Newbie with recent HT - question on using Minoxidil for shock loss (pics attached)

[newhair7]

First off, I wanted to say how much I appreciate all of the great info as well as helpful advise I have found on this forum. It's great to see so many take the time to help each other.

 

I had a FUT 6 1/2 weeks ago of 2500 grafts. Prior to this, I had several smaller strip procedures (combined total of 3200 grafts) with an 8 year gap in between this recent procedure and the last one I had. After many years I finally decided to attack the crown area (I have also been using Finasteride for many years, which has helped to maintain the hair I have).

 

At any rate, over the last 4 weeks or so I have seen continued thinning on one side of my head below the donor scar line, which I am pretty certain is shock loss (but please confirm?). The photos attached are from a few days ago, and it has become slightly worse since these pics. In addition, I have noticed that there is very little hair (very bare) a few mm just above and below the scar line. I do not recall having these issues with any prior procedures.

 

About 3 weeks ago I started applying 5% Minoxidil 2x per day to the thinning part of the donor area in hopes of minimizing the shock, as it has been suggested that this can help.

 

My questions for anyone that can reply:

 

1. Since Minoxidil is also known to initially shed hair, is it possible that using this has actually made the shock loss worse? Or does shedding from Minoxidil only apply to miniaturized hairs?

 

2. Is it common to see a thin, bare area a few mm just above and below the incision line. This seems to be different than the general shock loss, but maybe it's also due to shock?

 

3. I had dissolvable sutures. They seem to have fully dissolved, but there still appear to be some red marks from the sutures. Can these sutures also cause shock loss of hair (or permanent hair loss) around the scar?

 

Thanks in advance for any replies.

Edited March 30, 2015 by newhair7

[Dr. David Josephitis]

newhair7,

 

Did you recall the sutures being very tender, or did the surgeon state that it was a "tight closure?" As is often the case with a second or third surgery, the closure can be a little tight in various areas of the donor scar. This is normal for FUT. The area you showed in the pictures is a typical area where hair loss like this can result. You were correct in thinking that this is shock loss from the surgery. Very likely, over time, the hair will grow back and you will have a similar scar in that area as you had for your prior two surgeries. Rarely, there can be permanent loss around the suture line. In my experience, there is typically pretty good return of the hairs that were lost. Unfortunately, you will have to wait another few months for these hairs to return.

 

The use of minoxidil is not a bad idea. I doubt that any of the loss is from that. Typically, you are right that the miniaturized hairs are the ones that can fall out initially with treatment. Still, minoxidil may help to speed up the regrowth of not only the shock loss on the sides, but also the transplanted hairs on top.

 

The red marks from the sutures should also resolve over time. The sutures along with the closure after multiple surgeries all help to contribute to the loss of hair. They are not solely responsible.

[newhair7]

Thanks DrJosephitis,

 

Yes, the surgeon said the left side had a tighter closer. He also had to cauterize with an electric cautery in a couple of areas due to bleeding, which I am sure did not help from a shock loss standpoint. Unlike this side, the other side of the strip looks really great.

 

The thing I find a little odd is that the area a few millimeters just above and below the incision line is very bare with very little hair (see attached close up photo with hair lifted up). But maybe this is common as well at this point?

 

From your experience, can sutures cause permanent loss of hair, or is hair loss from sutures usually temporary?

Edited March 30, 2015 by newhair7
Attaching photo

[gillenator]

newhair7,

 

I opened your photo for a more expanded view. IMHO, it appears that the scar itself would potentially be the area that may be more barren of hair. Do you have any idea how wide it is?

 

I agree that the thinning hair both above and below the scar will improve with time and growing the hair to adequate length can help hide the scar itself. Even if the scar heals to the existing width, I would not recommend a revision because of the lack of adequate laxity. So the scar would not come out thinner and could even come out worse.

 

The other thing about applying minoxidil to the area could cause more or further shedding in that general area with initial use. There is no way on knowing beforehand and just another risk. And even if there is additional shedding, it still may facilitate the regrowth overall.

 

Wishing you a speedy healing process and regrowth.

[newhair7]

Thanks Gillenator,

 

I would say the scar is approx. 3 millimeters in the widest areas, although some of this may be redness (tough to tell). On the other side of the strip, the scar is much finer, at about 1 millimeter.

 

The general bare area I am referring to is the few millimeters just above and below the scar line. It seems to be about the same width as the vertical sutures that were in place before they dissolved (maybe 7-8 millimeters).

 

This bare area seems to be most pronounced in the last inch or so of the strip on the left side. I have attached a photo and highlighted the area (between the red lines) that I am referring to. This area is approx. 7-8 millimeters (with scar in the middle). Is this the area that you said should improve?

