Failed FUE surgery ??

[Folly]

Hi guys,

I'll try to make this short. Had 1,250 FUE grafts in April 2011 to thicken up my frontal hairline. I'm 28 and this is my 1st hair transplant. A couple of months before the surgery i started using Rogaine foam 5% and started shedding serious hair 3-4 weeks before my surgery. My HT surgeon had agreed on 900 -1,000 grafts but due to how much shedding I had due to the rogaine, he suggested 1,250 (to which I agreed). I had a lot of nerve damage to my head after the FUE surgery and my crown area was numb for about 3 months post-op. Basically, 7.5 months on from the FUE surgery and i'm still shedding a lot of my normal hair. However after my surgery, i noticed that i started shedding much thicker hairs. Before surgery, it was just thin hairs i was shedding, which was obviously from the rogaine. My HT surgeon told me that I am experiencing Telogen effluvium but he is not sure what is causing it. I had the normal blood tests done and nothing out of the normal. He pulled out ~13 hairs from a 'pluck' test last time I saw him. I think it might just be aggressive MPB and the surgery/Rogaine have just triggered it all off. I've never shed like this before. I think i've lost 30-35% of my hair in the last 7.5 months. Planning on having a scalp biopsy in a few weeks if the shedding continues. The shedding has been all over my scalp, even the donor area.

Anyway, the reason for this post is that my FUE grafts have grown in the recipient area and then fallen out. My HT surgeon looked at a few grafts that were growing a month ago and easily pulled them out with tweezers. They weren't holding. My grafts started to grow very early on....around the 2 month post op mark, but ALL the grafts seem to have grown and fallen out. My HT surgeon says this is because i'm going through this strange shedding phase and the grafts should re-grow, but i'm not too sure. I've attached a picture of my grafts 2 weeks post op, which shows them growing. I assumed if the grafts grew after the surgery before they fell out and went into resting phase, that it meant they were properly put in and would definitely regrow at some stage.

Does anyone know what has happened to my grafts ? Have they been 'rejected' by my scalp? Are there some people who just can't have hair transplants, i.e. their scalps just won't accept it ? Also, after donor hair extraction, the donor hairs were out of my scalp for many hours (4-6 hours) before placement into the recipient area, as there was only one technician working that day. I was in surgery for 15-16 hours in total. I mentioned this to my HT surgeon and he said that the grafts were placed in a special solution, so this is not the reason for the grafts shedding. I'm praying to god the grafts will grow again, but i guess it's just wishfull thinking. This feels like a failed hair transplant to me (i'm 7.5 months post-op). I'm just surprised because the grafts were growing immeadiately post op, until the fell out at the 3-4 week mark, as expected.

My HT surgeon is pretty well known in Europe and has been accredited quite a few times on this forum. Won't be naming him for the time being....sorry !!

I have one of those USB microscope thingys to view the grafts. I have seen a few grafts in my recipient area lying dead on my scalp (flat on the scalp). Also watched a few grafts grow and then disappear. Seen a few normal hairs doing a strange spiral pattern as well. My HT surgeon said this is due to trauma and they will straighten out in time. Also seen a few normal hairs that appear to be looping in an arc pattern from one point on my scalp to another. Seen quite a lot of those actually. I have pics of all of these if anyone is interested in seeing them. Oh the fun you can have with a USB microscope !!! Seriously, don't buy one after surgery.....it will take over your life .

Any help or advice on what I should do next is appreciated. Thanks guys.

[Smiley]

It's only been 6-7 months post op for you. So your full growth hasn't been reached. And from what I see in your pic, it looks like there are new hairs growing in. But I can't make the assumption without seeing your pre-op pics.

[Tracy C]

Any help or advice on what I should do next is appreciated. Thanks guys.

At only 7 months it is much too soon to determine that your surgery has failed. If you still do not see improvement after 12 months, then you have reason to be concerned. If you still see no improvement after 18 months, then you can determine that the surgery has failed. It takes a long time to treat hair loss. The truth is some people take longer than others. Do your best to not worry and stress out over it. Stressing out over it can make the problem worse.

