Hair Transplant Failures – What Could Cause the Grafts to Not Grow?

I’ve been writing about hair transplant failures more and more on this site lately, because it is a growing concern. I have been seeing, on average, 1 patient per week (from outside my office) who had a hair transplant with a significant failure of the grafts to grow (greater than an 80% failure).

I just saw another patient who had received over 2000 grafts a few years ago. He was not a happy camper. There was very little growth and he had a very detectable scar which did not allow him to cut his hair short. He had such high hopes that the new hair from the transplant a few years ago would solve his image problems, but after much consternation and considerable anguish, he found that his situation was worse off than if he never had any procedure at all.

The patient explained that he did not like his doctor’s lack of concern in addressing the failure of his transplants to grow nor the detectable scar that plagued him every day. He was disappointed that his research on this particular doctor left no clue to the quality of this doctor’s work, nor his indifference to his plight. Before the surgery, when the doctor’s team “sold” him on the transplant solution, the environment was welcoming… but after the grafts failed to grow, he did not feel welcome by that particular doctor as he was made to feel that the failure of the transplant was his fault, not the doctor’s problem.

This particular patient had as much focus on his scar as he had with the failure for the transplants to grow, because he had the same look from the front and top view as he had before the surgery. He had no deformities from the surgery and his recipient area healed well with no scars present.

So what could be the possible causes for a failure of transplants to grow?

I should start off saying that I have never seen the cause of the problem stemming from something the patient did or did not do. Many of the patients who come to see me because their transplant did not grow felt that they were responsible for the failure. I think that patients feel that the surgery is a mysterious process and that there must be something wrong with them.

I have seen problems appear with graft growth in some women, as they may have had an undiagnosed condition called diffuse alopecia areata as a cause. Sometimes there may be problems with the recipient area skin (e.g. blood supply or scarring). That being said, most failures reflect surgical factors that are within the scope of what the surgeon and his team control.

Quality control means closely monitoring the activities of each and every staff member in the hair transplant process. Most of the failures reflect a failure of one or more of the following:

• Graft drying: exposure to air for more than 10-20 seconds can kill the graft. The smaller the graft, the greater the risks for graft damage or graft kill. This risk occurs at many times in the procedure: (a) immediately after graft removal, the grafts are not immersed in a bath of a physiologic solution, (b) during graft trimming, when the grafts are optimized with regard to the size, (c), during movement of the graft from one place to another, (d) during placing, when the grafts are held in the air for more than 10-20 seconds.
• Graft storage: The solutions used contribute to the survival of the graft and the longer it is out of the body, the greater the potential damage. This risk reflects upon the skill of the surgical team and the experience of each technician.
• Graft handling: Managing the movement of the grafts from the physiologic bath solution to the recipient area takes time. Some doctor’s assistants who place the grafts will pile them up on the finger or hand, leaving them exposed to air for more than 20 seconds.
• Graft placement: This requires a special skill that often takes more than a year to acquire. Often it reflects a talent. The grafts must be delicately handled, because crush injuries are a potential problem.
• Graft depth: There is such a thing as a graft that is placed too deep or too superficial. Too deep can kill the graft as it turns the graft into a foreign body. It can also produce pimples or folliculitis sometimes weeks after surgery
• Grafts destroyed or never done as claimed: For long cases, I am under the impression that some doctors and/or some of their technicians actually toss the grafts in the garbage because: (a) they were too tired, (b) the placing was too difficult, (c) they never harvested or placed the number of grafts that they actually charged for. All of these things probably happen far more often than anyone cares to admit, but because it is a financial issue, the doctor and/or the team gets greedy. That means that from some surgeons’ points of view the surgery is about money, not grafts… and certainly not results.

When I see claims of FUE or strip surgery in the numbers that some patients from other clinics tell me that they received, I know in my heart that it could be a scam. This, of course, is a felony, but how does anyone know it if it is not reported? I have been told by many technicians that these things happen at other medical offices where they worked. Once, I had a technician toss away some grafts in my own practice and I fired that tech on the spot. This problem is the most alarming of the problems in this industry.

When a surgeon and his/her team finish placing the grafts, violations to any significant degree of any of the above can result in placing grafts that were killed in the surgical process. The surgeon and the patient will not know if the procedure worked until 6+ months after the procedure was done. By that time, the patient’s check has cleared the surgeon’s bank account by the time he finds out if the surgical techniques worked out or if the patient was honestly delivered what they purchased.