2 and a half years after Neograft procedure and almost all of the transplanted hair is gone! How can this be explained?

Neograft procedure was done in January of 2013. Over 2700 grafts. After about 12-18 months I was very pleased with the results. I would say 80% of the transplanted hair grew in nicely to cover up top. Shortly after that the transplanted hair started to fall out. Now it's almost all gone. The doctor said he's never seen this happen and doesn't have any explanation as to why this would occur. Has anyone seen this happen? I am considering a second treatment. Please help!

Doctor Answers 11

Nearly all 2700 NeoGraft FUE follicles did not survive the transplant...what happened??

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Dear Harold R,Thank you for writing in with your question. This question is representative of the very reason I chose not to acquire a NeoGraft device and went with the ARTAS Robotic Hair Restoration Surgery system instead. Our patients are very pleased with the results from the ARTAS procedure. Regarding NeoGraft: I was worried about physicians buying this device and then calling themselves a “hair restoration expert” and then using that device to deliver sub-optimal results. I’ve expanded on these thoughts below.Here’s a little background on the issue, and some insider information about the hair restoration surgery industry: The Neograft device was introduced about 7 years ago, and is simply a machine that a physician (or, most likely a technician) uses to perform the follicular unit extraction (FUE) procedure. It is more or less a motorized, hand-held circular punch, attached to suction. I attended a physician's office in Florida in 2009 for a demonstration of the NeoGraft device. I've been performing FUE procedures since 2003, and I was very interested to see this device. While at this meeting, hosted by the NeoGraft corporation, it was interesting to note that I was the only dedicated hair restoration surgeon in attendance. The others there to see and perhaps purchase the machine were spa owners, obstetricians, several family practice doctors, and a few business managers for doctors who dabbled in cosmetic surgery in general. I was pretty surprised. It seems the marketing that NeoGraft was performing was in fact not directed at actual hair restoration surgeons, but towards doctors who have never once performed a hair restoration procedure in their lives.  You can see where problems might arise.  The graft placement feature of the NeoGraft device with positive pressure is a gimmick, as I asked the head trainer for the NeoGraft corporation to place a graft using this. We were observing a live procedure, and we watched as he tried several times, but was not able to place a single graft with the machine. NeoGraft has done a tremendous amount of marketing, and I see physicians who have never done a hair transplant around the country acquire this machine, piggyback on the marketing done by NeoGraft, and start to offer this complicated, and permanent procedure to the public. In much of the country, the doctor will simply hire a technician (the going rate for a NeoGraft tech in Atlanta is $70/hour) to perform the procedure. Some States, like California, don't allow technicians to cut human skin, but most States allow it. In States that don't allow it, like California, it still happens every single day at clinics all around California.It should be noted at this point that hair restoration technicians have the same exact medical training requirements as grass cutters: absolutely none. The physician only need sign the papers and be on the premises. No joke. So, whether using the NeoGraft, or the much more advanced ARTAS robotic hair restoration system, or any other device, including a 50 cent 1mm biopsy punch, it is the experience and dedication of the surgeon and his team that will determine the outcome. Hair Restoration is it's own specialty now. There's a global society (the International Society of Hair Restoration Surgery) and a Board. Choosing a surgeon 100% dedicated to hair restoration is paramount. If "NeoGraft" suddenly appears on a long list of other procedures a physician offers, I would be wary, as it is unlikely that the physician has a full-time, highly-trained team of hair restoration technicians, and is just hiring one of many "hired gun" technicians that will arrive at the office, and do the procedure for $70 an hour. There are hundreds of subtleties and nuances in hair restoration, and assuming that because a physician now offers NeoGraft, in addition to all the other procedures offered, will be competent and excel at hair restoration surgery is simply foolish. The fact that your surgeon has zero explanation is telling. I’m sitting here in my office in Atlanta and I can think of three reasons off the top of my head as to why this happened, and none of them are things your surgeon’s going to be especially proud of. Look at the experience and dedication of the surgeon who will be performing the surgery, and make sure technicians are not actually the ones who will be performing the surgery. Also make sure the physician you choose is actually a trained surgeon. The majority of hair restoration "surgeons" are, in fact, not trained in surgery at all, and hold no board certificates in any surgical specialty whatsoever, so examine your physician's credentials carefully. You should feel perfectly comfortable asking for a copy of the surgeon's resume to review. Look for many years of dedication exclusively to hair restoration, not just cosmetic surgery in general.This problem is so rampant and common that the International Society of Hair Restoration Surgery, the global community of physicians practicing hair restoration, issued a consumer alert about this issue. I see patients every month who had a hair restoration performed by a technician with the NeoGraft device presenting to our office asking for help; asking me to repair the unnatural looking hair transplant results. This is often very difficult, and occasionally impossible. Because as we say in this specialty, "the good thing about hair restoration is that it's permanent. The bad thing about hair restoration is that it's permanent." Consult with more than one surgeon, make sure he or she is actually a trained surgeon, and get a feel for who you think will be the best for you. A machine absolutely does NOT guarantee good, or even acceptable results.I hope this information is helpful to you.#hairishot #ARTAS #hairtransplant #hairrestoration #neograft #andersonhairsciencescenter #trustdale #atlantahair #regrowhair #ISHRS #balding #atlantahairsurgeon #IAHRS #baldtruthtalk #hair #hairloss #FUE

Atlanta Hair Restoration Surgeon
5.0 out of 5 stars 173 reviews

Transplanted hair gone 2 years after Neograft

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How are you certain that it is the transplanted grafts that shed?  You may need a small scalp biopsy to see if there is any auto immune process going on.  Its best to see your doctor and discuss with them.