[Folly]

Hi Tracy C and Smiley, thanks for the relplies. I know it has only been 7.5 months post op, but the grafts have grown and fallen out. That's not normal is it? I've seen this with my microscope and my HT surgeon has also seen it. He pulled out the grafts in my hairline easily with tweezers, as they seem to have no strength.

I actually think i know what has happened. I think the nerve damage i had to my head from the FUE surgery, is causing blood circulation problems around my entire scalp. That's why i'm continuing to shed huge amounts of hair all over my scalp and also why my grafts have fallen out. I guess the hairs on my scalp (both grafts and normal) are not being nourished properly, whether it's blood, oxygen or vitamins. Have a look at the 'dead hair' picture i've attached. This was a graft in my hairline, that grew and died. I currently have these all over my scap, even in areas untouched by the surgery.

Does anyone know if this can be confirmed by a test/biopsy ? Most importantly, can there be permanent follicle damage from this ? I'm going to google how to increase blood circulation in my scalp. Thanks.

[Tracy C]

Hi Tracy C and Smiley, thanks for the relplies. I know it has only been 7.5 months post op, but the grafts have grown and fallen out.

We need to be clear on terminology here. Grafts can only fall out during the first week after surgery. Grafts are permanent after that and do not fall out. Hair can shed out, both from the grafts and native follicles, but the grafts themselves do not fall out. The hair that sheds out usually grows back.

If I am correct in assuming that you yourself are not a doctor, you are not qualified to determine what is going on. It is very likely that you are creating unnecessary stress for yourself over this. That unnecessary stress can and probably is causing excessive shedding. Stop worrying and over thinking about it. The only thing you are achieving by doing that is making the problem worse. If you really must look deeper into this, you need to consult other doctors. Specifically dermatologists who specialize in treating hair loss. Do not waste your energy "researching" this for yourself online. There is far too much junk information on the internet. You are not likely to find sound answers.

[VictimOfDHT]

Folly, unfortunately, HTs do fail sometimes regardless of how good your doctor is. I've had 4 1/2 HTs totaling more than 4500 grafts over the past decade mostly in the hairline and temples and last Feb I had this sudden massive shed and within 2 months my hairline and temples went from almost non balding look to NW 2. The shed was all over but especially in the transplanted area and I too can say I've lost about 30% of my hair.
It turns out that some people do lose their transplanted hairs either because they succumb to the effects of DHT -just like the original hair- or are rejected by the scalp, which I really don't understand. I mean we know that the body will reject parts from a different body but your own ?? The other thing, I too was noticing that my transplanted hairs were easily plucked out even with the slightest pull. My doctor is a very reputable one, so I know this can't be because of something he did wrong. Another thing I noticed about the transplanted hairs is that they definitely look curlier and many of them do have a strange spiral pattern. Some even looked like a coil or spring. There is no doubt about that.

Till this moment I'm still in shock and still baffled by the mysterious shed that's left me looking my worst. I just had a biopsy done a week ago and still waiting for the results.

So, to answer your question, yes, HTs can fail sometimes but I'm not saying that's what happened in your case. Also, one disadvantage with FUEs is that grafts do have a lower survival rate than in FUTs but that shouldn't be too much of a concern as most grafts do survive and produce hairs.

The pic shows you still have a lot of native hair and I'm wondering how you know that your transplanted hairs are falling out. Also, what makes you think you have nerve damage to your scalp? You had an FUE and not an FUT and I think it's FUTs that are more likely to cause nerve damage because of the cutting and removal of the scalp that's involved but that's not the case with FUEs. But even with FUTs nerve damage is rare especially at the hands of a good doctor. And although I'm not a doctor I don't think nerve damage will cause hair to fall out.

I really don't know what to tell you. I understand your worries and frustration as I am in a similar situation. It seems for some of us even an HT is no solution. A costly no solution to this curse. I hope things work out for you anyway.

[Folly]

Hi VictimOfDHT, thanks for the reply. That's really helpful. I'll answer your questions first.

1) The pic shows you still have a lot of native hair and I'm wondering how you know that your transplanted hairs are falling out ?

