Introduction and Shockloss Questions

[spartan13]

Hi all! I've actually been lurking as a non-member for maybe six weeks or so and finally decided to take the steps to join up. Some brief background before I get into my question:

 

I've now had 4 HT's. 2 smaller ones (maybe 400-500 grafts) with NuHart back in the mid-to-late 90's. I had another one in 2006 (approx. 1200) and I am almost exactly 3 months post-ops from procedure #4 (approx. 2300 done on Jan 10). What prompted me to join the forum is I've been going through what I can only describe as devastating shockloss with this last one, and am having a really hard time coping. I understand the phenomenon well, and went through it on procedure 1 (though not really on #'s 2 or 3)...but a few things make this time different. First, as I have a professional job I can't ride it out under a baseball cap like I could with #1 when I was still in school. Second, being 40 now instead of 22 I know I'm at a much higher risk for not getting a complete (or even partial) recovery from shockloss like I did before. Third, and worst of all...this extreme shockloss has exposed a ton of scarring and dimpling in my recipient area from those 90's procedures that I never even realized was there.

 

My first month post-op was great as I noticed very little shedding and still had my little "shoots" hanging around. By the end of February my crown had cleared out a good bit more, I had lost the "shoots" by then, and had thinned noticably in front from where I was pre-op. At this point, I'd noticed that alot of my shed hairs were of the thinner variety. I'd gotten a break for a couple of weeks where it looked like I might be finished with the shockloss phase. Now though, at the end of month three I'm enduring a new shedding phase that's probably in it's third week where the crown has stabilized but my recipient area has gotten decimated like never before. The vast majority of hairs I'm losing now are much thicker and stronger than any I've lost previously, and it seems like it will never stop. Standing under the shower head after shampooing results in 25+ hairs in the hair catcher. Drying and combing loses me another 25-30. Even now as I type this, I scissored my fingers and gently pulled them through the hair at the back of my head (I wear my hair longer and combed straight back) twice, producing three thick black strands.

 

So what I'm wondering is: is this level of shockloss this far post-op way out of the norm? Most of what I've read doesn't seem to indicated extreme shedding at three months is normal. I'm just trying to figure out if this is something to ride through or if this is unusual enough that I should be getting looked at. Forgot to mention...I've been on finasteride for seven months, minoxidil almost as long with a brief pause around my January surgery, and have been doing LLLT treatments 3x per week for the past two months. Basically all of the things that I've read will help minimize shockloss, which makes this even more depressing.

 

Any thoughts, feedback, suggestions, etc. would be greatly welcome. Thanks!

[hsrp10]

did you shave for the surgery where the grafts were placed? and was your surgeon one recommended on here?

 

also examine other issues as well, are you using any harsh shampoos like Nizoral which can cause sheds, or did you start/stop any hairloss meds in the past few months?

 

if it's purely from the last op then contact your doctor and I think 3 months for extreme shockloss is a bit far out but never know

[Since21]

It's normal to lose up to 100 hairs a day. I would say I have at least 25 hairs in the drain after I shampoo. I stopped blow drying my hair and let it dry naturally. I don't know if it helped, but my hair is less flyaway now. I'm almost 5 months out from my first procedure.

 

I started using Rogaine for the first time about 10 days post-op per my surgeon's instructions. I stopped after a week and a half because of the shedding. They say you're supposed to stick with it through the shedding phase, but it was too much for me to handle psychologically at the time.

 

I also had shock loss in an area of my donor scar around the 2 month mark. It made me very anxious but I tried to forget about it. I just stopped looking at it. When I checked again about a month later, it seemed to have recovered and wasn't as noticeable.

 

I won't even go into the dandruff I'm battling right now. But suffice to say, it's quite a journey we're on. Lots of variables and anxieties to endure. As hsrp10 suggested, you need to contact your surgeon. Let him/her know what's going on. Hopefully you chose well and all this is just temporary.

[spartan13]

My surgeon is Dr. Robert Haber, who also did my last procedure in 2006, so I feel like I have a very reputable clinic behind me. As to some of the other questions...I did not shave the recipient area (or anywhere for that matter) prior to surgery and did have alot of existing hairs where the new grafts were placed. However, I had thought most of those were transplant hairs from my prior procedures.

 

As for harsh shampoos, I did use Nizoral exactly once since my HT and got a good enough shed to scare me off of trying it again. Maybe in the future if my shockloss resolves and my new grafts come in good, I may give it another try. But right now I'm just scared to do anything that will cost me one more hair than I would otherwise lose.

[Since21]

Keep us posted, spartan, and welcome to the forum. My experience on here so far has been that almost everything I've gone through has been discussed or experienced by someone else. Grow well and good luck.

