What Is Shock Loss?
It is important to distinguish the difference between “temporary” shock loss and “permanent” shock loss. We will first discuss temporary shock loss and further discuss permanent shock loss later in the article.
Shock loss (temporary), also referred to as telogen effluvium, is a common and typically temporary phenomenon that can occur following a hair transplant procedure. It involves the shedding of both transplanted and existing hairs due to the stress the scalp and follicle undergoes during a procedure.
Hair growth occurs in four stages. Each stage plays an important role in the life cycle of hair. The four phases are:
- Anagen (growth phase)
- Catagen Phase (transition phase)
- Telogen Phase (Resting Phase)
- Exogen (shedding phase)
Some experts consider the telogen phase the shedding phase as well.
Disruptions in the cycle, such as a hair transplant procedure, can lead to hair loss conditions such as shock loss/telogen effluvium, where many hairs enter the telogen or exogen phase prematurely.
Hair Transplant Shock Loss Timeline
When will you begin to notice the first signs of shock loss? Understanding the timeline of shock loss following a hair transplant can help manage expectations and alleviate concerns. Here’s a breakdown of what to expect:
Early Phase of shock loss (Weeks 2-8)
Weeks 2-4: Noticeable shedding of transplanted hairs starts
The shedding of both transplanted and native hair is often called “shock loss” and is a normal part of the hair transplant process. Hair can start to shed within a few days of the procedure but most of the transplanted and existing hair will remain in the first 2 weeks. Often at the 1-2 week mark, you get a preview of what’s to come and things are looking pretty good. At that 2 week point you may notice the hair starting to thin in mostly the recipient areas. Usually by week 4-5, all the transplanted hair and any of the existing hair that may have been shocked will fall out. In a very small percentage of cases, the hair will not fall and continue to grow from day one of the transplant. However, you should not count on this rare occurrence.
Weeks 4-8: Continued shedding of transplanted hairs.
During this time, most of the hair will have shed due to the trauma of the procedure. While some hair can continue to shed after 5 weeks, most all the hair that will shed will do so by week 5.
Intermediate/final Phase
Months 2-3: Peak period for shock loss. Most all the transplanted hair will have shed and some native hairs might have also shed, leading to a temporary decrease in hair density. Considered the “ugly duckling” phase, this period is when you may look the thinnest.
Months 3-4: Shedding is mostly done and new hair growth from the transplanted follicles begins. These new hairs might be fine and lighter in color initially. Typically, at month 4, you will have more hair and look better than before the procedure or very close to turning the corner. In some cases, there is a notable improvement even at just 4 months post-op. Each individual’s timeline can vary.
Does everyone get shock loss after a hair transplant?
Not everyone experiences shock loss after a hair transplant, but it is quite common. The extent and occurrence of shock loss can vary widely from person to person. Several factors influence whether someone will experience shock loss and how severe it might be:
Skill of the Surgeon:
Experienced surgeons using advanced techniques can minimize the trauma to the scalp, reducing the risk of shock loss. Precise angle and direction control of the recipient site incisions using smaller custom sized blades can reduce the chance of shock loss.
Procedure Type:
Different hair transplant techniques, such as Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT), might have varying impacts on shock loss. The type of method used for extraction should have little to no effect on shock loss in the recipient area. However, shock loss in the donor area can be affected differently by each method. With FUT, there can be some temporary shock loss above and/or below the incision that will grow back. “Permanent” shock loss can also occur if a lesser skilled surgeon transects some of the follicles along the incision line. In this case that area where hair will not grow back just parallel to the scar line can in essence visually increase the width of the scar. With FUE, temporary shock loss can also occur depending on the punch size and other factors including the technology and skill of the extractor. Permanent shock loss can also occur if extraction techniques and technology are poor, the donor area is overharvested or there is a general lack of skill by the operator. At Hasson and Wong, temporary shock loss in the donor area is uncommon, permanent shock loss is averted.
Scalp Sensitivity And Shock Loss:
Some patients will have a more sensitive scalp which may react slightly differently to the trauma of surgery, making them more prone to shock loss.
Hair Characteristics And Shock Loss:
The type, density, and health of the existing hair can influence the likelihood and extent of shock loss. A healthy hair follicle that is not experiencing any miniaturization and is deemed permanent may be less prone to shock than a hair follicle that is shrinking and producing thinner hair.
Hair Health:
Individuals with pre-existing conditions like androgenic alopecia (pattern baldness) might experience different levels of shock loss compared to those without such conditions. As earlier mentioned, thinning miniaturized hair is at greater risk of shock.
