I have some spiky stubble hair that does not grow after 9 months of FUE transplant. Is this hair dead? Will a new shaft grow?

When our patients return to our office, I have found that it's most helpful to provide them with a magnified visual of what is taking place atop their head.  Often times, you clearly see a healthy hair shaft protruding from the same follicle as stubble.  This best illustrates that it is NOT a dead graft, but rather one that remains partly in the post-operative dormant phase.   
While mechanically extracting the stubble is fine, I also encourage patients to use any products that promote the shifting of hairs into the growth phase of the cycle (e.g. minoxidil, finasteride).

Dear gedela vinay,Thank you for submitting this question. If a graft perishes prior to implantation, it will not grow, and instead becomes a foreign body in the scalp. The remainder of the follicle is resorbed by the body and the hair remains alone. After 9 months this is most likely the case. Hair usually comes out of its dormant phase before 9 months. While there is a possibility that a new follicle will emerge from where you pulled the spiky hair out from your scalp, in my opinion that’s unlikely.There are 5 main reasons for failure in FUE procedures. One is patient-dependent, and the other 4 are surgeon/surgery team specific reasons for failure.Health of the patient. Diabetes, advanced age, use of tobacco, and other factors that can impair wound healing can also impair the growth of new follicles. This is the one factor that is patient-dependent.The follicles were allowed to warm up. The follicles must be cooled to specific temperatures while outside your body to ensure their survival. The cooler temperatures slow down the metabolism of the follicles allowing them to survive longer than otherwise while in the Petri dish awaiting transplantation. At our Center we use infrared temperature sensors that we use to regularly check the temperature of the grafts to an accuracy of within 0.1 degrees Fahrenheit. The follicles were allowed to dry out. All follicles must be kept moist with appropriate holding solutions. The industry standard is to use normal saline, which is simply salt water. At our Center we use a combination of Hypothermasol® (source: Biolife Solutions, Inc.) and Liposomal ATP (source: Energy Delivery Solutions, Inc.) to help feed the follicles and ensure maximal growth of all the transplanted follicles.The follicles were handled improperly. This is a function of the surgical technicians involved in the case. If they are part-time, or independent contractors, or inexperienced it can be a problem as if grafts are handled improperly they can be damaged or even terminated due to improper handling by inexperienced surgical technicians. At our Center we have a full-time staff of highly experienced surgical technicians. I have 6 full time staff on my surgical team, and our combined experience in hair restoration is over 60 years. Four of my techs have over 10 years continuous experience in the field of hair restoration surgery, including FUE.The follicles were left out of the body too long. This is the most common reason for FUE failures. Not matter what is done, follicles will not survive outside the body forever. Technically they are slowly perishing while outside your body, and if they are not efficiently replaced into the scalp, some don’t survive. I read on blogs about people having FUE procedures, and they describe arriving at the facility at 6AM and leaving at 11PM or later. A significant portion of grafts that were removed early in the AM would not have survived 12+ hours outside the body, and this can lead to poor growth. At our Center we have a “clock on the grafts” and all surgical staff are well-aware of the time the grafts have been outside the body. For FUE cases we are careful to make sure the grafts that were harvested early in the case are the very first ones to be implanted so the time spent outside the patient’s scalp is minimized.You have waited 9 months and are concerned about the growth of your FUE grafts. My suggestion is to meet with the physician who performed the FUE procedure to see what he or she thinks. After 12 months, if the spiky, non-growing hairs that come out easily with tweezers are still there and look the same, it is most likely that all of those spiky hairs represent grafts that did not survive the transplantation process. I hope this information is helpful to you.Kind Regards,KWA

Hello and thank you for your question!

At 9 months post-FUE transplant, most of the transplanted hair should have grown in, but it's not uncommon to have some areas where the hair appears to be slower to develop. If you notice spiky stubble that hasn’t grown further, a few possibilities could explain this:

Dormant or slow-growing follicles – Some hair follicles can take longer to start growing fully, even up to 12-18 months. This means it’s possible that the stubble could eventually grow into normal hair.

