I get this question almost every week from patients around week 3, so here’s how I usually explain it.
Weeks 2–4: most of the transplanted hairs fall out. That’s expected. By around day 10–14 the grafts are anchored; the follicle stays in the skin and goes into a resting phase, and only the hair shaft it was carrying sheds. A hair coming out at this stage is not a lost graft.
Shock loss around the grafts: some patients also lose native hair around or between the transplanted area in the first days or weeks. A 2023 case series of 28 patients described this kind of early effluvium, sometimes in a line along the recipient area, and it was fully reversed within 3 months. Their practical advice, which I agree with, is to photograph both transplanted and non-transplanted areas right after surgery and to warn patients about it beforehand.
Months 3–4: new hairs start coming through, often thin and uneven at first. This is the “ugly duckling” phase.
Months 6–12: most of the visible change happens here. The front usually leads; the crown is slower, and I don’t judge a crown result before 12–18 months.
Call your clinic instead of waiting if you see spreading redness, pus, fever, increasing pain, or bleeding that doesn’t stop with light pressure.
One simple habit helps more than anything: monthly photos in the same light and from the same angle. Memory plays tricks in this phase, photos don’t.
Reference: Mir-Bonafé JM et al. Immediate-Onset Linear Effluvium Associated With High-Density Hair Transplantation: A Series of 28 Cases. Actas Dermosifiliogr 2023. pubmed.ncbi.nlm.nih.gov