Thank you for your question!
You stated in your question that you’re using 15% minoxidil and you’re asking if
minoxidil can actually damage or kill transplanted hair. And you’re noticing that after the
course of one year, that you have fewer transplanted hair.
Well, I can give you some guidance on this question. I’m a board certified cosmetic
surgeon and fellowship trained oculofacial plastic surgeon practicing in Manhattan and
Long Island for over 20 years. Hair transplant has been a big part of my practice for this
time. And in addition, I’m the founder of Trichostem™ Hair Regeneration centers, a
non-surgical treatment alternative for hair loss using a wound healing technology that
we developed in our practice. So I can certainly speak with a lot of experience about situations
Now of course, in your question, unfortunately, I don’t have the complete story as to the
timing of when you had the transplant, when you started using the 15% minoxidil and what
that may mean when you observed fewer transplanted hairs but let’s start first of all with
the question why be on 15% minoxidil. I realize that there are a certain percentage of our
colleagues who believe on these custom formulations and certainly, in our practice, we have tried
these various formulations. The idea is that if we can’t get something which is like
over-the-counter like a 5% minoxidil, we believe that there is value in using a higher percentage,
then you get these custom or compounded pharmaceuticals created and provide them to patients. So I’m
not necessarily denying any potential benefit but let’s say we’re talking about the
transplanted hair one year after transplantation. You’re always looking at a slice of time
and it may not be that the minoxidil is causing the hair grafts to shed and not come back
but it might be that you caught the transplanted hair in a particular stage in the growth cycle.
To understand this, let’s just go over the basic hair growth cycles. There’s the anagen
phase which is the active growing phase. There’s catagen phase, the intermediate phase where
the hair is still present but it’s no longer actively growing and there’s the telogen
phase where the hair sheds. During the telogen phase, there are 3-4 months of lag at a minimum
before new hair growth occurs.
So in our practice, when we do these surgeries but as of late, we have actually been doing
a lot more of a treatment called Hair Regeneration. I’m just going to give you the context of
how minoxidil fits into this equation. As far as I’m concerned, minoxidil does help
people with hair thinning because it appears to prolong the growth cycle of thinning hair
which means that the hairs that are thinning progressively at least stay a little bit longer.
It’s important to understand, going back to the growth cycle, the anagen or the active
growth phase decreases with hair thinning and the telogen actually increases which means
you shed a hair and then you don’t have the hair to replace that hair for a longer
period of time and when that hair comes in, it’s thinner.
When we do this treatment called Hair Regeneration, we figured out that essentially for people
with thinning hair, once they have the treatment, essentially the hair has stopped thinning.
In other words, we no longer need the benefit of minoxidil. And I’ve been doing this for
many years and so I have a lot of clinical data in fact we have patients who come to
us from all over the world and we really rigorously collect a lot of information with every visit
when we see our patients for microscopy photos, standardized position photos of the top of
the head and various views and digital photography. And I’ve made observations because a lot
of times, people have been using, with thinning hair, minoxidil for a long time and sometimes
it becomes a security blanket. What I have observed that for a lot of our patients, I’ll
actually stop the minoxidil about a month or so after the procedure if the patient wants
to. Sometimes, people just want to stay on their regimens until their hair starts to
regrow and they see it and they’ll stick with the regimen they were doing before the
So I think that, in that respect, transplanted hair by definition is not hair that should
be thinning. Now, of course, we can have a long discussion about the source of hair in
procedures such as FUE grafts but let’s say you had a standardized FUT or strip surgery
or even an FUE. Those hairs are genetically resistant to shedding. Therefore those hairs
should actually be fairly resilient and be able to grow but something that not everyone
fully appreciates is that a certain percentage of the hair grafts don’t actually make it.
They don’t continue to grow. There’s a certain loss. We’ve seen patients who come
to us for surgery who had megasession procedures and they lost 90% if their grafts done elsewhere
and we were left with much less hair to work with to do surgery. So it is a potential.
In the case of FUEs, approximately 30% of hairs are actually transected which means
that those hairs don’t actually have the root when they’re placed so they can actually
shed and go away.
So I think you need to speak to the doctor who performed your surgery and the doctor
who is prescribing the 15% minoxidil and get an orientation of what’s going and why you
should continue using minoxidil. If it’s to maintain your existing hair, well it might
be that the minoxidil itself maybe inflammatory or irritating to the scalp and it might be
causing some breakage or some potential shedding of the hairs but not knowing what the vehicle
is or method in which the minoxidil is being delivered in terms of the formulation, I can’t
just say that that’s certain. So you have a reason to be concerned and I think that
discussing this with your doctor, reviewing your photos. You know, when we do surgeries,
we do a plan, we take pictures immediately after surgery, we take pictures throughout
the follow-up period. It’s just what we do just to track progress and if there was
hair in a certain hair and there isn’t hair now, it might not really be a minoxidil issue
or an inflammatory issue but at least be able to document what it looks like 3 months from
now, 6 months from now, 9 months from now. It may be that these hairs are just temporarily
not growing but again, without more detailed information, I can’t give you a more definitive
So I hope that was helpful, I wish you the best of luck and thank you for your question!