6 Years After Fue... Shedding Transplanted Hairs... :(

[jumpingjackgazz]

Hi all,

I'd like to share my experience and see if some of you guys went through the same process and eventually found some solution or could give advice…

Ok, So I got a hair transplant @ASMED back in Feb 2013, 3000 grafts on the first third of the scalp.
Got very happy with this transplant, got a huge growth rate on the transplanted grafts, and very happy with the cosmetic improvement, until a few month ago...
So it's been 5 to 6 years I had this transplant, and back in October 2018 I start to notice thinning of my hairs. And today I can see that almost the entire transplanted hair are thinning and falling…. The bad trip is back….

Have some of you experience the same ?

I got a theory for that, from what I understand, when transplanted, a graft, whatever its current state (Anagen, Catagen or Telogen), it's reseting its state to a dormant Telogen phase then starting a new cycle and regrowing after 3 to 4 months (the Telogen duration). Thus, if I'm not wrong, all the transplanted grafts are kind of all synchronized, all starting in a 3 to 4 months time window a new cycle (starting anagen).

Now after 5 to 6 years (anagen average time is btw 2 to 7 years), they switch to catagen (3 to 4 weeks) then Telogen (so shedding for 3 to 4 month) and hoppefully start a new Anagen cycle.

This is the theory I have to explain that.
But this would imply that all the transplanted heads would behave the same… and I have not read anything like that on the internet…

Any comment would be appreciated !

ciao

 

[Feelsbadman.jpg]

Do you take finasteride? The surgeon may have harvested non safe donor hair. Maybe some of the grafts are susceptible to DHT.

 

[jumpingjackgazz]

Yes I do take Fina for years before transplant, I've also added Duta since a couple of month...
For your info, I've asked my contact @ASMED and they told me Dr Koray is not thinking grafts on the donor are not immune to DHT !!!
I was kind of surprised hearing this cause I found a video of Lupanzula telling the opposite !

 

[Rocknroutlaw]

Yes I do take Fina for years before transplant, I've also added Duta since a couple of month...
For your info, I've asked my contact @ASMED and they told me Dr Koray is not thinking grafts on the donor are not immune to DHT !!!
I was kind of surprised hearing this cause I found a video of Lupanzula telling the opposite !

on this matter, I have never believed strongly one way or another. Some say your grafts from donor areas not previously miniaturised will not be subject to the effect of DHT, others say your crown and temples are the least well circulated and therefore without keeping the DHT under control the grafts will eventually succumb to miniaturisation...
Without in depth knowledge, I am inclined to believe the latter. I am therefore committing to Finasteride and Minoxidil for life :/

 

[Feelsbadman.jpg]

on this matter, I have never believed strongly one way or another. Some say your grafts from donor areas not previously miniaturised will not be subject to the effect of DHT, others say your crown and temples are the least well circulated and therefore without keeping the DHT under control the grafts will eventually succumb to miniaturisation...
Without in depth knowledge, I am inclined to believe the latter. I am therefore committing to Finasteride and Minoxidil for life :/

It's not the location that is the issue. It's the hair follicle. Balding follicles have been transplanted to well circulated areas like the arm and they still continue to bald right on their genetic schedule. Besides, transplanted hairs have very good circulation, they are implanted fairly deep and I believe the act of transplantation actually creates ample new blood vessels to accommodate the follicle.

Donor hair is not COMPLETELY immune to DHT. There have been in vitro studies where donor hair follicles are exposed to supraphysiological levels of DHT and they begin to miniaturize as well. Everyone's donor hair is different and has different thresholds for DHT tolerance. Most people's however will be fine for life.

It could be that OP's donor hair is experiencing some thinning. Had he not had the transplant, those hairs that would still be on the back of his head would still be undergoing the effects of Androgenetic Alopecia, possibly.

OP, how is the rest of your donor hair doing? Maybe have it inspected professionally for miniaturization.

 

[Rocknroutlaw]

It's not the location that is the issue. It's the hair follicle. Balding follicles have been transplanted to well circulated areas like the arm and they still continue to bald right on their genetic schedule. Besides, transplanted hairs have very good circulation, they are implanted fairly deep and I believe the act of transplantation actually creates ample new blood vessels to accommodate the follicle.

