VIDEO- Dr. Feller discusses SHOCKLOSS

[Dr. Alan Feller]

[tacolinowest]

doc how about shock loss in the donor, have you ever seen it not return?

[irishsailor]

Great video dr feller. It's nice to see you back online again. Hope you and the team are keeping well

[Dr. Alan Feller]

Thank you Irish. We're all doing well on this side of the pond.

 

Taco,

Yes, I have seen donor shock from strip (FUT) but have as yet to see the permanent variety.

In my experience, this "shock" presents itself as thinning just below the donor strip scar. Temporary retarded growth around the scar may also occur but usually recovers before the end of the first year.

 

The very worst donor shock I have ever seen has not been from strip, but rather from FUE megasessions. This comes as no surprise as FUE traumatizes a larger area of scalp than strip surgery.

[tacolinowest]

i just called your office , i went spray tanning yesterday and a few inches of the recipient area got spray tanned, im a bit worried there are little brown dots in the recipient area right now, i dont know if i harmed it, im about 7 weeks post op, please help

[hairthere]

Another good video Dr. F!

 

Taco, Don't worry about the spray tan. Your surgery was long enough ago that your grafts are very safe.

[Dr. Alan Feller]

Thank you Hairthere, and I agree that the spray tan is likely no issue at all this far out from a procedure. I'm not even sure it would be an issue a week out from the procedure as the incisions sites are already well sealed.

 

If anyone has any more information on Spray Tans and possible harmful effects please chime in.

 

So try and relax and let it go Taco. What's done is done, and likely harmless to your grafts. Enjoy your tan and your summer.

[TommyLucchese]

Great video doctor, as always. Even almost 11 months post op and with no immediate thoughts about another transplant (unless future loss occurs) I really enjoy watching your videos. Please keep them coming!

 

I'd be interested to hear you discuss shock loss in the crown in any future videos if possible. You actually denied my request/inquiry about some grafts to boost my crown due to the risk of shock loss so the topic does interest me. I'd definitely love to fill that section in again one day if I could!

Edited June 19, 2013 by TommyLucchese
because I can't spell

[Shampoo]

You actually denied my request/inquiry about some grafts to boost my crown due to the risk of shock loss so the topic does interest me. I'd definitely love to fill that section in again one day if I could!

 

Tommy....I have never heard that. Is the crown more likely to suffer shock-loss? What have you heard? During my surgery in August 2012 the crown was a secondary focus but still greatly improved. Sometime over the next year I'd like to have a "crown-focused" surgery with about 2500-3000 grafts placed in my crown to really thicken it up. So I am curious about crown shockloss?

[Nick153452]

Tommy....I have never heard that. Is the crown more likely to suffer shock-loss? What have you heard? During my surgery in August 2012 the crown was a secondary focus but still greatly improved. Sometime over the next year I'd like to have a "crown-focused" surgery with about 2500-3000 grafts placed in my crown to really thicken it up. So I am curious about crown shockloss?

 

 

I see that you have already had a large amount of grafts alread extracted. What did H&W estimate your donor area to be?

[Shampoo]

I see that you have already had a large amount of grafts alread extracted. What did H&W estimate your donor area to be?

 

Nick....Dr. Wong said I had "plenty" of donor hair left...but I can't remember the exact number or if he even said a number.....I was a bit woozy, but I remember asking him "enough for another mega-session?". And he replied that I actually have enough for a couple more surgeries if needed...not two mega-sessions....but most likely I wont be needing multiple mega-sessions. At my age with my pattern fully defined, plus me being on meds....I really think I won't run out of donor. I kind of think this next surgery will be the last. Of course I will get more specific with him when it gets closer, but right now I am just at the ten month juncture. Just a guess but I would think I have maybe in the 5500 range....and at my age (54 going on 17) that should be plenty.

 

I do have a question I would like to ask a doctor....when I go back for my "crown focused transplant"....if I can afford it is it best to go ahead and get a larger session even-though I dont really need it right now, but doing a larger session in my followup next year would prevent another new scar down the road....so should I take advantage of the scalp being cut as long as they are there and get more grafts.....or should I keep all I can in reserve for later and just do what I need now which is the crown?

