FUE Transplant

[John P. Cole, MD]

The normal sequence of events following a hair transplant is for the transplanted hairs to elongate for about 2 weeks. Then the elongation ceases and over a period of weeks the hairs should shed. Occasionally, the hairs do not shed. They stay in their state of elongation following the first two weeks after hair transplantation without falling out. These are dead keratin and they should be removed because the body will attempt to wall off the dead keratin or form a cyst, pustules, or "black head" around the non-growing hair. You can pluck them with tweezers and they will come out like a pin out of soft, warm butter.

Then about 3 months following a transplant the hair resumes growth. You will see about 10% more growth each month so that at 5 months you have 50% and at 8 months 80%.

Your situation is far different as i understand it. Your hair resumed growth and then fell out. Looking at the high mag. photo of your scalp, i see a follicle that is bent over in a C shape. The follicle is quite coarse. The follicle is dark.

Often times follicles will look similar to this when they resume growth right after a transplant with the exception that the distal tip tends to be fine and lighter in color. Following a transplant a few transplanted hair might continue growth with the exception that they will show the trauma of the procedure (donor removal and re-transplantation). They usually start fine and light at the tip and then the hair becomes coarse and bends over like this one. They are phul pinkus hairs and represent trauma. over time they turn out normal.

your bent over hair is a little different. it might represent a follicle that was an ingrown hair. I think it represents trauma and i would expect that follicle to fall out temporarily and then resume growth.

The history is really bizarre. A proper transplant will follow the coarse that your transplant seems to take. Nothing about a transplant has any influence on what happens to the follicles after 9 months other than how the grafts appear. By this I mean natural appearance, proper hair growth direction, etc. Fall out following regrowth suggests something else.


The other hairs in this photo look ok. the other follicles are finer and lighter in appearance. did these follicles fall out too or just this one that looks like it would fall out. Follicles can look like this without the procedure necessarily being performed poorly.

So, are you saying that all the grafts fell out after they resumed growth? If so, something is going on. Some sort of medical condition and it should be evaluated and biopsied.

Follicles can be damaged by both strip procedures or FUE, but I really feel there is a greater risk to the follicles with FUE because the only tissue around the follicles is the dermal sheath. You don't have adipose. You really have to be more careful when placing FUE grafts. I think it is up to the surgeon to monitor the graft placement and insure that FUE and strip graft placement is atraumatic.

Ok, let me know if I understood your case properly.