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 like yours. 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 treatment.

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 answer. So I hope that was helpful, I wish you the best of luck and thank you for your question!