Shock Loss. A warning against frequent procedures

[Mikey1970]

I first noticed recession at my temples at 18 years of age. I was referred by my GP to a dermatologist who recommended i use Ionil T shampoo daily and to this day i believe that slowed down my rate of hair loss dramatically. I still use Ionil T shampoo virtually everyday.

 

I had my first HT in 2004 at age 33, a modest procedure of 850 grafts to largely improve and lower my hairline. I was very happy with that procedure and cant recall experiencing any shock loss.

 

In April 2014 at age 43, I had my second HT, again to largely improve & lower the hairline. From 2004 to 2014 my hair had remained largely stable but maybe facing a midlife crisis after the breakup of a long term relationship, i was greedy & wanted an even better result at the temples & hairline. I again had 850 grafts but this time the surgeon wanted to "thicken up" my existing hair across the front. I had massive shock loss from this procedure around 2-3 weeks post op but recovered 100% in approximately 3 months.

 

I had a 180 graft touch up to the corners of both temples in November 2014 & suffered no shock loss and a 30 graft touch up on the hairline at the front in February 2015. The shock loss i have had from my latest procedure didnt occur until May 2015 around 3 months post op, at which point i dramatically lost hair in the area of my left temple (approx 2 inches from the area of work) virtually overnight.

 

I had no idea that such a small procedure could do so much damage. The area in my left temple area was thick, largely native hair prior to my last procedure. It is now 6 months since the procedure and 3 months since i noticed the significant shock loss and i am left wondering if this is now permanent? My surgeon has remained supportive and thinks it is prolonged telogen due to the consecutive & rapid treatments but i would appreciate others thoughts? Most of the literature i have read says that temporary shock loss should begin to recover 3-4 months post op but in this case i didnt even have the loss until 3 months post op! I think the follicles are beginning to look more pronounced but i cant be sure.

 

Under magnification there is a lot of fine whispy white hair to be seen and the hair on that side feels "wirey" to touch. Under magnification the follicles in the centre and right hand side of my head look dark & black but in the area of shock loss are pale. My surgeon puts this down to the fact I had been applying Rogaine Foam 6-7 times a day on the left hand side until i told him at which point he freaked & told me to stop...

[TakingThePlunge]

This is quite surprising. I don't think I've ever heard of a similar case brought on by a small touch up. If this is truly shock loss from the procedure, I'm going to say there is a high probability of is regrowing. Have you ruled out any other potential causes?

 

Unfortunately, I think only time is going to tell for certain.

[Mikey1970]

Thanks for replying David,

 

Yes, im quite certain this was shock loss from my small touch up procedure in February 2015. I have consulted with both my surgeon and a trichologist. What surprised me is that it took 3 months for the shock loss to occur. My previous experience with shock loss was around 3 weeks post op & a full recovery at around the 3 month mark.

 

I think it is beginning to slowly fill in but I cant be sure. Has really given me a feeling of apprehension about future procedures if the need arises...

[glajo]

Been there, done that and yes I know how you feel. It is TRAUMATIC. Ask your doctor if applying rogaine to the area will help in regrowth. Good luck man!!

[Mikey1970]

I guess the dilemma I am facing is what to do if it stays this way and is permanent shock loss. As I have said, this has occurred a good 2 inches away from where the work was done! If I try for a repair job this now involves working towards the middle of my scalp & where could the shock loss appear next? I am having nightmares and envisaging a game of chasie across my whole scalp...

[Spanker]

Honestly, I don't know how anyone could say for sure that hair loss 2 inches away from the recipient zone 3. Could it have been from the anesthetic?

[Mikey1970]

Hand on my heart, I had thick dense hair there when I had a small, 30 graft touch up at the front of my hairline in mid Februry 2015. In Mid May it pretty much fell out overnight.

 

The transplanted hair goes right up to where there shock loss appears, so it is likely the area that MPB would have progressed in, but my hair was largely stable for the preceding 10 years and the hairs did not appear miniaturised. As I have written, I was smashed by shock loss from a larger procedure in April 2014, including the current area, but I fully recovered from that.

 

I am starting to wonder if the frequent procedures have accelerated MPB which had been pretty much dormant for the past 10 years. I am on daily fin & minoxodil. Even the trichologist says I have done everything right, apart from the recent, rapid procedures...

 

Thing is, what do I do now if it doesn't improve? Gillenator has already advised me via private message to do nothing for the next 14 months at least...

[Spanker]

I think that's good advise.

[gillenator]

Mikey,

 

I read your prior post about applying minoxidil 6-7 times daily and that in itself can potentially induce hair loss in any area of the scalp. No doubt that is why your doctor advised you to cease from doing this.

 

FYI, every now and then I will hear from someone who uses upper end levels of minoxidil that they purchase overseas (online) and have counter-productive results from these products. Or they purchase an FDA approved product like Rogaine Foam but apply it numerous times throughout the day for prolonged periods.

 

Some of them have experienced extensive shock loss, some irregular patterns of hair loss, and some prolonged telogen stage periods where nothing grows for months at a time.

 

Whether we are treating MPB in general, or using it post-op to facilitate regrowth of grafts, it's best IMHO to only apply it as directed on the labeling, and nothing more.

 

So I hope things stabilize for you and resume the normal course in your final results...

[jane1]

Your bald spots are still visible on your temporal area.

[MAW99]

Does this mean I shouldn't check into getting product from overseas? I have some friends who swear by the minoxidil they get from a supply house overseas. I was thinking about buying some but now I'm thinking I should stay local so I can consult with a local doctor in case I have issues.