Miniaturized hair – In some cases, the transplanted hair can grow back thinner or weaker (miniaturized), which may give the appearance of stubble that doesn't grow.

Follicle damage – If the follicle was damaged during the procedure or didn’t survive, the hair might not grow at all. In this case, the hair could be “dead.”

It’s best to check in with your surgeon, who can examine your scalp and provide a more detailed assessment. They may suggest waiting a bit longer or discuss other options like touch-up procedures if needed.

Best of luck!
Genie Alexander, RN BSN for Anna Petropoulos, MD FRCS at Center for Classic Beauty, Danvers & Boston, MA

If the hairs never fell out and you have the same hair shaft that has not grown for the past 9 months, it is best to contact your doctor for a recheck.

Hello, Dr. George Abrahamian here from LA FUE Hair Clinic in Pasadena, CA. Typically during a hair transplant what happens is the hair follicle is excised from the donor, whether through FUE or FUT, and implanted into the recipient site. The recipient skin will then absorb the follicle, and that follicle will then mature over time. Typically, grafted hair follicles will start maturing around the 3rd month post transplant, and can take up to a year to fully cycle through their phases enough for you to see the final outcome. Once the body accepts the hair follicle, the hair that was grafted along with the follicle goes dormant, and will likely never grow. New hair should start to sprout from that follicle, but the transplanted hair itself likely won't. Starting approximately 10 days after hair restoration, the grafted hairs should start to fall out on their own, and once you're able to touch and massage the transplanted areas in the shower based on your clinics post operative timeline, you'll notice more and more of these short stubble hairs shedding, until most, if not all of the transplanted hairs fall out. In some instances, the body will retain this dormant hair, and it will essentially just be a foreign body that is present. If you look closely, especially 9 months after your transplant, you will likely see some new hair sprouting around the retained dormant stubble. I recommend speaking with your surgeon to see what your options are, but the majority of the time, manual removal of the stubble is indicated, as they can clog up the channel where the hair is trying to grow. It does not mean the graft didn't take, especially if you see hairs growing from the same channel, it just means that the body held onto that dormant hair for longer than anticipated. You can also try using your non surgical options like Minoxidil and Finasteride to try and shift the growth stage of the hair out of dormancy, but this is few and far in between, and these options are far more beneficial for hair that is already able to cycle through their anagen, catagen, telogen and exogen phases. I hope this helps.

Thank you for posting your question. If after 9 months post procedure, you still have original grafts still on your scalp, or hairs that seem like they are not growing, that can possibly mean that the scalp is not properly washed at the moment. Try to go in there, and use the tips of your finger in circular motion to wash away any of the original grafts implanted. Otherwise, the new hairs can become in-growns as well, which you want to avoid. Hope this helps.

The stubble hairs are probably shafts from the grafts that were transplanted. These shafts normally would fall out or "shed" 3 to 6 weeks after a transplant.The bulbs remain under the scalp and become dormant for approximately 3 months. Then they grow new hair. In your case the stubble hairs are these originally transplanted grafts shafts that have not shed and are actually trapping a new hair from growing. You can easily tell by gently tugging on the shaft with tweezers. They should come out. And NEW hair should follow.

Good morning, gedela vianyIt is possible that hair is still growing. I wanted to ask you, are you doing any non-surgical treatments?" For what you mentioned, I believe you will benefit from PRP treatment. Platelet rich plasma is concentrated blood plasma which contains growth factors and other bioactive proteins that will help you.Best of lucks and I hope you find this helpful.Sincerely, WY

These small shafts of hair that you feel and easily fall out, reflect the actual hairs that were originally transplanted. These usually fall out before the new hairs grow and they do not necessarily reflect a failed hair graft. Take a close look at these small stubs of hair and see if there is new hair growth immediately next to them. That would indicate that these new hairs are from the original graft marked by the stubble. If, however, there is no immediate growth just adjacent to the stubble, then it may mark a failed graft. These hairs, as you pointed out, always come out easily.