Medication:
Certain medications prescribed for hair loss (e.g., minoxidil or finasteride) may influence the rate and extent of shock loss. Medications such as XYON Health’s topical dutasteride can impact temporary shock loss. When these medications increase the health of the hair follicle making it stronger, it may be less prone to shock.
Will my hair grow back after Hair Transplant shock loss?
If the shock loss is telogen effluvium or temporary, yes, it will grow back. If it is not telogen effluvium and more of the permanent variety, the hair will not grow back.
What exactly is “permanent” shock loss?
Permanent shock loss is what the name implies, the loss is permanent and hairs damaged by transection (cutting across the existing hair follicle) will not grow back.
While temporary shock loss is expected and quite common, any permanent shock loss of viable hair can also occur and should be avoided. While temporary shock loss could be described as a phenomenon associated with indirect trauma, permanent shock loss can be the result of a more direct trauma. When making recipient site incisions among existing hair, those incisions must be precise and well executed so as not to cut into the neighboring follicles thus preventing them from surviving the procedure. The field of vision must also me optimal and certain technology must be employed.
There are a few factors that will greatly reduce the chance of permanent shock loss.
Small custom sized blades.
To successfully make incisions between existing hair without causing damage, in general the smaller the blade the better. If the blade size is not custom sized to the follicle and is larger than needed, the larger blade working in tight quarters has a greater chance of causing damage. In this case the incisions will need to be placed farther away from the existing follicle to prevent damage which will result in a lower density transplant.
The angle of the recipient site incisions
The angle of the recipient site incisions must be exact and parallel to the existing hair. If the angle is slightly off and the incision cuts across the adjacent existing hair follicle and transects it, the follicle will no longer produce a viable hair. What should have been temporary shock loss then becomes permanent.
Shaving of the recipient area.
When hair in the recipient area is too long, it can create a couple issues. At a certain length, the hair will obstruct the field of vision and also make it more difficult to assess the exit angle of the hair shaft. To precisely make an incision parallel to the existing follicle, the exact exit angle of this native hair must be determined. Longer hair can distort the exit angle making it more difficult to detect. Therefore, a shave of the recipient area is necessary. Once the hair shaft is shaved to the necessary length, the angle of that hair shaft can be established and the correct incision can be made parallel to the adjacent follicle. This will eliminate any transection or damage to the follicle or “permanent” shock loss.
Surgeon skill.
Especially in cases where high density is desired and necessary, the surgeon must have an extensive understanding of how to avoid permanent shock loss and the necessary tools and expertise to prevent it. The more density required, the higher the degree of difficulty when transplanting among existing hair. Experienced surgeons who routinely achieve high densities will take the necessary steps mentioned above to produce the best outcome. Transplanting among existing hair without a shave, without custom blades, without a high degree of skill etc. may be possible without causing damage but the density will likely not be acceptable to the patient. At some stage, the patient will want a better result with more density and these steps will ultimately need to be employed.
Hair Transplant Donor Area Shock Loss
What Does Hair Transplant Shock Loss Look Like?
Here are a few examples of what shock loss in the donor area might look like, including examples of recovery times and what the recovery process could look like as the area returns to normal.
In this FUT case, within the first 2 months post-op, the scar is healing nicely but some temporary shock loss was apparent in the donor area above and slightly below the scar.
At 3-4 months post-op, those fallen hairs started to grow back and there is virtually no evidence of the previously shocked follicles.
In this FUT case, the worse of the temporary shock loss was confined mostly to an area of the donor in the back. The loss was substantially above and below the scar line at 3 months post-op just before it started to grow back.
At 5 months post-op, those shocked follicles are producing hair again. From this point forward, the area will continue to improve each month until full maturation.
Hair Transplant Shock Loss Conclusion
In most hair transplant procedures, some degree of shock loss is likely to occur. Understanding that shock loss is usually temporary and a normal part of the hair transplant process can help manage expectations and alleviate some of the anxiety. Be prepared for the possibility of your hair looking thinner before it gets better. New hair growth typically starts around 3-4 months post-op, with substantial improvements occurring within 6-12 months. Full results from a hair transplant can take up to 18 months. The use of medications such as topical dutasteride can reduce the severity of temporary shock loss. We can provide personalized advice and support if shock loss occurs. And most importantly, make sure you are in the capable hands of a surgeon who recognizes the impact permanent shock loss can have on a result and who is adept at preventing it.
