shock loss

I had a transplant about one year ago to hide a scar from a brow lift. Unfortunately, the scar is still very visible, but what I’m most worried about is the dramatic thinning of my hair along the donor scar line and below it. In fact, right now, I have an irritation, the second one in a month, that is about an inch wide. This one burns and appears infected. My doctor thinks it was just an ingrown hair, but I’ve never had one like this ever! Could I be having thinning hair and irritations because of my hair transplant. Will it stop? Is it likely my hair will ever regrow what I’ve lost since the hair transplant?
-Susan
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As for your donor area, it does sound like you have local infection and inflammation at the site.  This could have started, as your doctor said, with an ingrown hair and may have spread to the surrounding area.  It could also be what doctors call an “inclusion body” like a stitch that did not dissolve and is instead working it’s way towards the surface.  Read the Story

I am a 26 year old female who had a transplant 6 weeks ago ( 1000 grafts, first transplant ) due to frontal thinning of hair. I am experiencing shock loss which I know to be normal, but I want to know is it normal to start at this time, how much hair usually comes out and how long does the shedding usually last for? – Christine
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Dear Christine,

“Transplant shock”, or thinning of pre-exisiting hair after a transplantation is as unpredictable as it is frustrating and anxiety-provoking.  It is thought that the shedding comes from the chemicals released by the inflammation associated with healing wherein the chemicals are perhaps useful in sterilizing the environment but are also noxious to the surrounding cells.  The cells of the hair follicle respond to stress by inducing the follicle to go into its resting phase, “telogen”.  Scalp hair generally grows for three years, then goes into the resting phase for three months  before reentering another growth phase.  This appearance of the resting phase usually becomes apparent as early as 3 weeks and can continue for perhaps three months.  Read the Story

I got a hair transplant 6 1/2 months ago and I am not seeing too much results, is that normal? Is it at 12 months that I will see the full effect or longer? Do grafts sometimes not grow? I also had a lot of shock loss.  By the way, I am a 24 years old female with PCOS. Thanks! – Melissa
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It is normal for hair-bearing grafts to enter a resting phase following surgical hair restoration.  The typical resting phase following a hair transplant lasts 3-4 months.  During this time the follicle does not produce any hair as it is resting and recovering from the stressful events relating to the surgical process.  Although hair begins its regrowth cycle at this 3-4 month mark, it takes several more months for full density to be achieved.  During this period the follicle recovers its ability to produce a thick and fully mature hair shaft.

Although the majority of patients begin their regrowth cycle around the 3-4 month mark, there are some patients who are fortunate to see earlier growth and there are those who see a much latter regrowth.  These variations are simply related to the normal variations of all human characteristics such as height, weight, IQ, etc.  Extremes which deviate from the average are much less common, but they do occur.  Read the Story

I had a hair transplant done October 08. I had stress hair loss on the upper back portion of my head from consistently wearing  bobby pins in the same spot day and night for years. I found a surgeon through a referral from a friend, we decided on 1000 grafts. On the morning of surgery, I asked for some grafts to be put in the front as it was thinner than it had been when I was younger, I am 49 yrs.old. In all, he put 1200 grafts in the problem area and 375 in the frontal area. Each micrograft was to yield 1 – 3 hairs. The large area is coming in and I can see new growth in the front, but the front is so much thinner than it was prior to surgery, I can’t even conceal it! Needless to say I am very distressed. I contacted the doctor’s office and they said it could be shock and it should grow back. Can I expect it to grow back? Should I be using any product to help the growth? Sincerely, Joyce
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Dear Joyce:

Thank you for your letter.  Based on your explanation of the surgery and the number of grafts, I would have to agree with the answer you received from the doctor’s office. The fact that the frontal area is thinner than it was prior to surgery suggests that you have shock loss. Read the Story

I have thinning hair on top of my head, not so bad, but bad enough to make me consider a hair transplant procedure.  If I were to get a hair transplant on top of my head, is it true that the hair (existing hair) surrounding the transplanted hair will fall out?  If so, does it grow back and how long does it take for it to regrow?
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The situation you are referring to is called “shock loss” of hair.  That is a side effect that can occur after a hair transplant, but by no means does it always occur.  When grafting into an area that already has hair, some of the existing hair can shed shortly after the procedure (usually for up to about a month).  The healing process after the surgery causes some degree of inflammation to the scalp.  This inflammatory process, in addition to actual damage directly to the existing follicles (known as transection), can result in the loss of some of the existing hair in the recipient area.