 

Not sure if it matters, but a trichophytic closure was used.

 

Sorry if I am being a little paranoid or over the top. It's just been a long time since my last procedure and I do not recall seeing this before, but those procedures were much smaller.

 

Thanks.

[gillenator]

newhair,

 

You're welcome my friend and a couple more thoughts on your case.

 

I have seen many post-op pics involving the try-closure method and one of the things that I have observed is the large variance of the end result. Sometimes it is the patient's physiological attributes while most times it is the lack of skill of the surgeon in doing this type of closure. Keep in mind that it is still very soon post-op for you and the redness of your scar should improve with time.

 

I always inform guys to not have this type of closure if the laxity is not adequate because the scar can potentially come out even more wider than if another closure method were to be used such as staples or a double-closure technique. Laxity can vary throughout the scalp including where most strips are excised (occipital zone). This can be attributable as to why one side of the closure comes out thinner and the other side much wider. I have read some commentaries whereby the surgeon stated that his strips can indeed vary in width throughout the zone to avoid wide scars.

 

At this point in time post-op (4-8 weeks) is when shock loss normally occurs and is almost always related to the trauma from the surgery. I am not a big fan of applying minoxidil while shock loss is prevailing because minoxidil can increase the level of shock when it is happening. IMHO, it's best to wait until the shock loss subsides and then applying minoxidil can potentially increase the rate of regrowth. Yes I think the area both above and below the scar will have regrowth. This will probably take roughly 3-6 months to fully occur.

 

Weak diffused hair is most susceptible to both shock loss as well as initial minoxidil applications. Yet strong hair can be shocked as well and shock itself is very unpredictable. The good thing is that you do not have much diffused hair in that area of your scalp where the donor strip is taken and why most of it should grow back.

 

After one year has passed, you can always add some FUE grafts to the scar if it is too wide after complete healing. Whatever you do, do not have a revision done because I truly do not believe you would benefit from a scar revision.

 

I wish you the best newhair7 and keep us in the loop as you progress in the healing process and the regrowth including your new recipient area...

 

Best wishes to you!

[newhair7]

Gillenator,

 

Thanks again for your reply, very helpful.

 

The interesting thing about my donor strip is that although I have had several small procedures a while back, they were never fully ear to ear. So the area in the last photo (the end of the strip) is the first time a cut was made this far to the sides. Most of my previous scar from 8 years ago was taken out and then the cut extended ear to ear, which the exception of an area that was too low to remove. It actually feels like I actually have more scalp laxity at the ends of the strip than anywhere else. I guess we will see...

 

Regarding minoxidil: While the general consensus seems to be to apply once there is evidence of shock loss, I cannot help but feel you may be correct in that minoxidil can increase the level of shock when it is happening. Of course I may never know for sure whether this is playing a role or not.

 

That being said, I am now going on 7 weeks since my ht, and I have been using Minoxidil for the last 4 1/2 weeks at 2x per day (a little longer than previously thought). In addition, the shock has definitely slowed down in some areas, and (dare I say) stopped in others. So I am wondering if at this point it makes sense to stop, or keep using and ride it out? Or maybe cut back to 1x per day instead of 2x? Uggh, so tough to know...

[gillenator]

newhair,

 

Always glad to be of any help. If you have been applying minoxidil for that long now post-op, then I would recommend that you continue doing so. Whatever has been shocked out by now has occurred so the risk of losing considerable more hair is low. So to clarify, it sounds like you are passed the initial shock loss period and things are probably stabilizing for you at this point in time.

 

If you are using 2% liquid minoxidil, then IMHO, applying twice daily is normal. However if you are using 5% foam, then once daily is adequate, again in my honest opinion.

 

In the next month or so, you should start seeing some gains in new growth and if you were to stop applying minoxidil, that could potentially have a reverse effect and cause you to loose any gains that are about to manifest.

 

Once you have regained the hair that was shocked out, you won't need minoxidil in that donor area. Why do I say that? Because the hair in the donor areas are typically terminal hair that is for the most part, DHT resistant.

 

We all react differently to meds and the tough thing to do is to accurately or precisely predict what will happen and when it will happen. Yet in general terms, you should start to see improvement soon and things overall will improve for you my friend...

[newhair7]

Thanks Gillenator.

 

Last couple of questions if you don't mind:

 

I have been using 5% foam twice daily for the last several weeks. Do you think that reducing this to once a day at this point will have a negative effect?

 

When you say have a 'reverse effect' if I stopped, you mean a 'delayed regrowth', not a 'permanent loss', correct?

 

Thanks.

