This is a very common question - SHOCKLOSS - Hopefully this can help patients wanting answers to their questions regarding Shockloss. Below is a culmination of a few posts by posters on the topic of shockloss - Hope it helps - They have been copy/pasted from a variety of places so may not flow..


Shockloss

1.Shockloss is something that can be experienced when transplanting into existing hair although highly unpredictable. Shockloss occurs when the native hair is weak and isn't strong enough to resist the trauma that's going on around it. More often than not the hair that has gone into shock will grow back but after 3/4 months - after the resting phase
Hair that goes into shock and doesn't return is hair that was inevitably on its way out anyway and wasn't strong enough to return.
Increased trauma to a localised area will increase the chances of shockloss
Shockloss is unpredictable and there is no hard and fast rule to avoiding it - especially if you are transplanting into existing hair.


2. There are risk factors that either heighten or lessen someone's risk. Diffuse thinners seem more prone to shockloss than receders because the hair in a diffuse area is often less stable than that of a receder. Very often, a lot of the hair in a diffuse area is "on its last legs" and in the latter stages of the miniaturization process.

3. Shock loss tends to occur both in the recipient and in the donor areas as far as I know. It's a normal response to trauma to the scalp which is surgery. However, permanent shock loss, while it can also happen if the hair that was shocked was going to fall out anyway due to MPB, sucks and can be a sign of a bad HT.



4. Any time hair is transplanted in between or around existing natural hair, there is a risk of temporary "shock loss" or telogen effluvium. This is even more common in women, but is almost always temporary. Only follicles that are transected (which won't happen in the hands of a skilled physician) or miniaturized hairs on their way out anyway may be permanently shocked.


5. An unfortunate possibility in hair transplantation is a phenomenon known as shock loss. This is mostly a temporary condition where native hairs are ???shocked??? due to trauma of the scalp during hair transplantation surgery, creating an additional but mostly temporary hair loss condition. Though nobody likes to experience this, fortunately, this is normal.

Shockloss can occur both in the donor and recipient area a few weeks to a few months after having hair transplantation surgery. There are two forms of shockloss, temporary and permanent.

Permanent shockloss, though rare, can occur in one of two ways:

The physician transects existing hair follicles (the risk is significantly lessened in the hands of a skilled physician; however, it is risky if you are in the hands of a clinic using older technology, using larger instruments to make incisions and inserting plugs, mini-grafts, or micro-grafts).
It can occur to hairs that have entered the miniaturization process??¦but these hairs would have fallen out eventually anyway. This is why getting on medication such as Propecia (Finasteride) is very important, to hopefully strengthen existing hairs and turn miniaturized hairs back into healthy hairs.
Temporary shockloss is more common and seemingly unpredictable - varying from person to person. In other words, there is no pattern or understood reason why some patients experience it drastically and others do not. Temporary shockloss occurs due to scalp trauma from surgery. But within several months, the hair grows back.

There are ways, however that temporary OR permanent shockloss can be minimized.

Using ultra refined follicular unit transplantation, the recipient incisions are much smaller and refined, using custom cut blades as small as .6 mm which causes less trauma to the scalp. This in itself can mimimize shockloss to the recipient area.
Conservative placement around existing hairs without super dense packing can also minimize shockloss to an existing area.
Finasteride, also, is known to help minimize the risk of shockloss.
I might add that if any of the three listed items above are missing, the risk for shockloss increases.



6. Shockloss is unpredictable, however, Propecia since it can strengthen hairs that would have otherwise been on their way out, can make it more "shock" resistant. It is not a definite...but it can help. At the very least, it helps minimize permanent shock loss.



7. Keep in mind that the risk of permanent shock loss only exists for native hair that is currently in a weakened state due to hair miniaturization (or if the native hair follicles are transected, but this is rare in the hands of a qualified surgeon). This means that this hair would have eventually fallen out and leave you bald anyway. Temporary shock may occur due to scalp trauma but will return.



8. Shock Loss Shed - affects native hair - likely to be noticed within the first month of your HT. Sometimes experienced around donor area. More evident if you don't shave down for HT...IMO. The may or may not return. I had some with each HT. I noticed for HT #2 that shocked native hair started to return at the 2 month 1 week time period. I could tell the difference between it and HT hair as the shocked native hair came in coarse like beard stubble versus HT new growth being very fine.



