Are There Factors in Determining Why A Transplant Might Not Grow?

Hi Dr. Rassman, I have seen postings on discussion boards from patients who have had transplants that did not grow. What are the factors in determing if transplanted hair will grow and is there any way of pretermining probability of growth?

A hair transplant will grow almost 100% of the time. When they do no,t the failure to grow can be segmented into:

1. Patient causes: These are diseases like the various forms of autoimmune and scarring alopecias such as alopecia areata. These take many forms.
2. Infection: If a person gets a bad infection in the recipient area, the grafts may not grow out.
3. Technical issues at the surgical team level: This is a common point of failure in the inexperienced teams that try to do hair transplants and have not worked out the many nuances in the process. The grafts can be killed off simply by keeping them exposed to air, which causes drying. Poor graft handling therefore is the #1 cause. I have heard of doctors who accidentally used sterile water to keep the grafts wet instead of saline or Ringer’s solution that will kill of 100% of the grafts, but this is a freak occurrence.

What most people do not understand is that this is a team process and like any team process, the surgery is only as good as its weakest member. In training a good team, the surgeon must have a tight quality control process in place to be assured of consistency.