[Nick153452]

Just a guess but I would think I have maybe in the 5500 range....and at my age (54 going on 17) that should be plenty.

 

 

Can I buy a few off of you?? I envy you.

[Cant decide]

Shampoo- For what its worth, I really dont think you need more than 2000 in the crown to make it solid. I actually think it looks good now.

[Shampoo]

Shampoo- For what its worth,

I really dont think you need more than 2000 in the crown to make it solid.

I actually think it looks good now.

 

Can't decide I always value your opinion and will consider that,

I will say the picture I have on my profile is a bit mis-leading

concerning the crown. I am thrilled with my over-all result

and the front is outstanding....but that picture angle & just

that picture make my crown look a lot better than it actually is.

My crown is much better than it was pre-op, but still needs some work,

but maybe like you say it could be solved in the 2000 range.

I'll see what Dr. Wong thinks is best.

[TommyLucchese]

Tommy....I have never heard that. Is the crown more likely to suffer shock-loss? What have you heard? During my surgery in August 2012 the crown was a secondary focus but still greatly improved. Sometime over the next year I'd like to have a "crown-focused" surgery with about 2500-3000 grafts placed in my crown to really thicken it up. So I am curious about crown shockloss?

 

That's my memory of it anyway. The consultation was over a year ago and there were many things said, so I could be wrong. But I did definitely ask whether anything could be done for the crown but doctor Feller said it wasn't a good idea. Maybe because of my age, not sure. I think it was a risk of shock loss but ........ maybe I'm wrong

[Shampoo]

Tommy....in another thread Dr. Feller states:

 

"You almost never see shock on the hairline because of the massive uninteruppted blood supply coming directly from the forehead area below which itself does not have to support hair and therefore compete. In contrast, the top middle part and crown are VERY prone to shock loss (permenent or temporary)...."

 

So it looks like you are correct, the crown may be more prone to shock-loss.

[Dr. Alan Feller]

I have found over the years through doing thousands of surgeries myself and viewing photos online from patients of other clinics as well that crown growth is the slowest and least predictable. This may be for a few reasons:

 

1. Probably the most common reason is that most hair transplant cases are weighted toward the front(as they should be) and so the crown gets not only the least number of grafts, but more single hair FUs as well along with what I call "srapple grafts". These are grafts that don't look as healthy and hearty as most of the grafts, but not poor enough to be discarded. Everyone has some number of these at the end of the case if the clinic utilizes true refined dissection techniques.

 

2. Doing crowns are more time consuming and difficult due to the sometimes radial pattern changes. This makes placing the grafts back in the scalp more of a challenge. Also, unlike the front and top which lay mostly on the horizontal plane, most crown surgery lay on both horizontal AND vertical plans making re implantation that much more work. This also limits the "elbow room" of the techs and slows them down. There are tricks around these issues that most top clinics have figured out though.

 

3. To get quality coverage in a crown MORE grafts are usually necessary to get the job done largely because some or all of the crown is on the vertical plane and much easier to "see though" by the person standing behind you. This is in contrast to the "back up" effect you get from hair transplants being viewed from the front. That's why all the "scam: pictures you used to see before the internet came along showed the classic top shot as the "before" pic and the classic front shot as the "after" pic.

 

4. I find, usually, the scalp skin is not only THICKER, but TOUGHER as well. This may be due to the skin being designed to take more abuse from behind because there are no eyes there to see an incoming trauma like a club or a rock. Or, it can be thicker from a lifetime of minor traumas and the skin has gotten tough as a result. Chicken or egg thing. Bottom line is that revascularization just seems to be slower in that area.

 

5. Compared to other recipient areas, the crown is the furthest away from the main blood supply sources and therefore at a disadvantage. This SHOULDN'T matter as there is a HUGE plexus of vessels throughout the scalp skin, but experience had showed this to be the case nevertheless. Does this mean shock loss, retarded growth, or poor yield is at a higher potential in the crown. Yup. You better believe it.