Donor hair is not COMPLETELY immune to DHT. There have been in vitro studies where donor hair follicles are exposed to supraphysiological levels of DHT and they begin to miniaturize as well. Everyone's donor hair is different and has different thresholds for DHT tolerance. Most people's however will be fine for life.

It could be that OP's donor hair is experiencing some thinning. Had he not had the transplant, those hairs that would still be on the back of his head would still be undergoing the effects of Androgenetic Alopecia, possibly.

OP, how is the rest of your donor hair doing? Maybe have it inspected professionally for miniaturization.

That makes sense. In that case, arguably taking a regular dose of Finasteride might be over-cautious...however as we are unsure of the DHT tolerance threshold of the new grafts, I guess it is best to continue :/

 

[Feelsbadman.jpg]

That makes sense. In that case, arguably taking a regular dose of Finasteride might be over-cautious...however as we are unsure of the DHT tolerance threshold of the new grafts, I guess it is best to continue :/

On the contrary, taking finasteride would be an imperative in your situation. Something most people don't notice is that finasteride and dutasteride also thicken up donor hair, mostly because no one pays attention to it unless geting a hair transplant but finasteride should be able to preserve donor hair for life I would imagine as donor has the highest DHT tolerance on the scalp.

 

[Pequod]

If you just started taking dutasteride then the shed may be related to that. I doubt it is the entire transplant going dormant.

 

[jumpingjackgazz]

Hi,

Thx for your comments.
I would agree with the DHT threshold story. Well at least this is the only plausible explanation I have been provided so far...

OP, how is the rest of your donor hair doing? Maybe have it inspected professionally for miniaturization.

The donor is good, I've not noticed any thinning. I'm just out of the hairdresser and density looks good !

That makes sense. In that case, arguably taking a regular dose of Finasteride might be over-cautious...however as we are unsure of the DHT tolerance threshold of the new grafts, I guess it is best to continue :/

Yep' and that's why I've added Duta to the picture. I've added it a couple of month ago while I've noticed the transplanted thinning hair 5 to 6 month ago, so the initial shed is not from Duta but may be today it's from it... @Pequod

So if I summarize :
- hypothesis 1 : I'm unlucky and most harvested grafts were already thinning and going to dormant...
- hypothesis 2 : I'm unlucky and my donor's grafts have a low DHT threshold and start to thin due to higher dose of DHT exposure
- hypothesis 3 : I'm unlucky, it's a mix of hypothesis 1 and hypothesis 2
- hypothesis 4 : I'm lucky cause my donor grafts are immune to DHT but DHT is not the issue but transplanted area is so calcified/fibrosed/low blood flowed that the grafts are suffering from lack of blood/nutriment/growth factor

Countermeasure :
- to hypothesis 1 : none
- to hypothesis 2 : Fina/Duta should make the deal
- to hypothesis 3 : Fina/Duta should make it for the more robust grafts
- to hypothesis 4 : Microneedling/DMSO for fibrosis/Magnsium oil for calcification should help

agree with that ?

 

[Rocknroutlaw]

So if I summarize :
- hypothesis 1 : I'm unlucky and most harvested grafts were already thinning and going to dormant...
- hypothesis 2 : I'm unlucky and my donor's grafts have a low DHT threshold and start to thin due to higher dose of DHT exposure
- hypothesis 3 : I'm unlucky, it's a mix of hypothesis 1 and hypothesis 2
- hypothesis 4 : I'm lucky cause my donor grafts are immune to DHT but DHT is not the issue but transplanted area is so calcified/fibrosed/low blood flowed that the grafts are suffering from lack of blood/nutriment/growth factor

Countermeasure :
- to hypothesis 1 : none
- to hypothesis 2 : Fina/Duta should make the deal
- to hypothesis 3 : Fina/Duta should make it for the more robust grafts
- to hypothesis 4 : Microneedling/DMSO for fibrosis/Magnsium oil for calcification should help

agree with that ?

That's a good summary.
I would just go ahead with the countermeasure of hypothesis 2 as well as 4.
I don't think microneeding could do any harm to either the donor or grafts, if done correctly without micro-tearing.
I'm just a week short of 5-months post surgery and hoping that light microneedling would help my new grafts grow, as well as staying on FInasteride/Minoxidil plus the supplements. It's quite a commitment but I'll have to stick to it.