. This is very normal, and in fact, expected. You should have been informed of this prior to your procedure in a discussion brought up by your treating surgeon.
Here's why: hair follicles are like little organs in the skin that do one thing: make hair. They are sort of like your nail beds at the base of each fingernail. However your nail beds produce fingernails continuously and without 'breaks' for the duration of your life. As in, you don't shed your fingernails every few months.
Well, that's what's going on with the hair on your head. The hair follicle on the scalp is in the growth phase, or "Anagen" phase for many years (3-8 years) and is the phase most of the follicles on your head are currently in....growth phase. It's a fact that most people have about 100,000 follicles on their head (without hair loss), with each producing an average of about 2 hairs per follicle. Every month, 50 to 100 hairs on a person's head (with no hair loss) enter a regressive phase and then a resting phase, which lasts a total of about 3-7 months. These phases are called Telogen and Catagen phases, respectively. Every day people shed 50-100 hairs, and at the same time 50-100 hairs re-enter the growth, or Anagen phase. If a person has no hair loss, it looks the same all year round.
It's like walking up to a pine tree, a tree that appears never to lose its needles.....yet looking down there are thousands of pine needles under the pine tree. The pine tree looks the same but constantly sheds needles. Genetic hair loss in men and women is about shrinkage, and eventual disappearance, of hair follicles as they cycle through the Anagen, Telogen, and Catagen phases on every person's head on Planet Earth.
In the pine tree example above, it is like your scalp hair, the hair follicles on your scalp are like the pine tree: constantly making and shedding pine needles.....on your scalp, your follicles are constantly making and shedding hairs. Incidentally, typical male hair loss itself (e.g.: male pattern baldness) is a condition where the hairs that are susceptible (e.g.: all areas of the head but the back and sides of the scalp....the "horseshoe" area) fall out as per normal physiology and come back smaller.
That's what hair loss is.....it's not that the hair falls out and fails to come back, it's that it falls out as a normal course of the cycling described above, and then comes back smaller then the previous hair. The growth phase in areas of hair loss drops from 3-8 years to perhaps 3-12 months, depending on the severity of the hair loss. Then when the follicle in the affected area goes through the stages again, the hair produced is even smaller. Eventually, the hair produced by the follicles on your head will be like the hair produced by the follicles on your forehead: it's there, but the hairs are "vellus" hairs, and don't cover any scalp, and do not provide for a hairline whatsoever.
Now, to answer your question directly:
The process of hair restoration involves the surgical transplantation of follicles from the permanent are to the areas of loss in a highly controlled, orchestrated fashion. When you look at the nitty-grit, technically the blood supply to the tiny follicles is being cut off, and the follicles are being stored a storage solution. This is not as good as a direct blood supply, so the chilling of the follicles (if it's done according to the strict Standards of Practice to which I adhere), the immersion of the follicles into a holding solution, and then the re-implantation of the follicle into it's new recipient site places a physiologic stress on the follicle. Like it had to run a marathon it had not trained for.
In plastic surgery, hair follicle transplants are technically called "free tissue transfers," in that the tissue being moved about on the body does not remain connected to its blood supply, which is the norm in most every plastic surgical procedure performed today. As such, re-vascularization of the follicles becomes a major issue with hair restoration procedures, and in dedicated Centers, steps are taken to mitigate the many possible injuries to the follicles, including desiccation and perfusion-reperfusion injuries that so often plague organ transplants.
In short, the physiologic stress placed upon the hair follicle during transplantation can often prematurely end the follicle's anagen (e.g.: growth) stage, and cause it to enter the regressive and resting stage. So a follicle 2 years into its 7 year growth phase (e.g.: anagen phase) may be sent into the regressive phase where the follicle sheds its hairs and appears to produce no hair.
This is not a time to worry however, because if the grafts were well-taken-care of outside your body by competent, full-time technicians in proper biotech organ-preservative solutions, it will produce another strong terminal hair in 3-8 months. The follicles don't know they have been moved from the donor area, and this is what makes hair restoration a permanent solution to an incurable, progressive physiologic phenomenon. It is up to your hair restoration surgeon to replace the hair you've lost. It is up to you, the patient, to try to curb the rate in which your hair loss occurs. It's a team effort.
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.