Hair Restoration Blog

Q:

My question is based on a hair transplant that wasn’t successful.  I received a hair transplant at [blocked hair transplant clinic name] and my hair never grew in the area and I followed all the directions carefully. Is there any other solutions to bring back my hair?
A:

The survival of transplanted hair is usually a concern among the patients who undergo hair restoration.  Transplanted hair might never grow or have suboptimal growth in several conditions.  We can categories those into two major groups:  1. Technical problem and 2. Patient factor.

• Hair Transplant Technical Problems:

  • Hair graft preparation and handling problems:  inexperienced technicians may manipulate hair grafts more than what they can tolerate.  That may damage the proliferated follicle cells during slivering, graft harvesting or implanting so the transplanted hair can never grow.
  • Graft maintenance problems:  Hair follicles should be kept in suitable physiologic solutions from the moment they are removed from body till the time that they are placed in their destination.  The temperature of the solution should always be kept between 0 - 4 degree Centigrade to lower the cell metabolism and prolong the longevity of follicular cells.
  • Problems during implantation phase:  If the sites are too tight, technicians may manipulate hair grafts too much that may affect the final potential of hair cells to grow.

• Patient Factors:

  • Many skin conditions may restrict or stop the growth of transplanted hair.  Some of those conditions are Alopecia Areata, Alopecia Cicatricial and many other medical conditions that may have caused hair loss in the first place.  Preoperative microscopic and macroscopic evaluation of hair and scalp is crucial to rule out any condition that may limit the growth of transplanted hair.  Hair transplant surgeons should raise questions for these in atypical hair loss conditions especially in patients who do not have a family history of similar hair loss condition.  The diagnosis should be confirmed by scalp biopsy.
  • Care after hair transplant play a major role in the final results of a hair transplant procedure.  Physical trauma to the transplanted hair may cause losing newly transplanted hair, including pulling hair, scratching head or psychological conditions such as trichotillomania in which patient pull hair due to an obsessive compulsive disorder.

If you experienced less than desirable results from your hair transplant surgery after one year from your hair transplant surgery, you need to see a good hair transplant surgeon to reevaluate your condition and potentially treat the disorder that has caused your less than desirable growth.

Trichotillomania (TTM) [Greek: tricho (hair), till (to pull), and mania], also called trich, is hair loss due to an impulse control disorder distinguished by the repeated urge to pull out hair of scalp, body, eyelashes, eyebrows, facial hair, nose hair or pubic hair.  Trichotillomania may result in noticeable bald spots or hairless patches.

Trichotillomania is more common during the first two decades of life with female predominance; however it could be seen in both sexes and all ages. Trichotillomania may resemble a habit, an addiction, a tic disorder or an obsessive-compulsive disorder. Trichotillomania often begins during the individual’s teenage years, but may happen at any age. Depression or stress can trigger the trich. Due to social implications, the disorder is often unreported and it is difficult to predict accurately prevalence of Trichotillomania.  It is stated that 2.5 million people in the U.S. may have TTM, with a 1% prevalence rate.

Patients with trichotillomania may live relatively normal lives.  TTM may not be known by the patients and in fact most patients deny any manipulation of the hair.  An additional psychological effect can be low self-esteem, often associated with being rejected by peers and the fear of socializing due to appearance and negative attention they may receive.  Trichotillomania can be effectively treated by habit reversal training along with a variety of psychiatric medications based on the underlying disorder.

I have recently seen a male patient with male patterned baldness in our Los Angeles hair transplant clinic who has previously undergone a hair transplant surgery in another hair transplant clinic about a year before with over 500 grafts on his crown area.  The result of the surgery that should have been completed at the time of our consult was very disappointing both to the patient and to us.  I performed a microscopic evaluation of the scalp in both the frontal and crown area.  I noticed broken hair at both frontal native hair area and crown area, which was evidence of manipulation of the hair.

Patient denied any hair pulling, but had disclosed having experienced a nervous breakdown recently.  However, he did not deny that he had been too conscious about newly implanted hair follicles after his hair transplant that might have forced him pulling most of his transplanted hair grafts.

I recommended a psychological evaluation and treatment of any underlying disorder and we decided to re-evaluate him in a few months after his psychological treatment.  I won’t recommend a hair transplant until he shows no evidence of trichotillomania for a considerable period of time.  I have previously treated a patient who has had hair loss due to trichotillomania at childhood with hair transplant, but was treated completely with no evidence of pulling hair for a long period of time.