Shedding Transplanted Hairs Years After the Procedure?

Hi Doctor,

A lot of questions on here about initial shedding after a transplant, but my question is regarding transplanted hairs shedding years later, due to the natural hair growth process.

I noticed my transplanted areas have become thinner over the past couple of months. It has been almost 4 years since my surgery. It is well known that the hair growth cycle for hair is between 3-4 years, then they shed to make room for new hair. I was wondering since all transplanted hairs are relatively growing at the same rate or time period, should we expect periods of thinness every 3-4 years when these hairs are ready to shed again? In other words going through a shed similar to your first initial shed before the hairs started growing again. I hope my question makes sense.

Transplanted hair is permanent for most people. In the recipient area, the surrounding non-transplanted hairs may not be permanent and you will continue to lose those hairs. Years after a hair transplant you may be noticing the non-transplanted hairs falling. This is assuming there was non-transplanted hairs mixed in with the transplanted hairs.

If your hairs were transplanted on a completely bald area of your scalp and you are noticing shedding, this is not considered normal. It may regrow if you are experiencing telogen effluvium, which is a temporary hair loss that can occur at any time… or you could be one of those rare people who lose transplanted hair. I always look at the permanent zone when someone asks me about hair loss in the recipient area, in case they are losing donor area hair. Whatever happens to the donor area will happen to the recipient area. For example — in elderly folks, there is a condition called senile alopecia which reflects thinning of the hair throughout the head, including the donor area.

In a very rare instance, you may actually be experiencing permanent transplanted hair loss which I have seen possibly a dozen times in my 20+ years in practice. I don’t remember a cause of this to ever have been pinpointed in most of those patients and I wonder if I should be biopsying them when I see that problem, looking for diseases like diffuse alopecia areata.