9. Shockloss is not losing the transplanted hair. Shock loss is when you lose the pre existing hair in the transplanted area.



10. If you make it to 4 weeks post op, then more than likely you will not have shock loss.



11. Shock loss also has a great deal to do with the skill of the surgeon and trauma to the scalp.



12. There is a much higher chance of shockloss with increased tension. You can still get shockloss simply from the surgical trauma induced. Other factors include trauma to underlying vessels arteries with reduction of blood supply, infection, wound dehiscence, hematoma formation.



Shock Loss can be as a result of the following:Ricardo Mejia MD

1. Telogen Effluvium: this is a physiologic process which is multifactorial and can affect "weak" minituarized hairs as well as good terminal hairs as well. Telogen effluvium is a reactive process caused by a metabolic or hormonal stress or by medications. Readers need to understand the hair growth cycle in order to understand telogen effluvium. All hair has a growth phase, termed anagen, and a resting phase, telogen. Catagen is an intermediate stage between the two which lasts only a couple of weeks. On the scalp, anagen lasts approximately 3 years, while telogen lasts approx. 3 months. There can be wide variation in time with patients. During telogen, the resting hair remains in the follicle until it is pushed out by growth of a new anagen hair. This process occurs independent of hair transplant surgery. It may also occur as a result of surgical trauma. What is concerning to patients is looking thinner or losing hair after a hair transplant. This is temporary and the hairs will regrow. This type of shock loss is not permanent except for the minituarized hair on its last cycle.

2. Iatrogenic or Doctor induced during hair transplant surgery via transection of the hair shaft during creation of the recipient sites. This is surgical trauma. In this case the hair shaft will fall out immediately in some cases or as early as a month after surgery. It is possible if the hair shaft is cut, the hair follicle will continue to grow in anagen phase without being shifted into a telogen stage. Consequently not all hairs that are surgically traumatized go into telogen. However, patients will lose hair and can look thinner after surgery. Obviously this is of most concern in men and women who have hair and we are transplanting around existing native hairs or repeat transplant procedures. This type of shock loss is not permanent.

3. Shock loss due to apparent loss of hair. In general, during most consultations with patients with existing native hair and in women especially, they are concerned about the apparent loss of hair or thinness after surgery. Doctors explain the above possible risks. If you had your 4th procedure and left your hair intact and not shaven and subsequently in the next 1-3 months lost everything in the recipient site, I would assume you would say you experienced 100% shock loss either due to telogen effluvium and or Iatrogenic. Fortunately, I have never heard of this case happening, but the hairs will regrow. If you shave your head in anticipation of a surgery, you have a 100% sudden hair loss. You will not see any apparent loss of hair in the next 1-3 months of surgery because you have altered the equation and removed the visible factor to evaluate shock loss or not. You may still experience the same telogen or iatrogenic shock loss but there will be nothing to show. For many patients, having to shave their head completely is a big shock and if you shave 100% of the recipient site, it is 100% hair loss to the patient whether or not any follicles truly experienced iatrogenic and or telogen following the transplant.
4. Permanent Shock Loss as a result of invivo follicle surgical trauma. I have not experienced this in my practice and do not believe it is a big factor based on the studies that have been performed previously. If you cut a hair follicle with any instrument ultra refined or not, you are still transecting the hair follicle. IF this was a real problem, I would expect clinics that are doing 4000-6000 grafts with high dense packing in native hairs to experience more problems. As of yet, we have been getting very good growth and results. Keep in mind the worse case scenario is taking a hair follicle out of the body, crushing the bulb and cutting the bulb directly and reimplanting it into the scalp. In some of the studies that have been done, the hairs still grow although perhaps not as good quality. The probability of permanent shock loss in the right hands is extremely rare. Perhaps some of the consultants or other physicians will comment whether they have experienced many cases of permanent shock loss .
5. Vascular Blood supply. The use of ultra refined tools and other techniques that have helped minimize trauma to the vascular supply can minimize permanent hair loss. This is a separate factor that is independent of transection of hair follicles. There have been cases of poor growth due to the underlying damage to the vascular blood supply. This is a more critical issue than transection of the hair follicle itself. In this case, patients can experience hair loss and possibly permanent if the underlying blood supply has been badly compromised by poor technique. This is a whole separate issue of poor growth rather than shock loss due to direct damage of the hair bulb itself.

