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Hair Loss/Transplanted hair keeps falling out

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QUESTION: Hi doctor.

I've had 5 hair transplants over the past decade totaling more than 4500 grafts the last of which was done about a year ago. All those HTs were done in the frontal area (probably the first 1/3 of the head) and I get a nice growth after each HT but then I start thinning again. I started my HTs when I still had a lot of native hair and I kept thinking I was only losing native hair but now I don't think that's the case because I believe all the hair I have now in the front is transplanted yet I'm still thinning. I went to see my doctor recently and he told me I have a rare condition where the transplanted hairs seem to get rejected after some time and he said there was nothing I could do about it.
Are you familiar with this problem? Why are those hairs rejected at 1,2,3 years after the HT? The hair in my donor site is thick.

Anything you can tell me, please?

Thank you.

ANSWER: I'm sorry but I have not heard of the condition your doctor is referring to. Some patients develop a condition called lichen planopilaris which can cause redness around newly transplanted hairs and then scarring of them. A biopsy should be done to prove this one way or the other since it should be treated with topical cortisone or oral medications to prevent the scarring. Have you been taking Propecia? If you have not been taking finasteride daily you may simply be showing the signs of progressive male pattern baldness. There is no such thing as permanent hairs from the back and sides of the head. Those areas thin as you get older and if you had hairs taken from those sites and those areas are now less dense you would expect the hairs which were moved to also be less dense. It is hard to imagine a dense donor area after 4500 grafts and the newly transplanted hairs falling out but not the ones in back. My suggestion is to see a dermatologist to have a biopsy done in the area of loss. After you know what it is it is easier to know how to treat the condition.

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QUESTION: Thank you very much for your quick reply. I don't have Lichen P or Lupus. I had a biopsy done before my last HT and it didn't reveal anything and that's why I went ahead with the HT. According to the doctor it's some kind of an autoimmune disorder that causes the grafts to be rejected, but what I don't understand is why if that's the case they're not rejected immediately after an HT instead of being rejected after a year or a few years later.

Yes I have been taking Finasteride and minoxidil for years. Like I said the hair in the back and also the sides is still thick and I don't have the horse shoe balding pattern in the back yet (no bald spot). That's why I don't believe the thinning in the front has to do with generalized thinning that affects hair with age because like I said the hair in the donor is still thick but with less density due to all the HTs. Another thing I need to add is that the thinning happens all of a sudden and within a short period of time (few weeks). So, it's actually shedding rather than gradual thinning.

I've read about other HT patients who had the same problem and at least two doctors who acknowledged the existence of such cases -although very rare- which really scares me because no one seems to know why this is happening and basically we're told we're out of luck.

Thank you again for the reply.

Answer
Autoimmune rejection of hair follicles usually means it is Alopecia Areata and on rare occasions it is diffuse so you do not see the shiny bald spot which is classic for AA.
I have never seen a case such as what you have described and it is hard to understand the mechanism of action of this condition let alone give it a name. Without being able to diagnose it with a name for this entity it is impossible to give a recommendation for treatment with much confidence the problem will be solved.
 Assuming this is some autoimmune disorder which is causing you to reject these hairs the treatment should be to apply a topical lotion along with the Minoxidil- something such as Lidex scalp lotion twice a day or clobetasol liquid once a day ( evening over the 5% minoxidil)-- or mix the two liquids together and apply it thinly twice a day. The cortisone lotions should block your white cells from attacking the hair follicles. This is the same type of treatment used for LP or Lupus long term or poison oak short term.

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Peter J. Panagotacos, <B>M.D.</B>

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I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.

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I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website www.hairdoc.com

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