Will my transplanted follicles suffer damage with a second procedure?

[FF]

Hi I'm 30 years old and I had a hair transplant last year. I was recommended the FUE procedure for 2000 grafts as I had a thinning hairline with no bald spots. I am currently on Finasteride and Minoxidil for 3 years. It is now 17 months after but my hair still has the thinning look. I'm not thrilled with the result. The doctor has suggested my hair loss has continued but I'm not so sure. Is it possible that the FUE surgery damaged the existing hair follicles?
If I have a second surgery to add density will the transplanted follicles be at risk? I have been reading about blood supply, scar tissue, and other factors but do these really have an impact on the surrounding follicles?

 

[Kevboy]

The risk is usually to miniaturised hair follicles that are on their last legs. The trauma, shock and injectables that go into your scalp can damage or kill them off. Transplanted ones should be healthy and able to withstand the things mentioned. The Finasteride you take should be helping your native and transplanted follicles.

 

[Guest!]

If you are a diffuse thinner and the surgeon was sloppy with the incisions (i.e. they just made them blindly without attention to existing native hair) then the doctor could have potentially damaged existing hair follicles. Alternatively (as Kevboy suggested) the trauma of surgery itself could have shocked any miniaturised hairs that were going to fall out anyway, in which case all you did was replace weaker hairs with transplanted ones resulting in what is basically a zero net gain. It's sort of hard to tell without seeing pics or knowing the doctor you went to.

Generally speaking any experienced surgeon doesnt have any issues with a 2nd surgery going over the same area, but it's never a bad idea to explore other options if you're not happy with your current results.

 

[NZK Medical]

Hi I'm 30 years old and I had a hair transplant last year. I was recommended the FUE procedure for 2000 grafts as I had a thinning hairline with no bald spots. I am currently on Finasteride and Minoxidil for 3 years. It is now 17 months after but my hair still has the thinning look. I'm not thrilled with the result. The doctor has suggested my hair loss has continued but I'm not so sure. Is it possible that the FUE surgery damaged the existing hair follicles?
If I have a second surgery to add density will the transplanted follicles be at risk? I have been reading about blood supply, scar tissue, and other factors but do these really have an impact on the surrounding follicles?

Hello @FF, your use of hair loss treatment is a big positive and probably helps to maintain your existing hair stance. Whether your previous FUE affected the hair growth of your existing hair. This would normally be considered shock-loss. Caused by the hair placement, maybe the medications used. Or simply the trauma of the procedure. Normally occurring within 3 months or so of the procedure. Depending on the cause of shock-loss often the hair can grow back. Especially when using treatments. Without seeing images any comment is really only general of course. Whether hair can be added for you will depend on a few aspects. But, there are a number of steps that can help reduce your concerns. Assuming it is possible to add more hair.

The use of custom-made recipient sites can refine the placement, angle, and orientation of the new hair placed. This includes the distribution of the hair unit size being placed. Custom sites can help to follow the surrounding hair growth. Whether transplanted or natural. Without creating risk. The exit point of the hair from the skin can be identified. Understanding how the hair grows will then confirm the position of the hair follicle under the skin surface. As a result, reduce any risk of damaging the surrounding hair units. Allowing the doctor to shave the surrounding hair often allows for ease of slit-making and graft placement. The benefit to this can be a better hair density being placement. Enabling to follow the natural existing point of the surrounding hairs. To allow your new hair to blend correctly. While not always necessary to shave, considering the positive impact it often gives to the end result. It should be considered a minor inconvenience. If you have concerns try to get the opinion of a number of clinics. Review their approach to adding hair density to areas of existing hair.

 

[FF]

The risk is usually to miniaturised hair follicles that are on their last legs. The trauma, shock and injectables that go into your scalp can damage or kill them off. Transplanted ones should be healthy and able to withstand the things mentioned. The Finasteride you take should be helping your native and transplanted follicles.

I believe the Finasteride and minoxidil have improved my hair which has me thinking the transplanted follicles had a low survival rate!

 

[FF]

If you are a diffuse thinner and the surgeon was sloppy with the incisions (i.e. they just made them blindly without attention to existing native hair) then the doctor could have potentially damaged existing hair follicles. Alternatively (as Kevboy suggested) the trauma of surgery itself could have shocked any miniaturised hairs that were going to fall out anyway, in which case all you did was replace weaker hairs with transplanted ones resulting in what is basically a zero net gain. It's sort of hard to tell without seeing pics or knowing the doctor you went to.

Generally speaking any experienced surgeon doesnt have any issues with a 2nd surgery going over the same area, but it's never a bad idea to explore other options if you're not happy with your current results.

I'm not mentioning the doctor for now until I can establish what happened. Your theory on sloppy incisions is a possibility but how would I find this out? That is reassuring to know there should be no problem going over the same area.

