Lack of density and growth 8 months post op, black female - will I need a second procedure? (Photos)

Question

I am 8 months post op a hair transplant done in the US by a reputable surgeon that specializes in textured hair (for context my hair is tightly coiled 4c). I have a few concerning areas for growth and density but one area in particular is my frontal scalp barely having any hair in this area. I know I’m supposed to wait until I hit the 12 month mark before I fully worry but I have a hard time believing hair will just appear in this area out of nowhere. I’m not sure if it looks that way because of the way coily hair grows but I doubt it. If that’s actually the case I’m worried the grafts did not survive and I’m going to need a second procedure. The area looks super shiny to me under bright light. When I comb out the whole area it looks less concerning but when I part the hair to examine it, it looks extremely concerning.

Anna Chacon, MD, FAAD · Answer

Thank you for your detailed question and for sharing clear photos, which are very helpful in assessing your concerns. Based on the images and description provided, here are a few key points to consider:

1. Timeline and Expectations:
At 8 months post-op, you are still within the expected window of ongoing growth following a hair transplant. While many patients experience significant visible growth between months 6 and 9, final results are typically evaluated at 12 to 18 months, especially for those with coily or tightly textured 4C hair, where curl pattern and density can visually mask or delay the appearance of fullness.

2. Hair Characteristics (4C Texture):
Tightly coiled hair, like yours, naturally grows in a compact and curly pattern that can make early growth appear sparse—even when follicles are active. Additionally, the coily growth pattern creates volume gradually, so it may look thin until more length is achieved and curls "fill in" the area.

3. Shine and Scalp Visibility:
The shiny appearance of the scalp in the frontal region may suggest a lack of follicular activity or poor graft survival in that localized area. While some shininess can occur due to tension, dryness, or product buildup, persistent shine—especially in an area that appears smooth or flat—can sometimes indicate scarring or failed graft take.

4. Uneven Growth or "Patchiness":
What you’re seeing could also represent differential survival of grafts—which unfortunately can occur even with a reputable surgeon, especially in individuals with textured hair, where follicular units are more delicate and extraction/implantation is more technically challenging.

5. Possibility of Needing a Second Procedure:
Based on your concern and the visual evidence, it is possible that a second procedure may be necessary to improve density, particularly in the frontal scalp. However, I would strongly recommend waiting until the full 12-month mark, as significant improvement can still occur in the next 3–4 months. Also, combing or manipulating the area less frequently might prevent mechanical stress that could hinder growth in fragile follicles.

6. Next Steps in the Meantime:

Continue gentle scalp care—avoid traction, harsh combing, or heavy styling

Consider using topical minoxidil (5%) to support graft stimulation, if cleared by your transplant surgeon

Assess for signs of scarring alopecia or inflammation (e.g., redness, burning, tenderness), which may require evaluation by a dermatologist

In Summary:
While it's too early to definitively determine transplant failure, your concerns are valid, especially given the visible lack of density in a focal area. If little or no progress is seen by month 12, further evaluation with a dermatologist or your transplant surgeon would be appropriate to discuss potential for touch-up grafting or secondary procedures.

Let me know if you have questions about topical treatments, scar prevention, or hair care routines tailored to transplanted 4C hair.

Lack of density and growth 8 months post op, black female - will I need a second procedure? (Photos)

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Lack of density and growth 8 months post op, black female - will I need a second procedure? (Photos)

Answers (1)

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Everything you need to know about Hair Transplant

Our mission is to create a world where every investment in modern beauty is Worth It.