Would doing a transplant over existing hair going to affect the survival rate?

Question

How is doing transplant over existing hair, whether or not those existing hair are from previous transplant or natural hair, will affect survival rate? What happens when such graft fail to survive? is it going to stuck inside skin? Which is better to achieve density, putting 4000 graft in 2 session with year gap, or put all 4000 in 1 session (assuming same recipient area)

Jae Pak, MD · Answer

A doctor would need to examine you and give you an assessment based on clear goals and expectations. All surgeries (no matter how minor) has risks. It is for you and your doctor to discuss these risks versus the benefits.

Amir Yazdan, MD · Answer

These are great questions. The survival rate of the transplanted hair would not be affected given you do your research and find a well qualified and experienced hair restoration surgeon. Sometimes the native hairs (existing hairs) may fall out due to shock loss which is normal after undergoing a surgical procedure, if this happened don't worry - they will grow back during the next growth cycle. The best way to prevent this and what I do with all my patients is put them on the drug Finasteride prior to their surgery as well as Minoxidil. 
Again, no, your grafts would not get stuck in the skin if they do not survive provided you're seeing a skilled physician. The grafts simply fall off/out just like your native hair does. 
I usually recommend not having more than 2,500 grafts put in at a time. Extracting 4,000+ grafts is considered a "mega-session" and you want to steer clear of these as your risk factors increase significantly. Possible risks include major scarring, shock loss, and low-graft survival rate. I've had to fix many cases due to physicians doing large sessions all at once and its not an easy task. You'll have much better results being patient and doing 2 sessions spread out.

Sara Salas, MD · Answer

Clinics that have the knowledge and skill set to employ the use of high magnification to see in between the follicle groupings. We use a Carl Zeiss prism Loupe that is similar to a microscope of 5-6X with clarity. Even then there is a chance to cause shock loss or incidental damage to miniaturized hairs that are so small they are not visualized. Shock loss follicles should return in 3-4 months. 
Only does the increase in damaged existing hairs occurs when there is ZERO magnification used and a blindly made site is made... let alone 3000 blindly made sites. In this condition yes there could be a hampering of yield.

Himansu Shah, MD · Answer

Thank you for the question. Transplanting in the area with existing should not cause any problems. You will always naturally lose hair so it is best to be on finasteride to help decrease hair loss. I would recommend two sessions. It is best to discuss with a board certified plastic surgeon. Good luck.

Michael Vories, MD · Answer

Grafting into existing hair should not affect the survival rate of the transplanted hair, but the native hair is subject to possible transection when the grafts are placed, resulting into loss of the native hair.  That is why for patients in this situation it is best to clip down the recipient area so the native hair can be visualized. This will help prevent damage to the existing hair.

Mark Taylor, MD · Answer

The art of hair transplantation is the proper technique to place the hairs for maximum coverage of survival.  I recommend that you have a consultation with an expert hair transplant surgeon.

Johnson C. Lee, MD · Answer

Hair transplantation is done purposefully into existing hair-bearing areas. This allows there to be a very natural appearance of your new hair without any obvious border or demarcation where your exisiting hair and your new hair begins. The hair is carefully placed so that the your existing hair is not disturbed and the grafted hairs are placed between them. The grafts will not be affected. If a graft fails, it simply is exfoliated out and you lose the hair like any other hair on your body. They are not retained in the body. Johnson C. Lee, MD

Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Edward J. Domanskis, MD (in memoriam) · Answer

Hair transplants can be interspersed between existing hairs esp if there are gaps. I no longer take the strips but use the FEW system. Dr. Ed Domanskis

William Rassman, MD (retired) · Answer

The only time that transplanting into existing hairs is a problem is when the existing hairs are miniaturized and already under-goiung the loss process.  This is why we recommend the use of the drug finasteride to stop this loss when a hair transplant is done the first time. Usually on a second go-around, hair loss does not occur.

Would doing a transplant over existing hair going to affect the survival rate?

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