The transplanted hairs are really obvious with the microscope. You can see in the picture in my last post, the thickness is 2-4 times that of my native hair. I just monitored certain regions of my hairline and over the course of time, watched the transplanted hairs disappear. My HT surgeon looked a few with binoculars and pulled them out easily with tweezers. So the transplanted hairs are definitely falling out of my hairline.

2) Also, what makes you think you have nerve damage to your scalp?

The anaesthesia injections to my recipient area caused me the nerve damage. Portions of my scalp were completely numb for 1-2 months and i didn't get complete feeling back until 4-5 months post-op.

God, i really hope i'm not one of these people who can't have a successful HT. I feel for you VictimOfDHT, this sh#t just takes over your life after a while. I'd love to know how your scalp biopsy turns out. I'm having mine in a week or so and i'll let you know the results when i get them. I'm seeing 'dead hairs' all over my scalp (like that shown in the pic above), even in my donor area. Hopefully, the biopsy will tell me what's going on.

VictimOfDHT, did all your transplanted hairs fall out during the shed you mentioned, or just some of them? Also, if a transplanted hair succumbs to DHT, it stills goes through the normal process of thinning over a period of years before disappearing, correct? Which means the transplanted hairs should regrow after your shed, albeit a little thinner.

[VictimOfDHT]

You're welcome, folly. Me and you might have the same problem with our transplanted hair. It just seems to disappear all of a sudden and it's easily plucked out.

No. I didn't lose all my transplanted hair. I'd say I've lost half at least. What would happen is I'd get an HT, then get normal growth for a year or two or in one case 5 years then all of a sudden I'd have one hell of a massive shed and I'm thinner again. The same thing would happen after every HT. This time however the shed is the worst and like I said the doctor was shocked by it.

Sometimes I tell myself I'm just losing whatever native hair left -because I had a lot of it when I first started getting HTs- but after 4500 grafts I'd still expect much better thickness in the recipient area, which is not the case. So really I have no way of knowing which transplanted hairs I'm losing. Like I said I've had 4 HTs (ranging between 800-1700) grafts each over the past decade and one small one that I don't even mention sometimes. I still have a lot of hair in the recipient area but nowhere as thick as it was several months ago and my biggest fear is that I'll eventually lose it all with time as the doctors predicts.

The other thing, if transplanted hairs are lost due to DHT effects then I'd imagine they'd be lost just like the original ones -gradual miniaturization of the hair but I don't know. That's definitely not the case with me though. Those god damn hairs are just disappearing all of a sudden. The doctor says they're being rejected ! I'll let you know what my biopsy reveals, if anything at all.

Numbness is a common thing with HTs. I had numbness both in the recipient and donor sites that lasted for a while. I just don't know how you know for sure that you have nerve damage but like I said I don't think nerve damage has anything to do with the loss of the transplanted hairs.

Looks like we're dealt a double blow with our hair loss shit. First we're losing hair then we have whatever the hell that we have that's causing the transplants to die, and that's making me sick to my stomache and really pissed off.

[gillenator]

Hey guys,

Do either of you have advanced classed of hairloss in your family history on either side, maternal and paternal?

Folly, how much did you pay for your USB scope just our of curiosity?

I'll be doing another post on this issue ...

[gillenator]

Folly,

Thank you for sharing your story and for your transparency in all of the details. Your case is complex and yet there are some issues that I see in your case that extent beyond the scientific facts and also truths that we do know about the effects from HT surgery. And yet we also know that individuals respond differently to surgery as well as hairloss medications.

Let's start with your hairloss from the beginning. If your HT surgeon performed FUE on you was he also the one who made a "formal" diagnosis of MPB? You did not mention using Propecia (finasteride), have you used it and if so, how did you respond?

