Hair Falling off 4 Years After Hair Transplantation (FUE) Procedure

The most likely reason your transplanted hair is falling out is Telogen Effluvium.  This is a temporary condition caused by something stressing the follicles and should abate once you are relieved of the stress.  

The other possible cause of this hair loss would be unlikely, but perhaps the grafts were harvested from donor hair which was located too high in the back of the scalp, in an area which was prone to the effects of DHT or other permanent hair loss factors.  If the only hair you are losing is the transplanted hair, then this is possibly the cause, although it would be difficult to determine.

We have been performing hair transplants now for over 20 years. It would be my opinion that this is very unusual.
I would suggest going back to the MD that treated you and let them examine.
I would want to see what your hairs look like under magnification. If I see miniaturization, I would begin treating with Laser to kick start the hairs back to the growth phase.

This can be a frightening and confusing thing for patients to see. Depending on your age and stage of hair loss at the time of your surgery, there are a lot of possibilities for what could be going on. In most patients, 4 years after surgery what is usually seen are the native (non-transplanted) hairs falling out. That is a natural progression of hair loss. However, in some patients the genetics of hair loss is so strong that some of the hairs from the donor area were destined to fall out. Often times these are hairs that were taken from lower down on the back of the scalp, near the neck. Some patients have receding hair loss here (but it recedes UP the scalp there instead of BACK like on the hairline). Other medical issues could also be also have developed since your original surgery that can cause problems in the skin and thereby cause hairs to fall out (autoimmune conditions or hormonal imbalances). The first step would be to see your original surgeon or another experienced hair specialist to get proper guidance. Hope this helps!

I suggest you to see your hair specialist and have a general check up, and get your hormones checked as well. 

Dear 34male
Thanks for the question. If necessary, hair transplant can be repeated 3-4 times depending on the density and the number of the hair follicles on the donor site.
A second hair transplant can be planned in cases of continuing rapid hair loss, with patients who desire a high density of hair, for the purpose of providing a hairy scalp on those sites where no prior transplantation has been done, and for the purpose of correcting the outcome with those patients who have had an unsuccessful hair transplant in some other clinic. I wish you all the best.

Hair loss after transplantation can occur for a variety of reasons.  First of all, hair loss which was harvested from the proper location can ultimately be lost.  For this reason, proper surgical planning can be helpful to only harvest hairs which will not be susceptible to androgenic alopecia.  In addition, some patients may have other factors to their hair which can contribute to hair loss which need to be properly evaluated.  Hair loss is a complex medical and surgical problem which requires specialized attention to achieve appropriate results.

I agree with Dr. Farjo below answer as well as I need to add that this is not the norm. You could have lost inherent hair due to male pattern baldness if not on a blocker such as finasteride. This means your natural hair was continuing to falling out. OR even more rare could there have been an extraction from the lower nape of your safe zone which can sometimes fall out prematurely with age. However this description here to me sounds like you need to consult with a hair restoration physician and confirm with him/her and get on a blocker!

You need a medical work up done. Make sure your thyroid function is normal. Most likely the hair loss is related to continued hair loss. Without photos it is not clear if the grafts are falling out or your make pattern loss is continuing. You need to start medical therapy with Finasteride and rogaine for six months. I would also consider a session of PRP after a dermatoscopic exam. Good luck! 

Transplanted hair can fall out at any point, but if taken from the proper area with good patient selection, this risk should be minimal. Overall hair quality can decline and can be a diffuse problem that should be evident on exam. Many non-surgical treatments could be used to slow or reverse this process. Additionally, any patient with this problem should be evaluated by a physician specializing in hair loss, as there could be a medical issue causing the problem.
All the best,

It is highly unlikely that your transplanted hairs are falling out.  It is most likely, that you are currently noticing the loss of the hairs around those that were previously transplanted.  The most common misconception with a hair transplant procedure is that once you have the procedure that you will not experience any more hair loss over time.  The hair that is harvested for a hair transplant are taken from a donor area of the back of the scalp where the follicles are not susceptible to male pattern baldness.  When these hair follicles are subsequently transplanted, they retain that same staying power as they had in the back of the scalp, so it is for the transplanted hairs that the above statement can be considered more valid.  What you are likely experiencing is hairloss from follicles that are native to that area and that were not transplanted.  I would recommend that most males who are experiencing hair loss, with or without having undergone a hair transplant procedure, use Rogaine and Propecia (Finasteride) to help reduce future native hair loss.  I would also recommend following up with your doctor or consulting with a hair loss specialist to evaluate your hair loss and perform any blood work necessary.  It is possible that you could be experiencing telogen effluvium, or temporary hair loss from undue or excessive stress, but I would still recommend that you get evaluated by a hair loss specialist.

If you had an examination by a doctor and have a diagnosis of male pattern balding, and the grafts that were harvested from a PERMANENT zone, then the transplanted hair should not fall out.  If you have an undiagnosed hair loss condition and had surgery, it may be another problem.  It is always good to follow up with your doctor for an exam.Just to be clear ALL hairs will fall out as they have a growth and dormant (fall out) cycle.  The issue is if they will grow back.  Normal hairs will grow back.