Post-Operative Questions About Telogen

First, I would like to appreciate your online service, for freely accepting questions and comments and for your valuable answers. Thank You.

I have had my hair transplant about 12weeks ago of approx. 1,650 grafts. My donor area took quite some time to heal, approx. 9-10weeks, before the occasional swelling in a few spots which have now completely subsided. During the first 10 days I had some grafts fall out, which I was told was normal, over the next few weeks I lost more of these transplanted grafts as has been considered normal procedure after a hair transplant. I have had to deal with pimples/puss modules in the transplanted region occasionally and again I read that this is normal. I have used Neospirin ointment to treat these modules and it has helped quite a bit. I am also taking finasteride 1mg for about 17weeks (started 5weeks prior to the procedure as recommended by the Doctor). It is now 12 weeks, and my questions are:

1. Is it possible that not all the transplanted hair has fallen out? Because when I touch the transplanted region with the palm of my hand, I still feel a few spikes here and there. Just today I noticed a couple of hairs with scab attached at the bottom fall out. Should i be concerned that even after 12 weeks not all of the transplanted hairs have fallen out?
2. As I do not see much new hair in the transplanted area as yet after 12 weeks, should I be concerned, when I have been reading that by 2-3 months the new hair would start appearing.
3. I am considered type VI and 35yrs of age. Even with taking Finasteride, I seem to lose at least 50-75 hair everyday after the two daily showers. Do HOT water showers have a negative impact?

Your valuable comments are much appreciated. Thank You

I am fairly sure that you are not losing hair transplants, but what you are seeing may reflect poor cleansing of the recipient area where the scabs stayed on too long. Without seeing you, I am assuming that what you are seeing is the hair from within the old grafts that is coming out (the hair that should have fallen out earlier). The ‘root’ of the transplanted graft is secure in a couple of days after a transplant until the scabs are all off. Rarely will a transplanted graft come out after the scabs are gone (in our hands in just a few days the wounds lock the hair graft into position because of the small needles we use). We have researched this extensively, and found that they can not be pulled out the earlier of (1) after 10-12 days, even if you try to pull them out, or (2) the disappearance of the scabs (usually a couple of days in our practice). In patients who do not comply with our washing protocol, the scabs may last for weeks.

Hair roots start taking hold and growing hair in 10-20 weeks after the transplant procedure, so I would not worry at this stage in the transplant growth cycle.

Hot showers will not cause hair loss, but if you are losing hair, then there may be a shock effect from the original surgery which should be about over shortly. You need to ask your doctor to map out your remaining hair for miniaturization to determine if your class 6 pattern will progress to a more advanced pattern. That should have been in the discussion when you and your doctor made a Master Plan for what was about to happen to you with a hair transplant.