Amir Yazdan, MD
Irvine Hair Restoration Surgeon
5.0 out of 5 stars 28 reviews

2 and a half years after Neograft procedure and almost all of the transplanted hair is gone! How can this be explained?

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I would doubt if almost all of the hair transplants have lost their hair production after having produced hair before. My first thought is that you are losing your existing hair in the transplanted areas and not hair from the grafts themselves. 

Since this is delayed hair loss, I seriously doubt if it is from the technique used for the hair transplantation. It's the skill and experience of the doctor or technician that counts far more than the equipment. 

I suggest you have your hormones checked along with routine lab work. If you are on anabolic steroids, you can count on more hair loss. You should also be on minoxidil 5% twice a day and finasteride, providing you have reviewed the side effects on the Internet and agree with them.

Thank you for your interesting question, and best of luck to you

Neograft hair loss

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I would highly recommend an evaluation by a medical physician prior to proceeding with another procedure. Labwork would be helpful to assess any medical conditions that may be contributing to this problem, such as thyroid disease, autoimmune disorders, etc.

Gregory Chambon, MD
Overland Park Family Physician
5.0 out of 5 stars 5 reviews

Transplanted hair fell out?

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This is very unusual and I have never seen a situation where the hairs that have been transplanted fall out after a year. 

It would be more likely that the hairs surrounding the transplanted hairs may have fallen out as they are susceptible to the genes that cause pattern baldness. 

I would really suggest getting another opinion at this point and seeing if maybe there is some underlying issues. 

Cory Torgerson, MD, PhD, FRCSC
Toronto Facial Plastic Surgeon
4.7 out of 5 stars 170 reviews

Explaining an Unsatisfactory NeoGraft Result

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One of the biggest mysteries about hair loss is why some hair follicles stop producing hair while others do not. Androgenetic alopecia, also known as male (or female) pattern hair loss, follows a very specific progression because only the follicles in specific regions seem to have a genetic sensitivity to dihydrotestosterone (DHT), a natural by-product of the androgen testosterone that occurs in both men and women. In these follicles, DHT causes gradual shrinkage, shortening the lifespan of each individual hair follicle and eventually causing the affected follicles to stop producing cosmetically acceptable hair altogether. However, hair follicles in other regions of the head, like the back or sides, do not seem to share this sensitivity, and so when they are transplanted into regions where hair has begun to thin, they continue to grow as they would have at their original site.

Every patient’s hair loss is unique and the “pattern” that androgenetic alopecia will follow can differ significantly from one person to the next, so unfortunately, without a great deal of experience, it can be difficult to predict exactly which follicles will eventually be affected by DHT and which will not. Grafts that are mistakenly taken from outside the appropriate donor zone may include follicles that are still susceptible to the effects of DHT, but which have simply not been affected by it yet. These follicles, once transplanted, will follow the same development that they would have normally, eventually shrinking and ceasing hair production just like the original hair follicles in the recipient area.

Moreover, the actual transplantation of follicular unit grafts is a very exacting process, requiring a great deal of skill. Care must be taken to avoid implanting too many grafts into any one location, as grafts that are packed too densely can overtax the available blood supply and fail to thrive. In the forty years that I have been performing hair transplantation surgery I have had to correct, time and again, the poor results of hair transplantation procedures that were performed by inexperienced surgeons, or worse that were performed by technicians with no surgical knowledge whatsoever. Ultimately, no matter whether a hair transplant is done with NeoGraft® or with a more traditional strip approach, the single most important factor governing the success of the procedure is the skill of the surgeon. Placing and angling each follicular unit in order to achieve natural looking results that will last require a degree of care and artistry that no machine can duplicate.

Edmond Griffin, MD
Atlanta Dermatologic Surgeon
4.0 out of 5 stars 6 reviews

Reasons behind Failed NeoGraft Procedure

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Our patients continue to be satisfied with their NeoGraft results. After regrowth commences 3-4 months after the shedding phase, patient's hair continues to grow naturally. I am unsure how this standard experience of our patients did not characterize your NeoGraft results. If you are considering a second treatment, I suggest you consult a board certified facial plastic surgeon because the board certified credential ensures you receive the highest quality knowledge, treatment, care and skill available. A consultation provides you the opportunity to relay your concerns and desired outcome to the surgeon while the surgeon can assess your health profile and discuss his/her pertinent advice. Shop around with different surgeons and be sure to inquire about their experience with NeoGraft, their patient testimonials and their Before & After's.

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 124 reviews

Transplanted hair gone after few years

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Not knowing all the details involved, in general if the doctor is not experienced and is not familiar with the procedure they can possibly take donor hair from outside of the donor zone, this could result in losing the hair eventually after hair transplant. It is of utmost importance to chose your doctor with hair transplant credentials and experience. You can do research and find sites that are informative for doctors experience in hair transplant. Having said that you need to contact your doctor to find out what caused it and get second opinions. 

Michael Meshkin, MD
Newport Beach Hair Restoration Surgeon
4.9 out of 5 stars 29 reviews

Hair loss

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Are you sure it was the transplanted hair that fell out and not the native hair that is susceptible to male pattern hair loss? 

Tim Neavin, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 53 reviews

If you have a diagnosis of genetic androgenic alopecia, transplanted hairs should not fall out.

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If you have a diagnosis of genetic androgenic alopecia, transplanted hairs should not fall out.  You may have had an un-diagnosed hair loss cause.

Jae Pak, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 106 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.