Grafts Falling Out After a Hair Transplant - Shedding Vs Losing Grafts
One of the most common concerns for patients after undergoing a hair transplant is the shedding of transplanted hairs. This natural process can be alarming, especially if it occurs soon after the procedure. However, it's important to understand that what typically falls out is not the hair follicle itself, but the hair shaft. In this article, we’ll explain why shedding occurs, how it relates to the hair growth cycle, and how to differentiate between normal shedding and potential issues with graft survival.
The Hair Transplant Process: What Happens to the Grafts?
A hair transplant involves the transfer of hair follicles from a donor area (usually at the back or sides of the head) to a thinning or balding area. The hair follicles are carefully extracted, prepared, and then implanted into tiny incisions made in the scalp. Over the following weeks and months, the transplanted hair follicles will establish themselves in their new location, eventually growing new hair.
However, the process doesn’t end there. In the days and weeks following the transplant, patients will typically notice shedding of the hair that was initially transplanted. This can cause concern, but it is actually a normal part of the process known as shock loss.
The Visual Difference: Shedding vs. Graft Loss
To further illustrate the difference between normal hair transplant shedding and graft loss, we have included a photo above, taken 1 week after a transplant - that shows:
On the left closest to the pen (for scale) a full hair graft, with the scab at the top attached to the visible hair, and the full hair root that is under the skin, this follicle has forcibly been pulled out after a transplant and will not regrow. You can see how much longer this full graft is compared to the others.
On the right, small pieces of the hair shaft that are attached to the scab and have snapped off or been shedded during the natural healing process. These are typical, and seen after every transplant - the graft and the follicle itself will still be safely under the skin and will start to grow, usually after 3-4 months. If you are seeing these do not be concerned, these are expected.
Why Does Shedding Occur After a Hair Transplant?
Shedding occurs after a hair transplant as part of the natural hair growth cycle. Here’s a breakdown of what happens:
The Hair Growth Cycle: Hair grows in cycles, with each follicle going through three main phases:Anagen (Growth Phase): The phase when hair is actively growing.
Catagen (Transitional Phase): A short phase where hair growth stops, and the hair follicle begins to shrink.
Telogen (Resting Phase): The phase where the hair is not actively growing. Eventually, the hair falls out, and a new hair starts to grow in its place.
Shock Loss: After the hair transplant, the newly implanted follicles enter a "resting phase" (telogen), which causes the hair shafts to shed. This is because the transplanted follicles are adjusting to their new environment. It’s important to note that this shedding is temporary, and the follicles themselves remain intact under the scalp, ready to start a new growth cycle.
Shedding of the Hair Shaft, Not the Graft: The hair that falls out is typically the hair shaft, which is the visible part of the hair that extends above the skin’s surface. The hair follicle, which is embedded in the scalp, remains in place. This means that even though you may notice hair shedding, the transplanted follicles are still present and ready to begin producing new hair after a few weeks.
What Happens After the Hair Shaft Falls Out?
After the hair shaft falls out, the follicle enters a dormant phase before entering the anagen phase, where new hair begins to grow. This can take several weeks to months, and the first signs of new growth may appear as fine, soft hairs that gradually thicken over time.
While it may seem like the transplant is failing when hair falls out, this process is completely normal. Most patients will see significant new growth between 3-6 months after the transplant, with the final results often taking up to a year to fully materialise.
How to Tell the Difference Between Normal Shedding and Graft Loss
While shedding the hair shaft is a normal part of the healing process, it’s important to differentiate between natural shedding and graft loss, as the latter can be a sign of complications. Here’s how to distinguish the two:
Shedding of the Hair Shaft
As mentioned, the hair shaft itself falls out, but the follicle remains intact beneath the skin. This hair shedding typically occurs within the first 2-4 weeks after the procedure and may continue for up to 6 weeks. The follicles will remain in place and start producing new hair once the dormant phase is over.
Graft Loss (Follicle Loss)
If a graft becomes dislodged or fails to take root, the entire graft—including the follicle—will be lost. This can sometimes occur if there is too much trauma to the scalp during the healing phase (e.g., rough brushing, scratching, trying to forcibly remove scabs before fully healed, or applying too much pressure on the scalp).
Forceful Pulling of Grafts
If a graft is forcibly pulled out—either by the patient accidentally or through improper handling—it may come out completely, including the follicle. This is different from the normal shedding process and can cause permanent damage to the transplanted area. If a graft is pulled out too early in the healing process, it may not grow back and could result in permanent bald spots.
Post-Transplant Care to Minimise Complications
Proper post-transplant care is crucial in ensuring the success of the procedure and preventing damage to the grafts. Here are some best practices to follow during the recovery phase:
Avoid Touching or Scratching the Scalp: After the transplant, it’s important to avoid scratching or rubbing the transplanted area, as this can dislodge grafts or cause trauma to the scalp. Gentle washing of the scalp with a prescribed shampoo is usually recommended after the first few days.
Follow the Doctor’s Instructions: Your surgeon will provide specific post-operative instructions, including guidance on how to care for your scalp, when to resume normal activities, and which medications to use. It’s important to follow these instructions carefully to optimise healing and graft survival.
Use Medications as Prescribed: Patients may be prescribed medication after a hair transplant such as Minoxidil, Finasteride, or Corticosteroids to help support the transplanted follicles and reduce the risk of complications. These can be used as part of a long-term hair care regimen to optimise the results of your transplant.
Avoid Sun Exposure: Sunburn can damage the healing scalp and impede graft survival. It’s crucial to protect your scalp from direct sunlight during the first few weeks after surgery. A loose hat or sunscreen is typically recommended.
Be Patient: Hair growth following a transplant takes time. After the initial shedding phase, new hair should start growing within a few months, but full results often take up to a year to materialise. Patience is key to seeing the full benefits of your transplant.
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