[gillenator]

newhair,

 

No I don't mind my friend. No, I don't believe that curbing back the foam application to once daily would have a negative effect. It's not that you can't use it twice daily but it may be a little overkill because of its strength. You can start by curbing back every other day for one week and then just apply once daily and try to leave it on at least overnight.

 

IMHO, minoxidil can potentially rejuvenate hair follicles out of dormancy quicker and then hold follicles in the growth phase for longer periods of time. There is no clinical proof of this, just my own observations over the years.

 

Minoxidil can also potentially improve hair shaft diameter which in itself will improve visual coverage.

 

So there may be many follicles on the threshold of entering the growth phase because you have been applying minoxidil to the area for the past 4 months or so. If you were to stop now, might that curtail the jump start that is in progress?

 

We can never know for sure but why change your regimen when you are that close to new growth? That's my point and hope that makes some sense...

[newhair7]

Yes, definitely makes sense.

 

Thanks again. I will post progress periodically in the event it helps others in any way.

[newhair7]

Hello, I just wanted to post an update as I said I would regarding the donor shock loss progress, in case it adds any value for anyone else.

 

I am going on 3 months this week since my procedure. My donor shock loss concerns that I posted a little over a month ago were related to both the loss of hair above and below the scar line. While the hair below the scar may have improved a slightly (hopefully will continue to improve), I have definitely noticed some hair regrowth just above the scar over the last week. I have posted a photo that I took today, which can be compared to photos in my previous posts.

 

I have been applying minoxidil to the donor shock loss area 1x/day. I was originally doing this 2x/day, but per Gillenator's suggestion I cut back on this. I am very inclined to agree with Gillenator that minoxidil may initially actually increase the level of shock when it is happening, even in the donor area. So far, most of the hair regrowth around the donor has been above the scar line where I have not been applied minoxidil (I have only been applying it below). So this has also made me wonder if minoxidil can delay the regrowth of shocked hairs?

 

At any rate, I have found it very helpful to take photos every week or two. Sometimes it's hard to notice change when it is slow, but looking at photos has helped me to see the changes over time that I may have not noticed otherwise.

[gillenator]

newhair7,

 

It's very encouraging to see the improvement and especially in such a short time. IMHO, the new growth and improvement above the scar where you have not been applying minoxidil is right on course. This is why I am of the opinion that applying nothing post-op and just allowing our own bodies to function and do the work often produces the right results.

 

As far as the delayed growth below the scar, it's no doubt related to the dormant stage that those hairs are currently in after they were shocked out and the initial impact of the minoxidil having a reverse effect. But give it another two months or so and I think you will start to see improvement in that area (below the scar)as well. Remember my friend, once the hair is shocked out, those follicles will rest for another 3-4 months before they enter a new growth phase.

 

In time, the redness of the scar should also start to dissipate and it certainly would not hurt to put some aloe rich cream on the scar at bedtime and allow it to absorb into the scar tissue overnight.

 

I think you are going to continue to see improvement and wish you the best in your progress and thanks for the update newhair7...

[newhair7]

Thanks Gillenator for the reply and encouragement,

 

Yes, I have been applying aloe on the scar every night.

 

I have been continuing with the minoxidil 1x/day for the shock loss as I do not want to take the chance of disrupting any potential progress that has been made under the skin so far. If I am thinking this through logically (and please correct me if I am wrong), since I have been using it this long, it's best to continue to use until things cycle their way back to (hopeful) recovery.

 

Since a few weeks after the procedure, I have also been applying the minoxidil 1x/day to my crown each evening, which is where the majority of the grafts were placed. I did this in hopes of encouraging faster growth of the grafts as well as maintaining the small amount of existing hair already there. Of course this was prior to realizing the initial reverse effect that minoxidil can have, but at this point I feel that I should continue to use it and ride things out, just like the donor area.

 

So far I have seen very little improvement in the crown (if any). I know it's early, but have to wonder if this will also be delayed due to the minoxidil use. My understanding is that it also takes longer for crown results in general, so maybe the timing of both together will be ok? Time will tell, and will post the results.

[gillenator]

You're very welcome newhair . And yes I agree that it would be best to continue your once daily regimen including the crown area so as to not disrupt what you already started. I just would not change the amount of frequency in the daily amounts and listen my friend, time will soon tell.

 

I don't think it will affect your overall yield or the final matured result. It's more the time period of regrowth that is impacted.

 

Again, the progress since your last photo update have been significantly improved so that's a very good sign that things are progressing, not regressing.

 

It's the waiting that can be challenging but you will get through this period newhair and am looking forward to seeing your final result...

[newhair7]

Thanks, will keep you posted.

[hairisgone]

Hi newhair,

 

How did the scar end up? Did you get all of the shock loss to recover above and below the suture line? If how long did it take to get back to its final density?