Whether or not someone will experience shock loss after their surgery can be difficult to predict.  In general, the more existing hair in the area to be grafted, the higher the likelihood of experiencing shock loss.  Also, the higher the concentration of miniaturized hairs in the recipient area, the higher the likelihood of shock loss will be.  Miniaturized hairs have miniaturized “roots,” and therefore they are weaker and more prone to shedding. Read the Story

I have read some accounts of hair transplant patients losing hair around their donor area in the back of their heads to shock loss. Is this something that happens often? I’m considering having a hair transplant but this concerns me.
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Shock loss is very unusual in the donor area. When it does occur, there are generally two causes: 1.) If a very wide donor strip is taken and closed (sutured together) under very significant tension.  2.)  If the patient has had a previous surgery and the new donor  strip is taken above or below the previous scar leaving a vulnerable area of hair in between. Read the Story

I have been suffering from AGA-female pattern baldness  since I was 17. The hair at the back of my head was comparatively  thicker compared to that on the crown. I’m 26 now and 3 months into my hair transplant (1697 grafts). I’m already regretting it since I have undergone severe shock loss these 3 months. After reading your article on shock loss I’m really concerned as to what should I expect since my shock loss is still continuing. Also, I’m wondering, will the hair on the donor site grow back?- Susan
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Susan:

Thank you for your questions.

First of all do not be alarmed or overly concerned with the “transplant induced shedding”, (also known as shock loss) of your natural non-transplanted hair that has occurred with your procedure.  Although this is not a common problem, it can and does occur when transplanting into hair bearing scalp.  If the transplant patient has “bald” scalp to begin with, there is no hair to “shock out” with the transplant procedure.

The “shocked” hair will start to reestablish itself and grow along with the hairs from the transplanted follicles.  This process typically BEGINS about two months post transplant.  So at three months post transplant, you are STARTING to grow the hairs from both the transplanted as well as your native non-transplanted follicles. Read the Story

I had a hair transplant over 14 months ago and I have never been more worried or stressed. I read your article on shock loss and I fear my hair loss may be permanent. I had a full head of hair going into the surgery, just a little thin at the front, and after the surgery hair would come out in handfuls in the shower. Now I’m grasping for hair to put into a ponytail. It’s a significant amount of loss, and yes it’s been over a year and I have seen no growth. please tell me? does this sound like it’s irreversible? -Denise
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Dear Denise,

It is difficult to predict how severe shock loss will be prior to surgery.  If the hairs that were lost were permanent hairs, they would typically have regrown at the same time the grafts did—within 3-6 months.  One thing that shock loss can do is accelerate a pattern that would have occurred anyway (without treatment), by putting the hair into its rest phase (telogen) in response to an inciting event (stress, surgery, etc).   Hairs affected by shock loss that were permanent, should have grown back in by now.  If you are not using it, you may benefit from the application of topical minoxidil.  The new 5% foam may be easier to use than the liquid form.  Read the Story

What are the chances of having “shock loss” resulting from a hair transplant procedure?
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Thank you for your question. Personally, I have not seen any significant post-surgical hair loss for the last 4-5 years. The reasons are many. First and foremost is the creation of precise angles of the recipient sites, while fallowing the exact direction of hair growth. Secondly, the use of very small needles and cut to size blades, that minimize the size of the sites created, hence the extent of tissue and possible follicular injury if there is native hair remaining. Lastly, the use of finesteride diminishes the DHT by 70% hence protecting the native and transplanted hair from any post-surgical increase in circulating DHT. Lastly, the use of minoxidil 5% acts synergistically to further protect the native miniaturized hair and possibly stimulate the growth of the transplanted hair. Furthermore, the growth of the transplanted hair with its increased caliber is of greater contribution to the hair mass and volume than the native thinner caliber miniaturized hairs. I do recall one patient about 6 years ago that had some shock loss post-surgically. Read the Story

Is shock loss from a hair transplant temporary? I have heard that if you experience shock loss there is a real possibility that this hair will not grow back. Is this true?
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Thank you for your question. “Shock loss” in the recipient area may be either temporary or permanent depending on the quality and genetic predisposition of the existing hair. It is generally felt that shock loss is likely temporary, however if the preexisting hair is thin and weak (likely to fall out in the near future due to the hair loss process) the transplant procedure may cause the majority of those hairs to fall out permanently. The downside of that situation is that the amount of hair placed may equal the hair that is shocked out and the patient experiences no “net gain” of hair. The upside is that even if there is no net gain of hair, the transplanted hair will last a long time, likely longer than the weaker would have lasted.

The more common situation is that the preexisting hair will thin out in the first 1-3 months after the surgery and will re-grow with the new grafts making the area look much thicker. Read the Story