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

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

William Reed, MD William Reed, M.D. was born in Kingsport, Tennessee. He graduated from Tulane University with a BS degree in 1969 and from Tulane University School of Medicine in 1973. Following graduation he did a surgical pathology internship and residency at Stanford University and a clinical pathology residency at University of California, San Diego. He changed his career path in 1976 by beginning to practice emergency medicine. He practiced emergency medicine in San Diego for the next nineteen years when he stopped to begin the full time pursuit of a career in hair transplantation surgery. In 1982, he broaden his interests in clinical medicine by cofounding La Jolla Medical Clinic and beginning to practice family medicine there. Dr. Reed's interest in hair transplantation began in 1993, when, motivated by his own hair loss, he discovered the emerging use of small hair grafts. He had two hair transplantations himself in 1994 and opened La Jolla Hair Restoration Medical Center in 1995. Dr. Reed is a member of the International Alliance of Hair Restoration Surgeons and recommended by the American Hair Loss Association. Visit Dr. Reed's Website: www.ljhr.com

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