Female Experiencing Shock Loss 6 Weeks After Hair Transplant Procedure. Is This Normal?

Written by William Reed, MD on February 18, 2009

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. Therefore the time that you can expect the resting phase to last is the time it takes for the follicle to register the insult and begin its three month resting phase. Usually you will see regrowth between month 3 and 4.

The issue of transplant shock can be a bit more complex than pure “telogen effluvium” as is described above. At times the transplant shock is to hair that is on its last cycle of growth and is not programmed to grow from this, its last resting phase. I can’t recall that I have ever seen a result that didn’t result in more density than before the procedure, but that is a concern that always is in the back of my mind. If that were ever to be the case, the solution is straightforward: transplant more grafts now that the “diseased” hair is cleared out, admittedly in an unforeseen, accelerated manner by the transplant procedure.

An additional remark is necessary about causes of hair loss other than the poorly understood “female pattern hair loss” that presumably was the diagnosis for which you were treated. There are rare inflammatory causes of hair loss that are almost always recognizable just by looking at the scalp. These conditions can be flared up by grafting and can be the reason that hair does not grow. I emphasize that this is uncommon and almost always recognizable by just looking at the scalp and seeing evidence of inflammation so I doubt it is relevant to your situation.

In summary and to address your specifics, then, your hairloss is coming at a normal time for the “transplant shock”. The amount of hair lost is very unpredictable and you can expect the thinning to begin to reverse itself between month 3 and 4 or 5. You could follow measurements of the width of a partline through the area if you want some concrete way to follow the regrowth. I think using minoxidil/Rogaine 2% or 5% with the approval of your doctor would be a good idea.

I hope this helps.

Bill Reed, MD
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

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