Recovery, shedding and the "ugly duckling" phase
After a hair restoration procedure the scalp is typically pink with tiny scabs forming around the micro-incision recipient sites. The small graft incisions generally heal within 7-10 days after surgery. The redness generally clears up and fades after a few weeks, but may persist for a few months in some fair skinned individuals. Typically, most patients begin to shed their transplanted hair around the 3rd to 4th week following surgery. During this time some patients may enter what is commonly referred to as the "ugly duckling" phase. The "ugly duckling" phase occurs when patients shed their transplanted hair and develop a condition called telogen effluvium or shock loss. Telogen effluvium (shock loss) is a form of short-term hair loss that occurs after stress, trauma or a surgical procedure. Telogen effluvium (shock loss) is described as a chronic hair shedding for an extended period of time lasting up to 6 months. This constant hair shedding causes patients to appear balder than they were before having surgery. Unfortunately, this can and does occur often however, the good news is that telogen eflluvium (shock loss) is a temporary condition that only lasts for a few months. Additionally, telogen effluvium (shock loss) tends to grow back in tandem with the transplanted hair.
Growth after surgery
Generally, most patients begin to see minor and subtle growth around the 3-4 months following surgery. However, it is normal for some patients to wait up to 5-6 months before seeing any noticeable growth. It is important to understand that no two people are the same thus, not every patient will grow at the exact same rate. In the initial phase of hair growth, the hairs are fine and whispy which can make it extremely difficult for a patient to notice or detect.
Density and hair loss pattern
Most individuals are born with approximately 100,000 hairs on their head prior to experiencing any type of hair loss. This breaks down to about 50,000 follicular units, thus a completely bald individual (front, mid-section and vertex-crown) would require upwards to 25,000 follicular units to restore what has been lost. The average donor supply can range from 4,000-10,000 follicular units thus it is not surgically possible to replace every single follicle that has ben lost due to androgenic alopecia or genetic hair loss. Luckily, the average donor supply can restore the appearance of fullness in the first two thirds of the scalp excluding the vertex (crown). Hair restoration does not create new hair, it simply moves existing hair to another location. Therefore, patients should be fully informed about the limitations of hair restoration, but just because hair transplant surgery has limitations does not mean that a patient can not be happy or satisfied with their results quite the contrary. However, the happiest patients tend to be those who approach surgery with realistic expectations.
While the idea of going in for surgery one day and having a full head of hair the next sounds enticing, the fact is hair restoration is a process of recovery, shedding, growth and maturation and results can take up to 18 months to fully manifest. In addition, patients must understand that hair restoration does not create new hair, but simply moves existing hair to another place. Therefore, patients with extensive hair loss must be cognizant of the limitations associated with a hair restoration procedure and plan accordingly.