I am not a licensed physician yet IMHO, I find it VERY disturbing to read that your grafts sat in solution for that long of a period. The solutions do not prevent free radicals from attaching to your grafts nor do they stop the process of ischemia reprofusion of the tissue (decaying process) once the grafts are removed from the donor area and exposed to the environment. To my knowledge, these solutions are useless after an hour. It is also surprising to hear that only ONE tech was present and assisting. With adequate staffing in the OR, your grafts would have and SHOULD have been placed back into the scalp much sooner. 12-14 hours for that size procedure also sounds discomforting. Did they not offer to re-schedule? Or did you travel long distance to Europe? Sounds like it could be Dr. Bisanga? You don't have to say if you do not want to but consider this. What if you had not yet had your FUE and then you read an experience like yours? Would you not want to know that ahead of time?

Okay, let's move on. Your intial use of minoxidil that soon prior to surgery was IMHO a disaster. Did someone recommend that you start minoxidil prior to surgery? Did you surgeon know that? Is it possible that the initial use of minoxidil started a massive shed in your entire scalp? YES. Am I saying that was what happened? No one knows for sure, but it is possible based on your story.

And listen my friend. Yes grafts can take right off and resume growing post-op, and yes some of the side-effects causing the massive shedding was in fact shockloss both from the trauma of the incisions and also the injections. Trauma induced shockloss can occur post-op right up to about 6 weeks post-op. Most patients on the average do not shed their grafts until they reach a 2-4 week post-op period.

But like natural hair, grafts (transplants) will enter the resting phase and then regrow 3-4 months post-op.

Now, at 7 months post-op, you should be seeing lots of new growth emerging. Remember, that's the norm, everyone varies somewhat. The other thing that disturbed me was reading your doc removing lots of dead hair from your scalp that came out without any resistance. Either those were transplants that were once growing or they are existing hair that entered the resting phase.

Remember that hair grows at about 1/2 inch per month so if that hair being removed is transplanted, it should not be any longer than 3 1/2 inches maximum. If it is longer, then that hair is most likely exisitng hair that was not transplanted. Use your scope and see if you can tell which ones are transplanted when magnified.

We stilll do not know for absolutely 100% if transplanted hair taken from the donor will in fact be subject to the effects of DHT when placed in a recipient area rich in DHT (sebum). If so, then yes two events are potentially possible. The first is that the hair will in fact begin diffusing in a miniaturization process and second, the hair follicles can be held in the resting phase and do not enter the growth phase again for reasons unknown. Even both can be occuring as I believe may be going on with Victim. Could locked follicles then be revitalized into the anagen growth phase with laser therapy, etc? We need lots of new research.

We hear lots of things on HM and cloning. Even with successful cloning, we do not know for sure if the cloned follicles will grow again once implanted into a completely new environment. That is still another hoop to get through.

We all wish for certainties in life and the reality is there are still many unanswered questions. I still marvel at all of the strides made in this field especially over the last 10 years.

I hope this has made some sense and wish you and Victim the best...

[VictimOfDHT]

Thank you, gillenator. I appreciate it.
My father had the typical horse shoe baldness but it wasnt like those who barely have a couple of inches left at the back of their head. My uncles on my mother's side have thinning hair and receded hairlines but they don't have the typical horse shoe baldness and even the oldest uncle who's well into his 60's still isn't completely bald.
I'm waiting for the result of my biopsy but don't know if it will help in figuring out what the problem is.

[Folly]

Hi Gillenator,

Great and informative post. Thanks. I bought the USB microscope for £40 from Maplins (UK gadget store), which is ~ $60 i guess. It's well worth the purchase, because you can monitor the miniaturization process and see if medications are working for you with great accuracy. You can also calculate density and so forth, so it's a great purchase for $60.

My father (65 years old) is an NW4, but his father and grandfather died in the their 70s with full heads of hair. My mother's brother also has a full head of hair. The real tragedy here is i didn't really need the HT for another 3-4 years. I've attached a picture of my hairline and crown pre-op, which was last April. I just had some very minor thinning at the frontal hairline. I thought, i'll start using Minoxidil to keep my existing hair and i'll get a HT so i can have thick hairs in my hairline, so i can do some styling. If i could only go back in time !!! I've lost so much hair since April (at least 35% density) and my hairline has been hit the worst, because i was thinning there anyway.

