Why can a hair transplant fail?

Homme ayant une alopécie androgénétique
Baldness affects many people in France and elsewhere. More than 66% of men and women are affected by this pathology and one third of them will eventually become partially or totally bald. Very often, androgenetic alopecia is not well accepted, whether on a psychological, social or professional level.
There is no treatment today, however effective, that can permanently cure hair loss. This is why more and more people, including a large number of men, are turning to surgery to restore their hair and thus permanently hide the effects of hair loss. Modern hair transplantation techniques, both FUE and FUT, allow for natural and undetectable results after a relatively painless procedure performed under local anesthesia.
For financial reasons, some are tempted to go for a transplant in other countries of the world. However, even though there are good and experienced doctors in many countries, a good hair transplant has a cost and it is risky to have it done abroad because of the price. This procedure, which may seem simple, repetitive and accessible to many, requires real expertise and experience from the doctor in order for this surgery to be successful and to effectively correct hair loss. The CMCC explains why a hair transplant can be a failure.

Causes of hair transplant failure BEFORE the procedure

A poor clinical analysis by the surgeon

As with any surgical procedure, and even if the transplant is only done under local anesthesia, it is important that the person who wishes to correct his or her baldness undergo a thorough examination. This is a step that should not be neglected, as it determines the proper management of their androgenetic alopecia.

Examen clinique d'un homme par un médecin en vue d'une greffe de cheveux

The clinical examination of baldness and new diagnostic techniques make it possible to precisely determine the best therapeutic strategy to adopt. Depending on the patient’s baldness, this strategy can be medical (treatments to slow down or stabilize hair loss), surgical (hair transplant) or both.
In the case of a hair transplant, the surgeon must also estimate the number of hairs needed to correct the baldness, keeping in mind that the donor area is made up of a limited stock of hair, which depends on the individual.
A poor analysis by the surgeon can lead to an excessive exploitation of the donor area and a disappointment for the patient who was expecting a better aesthetic result, especially in terms of the quantity of grafted hair.

Poor preparation

The preparation stage, carried out before the operation, is crucial for a successful transplant. The objective is to prepare the scalp to receive the grafts. To do this, it is recommended :
  • to massage the scalp, especially the area where the new follicular units will be implanted;
  • to stop smoking at least 15 days before the operation;
  • and to follow a Minoxidil treatment before the operation, or even to make injections of platelet rich plasma (PRP treatment).
The objective is to stimulate the vascularization and oxygenation of the scalp, two elements that will play an important role during the grafting process.

Causes of hair transplant failure DURING the operation

All the steps involved in a hair transplant are important and must be followed. Neglecting one of them can lead to the failure of the whole procedure and prevent the correction of the areas affected by hair loss.

Poor extraction of hair

Telling a patient that the surgeon will remove 1,000, 1,500, 2,000 or more gratfs is not enough. It’s not the quantity that matters, but the quality of the grafts the doctor removes during the session. 2,000 well harvested, good quality grafts are better than 3,000 poorly extracted, poor quality implants. Extracting properly is particularly relevant when using the FUE method. One of the advantages of the FUE procedure is that it leaves much more discreet scars than strip harvesting, but the risk of damaging the hair bulbs is totally dependent on the surgeon.

Prélèvement de greffons par un chirurgien pendant une greffe de cheveux

Unfortunately, the patient cannot know if the roots have been damaged once the hair follicles have been transplanted. Only the result nine to twelve months after the procedure will confirm whether the hair bulbs have been preserved.
The consequences of a bad extraction are a weak regrowth of the implanted hair and a decrease of the hair stock in the donor area.

Poor conservation of the implants

Once the grafts are extracted, they are no longer vascularized. To increase their chances of survival, a specific low-temperature preservation product must be used.

Improper handling of the follicular units

Incorrect use of the micro-tweezers on the roots can lead to irreversible destruction of the roots. In this case, it will be impossible for the transplanted hair to grow back.

Prolonged exposure to the open air

The longer the implant is exposed to the air, the lower its chances of survival. The surgeon’s expertise and experience, as well as the use of proper instruments during the procedure, will reduce the time that the grafts spend outside of the hair dermis.

Poor transplantation in the target area

Transplantation to the bald area is a delicate procedure and the doctor must make sure that each implant is properly inserted into the receiving area. This is important because the follicular unit will be revascularized in the receiving area to continue to live, produce hair and conceal the patient’s alopecia.
The insertion of the implant must therefore be done at the right depth and the size of the implant must be perfectly adapted to the size of the receiving area. To reduce the risk of improper transplantation, it is common for the doctor to use a Choi Implanter. One of the advantages of this instrument is that it can perforate the scalp and insert the implant at the same time.

What causes hair transplant failure AFTER the procedure?

Patients should be reminded that failure to follow the healing protocol can have an impact on hair growth.
In the days and weeks following a hair transplant, a healing and revascularization process takes place to ensure the survival of the transplanted follicles. Following a precise protocol will promote re-growth and maximize the clinical results of the graft.

Learn more about hair transplants