How long does a hair transplant last? Historical article by Dr. Massimo Gabellini, reviewed and reposted


The decision to undergo hair transplantation surgery is almost always a painful choice, dictated primarily by discomfort imposed by hair loss and its associated psychological consequences. For many patients it is seen as the first choice and perhaps the only way that can effectively buffer the problem of baldness, but it is important to make some considerations about it, which cin allow us to examine the issue from different points of view. Indeed, we must keep in mind that those who undergo a hair transplant may over time wish or find themselves forced to consider the possibility of a second surgery:

  • to implement the result obtained,
  • to remedy a progressive deterioration that he or she would not have expected.

Transplanted hair, in theory, is hair that retains the characteristics of the donor area, so it should not be sensitive to the hormonal action of DHT that causes miniaturization and over time follicular atrophy. But AGA is not a pathology that manifests itself with similar and unique characteristics in all patients, and its evolution is difficult to predict, just as it is difficult to predict precisely how far the area will go with the hair loss, although some evolutionary parameters can provide us with valuable indications.


How long does a transplant actually last?

Why is it that in some cases hair transplants seem to have an expiration date?

Often when harvesting the occipital region, especially with the FUE technique (but it can also happen with Strip harvests), it is easy to cross that thin, undefined boundary line that marks the transition between the safe area and the aga-sensitive area, so it is likely to think that follicular units may have been harvested and transplanted that actually exhibit characteristics of sensitivity to hormonal action that they would manifest only in the future, and such an occurrence is obviously more likely in the case of hair transplants with high numbers of Follicular Units harvested.

Also as mentioned aga is not only defined by sensitivity to the hormonal action of dht, but is caused by a combination of systemic and local factors and concurrences, including hormonal sensitivity, that lead to follicle miniaturization: hence it is essential to always combine comprehensive therapy to maintain, before, during, and especially after transplantation, the native and transplanted follicles. And there is no getting away from this dogma: too often the reasoning leading to transplantation is justified with the hope of not having to worry about hair once the procedure is performed. In reality, the management of the problem becomes even more complicated, because one is forced to never let one’s guard down, or risk having to undergo a series of procedures on a deadline. Of course in many cases transplantation, in addition to improving the patient’s quality of life, usually allows for rather long times of satisfaction, but the reality is that a “touch-up” sooner or later will have to be done if the results are to be maintained.

In fact, over time, dht-insensitive “follicles” transplanted into the “sensitive area” may lose some of their insensitive characteristics in favor of “behaving” more like follicles in the recipient area:

this means that a transplanted hair may become more sensitive to the “incidences” responsible for hair loss, both hormonal and metabolic, thus going into miniaturization.

Studies to confirm this hypothesis are not many, but daily clinical practice forces us to take into account this infrequent but possible occurrence, which cannot be predicted at present. The cause of this occurrence may depend on several factors and certainly genetic predisposition plays a major role; in addition the recipient area during the various stages of transplantation suffers “trauma”and the transplanted follicle may in turn be affected. Incisions and positioning are capable of going to partially compromise vascular inflow, as well as the skin architectural structure: the transplanted follicle also becomes more vulnerable to the stresses that normally cause its aging, not to mention then the “anxiety factor,” which normally accompanies the life of those suffering from alopecia and becomes an often important variable in the determinism of some conditions.

The focus, therefore, should not be on the surgeon’s ability or lack thereof, either to perform the procedure (obviously a factor of primary importance) or to identify these factors (which he or she must certainly take into account), but on the individual’s sensitivity to all the factors mentioned, and therapy always remains crucial to maintaining the results of a good hair transplant.

As mentioned, those who undergo a hair transplant must then consider that in the course of life a “touch-up” will still have to be done: individual sensitivity intervenes precisely as a determining factor of the time lapse between the first surgery and subsequent ones. For this reason, the decision for a transplant should never be taken lightly.


UPDATE 09/11/16, Dr. Massimo Gabellini responds to Bellicapelli’s user.

I feel like making some clarifications:

Finasteride is still an excellent drug for the treatment of AGA and in many cases may be the first choice, but hair therapy does not mean exclusively finasteride, because as some of you rightly testified, the drug is not tolerated by everyone in the same way. It is critical to modulate dosages in order to limit sides, but even at low dosages finasteride can cause side effects that advise against its use, so in some cases it should not be taken.

The central focus of the article revolves around the need to understand that the cause of baldness is multifactorial and must be sought in a series of events that play a different role depending on the individuality of the affected person.

The transplanted follicles may thus become more susceptible to the concomitant causes of androgenetic alopecia, which are not expressed by simple sensitivity to dht: the incidences called into question involve psychological aspects, hormonal sensitivity to estrogen and serotonin, and in rare cases increased direct susceptibility to dht that would probably have occurred in donor area anyway.

The aim of therapy is precisely to treat all round these incidences, making use of everything we have at our disposal: finasteride, lotions containing minoxidil and substances active on follicular metabolism, supplements designed to restore nutritional deficits, correction of dysmetabolic, endocrine and martial deficiencies-in short, everything needed to rebalance our bodies. All the more so, when performing surgery that has cost us sacrifices in economic and psychological terms.

AGA as mentioned does not respond exclusively to finasteride, and especially with advancing age, the indication to take the drug may not be the most appropriate route.

In my personal direct experience as a patient I have used finasteride for several years at different dosages and I will not hide that more than once I have manifested side effects that led me to abandon its intake for some periods (side effects in my case always returned with discontinuation). My current personal therapy does not include taking finasteride for the time being and the results are still good ( although in my case I still do not have to “manage” transplanted hair).

I have probably added nothing new to your knowledge, but at the state of the art there is little that is concrete, and the purpose is essentially to make patients aware of the need to continue the therapy in a complete way even and especially after an autotransplantation procedure, in order to avoid that the above-mentioned incidences may result in the loss of the improvements obtained.

Several studies promise improvements, and I hope to see a major breakthrough in baldness therapy in the short term, but promises still do not make hair grow back.

Best regards to all.


Massimo Gabellini


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