Why Do Some Hair Transplants Fail? - Bernstein Medical - Center for Hair Restoration
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May 20th, 2024

Hair transplantation has emerged as a highly sought-after and extremely reliable solution for hair loss. For many, it does not just restore hair, but also the confidence of millions of people around the world. Despite the continuous advances in technology and techniques, some hair transplants still, unfortunately, fail. Understanding the reasons behind these failures is essential for anyone considering this procedure – especially the surgeon.

“There are so many factors that contribute to a successful hair transplant,” says Christine Shaver, MD, a hair transplant surgeon at Bernstein Medical – Center for Hair Restoration in New York City. “This is not something you can cut corners with, so you want to make sure that your doctor does hair restoration surgery full-time and preferably has specific training in hair loss i.e., is a board-certified dermatologist.”
Today, we are exploring the twelve main factors that can contribute to the unsuccessful outcome of hair transplants.

1. Age

A major reason that hair transplants fail is that they are performed on patients that are too young. A critical bit of information is the stability of the donor area. If the donor area is not stable then, over time, the transplanted hair (which comes from the donor area) will begin to disappear. The main way in which a physician assesses this stability is to look at the percent of miniaturization in the donor area compared to normal full-thickness hair. Miniaturization is the progressive thinning and shortening of hair in response to the hormone (DHT). Eventually this hair will disappear. Unfortunately, patients may not show any significant miniaturization at a young age, although they are destined to have extensive miniaturization and baldness as they grow older. Therefore, evaluating a patient for surgery that is too young may give a false impression of donor stability and surgical candidacy.
In our practice, we wait until a person is a minimum of 25, as this will give us the best chance of not performing surgery on a person who may not be a candidate in the future. Equally important is that younger patients may respond dramatically to medical therapy, even if they have significant hair loss already.

2. Being a Poor Candidate

One of the primary reasons for hair transplant failure is poor candidate selection on the part of the physician. Besides age, not everyone is an ideal candidate for the procedure. Factors such as the extent of hair loss, the quality and quantity of donor hair, and the patient’s overall health and scalp (such as extensive sun damage) play a crucial role in determining suitability. Patients with extensive hair loss and limited donor hair may not achieve the desired density. An ethical doctor will be forthcoming about this as part of the consultation. Similarly, individuals with certain medical conditions or scalp disorders (particularly auto-immune diseases) may experience complications that can hinder the success of the transplant.

3. Unrealistic Expectations

Patients often have unrealistic expectations regarding the results of hair transplantation. This can lead to disappointment and the perception that the transplant has failed when that is not necessarily the case. It is essential for the surgeon to provide a thorough explanation of what can and cannot be achieved. While hair transplants can significantly improve appearance, they do not restore hair to its original density. Setting realistic goals and ensuring the patient understands the limitations of the procedure can prevent dissatisfaction. It is important to stress that unrealistic expectations are especially common in younger patients – regardless of how adequately they are counselled – leading to a poor decision that may affect their entire life.

4. Inadequate Surgical Expertise

The skill and experience of the surgeon are critical determinants of a successful hair transplant. Inadequate surgical expertise can lead to poor graft handling, incorrect implantation angles, and uneven distribution of hair, among other issues. This can result in an unnatural appearance or failure of the transplanted hair to grow. It is important to choose a board-certified surgeon with extensive experience in hair transplantation to minimize these risks.

5. Poor Post-Operative Care

Post-operative care is as important as the surgery itself. Patients must adhere to the post-surgical instructions provided by their surgeon to ensure optimal healing and graft survival. Failure to follow these instructions can lead graft dislodgement, infection, or poor healing, all of which can compromise the success of the transplant. Activities such as smoking, excessive physical exertion, and improper washing of the scalp can negatively impact the transplanted hair as well.

6. Infection and Scalp Conditions
Infections and scalp conditions can significantly affect the outcome of a hair transplant. Infections can arise from poor surgical technique, inadequate sterilization, or lapse in post-operative care. Scalp conditions such as psoriasis and dermatitis can also interfere with caring for the grafts. It is crucial for patients to disclose their medical history and for surgeons to address any scalp conditions before proceeding with the transplant. Ensuring your doctor of choice is a board-certified dermatologist can help identify potential scalp condition issues. 7. Insufficient Blood Supply

7. Insufficient Blood Supply

The success of hair transplants relies heavily on the blood supply to the transplanted follicles. An insufficient blood supply can lead to graft failure, where the transplanted hair does not take root or grow. Factors that can impair blood supply include making recipient sites (the holes that the grafts are placed into) too large or spacing these sites too close. Pre-existing vascular conditions including extensive sun damage and, of course, smoking will inhibit growth or result in complete failure of the hair transplant. Patients that have blood disorders that increase coagulation, such as sickle cell disease, may be of particular risk. Surgeons must also ensure minimal physical trauma to the scalp during the procedure. A donor area incision that has been closed too tightly can also compromise blood flow to the scalp. Scalp necrosis is an extreme condition, where not only does the hair not grow, but parts of the scalp may be destroyed as well, leaving unsightly scarring.

