Hello Doctor Mohebi,
I hope all is well and that Orlando was a success.
I am now creeping on 3 weeks post operation and just as you expected the en masse shedding commenced at right around the 2 week mark. The good news is that I still have a sizable number left, which goes to show a large number of grafts are the way to go, but I did have a couple of more questions I thought were valuable and perhaps worthy of your blog.
1) Even though I am at my 3rd week post op and many hairs have already been shed, many more seem to be sticking around — at least for now. I am wondering if there’s any kind of benchmark to assess when I can expect the shedding to stop. I would like to be able to clip all of my hair short so as to not have to keep “covering up” with hats and the alike, but I am not sure how much more shedding will take place. Should I just wait til new hairs start to grow (1-3 months post operation, as I’ve been told) or is it relatively safe to assume that most of the hair which has not been shed after approximately a month will stick around (hang in there)?
2) For a more long-term question, what happens to the new transplants that have fallen out? Given that telogen effluvium has taken place, I am assuming that the new hair will sprout once anagen takes place. But here’s the dilemma: If the front of my head contains transplants that ALL FALL OUT (for the sake of the argument, as you have stated that 90% or so of patients experience this) then that would suggest that all of this hair would be hitting CTR+ALT+DEL (or restart!) at about the same time. If that is true, then all this hair should be hitting catagen and then telogen again at relatively about the same time, say between 2-3 years for most people. Am I then to assume that my forehead will become synchronously thin at about 3 years only to become very full again a few months later????
These are very clever questions and I will happily post them on our Hair Restoration Blog for others to see. I will try to answer your questions in the order you asked them.
Hair Shedding After Hair Transplant
Losing hair shafts of newly transplanted hair generally occurs in most transplant cases and only a small percentage of them will continue growing the transplanted hair from the day of surgery. Even if you are one of those lucky people who never loses their hair after surgery, you still may lose a significant number of hair shafts and only some of them will continue growing without going through shock loss. It is not always easy to predict the timing of hair shedding in transplanted grafts, but if you have kept them for the first month after hair restoration surgery, it is likely that they will not shed.
As far as clipping your hair, you could have done it at any time after the first week following your hair transplantation. Just be careful about the length of hair on the donor area. You don’t want to expose your wound on the back and clipping your hair short tends to do this. The transplanted hairs are part of your scalp at this stage and you cannot dislodge them even if you try.
Are all transplanted hairs entering the resting phase at the same time?
When hair shafts fall out due to telogen, the follicles enter their resting (or telogen) phase. In this phase the grafts lose their shafts, the follicles shrink and become dormant for a short period of time (usually 4-6 weeks). Following telogen comes another anagen phase in which new hairs sprout from the same transplanted hair follicles. The initial hair grown is short and fine almost similar to vellus hair, but unlike vellus hair, it becomes longer and thicker over time.
For some reason, the biologic timer of your hair follicles are not quite synchronized. The shedding of the transplanted hair won’t happen at the same time and therefore you won’t have to experience baldness again in the transplanted area a few years from now. You should have some of your hair growing while a small portion of them remain in resting phase the whole time.