Frequent Hair Transplant Questions

Hairs The Question™


Q: Why does hair take so long to respond to treatment?

A: It is because of the hair’s physiology – that is – how the cells of the hair act to grow and shed hairs throughout your lifetime. I am going to use the big “doctor words” so you know what they are, but there will be no test at the end. Don’t be afraid of the big words either – heck, memorize them! Knowledge is power and the more you know when you speak to your doc or go online, the better prepared you will be. Incidentally, these are the three MAIN stages. There are probably two more but they are not really relevant at this point. Here goes;

ANAGEN – This is the stage of hair growth where you hair actually GROWS. This stage can last anywhere from 2-10 years depending on the genetics encoded in your hair. More specifically, it is the genetics encoded in the STEM cells of your hair that determine how long this stage is and what form the hair takes when it grows (coarse, fine, curly, straight, red, black, blond, etc.). Hair grows at about

1/4-1/2 inch per month. Ever look at the photos of people with the longest hair in the Guiness Book of World Records? Their hair has a really long Anagen phase…

When you have hair loss or thinning, (or even regrowth!) it is THIS stage that is affected. Lots of things can affect it, too; chemotherapy, beta blockers, antifungal treatments and other drugs, stress, hormones, low protein, vitamin deficiencies, thyroid problems

– you name it! This is not an all-inclusive list, by the way, just enough to give you an idea of the range of agents that are out there affecting hair.

Incidentally, for those of you out there who have had (or are thinking

of!) laser hair removal, the hair must be in this stage in order to be targeted by the laser which is why it takes multiple treatments to get rid of all the hair in an area like your armpits!

CATAGEN – This is the “shedding” stage of hair. It is normal to shed hair periodically and on a typical scalp you can have 10-20% of your hair in this phase at any one time. It takes about three weeks for the hair follicle to let go of the hair shaft in the follicle (remember the hair shaft is dead protein- but the hair follicle contains the living cells beneath the surface of your skin that regenerate the hair). After that hair shaft is released, you usually brush it out or rinse it out when you wash your hair. Some patients experience this seasonally and a good analogy is if you have a pet with long hair – they shed their winter coat every spring (I know my dog does, we call it his “blow.”)

Catagen is the stage patients are most afraid of, because the shedding happens about three weeks after a hair transplant, or starting minoxidil (Rogaine), or any treatment where the hair follicle says to itself, “Hey, let’s grow a new hair!” However, if YOU know it is going to happen and what is going on, that can take the fear out of it. It will still be an “ugly duckling” phase, but at least it won’t catch you by surprise.

TELOGEN – This is the phase that is most familiar to women patients since they have heard it in the phrase “Telogen Effluvium” when their doctors give them a diagnosis. This is the “resting” phase of the

hair and it lasts about 6 months (sometimes more, sometimes less).

Your hair follicle is alive and well, it is just dormant and it does not have a hair shaft sticking out of it. Think of the follicle as a vase and the hair shaft as the flower sticking out of it. In telogen, the vase is empty – but only temporarily.

When the hair follicle starts to come out of this phase it does so in successive “crops,” re-entering the Anagen phase whenever and however its little stem cells want to. If you went into Catagen as a result of going on minoxidil (which can happen because the little hair follicles says, “Hey, let’s grow a new STRONGER hair!”) and you stayed on it as you should – the hair that grows back will be more robust as a result of the influence of the minoxidil.

This is why you need to stick with a hair loss treatment for so long before you will start to see it working – the hair has to go through all these phases! If you add it all up and account for how long the hair has to be before you see it (at a 1/4-1/2 inch per month!) it will be 9-12 months before you can say you even gave a treatment a fair shot! So don’t leap from one hair loss treatment to another – you have to give it a good year to even have a chance. Besides, stopping and starting hair loss treatments (like minoxidil) can also result in increased shedding because – think about it – the stem cells are no longer getting the signal to grow the better hair so they slip out of the anagen (growth) phase…

….and go through catagen (shedding)

…and telogen (resting) before getting back to

…anagen (growing) again!