8. Medications that Increase Bleeding

Anti-coagulants, such as coumadin and Plavix, may significantly increase bleeding and result in grafts popping out of the recipient sites. It may also cause blood to accumulate under the skin placing undue pressure on the tissue above.

9. Graft Rejection

While rare, graft rejection can occur in hair transplants. This happens when the patient’s immune system identifies the transplanted hair as foreign and attacks it. Graft rejection is more common in individuals with autoimmune disorders. Pre-surgical screening and appropriate medical management can help mitigate this risk. However, it remains a potential complication that can lead to transplant failure. Scalp conditions such as lichen plano-pilaris and frontal fibrosing alopecia can cause graft rejection. Although these conditions are readily diagnosed by an experienced dermatologist, they can be easily missed by the untrained eye. Unfortunately, sometimes these conditions do not appear until after the actual hair transplant.

10. Shock Loss

Shock loss refers to the temporary loss of existing hair around the transplanted area, which can occur after the procedure. Although it is often temporary, in some cases, the hair does not regrow, leading to a perceived failure of the transplant. Shock loss can be minimized by employing less invasive techniques and ensuring that the patient is in good health before the surgery and using medications to make the hair in the recipient area more stable – such as finasteride and minoxidil.

11. Improper Graft Storage

The way grafts are stored during the transplant procedure is crucial for their survival. Grafts that are not kept at the appropriate temperature or in the correct solution can suffer from dehydration and cell damage. This is a common cause of poor growth or death of the transplanted hair. Surgical teams must adhere to stringent protocols for graft handling and storage to ensure their viability.

12. Lack of Experienced Support Staff

The success of a hair transplant is not solely dependent on the surgeon, but also on the surgical support staff. The nurses and medical technicians who assist in the procedure must be well-trained and experienced in handling grafts and assisting with the surgery. Inadequate support can result in mishandling grafts and errors during implantation, which will compromise the outcome. It is important during your consultation to ask whether the surgical team consists of full-time staff with experience working together. Unfortunately, especially in smaller or part-time hair practices, this is often not the case.


While hair transplantation can offer a significant improvement in appearance and confidence for many individuals, it is critical to consult with a top tier expert in hair transplantation. If you ever feel sales pressure, that should be a red flag.
Understanding the reasons behind transplant failures can help potential patients make informed decisions and set realistic expectations. Successful outcomes depend on proper candidate selection, realistic expectations, surgical expertise, diligent post-operative care, and addressing any underlying health conditions.
Choosing a reputable and experienced surgeon, following pre- and post-operative instructions meticulously, and being aware of the potential risks and complications are essential steps to ensure the best possible outcome. While some factors may be beyond control, many aspects of the procedure can be managed to minimize the risk of failure. With the right approach, hair transplantation is a highly effective solution for hair loss, helping patients regain their hair and their confidence.

Why Choose Bernstein Medical – Center for Hair Restoration?

Bernstein Medical is a world-renowned hair restoration clinic, founded by Dr. Robert M. Bernstein, a pioneer in the field of hair transplantation and follicular unit transplantation (FUT). With over 25 years of experience, Dr. Bernstein and his team specialize in providing advanced hair restoration solutions for both men and women, utilizing the latest techniques and technologies to deliver natural-looking results.

The Medical Director is Christine Shaver, MD. Dr. Shaver is a board-certified dermatologist and Mohs micrographic surgeon. A graduate of M.I.T and Yale, she is a highly trained expert at blending art and science to create desired outcomes for her medical and surgical hair transplant patients.

At Bernstein Medical – Center for Hair Restoration, patients receive comprehensive evaluations and personalized treatment plans throughout their hair restoration and preservation journey. From non-surgical options such as SMP (Scalp Micro-Pigmentation) and medical management to surgical procedures like FUT and FUE, the clinic offers a range of cutting-edge treatments tailored to each patient’s unique needs and goals. The personalized care you will receive from both the doctors and staff is exceptional!

The experts at Bernstein Medical – Center for Hair Restoration are happy to discuss what solutions are best for you,

To book a consultation online, click HERE
Call us at: 212-826-2400
Visit our website www.bernsteinmedical.com for more information

Posted by on Updated 2024-05-22

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