Ricardo Mejia MD



The area below was copied from "calling all docs Diffuse thinners"
quote:
Keep in mind that the risk of permanent shock loss only exists for native hair that is currently in a weakened state due to hair miniaturization (or if the native hair follicles are transected, but this is rare in the hands of a qualified surgeon). This means that this hair would have eventually fallen out and leave you bald anyway. Temporary shock may occur due to scalp trauma but will return.


A few points I would like to clarify.

I do not believe there is "permanent" hair loss form transection of hair follicles in the scalp. There is Iatgrogenic or doctor induced hair loss when the hair shaft is cut below the scalp, and falls out, but it will regrow. This is not strictly due to poor placement. There are other factors involved. I am not aware of any studies that have proven permanent hair loss. You may recall our previous thread discussing this very issue. I would recommend readers review this carefully.

Transection risk with megasessions and shock loss

"shock loss" can have many definitions as I have explained in the thread above. Most patients view it as the apparent loss of hair density after a procedure in existing native hairs that results in a thinner look usually within three months after a transplant. In general, the hairs will regrow as I have explained in my other thread. For all hair transplant practices that shave the recipient site, you are getting 100% immediate shock loss. The hairs are gone visually! For all practical purposes, can not tell whether you really experienced true "shock loss" or not because the hairs are no longer there. Therefore it is a moot point in practices that shave the recipient site. MOst of my professional patients do not want that type experience, which is why I do not always do it, and work around the native hairs.

"shock loss" is a lay term for telogen effluvium which can be multifactorial and a result of the stress from surgery, antibiotics, postoperative illnesses, medications, weight loss diet etc. Therefore it is not strictly due to trauma or poor placement. This type of shock loss and Itrogenic shock loss can affect miniaturized and terminal hairs equally. I am not aware of any study that states Shock loss ONLY preferentially affects only the weak minituarized hair. It is probale and perhaps Dr. Beener has added insight from his years of research activity in this field. However, I see lots of patients with telogen effluvium and they are loosing good terminal hairs not just minituarized weak ones. I agree with Dr. Beener, It is true if a weak minituarized hair was on its last leg and was "shocked" out, it will not regrow.

WHen transplanting at higher densities within existing hairs and with shaven recipient sites, there is a higher risk of transection of the hair follicles, especially if you are using a multibladed handle which makes several recipient incisions sites at the same time and you are doing it fast. It is a lot harder to try to align all the blades to be perfectly parallel to the hairs of varying densities, and the exit angle of the hair is not always the same under the epidermis. If you shave the recipient site very close with no superficial hair, you can not tell very well what the exit angle is and thus even harder or impossible to avoid native hairs with multibladed recipient site handles, especially in native hairs with pretty good density such as early diffuse thinners. I use a single bladed recipient handle to maneuver within existing hairs to minimize the possibility of Iatrogenic trauma. Spex is right, it is unpredictable. The good news, dakota is "permanent" shock loss is a term that is used too loosely. Review the previous thread. We need to understand and define the multitude of factors involved and the defintions and type of shock loss one is referring to. In summary, the hairs will regrow even if doctor tansected without a permanent loss and even hairs lost due to the myriad of factors with telogen effluvium, with the exception of the minituarized hair on its last leg. There is a higher risk of transection in native hairs with higher density recipient sites and high dense packing sessions, yet they are not permanently damaged.

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SPEX

Consultant for Dr. Feller, Coalition Member and Dr. Lindsey, Coalition Member.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own. "Research-Research-Research"

My Hair Loss Blog with Pictures

Hello Specs, thank you for the informative explanations of 'shock loss.' With all the info. available out there does anyone have a feel for what percentage of native or previously transplanted hair can be shed due to 'shock loss?'

lonniefargo,

Here's the deal. As much information that exists out there, still shockloss is very unpredictable. The more exisiting native hair that there is within the recipient area and neighboring areas of the scalp, the more there is to shock.

And hair that is diffused and even miniturized will shock out more readily and the weakest hair may shock out permanently. That weaker hair is on its way out anyway.

Transplanted hair does not shock out like debilitated native hair. Transplanted hair that is in fact "terminal" hair, will grow back even if it does shock out.

This is the short version to your question, and remember, everyone responds a little bit differently to the shock trauma induced to the scalp from the incisions.

