shock loss question

[OttawaJay]

I'm at NW3 and considering HT. Dr Rahal suggested I need 2500 graphs in a consultation but didn't intend on going into my widows peak, which still has hair but is awfully thin. (You can easily see the scalp.) His reason is the possibility of shock loss, which is certainly something to be fearful of.

 

I'm happy to know he's considerate of it and not just ready to jump in. But when I said I don't think I should bother getting HT done until I lose more hair, as I specifically want more hair in peak, he said he'd be comfortable doing it after re-reviewing my photos. Kind of a flip, so not sure how to take that.

 

Is shock loss from HT permanent or does it grow back? Is shock loss a handful of hairs here and there or whole areas? Any idea how likely?

[Dr. Carlos Wesley]

Thanks for this great question, OttawaJay! This is a postoperative phenomenon that really varies from practice to practice as well as from patient to patient. Shock loss ("postoperative effluvium") is something that affects women more than men. In our practice, we generally state that significant postoperative effluvium is seen after about 40-50% of female cases and 10-15% of male cases. When it happens, it occurs 2.5 to 3 weeks after a session, but grows back 2.5 to 3 months postoperatively. In an area that has been treated, 1 to 3 out of every 10 hairs may temporarily fall out before regrowing.

 

The greatest emphasis should be on creating the recipient pattern to avoid transection of existing hair. Now, that's not to say areas of future loss (e.g. your widow's peak) should be avoided. Quite the contrary, actually. It's essential to treat the areas of future loss so that patients are never obligated to return for a follow-up session in order to simply make it look natural again. For example, not treating a tuft of hair in a patient's central hairline would ultimately leave an unnatural bald patch after a patient has progressed with their normal course of MPB or FPHL. They would then have to return to treat that in order to simply look normal again.

 

The key is simply attention to detail and taking a good 2+ hours when designing the pattern in order to carefully navigate through areas with pre-existing hair that requires thickening. This enables the recipient sites to be carefully created at the exact same angle and direction of the pre-existing hairs (even if there are sudden changes, as seen in a cowlick). Rushing through this process, like an automatic sewing machine, increases traumatic follicle transection which may not always be temporary. Fortunately, the majority of the physicians on The Network are great and don't rush this process. But, as a patient, please don't be afraid to ask your surgeon how long it takes them to create the recipient pattern.

Edited July 11, 2012 by Carlos K. Wesley, M.D.
tone

[OttawaJay]

Wow that was extremely informative. Thanks!

 

If shock loss is not permanent, then there really nothing to fear.

[Dr. Carlos Wesley]

That really depends on the cause of the loss.

 

While "shock loss" that is indirect and due to the micro trauma of the local blood supply from making an incision near a pre-existing hair follicle is temporary, direct trauma to pre-existing hair follicles from rushing recipient incisions at the wrong angle or direction may not be temporary and isn't simply "shock loss". Again, it all comes down to how slowly and carefully the recipient sites are made when working in hair-bearing areas.

[zenmunk]

Excellent reply, Dr. Wesley. The general consensus on the forum seems to be that weak existing hairs "that are on their way out" may not return after indirect shock loss even if a patient is on finasteride. Meds supposedly help prevent shock loss, but no guarantees. What is your opinion on this? Thanks.