9 months post op 5700 grafts, I can still see my scalp clearly in the light as if I am bald. When will my scalp get covered?

Question

Hi I’m 23 years old and I had my surgery done last December, so it has been nine months from the operation. I had 5700 grafts and I am happy to see the change but I feel bad because I can still see my scalp clearly in the light as if I am bald. I have 3 months till I complete a whole 12 months, when will my scalp get covered ? Thank you

Anil R. Shah, MD · Answer

First question is how many actual grafts were implanted.  Graft count is often artificially inflated.  Time for hair to matriculate can take up to 18 months so time may be necessary for your hair to cycle.  The use of rogaine and regenerative techniques can help your hair cycle faster and grow per anecdotal evidence.  If there are still scalp coverage issues, discuss with your hair surgeon and determine any other steps and measures to help create scalp coverage.  Best Dr. Anil Shah

Ilhan Serdaroglu, MD · Answer

Final result and canopy effect of hair transplant related with caliber of your native hair in donor area; characteristic of hair (waviness or straight hair) ; surface and density of donor area that directly affects the number of harvested grafts; color difference between hair and skin and finally hair style. If you are not satisfy with result of your first operation, would better to check those parameters and think about to plan a second HT to increase the density .

William Woessner, MD · Answer

You should consider consulting a physician member of ISHRS.org to examine you and to analyze your situation.

Sara Salas, MD · Answer

You should have seen significant growth by 9 months and possibly more growth up to 12 months however we do not have a before surgery picture. Go to the original clinic with these concerns to try to come up with a solution.

Karl Hekimian, MD · Answer

It is not unusual for scalp show to persist after one procedure.  Give it a full year and then go see your surgeon to discuss options, such as another procedure or scalp micropigmentation.

Amiya Prasad, MD - Account Suspended · Answer

Thank you for question. You are 23-years-old, and ask why 9 months after a 5700 graft hair transplant you still look bald. You also ask when your scalp will be covered.
I can certainly give you some guidance about this, with the photo you shared for reference, and without a physical exam. I’m a Board Certified Cosmetic Surgeon and Fellowship-trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I’ve been performing hair transplants since I started my practice, and have been prescribing finasteride to male pattern hair loss patients since 1997. I’m also the founder of TrichoStem Hair Regeneration Centers, based on a system originally developed to help hair transplants and the donor area heal better, but has since become a non-surgical treatment for pattern hair loss for men and women.
First of all, you should not have had a transplant at 22 or 23-years-old, and one of the reasons why is indicated in your concern. Male pattern hair loss is most aggressive if it starts in the 20s or younger, meaning you have very high DHT-sensitivity. Only 20% of your contemporaries have male pattern hair loss, so you want to have the same hair density as 80% of your contemporaries. However, it is impossible to get the same density as them from a hair transplant, which is why you are unsatisfied, and why an ethical surgeon would not have transplanted hair in someone as young as you. Also, due to your very high DHT-sensitivity, your hair is continuing to thin and be lost at a faster rate than it can be transplanted, which is another reason why most surgeons won’t perform hair transplants in patients this young. 5700 hair grafts is also a lot, considering that each graft needs a circumference of skin for graft survival, so not all your grafts may have survived. Also, considering that you had about 100,000 hairs at your peak, and 5700 grafts containing about 1-3 hairs per follicular unit, and you have lost much more than half your hair at this point, the numbers don’t add up in replacing all the hair you have lost. Your surgeon probably didn’t tell you about collateral loss, where the trauma of transplanting hair near native hair follicles can cause permanent damage and loss of those follicles. Doctors often justify this because the hair is thinning anyway, and will eventually be lost.
I think it’s more important for you to manage your progressive hair loss. You need to take DHT-blocker like finasteride as you are highly DHT-sensitive to slow hair thinning. We can also apply our Hair Regeneration treatment to thicken the thinning hair you have, and stimulate growth from dormant hair follicles that are still viable but not growing, if they haven’t been damaged by your transplant surgery. Hair Regeneration is a PRP+ACell treatment we have done for patients since 2011 to help them manage their hair loss, with or without a transplant. This treatment also helps graft and donor area healing soon after a transplant, but that 1-2 month window is now closed. However, this treatment can help you increase hair coverage without another transplant, and can delay the need for another transplant, provided you also take finasteride concurrently since Hair Regeneration doesn’t block DHT-formation.This treatment can last 3-5 years, but in patients with very high DHT-sensitivity and refuse to take a DHT-blocker, it may only last 1-2 years.
I suggest you try these other treatments for hair loss, and don’t continue with more transplants until you are over 30. Ideally, you should have tried other hair loss treatments first before a hair transplant at your age, but it’s too late for that. If you keep having transplants in your 20s without controlling DHT, your hair will still thin, and by your mid-30s, you likely won’t have much hair coverage, even if you have multiple hair transplants. Starting hair transplantation in your 30s, you will be closer to hair density of the increasing number of men in your age group who have pattern hair loss later in life. I hope you found this information helpful. Thank you for your question.

William Rassman, MD (retired) · Answer

I have a problem that a 23 year old should not have a surgery and a surgery of 5700 grafts through an FUE will cause balding in the donor area. Do you have a see-through donor area?

9 months post op 5700 grafts, I can still see my scalp clearly in the light as if I am bald. When will my scalp get covered?

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