[spartan13]

Connecting the dots a little more (I hope). My scalp has been tingling and prickly off and on the past month or so when most of my damage has been done. It hasn't been severe or constant, but it has come and gone each day. I just figured it was the grafts "working" and it meant growth was coming. Last night while watching TV with my wife I experienced more significantly than usual. Then this morning was the absolute worst post-shower shed I've ever had. After much Googling this morning, I found that this sensation is not a good thing and seems to mean scalp inflammation in most cases. I called my HT surgeon's office (he's also a practicing dermatologist) to tell them of my symptoms. He wasn't in, but the nurse took alot of info and they are going to get back to me Monday. She mentioned they'd likely call in a prescription. What's weird is that there is no noticable redness, flaking, or scaling on my scalp whatsoever. Ironic that after having gone through HT's 3 times before that I am having my absolute worse experience now that I am a "veteran" at this. By this point, all I was is to look like I did before I ever went in for #4!

 

Sometime this weekend I will make an effort to gets my wife to take some pics to post up. Unfortunately I didn't take any pre-op to give everyone some basis for comparison, but I can at least track progress going forward from here.

[Since21]

Is your surgeon located where you can go see him? You can google anything health-related and come up with worst case scenarios, so I'm hoping due to lack of any physical symptoms, nothing out of the ordinary is going on.

 

I went back and read your original post, and if this your first time around with Propecia and Rogaine, I wouldn't be surprised if that had something to do with that. I don't know what LLLT treatments are, but it seems you are exposing your hair to a lot of possible shed cycles, all in a compressed period of time while your scalp is trying to recover from the 'shock' of surgery.

 

Like I said, it only took a minor shed on Rogaine after taking it for 10 days for me ditch the stuff. I watched a video from Dr. Feller where he advises you try and get through those shed cycles because it's normal, but I couldn't handle it.

[spartan13]

He's about an hour and a half from me, which isn't too bad. I have a pretty open schedule at work next week, so I may ask to be seen once we talk on Monday. I did just have my wife take those pics, and the scalp doesn't really look bad (as you'll see when I get them posted tomorrow), so hopefully you're right and this is nothing too nefarious going on.

 

I re-started finasteride very early in September of last year, and minoxidil sometime shortly afterwards. So the only really new thing was the low level laser therapy (LLLT) which I started about a month after my HT - simply one of those laser combs that you may have seen advertised. So yeah, there is kind of alot going on up there. However, I did see alot of Dr.'s post on the various forums about the benefits of undertaking finasteride and minoxidil after transplant surgery...so who knows. Hopefully by this time next year things will have resolved to some satisfactory level.

 

I will definitely re-post any new information/developments after talking to my surgeon next week as well as getting those pics up.

[Since21]

I did a lot of research before and after my procedure and I have never heard of anyone doing LLLT. Just my .02?, but I would stop it immediately. Did you do that after your other three procedures? Also, what is different this time in terms of what you were taking/doing at the time of the other procedures vs what you are now?

[spartan13]

I'm not sure how long LLLT has been around (I just recently found out about it myself a handful of months ago - so I haven't used it before), but I believe it only recently received FDA approval so it is probably only just starting to get more serious traction in the hair restoration world. I checked with my HT surgeon and he gave me his blessing to undertake it and he did add he thought the modality had some efficacy.

 

That said, this LLLT is about the only thing different I've done this time around (other than twice as many grafts as my last one) as I had been on finsteride for several years before taking a 6-9 month break and starting again last Fall. Even today, the nurse told me the laser comb should be fine to continue with...but I'm with you. I'm putting it away at least until things (hopefully) turn a corner in the coming months. If I recover, then I'll think about using it again sometime in the future for maintenance.

[spartan13]

In the last week and a half since my last post I'm happy to report that the intense shedding has subsided. I'm not seeing even a visible amount in the tub's hair catcher, and I've only been combing out between 7-15 post shower. Hopefully this means the worst is over.

 

In speaking with my surgeon, he believed that the tingling and prickling sensations were a result of my nerves regenerating versus something like inflammation as I never experienced any redness or tenderness on my scalp. And while he didn't believe the laser comb had any ill effects, I still have not used in the past couple of weeks. I have gone back to minoxidil at night on my crown and continued the finasteride throughout.

 

Since21, I saw on a nother thread that minoxidil thinned out your crown and mid-scalp area. That's exactly what happened to me, but I was blaming it all on shockloss. Maybe a combination of the two.. I don't know. But at this point, I figured I might as well stick with it since the damage is done.

 

I had problems geting the pics from my phone to my desktop which is why I haven't posted them yet, but I will try again this evening. I cleaned up some programs I think might have been gumming up the works, so we'll see.

[Since21]

Since21, I saw on a nother thread that minoxidil thinned out your crown and mid-scalp area. That's exactly what happened to me, but I was blaming it all on shockloss. Maybe a combination of the two.. I don't know. But at this point, I figured I might as well stick with it since the damage is done.

 

Maybe it was both, but I attribute it more to Rogaine because it began shortly after I started using it. From what I've read, that's the paradox of HTs. It can lead to an increase in hair loss due to the overall trauma to the scalp from the recipient incisions 'shocking out' weak diffused native hair. Then of course the chase begins with further procedures.