Got it? Good! I hope this helps everybody. Anyway, I am sure this probably caused more questions than it will answer – but at least it is a start.

Q: Do you need to shave the head before hair restoration surgery?

A: There is no need to shave the recipient area (i.e. frontal, top and crown areas) of a patient’s head before surgery.  In fact it is likely to increase the rate of minor infection (i.e. ingrown hairs) and worsens the visibility of the area for the patient during recovery.  Many hair transplant surgeons have also noted that without a longer hair length in the recipient areas (i.e. the back of the scalp), the ability to approximate the angle and direction of the native hair is compromised leading to less natural outcomes.

The only reason to shave any part of a patient’s head before surgery is in preparation for an FUE surgery and in THAT case one would only shave the donor areas (i.e. the back and sides).

Q: I just got engaged and I want to fix my male pattern baldness before the date.  How long does the hair take to grow and will it look natural?

A: Realistically, you can’t “fix” male pattern baldness.  You can however slow or stop the progression with Propecia and/or Rogaine, and in most cases replace the hair that you’ve lost for a mature and totally natural-looking hairline.  You don’t say how old you are, but depending on your age and how much hair loss you have experienced, you should be able to achieve a noticeable improvement in 6 months after the surgery, a very good improvement at 9 months, and your full result at a year after surgery.
I always like to warn people that if you start the process a little too late, you will end up with your wedding picture as your “before” pictures and the ones where you are holding your first child as your “after” photos.  Depending on your comfort level and who you decide to tell (because you don’t have to tell anyone and they won’t be able to pinpoint the difference in most cases), this may be an “interesting” moment when you explain to your children how you re-grew hair.

Q: Does wearing a hat make your hair fall out?

A: No. Neither does masturbation, chocolate, sunburns, shaving your head, or any other random cause you can think of.  Almost all hair loss is caused by a combination of genetic susceptibility and the action of the hormone DHT. In patients with pattern hair loss, the hair follicles at the back of the head are not genetically susceptible to DHT but the ones at the top are.  This is why a skilled surgeon can take hair from the back of the head and move it to the top/front and it will grow — because those follicles are immune to the effects of DHT no matter where you put them.
That being said, the “hair-loss-from-hats-rumor” is the most persistent, long-lived rumor regarding erroneous causes for hair loss that exists in the hair loss community. Frankly I hear it so much I find it funny.   Le me be clear; It is a symptom of hair loss, not the cause.  The likely etiology is the fact that wearing a hat (baseball caps in particular) not only hides the baldness and protects the exposed skin, it also reframes the face in the way the hairline once did – making people appear younger and drawing attention back to their faces (away from their receding hairline).  It is so effective that people who are starting to lose their hair adopt the tactic almost immediately, and thus perpetuate the rumor.  In this way it is lovingly passed down from fathers to sons to friends and to brothers and sometimes sisters. For those of you reading this, PLEASE join in the fight to eradicate this scourge of a rumor!  Wearing hats does NOT cause hair loss.

Q: I recently had cancer and have lost nearly all of the hair on my head.  My last chemo treatment was about three months ago and my hair has not grown back yet.  Can hair transplant give me a full head of hair again?  I want my life back.

A: One of the reasons hair loss is associated with illness in recent decades comes from the world of chemotherapy patients.  Certain types of chemotherapy drugs (not all – which ones you get depend on what sort of cancer you are treating) will cause temporary hair loss by interrupting the growth phases of the hair follicles.  In almost 100% of the cases, the hair will grow back.  It does take a little time, however, and the hair that grows back has been known to change in character, that is, it might be curlier or thicker or thinner, or even a different color that it used to be (incidentally, many case studies of this phenomenon have been reported in the medical literature).
Most hair surgeons and Oncologists will have you wait at least a year before giving up on having your hair come back, and that is my suggestion as well.  You may not need hair transplant at all or perhaps a more limited amount than you think!  Also, you have to wait since you need to have a supply of donor hair (usually from the back of your head) to transplant from.  Remember, there is hope, and you WILL get your life back, and not just because of the hair, either.