It is in fact the trauma that induces the shock and why it is critical to choose the right surgeon who is employing the least invasive instrumentation and techniques.

Many female patients are encouraged to do smaller sessions to minimize the overall trauma.

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Gillenator
Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians: Dr. Glenn Charles, Boca Raton, FL - Dr. Jerry Cooley, Charlotte, NC - Dr. Jim Harris, Denver, CO - Dr. Robert True & Dr. Robert Dorin, New York, NY

Gillenator, thanks!!! You restored comfort. Your comment, "Transplanted hair that is in fact "terminal" hair, will grow back even if it does shock out." And, "critical to choose the right surgeon who is employing the least invasive instrumentation and techniques." Both these make lots of sense to me. Most of the area where I received transplants already had transplanted hair. And I've read this will come back. Also, while I have much confidence in my surgeon I believe with 1,500 graphs in such a concentrated and necessary area it would unavoidable to escape trauma completely. Now, I am resigned to the most important task of all in this endeavor. Patience. Thanks, again!!!!!

lonniefargo,

You are very welcome my friend. I had a total of four HT procedures, each one adding density and coverage where prior transplants were and even where some native natural hair existed although not much.

Best wishes to you in your endeavor!

__________________
Gillenator
Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians: Dr. Glenn Charles, Boca Raton, FL - Dr. Jerry Cooley, Charlotte, NC - Dr. Jim Harris, Denver, CO - Dr. Robert True & Dr. Robert Dorin, New York, NY

Yeah, this is my fifth and the most graphs I've ever received in one session. My first procedure was 750 graphs back in '95..I was somewhere between 3-5 on Norwood at the time (30 years old )...micro graph technology was used..while hairline was created it was very 'pluggy' looking. I subsequently had a repair procedure in 2003 of about 847 graphs of 1's - 4's to 'soften' and repair...they 'deplugged' some of the prior graphs as well. I had another 610 of 1's-4's in 2004. Then in 2006 I added 290 to more softening. I've been happy with the result of the last 3 procedures since my first one. Each one in and of itself has been a great improvement to my thinning hairline and beyond. I will tell you since then even though I've taken propecia and in the last couple of years started rogaine I still have had some thinning throughout. I'm 46 now. So I know my hair is going to thin even in areas where the hairs are genetically stronger. This one being my fifth and probably final procedure I'm really hopeful of great results. I REALLY wanted to build up my hairline and get more density as well as soften even more. Again, this will probably be my last procedure for sure. As my surgeon is concerned about my donor area getting too thin. I'm hoping to achieve an end result this time where I can comb my hair straight back and have a full, denser look without the use of too much concealer.

Shock loss to my frontal area and hairline this time has been significant in my opinion. If I had to put a percentage I would say I've lost 30-40% right on hairline and just behind. And all if not most were previously transplanted hairs! But I understand also because there was a lot of graphs place in that area. Imagine 1,500 graphs all at once...

Anyway, like I said earlier. I will be patient and hope to see 'some' growth start around 90 days from my procedure which was Aug. 26th..

I also want to add also that I stopped using Rogaine for a period of close to a year. I thought it wasn't having that big an impact. Boy was I mistaken. I started again approx. 4 months ago. And it is AMAZING how well I've responded this time. I only apply to crown. I don't bother anywhere else. And I had thinned immensely in that area. I will tell you today my hairs are thick and healthier in the crown than they've EVER been. I'm SUPER pleased with the results I've gotten. I would encourage everyone who has thinning in the crown area and slightly beyond to GET ON THE ROGAINE.

My balding crown needs its weak minaturized hair, on life-support from either/or both minox and fin, for a kind dodgy combover. This hair has been minaturized for ten years!! It is slowly dying. I desperately wanted to transplant into my crown to fill and boost the area, and yet time and again, a visit to reputable surgeon ends the same way. 'I don't wanna touch it', they say. It is infuriating to read posts saying, skilled surgeons bla bla, on it's way out. Mine are one-foot-in-the-grave permanent and I don't have enough donor to sacrifice them and go over the whole area.

So my message is this. Instead of writing off shock loss to hair that is on death row, take note that some of this minaturized hair will stay on life support as minaturized hair, never regaining their full diameter, apparently extremely vulnerable to PSL (Perm. Shock Loss) and yet necessary for the illusion of hair. It's a delicate situation when your donor is so limited

Scar 5
Well noted. Thank you.