[spartan13]

Yes, I've read that same thing quite a bit myself about HT's accelerating your MPB. I'm still holding out hope that at least some of my shockloss resolves itself, but I'm working under the assumption that how I look now is likely how I'll look by the end of the year. Any improvement over my current state will just be a bonus. Even though I was obviously not happy with my pre-op follicular count at the time, I'd love to have that back right about now. While thinning, at least I could have a conversation with people without having them stare at my hair the whole time. I know it's trivial compared to some people's problems, but God, does it take an emotional toll. At this point, I just have to stick with it and hope for the best.

 

Still can't get my phone to synche correctly with my computer, so I'm going to try emailing the pics to myself and get them onto my PC that way.

[Since21]

I know it's trivial compared to some people's problems, but God, does it take an emotional toll.

 

Yesterday was the 5 month mark for my first procedure. I can't imagine how someone does this multiple times and my journey has been fairly uneventful. The waiting and wondering and and worrying exhausts a lot of energy.

 

I just saw a case posted on here of a patient who received 5,652 grafts over the course of two procedures - the second procedure taking place 18 months after the first. All I could think, regardless of the result, was that 3 years of his life was consumed by this!

[spartan13]

You know what's weird...this is my fourth procedure, and the first three were almost a non-event. I find it ironic that my fourth and last procedure is the absolute hardest one I've had to endure. Even though this is nothing new to me, and intellectually I know what to expect and generally when I can expect it...it's just so damn hard not to be pessimistic. While nothing I'm going through at this stage could be considered abnormal by any means, I'm already starting to research fraxal repair for my recipient area pitting and cobbling which, pre-op, I didn't even realize I had because I couldn't see it through my hair then.

 

But to your point, I honestly never gave much of a thought to any of my prior procedures once the donor area healed, and it was quickly back to life as normal. So perhaps for a number of guys, three years is no biggie. I'd have said the same about myself in the not-to-distant past. But yeah...I certainly couldn't imagine enduring the likes of this last procedure for multiple years. Yikes!

[spartan13]

OK, finally got the picture thing figured out correctly, so here are two of them. One shows my hair combed straight back which is how I usually wear it. The other shows the hair parted in the middle to give a better representation of where my hair loss is at. Again, these are exactly three months post-op after a ton of shockloss. I'm kicking myself now for not taking pre-op photos, but I honestly expected this procedure to be similarly easy to my prior 3 so I never gave it much thought. Anyway, I've probably lost conservatively 50%-60% of the hair between the tip of my widow's peak to the crown in the three months after surgery. The front was thinning, but not nearly this bad, and the mid scalp was still pretty bulky. Such that when I combed my hair straight back I could totally make the thinning crown disappear. I don't mean to sound negative or alarming, but my attitude now is: forget improvement...I just want to look how I did four months ago pre-op.

[Since21]

Where were the majority of the 2300 grafts placed? If it was the frontal third, then you can take some comfort in knowing that what you may have lost from shock loss you will get back in new growth (if the shock loss is permanent). So you may very well end up where you were four months pre-op. If the shock loss is temporary, then you will see improvement through new growth and recovery of shocked out hair.

[spartan13]

Yes, it was the frontal 1/3 where all the work was done. So if the transplant yields at least some results, I'm hopeful the extra density will mask all of the scarring once again. Just incase, I might start looking into fraxal repair to get a handle on costs and how the treatment goes. I saw in another thread that someone seemed to have good results with that in a similar situation as mine.

[ATP4Hair]

Spartan 13:

 

Shock hair loss as you describe it is a common event in the first few weeks to several months after HRS. Most physicians suggest that you not be alarmed as the transplanted follicular units can often regenerate a terminal hair within 1 year after surgery. However, just because shock hair loss is "normal" does not mean it is necessary as part of the HR procedure.

 

The use of LLLT prior to or after HRS is, IMHO, not advisable for a variety of reasons. First, while LLLT was approved for topical uses, its impact on hair growth and follicle viability is at best sketchy, and the use of LLLT for this reason amounts to nothing but "smoke in mirrors." As you may know, the purpose of LLLT is to excite the mitochondrial electron transport chain to create ATP. While this has been proven true, the result that is often not mentioned is that LLLT produces reactive oxygen species (ROS). ROS can create an inflammatory state as a result of the damage done by the ROS on cells of the scalp. Second, the recommended usage of LLLT is 3-4 times a week for 5 min. Our body's cells collectively uses our body weight in ATP/day. A 5 min application of LLLT is not going to overcome the ischemia the follicles are subject to for the 3-5 day period prior to restoration of normal blood flow to the follicle.

 

The major issue in shock hair loss manifests itself in this critical 3-5 day period as the level of intracellular ATP remains well below normal intracellular levels (~ 1-5 mM). A shift in adenine nucleotide levels from ATP to ADP, and AMP lowers the cellular energy charge (see Daniel Atkinson, Biochemistry , 1968, 7 (11), 4030). During severe ischemic periods, the intracellular ATP levels can drop significantly from a value of ~0.9 to well under 0.6, resulting in an energy charge that is more conducive to apoptosis (cell death) rather than cell survival. Thus keeping intracellular ATP levels of transplanted hair follicles near normal during the post-operative period is paramount to graft viability.