 

[FF]

Hello @FF, your use of hair loss treatment is a big positive and probably helps to maintain your existing hair stance. Whether your previous FUE affected the hair growth of your existing hair. This would normally be considered shock-loss. Caused by the hair placement, maybe the medications used. Or simply the trauma of the procedure. Normally occurring within 3 months or so of the procedure. Depending on the cause of shock-loss often the hair can grow back. Especially when using treatments. Without seeing images any comment is really only general of course. Whether hair can be added for you will depend on a few aspects. But, there are a number of steps that can help reduce your concerns. Assuming it is possible to add more hair.

The use of custom-made recipient sites can refine the placement, angle, and orientation of the new hair placed. This includes the distribution of the hair unit size being placed. Custom sites can help to follow the surrounding hair growth. Whether transplanted or natural. Without creating risk. The exit point of the hair from the skin can be identified. Understanding how the hair grows will then confirm the position of the hair follicle under the skin surface. As a result, reduce any risk of damaging the surrounding hair units. Allowing the doctor to shave the surrounding hair often allows for ease of slit-making and graft placement. The benefit to this can be a better hair density being placement. Enabling to follow the natural existing point of the surrounding hairs. To allow your new hair to blend correctly. While not always necessary to shave, considering the positive impact it often gives to the end result. It should be considered a minor inconvenience. If you have concerns try to get the opinion of a number of clinics. Review their approach to adding hair density to areas of existing hair.

I do believe the Finasteride and Minoxidil made a positive impact. My hair looks and feels healthier with improvements I can see on the back, sides and top which leads me to think it was not permanent shocked follicles. I was reading that going over the same area is trickier because of scar tissue created by previous incisions although it was mentioned by Qui bono there should be no problem. I'm thinking the scar tissue would be minimal, therefor, no issue with blood and nutrients to a new follicle. Is this correct?

 

[NZK Medical]

Hello @FF, glad you are getting the benefits of the hair loss treatments. It shows how a combination of meds and hair transplants can complement each other. Placing between existing hair, be it existing natural or transplanted hairs obviously requires greater skills. But, whether there is any significant scarring is another matter. Technically micro-scarring occurs when the recipient site is made and the hair placed. But even under magnification, it´s often not possible to see once healed. Like a paper cut when healed. This should not be considered an issue to placing more hair, assuming there is room.

The obvious scarring that can cause an issue is ridging. Caused by the poor placement of the previous hair transplant. Ridging raises the skin tissue around the hair. The transplanted hair may have still grown through the scarring. The ridging or cobblestoning is also known. Does affect the placement of new hair. Often the yield may be lower when trying to place in or too close to the ridging. You would know if you had this problem. The ridging, as it sounds is a raised area. Easily felt to the touch.

 

[Guest!]

I'm not mentioning the doctor for now until I can establish what happened. Your theory on sloppy incisions is a possibility but how would I find this out? That is reassuring to know there should be no problem going over the same area.

Impossible to tell really. Although i had a surgeon make around 2500 incisions within a very short timespan without even marking out my recipient (they literally did all the incisions within minutes - just went bamn bamn bamn - and walked out of the clinic). So for my case i got told by another doctor that they likely transected my native hair given im a diffuse thinner.

Good surgeons take time with the incisions ... they care about angulation and try to minimise any damage to the surrounding native hair. So if you remember the incision process was careful and took more than a few minutes then this is unlikely.

A problem like ridging is more obvious given the damage to the skin is present. Not sure but pitting might cause an issue to future surgery as well - but again you would probably know if you have these due to an unnatural appearance.

It sounds like your issues are just concerned with general growth, in which case id personally be looking at another clinic.

 

[Bigmac]

Depending on how the first surgery was performed you could have scarring in the recipient area which can have an effect on the next surgery. If there are no underlying issues/scalp issues, just poor yield from whoever, then a second surgery should work fine providing you choose a competent clinic.

 

[FF]

Appreciating the advice guys. Weighing up my options right now.

 

[NZK Medical]

Depending on how the first surgery was performed you could have scarring in the recipient area which can have an effect on the next surgery. If there are no underlying issues/scalp issues, just poor yield from whoever, then a second surgery should work fine providing you choose a competent clinic.

On a side note, from Bigmac´s comment. Suppose your scalp has no scarring that would cause concern for a new procedure. To place hair between the existing hair growth. It would likely be beneficial to shave the area for the new graft placement. Having the existing hair short helps in a number of ways. The exit point angle of the hair shaft is easier to follow when the hair is short. This helps to follow the correct angle and orientation of the hair. Including the lay of the hair. When grown out and long this allows for the hair to lay naturally. Rather than possibly facing opposite directions. Also, it can help when making custom-made incisions for graft placement. The density required and the size of the graft to use in any one area.

 

[Monoo]

Very helpful posts!