 

Shampoo, I really don't know what your particular situation is so couldn't give any useful advice in your situation, but no doubt in my mind mind Dr. Wong has balanced all your variables and will make a plan most suited to you. It sounds like you have an incredible donor area so no matter what I think you're on easy street compared to so many other hair loss sufferers like myself who simply don't have enough to cover the crown in addition to front and top.

 

Dr. F

[Mikey1970]

Dr Feller, in the video you say that shock loss might take 6 months, or a year and 6 months to recover but it usually comes back.

 

Could you please elaborate on this? Most of the online literature i can find states that shock loss in the recipient area should begin to return 3-4 months post op. Can it really be delayed to 18 months and what might cause such a lengthy recovery?

 

Im not sure if you have read the posts from my experience but I had a HT in April 2014 & experienced heavy shock loss that recovered fully within 3 months. I then had two small touch up's in November 2014 & February 2015 and was hammered with shock loss 2-3 inches from the area of work in May 2015. It is now late August 2015 and I dont know whether to give up but your video saying it can take up to 18 months gives me some hope.

 

Thankyou.

[Dr. Alan Feller]

Dr Feller, in the video you say that shock loss might take 6 months, or a year and 6 months to recover but it usually comes back.

 

Could you please elaborate on this? Most of the online literature i can find states that shock loss in the recipient area should begin to return 3-4 months post op. Can it really be delayed to 18 months and what might cause such a lengthy recovery?

 

Im not sure if you have read the posts from my experience but I had a HT in April 2014 & experienced heavy shock loss that recovered fully within 3 months. I then had two small touch up's in November 2014 & February 2015 and was hammered with shock loss 2-3 inches from the area of work in May 2015. It is now late August 2015 and I dont know whether to give up but your video saying it can take up to 18 months gives me some hope.

 

Thankyou.

 

I'm sorry you're dealing with shock loss. Most of what you will read will refer to regrowth of shock loss in the recipient area within 3-4 months. That is, it will begin to recover in that time. But no two physiologies are exactly alike. Neither is the amount of damage the skin can tolerate.

 

Are the hairs in the area that you now believe is shocked normal healthy hairs? Or were they on their way out? If this is the case, the surgery may have just sped up the hair loss process. But that is NOT shock loss. Any photos?

[Mikey1970]

The area of lost hair was dense, healthy hair but just above the area transplanted to replace temple recession. My hair loss had been stable for at least 10 years but I had sought a transplant to improve my hairline. I will attach photos when I get access to my laptop. Thankyou for replying.

[Windjammer]

Dr. Feller, how often do you notice patients that get shockloss in adjacent areas to the recipient zone? For example, someone that has work done in their forelock--nowhere else, but experiences shockloss in their midscalp or 2/3s zone. I had this happen to me after my FUT procedure. Curious if you can elaborate further, other than just that the trauma inflicted on the recipient zone spread to more sensitive areas of the scalp. Thank you.

[Mikey1970]

Dr Feller. Here are some photo's of the shock loss i am describing. I recovered completely from a larger procedure in April 2014, but a tiny 30 graft procedure to the centre of my hairline has done this damage, 2-3 inches away in my left temple area. I think i am noticing some small improvement but it is very, very slow....

 

Again, thanks for taking the time to offer your thoughts.

 

 

 

 

 

 

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[Dr. Alan Feller]

Dr Feller. Here are some photo's of the shock loss i am describing. I recovered completely from a larger procedure in April 2014, but a tiny 30 graft procedure to the centre of my hairline has done this damage, 2-3 inches away in my left temple area. I think i am noticing some small improvement but it is very, very slow....

 

Again, thanks for taking the time to offer your thoughts.

 

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I honestly can't tell from those photos what's going on. Could you send me before photos of before your first and second surgeries and then label the after photos ?

 

If you could visit me that would be best. If you aren't around here maybe you could try:

Virginia -Dr. Lindsey

Chicago-Dr. Konior

Arizona- Dr. Alexander

Oregon State-Dr. Gabel

 

Or any other high profile doctors like Rahal, H@W, or the Shapiro bros., etc...

[Frankmello]

Thank you, Dr Feller- this extremely informative!!