Know the pitfalls and how to avoid them before you buy!
Imagine you spent $20-50,000 dollars on a new car, only to find out afterwards that the car seat won’t fit, the oil change is more frequent than you anticipated, you probably need a whole new set of tires on account of the approaching winter, and – to top it all off – it won’t fit in your garage.
You’d probably wish you’d known all of that before you signed the paperwork.
Getting a hair transplant can be a similar experience. Just because you’ve found a surgeon and booked your surgery doesn’t mean that your new head of hair is in the free and clear.
Hair transplants are a tricky surgery to get right. There’s a reason they come in at a higher price point. It’s not just technique that matters.
So, let’s talk about the 7 top reasons why a hair transplant fails.
Man with a Plan – Go to Turkey. Get a cheap hair transplant. Enter new head of hair. No downside. Super easy, right?
1. Wrong patient selection
Underlying hair conditions, such as scarring alopecia or active alopecia areata, can put a hair transplant at risk, especially if they’ve gone untreated. With scarring alopecia, it’s possible to proceed with a hair transplant if inflammation is under control (confirmed by biopsy). With active alopecia areata, you run the risk of harvesting hairs from or transplanting them to areas where the condition could be active. Undiagnosed or uncontrolled diabetes can inhibit the healing processes and an unaddressed thyroid issue can lead to hair loss and a failed transplant as well.
You don’t want a patient who ignores advice and refuses to follow protocol. It’s incredibly hard to ‘pop out’ grafts from a well performed hair transplant, that said, no surgeon wants their patient to inadvertently give it their best shot.
A final note about patient selection – they need to be on board with reasonable expectations for their procedure. No two surgeries are the same, meaning a patient can’t come in expecting the same results as another patient or to have the hair of their early 20s if that’s not a reasonable expectation for their starting point. It doesn’t matter how good the surgeon is, if expectations aren’t on board, then chances are the patient won’t be happy with the outcome.
2. Stability
If the foundation is shaky, you’re likely to be in for a bumpy ride. Those of you who follow the channel know I’m a stickler for medical therapy in conjunction with a hair transplant, and with good reason. If hair is still falling out and you and your surgeon aren’t certain how your hair will look in a few months, you don’t have a good base for a hair transplant – Partially because you could end up with odd looking spots of hair loss once the transplant is done as the rest of the hair loss progresses, but also because of the nature of a hair transplant.
A hair transplant is controlled trauma. Harvesting and transplanting grafts can trigger more hair to fall out if you are starting out with an unstable base.
At the risk of sounding like a broken record, medical hair loss therapy is incredibly useful in helping to stabilize hair loss so a transplant can proceed.
Medical hair loss therapy is an important first line of defense to explore if considering a hair transplant.
3. Poor design
There is an art to designing a good hair transplant and it’s just as important as your surgeon’s technical skill. Properly placing and executing the hairline is tricky – placed too high or too low, and you risk unideal face framing.
The shape and placement of individual hairs is just as important. Natural hairlines are uneven, and a too perfect hairline looks unnatural – perfection doesn’t exist in nature. There’s a decision to be made about the temples as well – are they addressed or better and more natural left alone? Patient preference and pattern of recession feature into these decisions, as well as how many grafts are available.
You also need to match the directionality of the individual hairs, and the densities need to make sense and mimic natural irregularity, staggering the grafts – the last thing you want are unnatural rows.
Beautiful hairlines have a natural irregularity that good hair transplants strive to mimic.
4. Over harvesting
Mega sessions (over 3000 grafts), common with FUE hair transplants performed overseas, can lead to ‘shock loss’ at the donor site when too many grafts are removed at once. Over harvesting can also lead to poor scarring, where FUE excision scars fuse together into a larger, more obvious spot.
It's a good reminder that FUT does have advantages, especially where a significant improvement in density is needed. Because you can control the exact zone where hair is harvested from in FUT surgery (even across multiple surgeries), you can ensure avoiding DHT sensitive hairs. That’s not the case for FUE harvesting, where you often end up harvesting hairs from high-risk areas. Those high-risk hairs can still be susceptible to DHT once transplanted, leading to the transplant partially failing over time.
5. Over grafting
Like with over harvesting, over grafting – packing in too many grafts in one small area – can lead to transplant failure. Whenever you move a graft (or implant one) the expectation (and goal) is for it to tap into the new area’s existing blood supply.
If more grafts than the blood supply can handle are transplanted, they can die. Worst case scenario (if you really overdo it) you can cause necrosis to the tissue. Like with over harvesting, you can also get shock loss in the surrounding recipient area when you over-graft.
6. Low density
Too few grafts can lead to low density and a failed transplant. When I begin a hair transplant, I like to start by making sites in the recipient area so I can get a more accurate picture of how many grafts I’ll really need. Eyeballing it can be deceptive; an area that looks like it needs 500 grafts may need closer to 800.
But again, this shouldn’t look unnatural. It’s a fine balance between improving density while preserving the imperfectness that the human eye finds appealing.
When improving density, you still need to preserve the natural imperfectness that the human eye finds so appealing. Too much density and perfect rows can be obvious.
7. Poor survival
Unviability of the grafts is another cause of low density, and it’s not all due to improper post operative care. Poor survival can start with harvesting. If the angulation isn’t judged properly, you can cut through the hair bulb as you excise it, leading to an unviable hair. The depth you place the graft also matters – too shallow and it won’t survive. You can also partially transect a group of hairs if too small a tool is used to extract them. Letting the hairs dry out can also really hurt the graft. They’re delicate – everyone on my team is working in tandem to make sure the grafts we transplant are viable.
So, there are some of the top reasons hair transplants fail. The theme with all of them is really getting your consultation down and making decisions that aren’t based on chasing a bargain. Be smart and make sure you and your surgeon are on the same page. A hair transplant is a major aesthetic decision. Be smart and do your homework so you won’t be looking to repair things later.
The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.