My HT surgeon told me at my pre-op consultation that my miniaturization wasn't too bad past the hairline, so he he decided to give me a thick extravagant hairline. He said i should start taking propecia/Minoxidil to prevent future loss. My consultation with him was 1 month before my op and i had told him that i started minoxidil 1 month beforehand (2 months before op). So he knew I had recently started minoxidil. I unfortunately had a huge shed between the 1 month of my consult and surgery. When i turned up for the surgery, he was amazed how much hair i had lost within that month. You're definitely right about not starting any medications before a HT. I didn't give the Rogaine enough time to see if it was working. I had to stop the rogaine, because i wasn't sure if i was having a bad reaction. I was just shedding so much hair, i had to stop. I didn't mention, but around September time, i stopped shedding hair for about 3 weeks. But i started using the laser comb and then started to shed again, so i stopped that also. I didn't realise the comb was also going to make me shed. I've just stopped everything for now, praying that i can get back to where i was before surgery. If my hair all grows back, i plan on using Rogaine and the laser comb again. I'm not willing to try propecia yet, due to the possible side effects, although i may try it in the future.

Gillenator, do you know of any info/research available online regarding donor hair survival once out of the scalp as a function of time ? I may arrange another consultation with ANY HT surgeon to ellaborate on this point. My donor hairs were definitely out of my scalp for 5-6 hours. It will be such a tragedy if this is the reason none of my transplanted hair grow.

FYI : Next week i'll be 8 months post-op and i cannot see A SINGLE transplanted hair in my hairline with my USB scope. I've had 0% growth. OUCH !!!

Thanks Gillenator. Good luck with the biopsy results VictimofDHT !!

[VictimOfDHT]

Thanks, folly. Just this morning I got a call from the doctor and he told me the biopsy was negative or it didn't show anything, which I was expecting. So, I'm left with this puzzle now-what's happening to my hair. The doctor said there is a lot that remains unknown about why or what causes transplanted hairs to fall out in some people. So I don't know what to do now. He said I'd need at least 600 grafts to thicken my hairline -if I chose to get another HT- but I'm just terrified that I might lose a lot of those hairs too eventually, but at the same time I can't stand the look of my thinner hairline.

I think you made the same mistake I made- started HT way too early. My first one was 1000% unnecessary. My hair loss at that time wasn't even considered a loss but I was too terrified of baldness that I couldn't even bear the thought of losing 2 % of my hairline. I don't know but I feel an HT does cause some kind of damage to existing native hair and causes it to fall out faster than it would've without the HT.

I don't know that much about FUE process but I'd say 4 or 5 hours is too long for the grafts to be out. I'm sure you can find some info online or you can ask other doctors. My doctor says with FUEs the survival rate of grafts is much lower than that of FUTs and many grafts are lost. I just don't know if they're lost (damaged) during the surgery or are lost after they've been transplanted.

BTW, your hair doesn't look bad at all. You have more hair in front than I have now after 4500 grafts. I just hope I get some of the hair that was lost in the past few months in that massive shed I had. One thing I feel good about is that the shed has finally STOPPED as of 3 weeks ago and I'm pretty sure it's because I got back on Minoxidil (kirkland brand) after several months on some other useless crap that claimed 15% minoxidil content. Unfortunately, I too have lost about 25-30% of my hair during that short period.

[Folly]

Hey guys, check this link out. Apparently donor hair grafts can be left in the solutions for up to a day, without cell death. Read the second last paragraph. They extracted grafts from some guys donor area, then he was rushed to hospital due to an emergency. The grafts were left in a solution overnight and the grafts were placed in the recipient area the next day. This guy still had good growth according to the doc.

http://www.***************/hair-loss...ansplantation/

That's a bummer about the biopsy results VictimofDHT. At least your shed is over and those hairs you lost should be growing back. If the grafts are going through the normal minituarization process, i'm guessing you'll still have them for many more years before they dissapear (at least that's something ). Especially if you're taking propecia ?

My derm did a blood and hair pathology on me yesterday. Getting the results back on the 12th of this month. He says a biopsy is not needed yet. I'll let you know the outcome.

[Folly]

Sorry, not sure how you add URL links. Just search for 'The Best Graft Storage Solutions in Hair Transplantation' and it's the second link in google.

Sorry