Should I fix scalp calcification or fibrosis before hair transplant?

Thank you for your question. You state you had 4400 grafts in a hair transplant, but describe it as a failure because it was a 15-20% yield, and there was a significant possibility there was underlying scalp fibrosis and calcification. You want to know how to figure out if that’s the case, and you were about to undergo a third hair transplant. You’re also asking about using magnesium oil prior to this hair transplant.
I can share with you my perspectives on your situation, and a little about my experience in comparable situations in our practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Hair transplant has been a big part of my practice for many years. I’m also the founder of TrichoStem™ Hair Regeneration Centers, a system we developed to non-surgically help men and women with genetic pattern loss. We use regenerative medicine and technology that may be applicable to a situation like yours.
Unfortunately, low yield of transplanted hairs occurs more commonly than is presented in the transplant industry. We have had patients who came to us after megasessions not done in our practice who had more than 90% of their grafts not growing. It was practically like they had no hair at all, so it’s a possible situation.
What I describe to our patients who have undergone transplant elsewhere, or have come to me for additional opinion about transplant versus Hair Regeneration, I help them understand the process of transplantation is fairly traumatic. When people say 1500 grafts, 3000 grafts, or in your case, 4400 grafts, you’ve had 4400 stabs made into the scalp. Intrinsically, there’s going to be vascular compromise, inflammation, and all of those variables can play a role. The fact you had a previous transplant is significant as there is scarring that occurs with every transplant, and it can compromise the integrity of the tissue.
Many patients have come to us from around the world for this treatment we call Hair Regeneration. Hair Regeneration was a discovery we made based on the use of a wound healing material when we were doing a lot of hair transplants, where thinning hairs became thicker. We were using a wound healing material to improve the outcomes in terms of graft survival, and healing of the donor area. Once we started using it for pattern genetic loss without surgical transplant, it actually created a new category to help people with thinning hair who would have previously gone for a hair transplant.
As a cosmetic surgeon, I have been using this material for rehabilitation of tissue. Patients have come to me who have had multiple eyelid surgeries and developed scarring, retraction, and other issues. Before doing another surgery, I’ll do what I refer to as tissue rehabilitation. I’ll use PRP, platelet-rich plasma which is derived from your own blood and is a concentration of the wound healing and growth factors necessary when you have a cut, as well as Acellular matrix. What I believe is going on that I see from the external perspective is the tissue gets healthier: vascularity and the quality of the tissue improve. So, one of the things I would consider in your situation would first tissue rehab before doing another transplant.
Another relevant example is patients who have had transplant elsewhere have come to us in a window within the first 3 months of having surgery. In those patients, we’ve actually helped expedite their healing and we observed that the grafts actually grow sooner.
It is a difficult thing when you manage patients who had transplants elsewhere. Sometimes, I am a little more cautious because if they had second or third transplant, we want to be strategic. Sometimes I’ll tell the patient to see how well the grafts heal. Maybe after a year, when the grafts are healed, we may help with the management of the scalp in terms of the existing hair, to try to preserve and prolong the lifespan and the tissue quality to help with the grafts once they’ve settled in.
There’s no specific right answer to your question. I think magnesium oil will have a limited value because just the anti-inflammatory potential benefit is not enough to create healthier tissue. Remember, it’s a hair graft where you’re moving skin-bearing hair to skin, so you need blood supply, and the tissue to heal. After multiple surgeries, the fatty cell layer under the skin, scar tissue, and other things can be compromised to a level that can affect impact of the hair graft yield. In addition, we also want patients to have their blood pressure checked, and be off of anti-inflammatories which can be blood thinners, but I think that probably already is covered.
It’s important for you to learn about PRP, Hair Regeneration, this emerging stem cell-based technology to help with tissue rehabilitation, and improve graft yield for further surgeries. This is something to discuss with your hair transplant doctor. Remember, your donor area, and probably even going beyond the donor area to body hair at this point, is always going to be limited, and every hair that doesn’t take is a hair lost, so make your decision very carefully. I hope that was helpful, I wish you the best of luck, and thank you for your question.

If your first hair transplant failed and believe it is due to fibrosis or scarring alopecia then your next surgery may also fail.

If  you had 4400 grafts and it failed and if it was performed with FUE, then you may have depleted your donor area (see article below).  In my 27 years in practice, I have never seen what you are talking about,  The usual cause of hair transplant failures are technical ones, but some scalp diseases like autoimmune disorders can cause hair loss and these should be ruled out with a biopsy of the scalp