[Mikey1970]

I have reduced the Rogaine Foam as directed by my surgeon. Pretty sure i am beginning to notice some slight improvement & will upload another photo when i am sure. It is a slow recovery, not a strong robust type as i have experienced before but the first positive sign happened a few days ago when i managed to style my hair in the morning & it was a bit more natural, & not the feeling that hair was missing.

 

What has blown me away is the reality that shock loss is unpredictable. Most of the literature states that it occurs in the first 1-3 weeks post op (i have experienced that myself), but on this occasion i lost a heap at 3 months post op. It is now 3 months again since then, so 6 months post op & i think im beginning to see some recovery.

 

Fingers crossed, at my worst i felt crushed. It has been truly traumatic. Will post my final results no matter what as it might help someone else in the future...

 

Cheers

[Mikey1970]

Will just quickly add that not only was the majority of this shock loss 3 months post op, but occurred 2-3 inches from the area of work & only 30 grafts. I have searched online for a precedent but havent come up with much. At this stage i can only put it down to having several procedures in a hurry, (3 procedures from April 2014 to February 2015)....& although the 2nd & 3rd procedures were only really touch up's i guess it all adds up...the anaesthetic etc.

 

My msg to others would be dont be a perfectionist, be grateful for good results & just be mindful of what can go wrong...

[Mikey1970]

Here is a photo taken yesterday. Over the past week i think i have begun noticing some really small fine hairs & i do feel that the area of complete bald skin is smaller. The photos do appear to be affected by things like light etc & it looks quite a bit better when my hair is wet. I return to see my surgeon & trichologist early to mid september so will know more then as they previously took photo's under magnification.

[Mikey1970]

Hi guys. Apologies for the running commentary. I posted a photo earlier today of the shock loss looking better, here is another just taken with it at its worst. Has got to the stage where my mood is on a see-saw & tied to whether i think this is going to recover or not. If this is permanent shock loss or a progression of MPB can it be fixed mid scalp without triggering shock loss somewhere else & me entering a game of chasie across my whole head? Cool heads have told me to wait a year or more before doing anything else but i dont want it looking like this. What a bloody nightmare...

[MAW99]

Glad to see your shock loss is getting better. Please keep us updated!

[Mikey1970]

Thanks for your interest mate. To be honest i dont know if i am recovering or not. If i am it is very slow. My friends & family tell me that when i have my hair styled normally nobody would even know there was an issue, but when i part it & examine the area of loss it is quite stark.

 

It does seem as though i have very short, blonde hair coming through the baldest of spots and i think the telogen has spread as a lot of the front of my scalp is prickly to touch....(think it might be new growth coming through??). The thing is though, this is 6 months post op & 3 months since i was really smashed by shock loss & i am none the wiser if this is normal or not? I had actually hoped to get more of an idea of what was happening to me by posting on this forum but apart from gillenator, david & a couple of other members i am none the wiser.

 

I see my trichiolgist & surgeon next month so should know more but i guess i wont know for sure until a year or so has passed. Apparently sometimes recovery from telogen can take a full year or more?? Fingers crossed....but i would never take a HT lightly again or pursue a small procedure for the sake of very minor improvements....

[Mikey1970]

6 weeks since my last post. I have recently seen my trichologist again who confirmed under magnification that i still have a lot of empty follicles in the affected area. He is now beginning to say that he thinks it is largely genetic hair loss & permanent. Hard to believe that prior to my latest tiny touch up procedure there was thick native hair there! I am in no doubt that frequent ht procedures have accelerated my hair loss which had been largely stable for the past 10 years. In hindsight i have made a big mistake & should have been grateful for the good results achieved in my first two procedures.

 

Anyway, what i really need now is good advice. It is only a relatively small area on the left temple area and i would like to get it filled in but worried that permanent shock loss could appear somewhere else if i do & i could just be embarking on a game of chasie all over my scalp. Or am i heading for another mistake? How safe would it be to get a small area filled in a thinning area behind the existing transplants without risking further shock loss? Any thoughts?

[Sean]

Shockloss is a real phenomenon regardless if it is multiple procedures or not. If a surgeon dense packs in a zone, there is a strong possibility your hairs could die. Your donor can also get a halo or loss of density shockloss effect. It depends on how the procedure was performed and what the surgeons surgical protocol is. Be cautious and proceed carefully...

[Mikey1970]

My surgeon seems to think 100 grafts will be enough to fill this in. Will have to go ahead with it when the time is right but want to make sure it is as safe as can be. Will leave it a full year since my last procedure until it do & probably seek a 2nd opinion.

 

It has been really tough!

[ZeoRanger]

Reading this thread I wonder if your overzealous use of minox had to with it. It seemed like your doc was quite concerned about it. Hence asking you to stop it immediately.

 

Hope your revision will work.

[Mikey1970]

Another couple of months has passed & it does seem to be improving slightly. There is no real area of significance that now has a completely bald patch but rather my left temporal area is quite diffused & id say quite a bit of the hair appears to be on the road to miniaturization. That said, a few months ago it was probably completely bald. When i style my hair wet it is almost undetectable now but i can't walk around with a spray bottle all day lol. When it is dried it looks diffused.

 

My surgeon has said he can thicken it up with 100 grafts but i am obviously now worried about further shock. My trichologist seems to think it might keep improving but it is now 10.5 months since the last surgery and 7.5 months since i noticed the shock loss so i dont know how much more improvement could be to come. Also wondering if PRP could be worth a try?

 

I keep recalling Dr Feller's clip on shock loss & he said it can take 1.5 years for shock loss to fully recover so maybe i might be lucky.

 

Not embarrassed to admit that this has really crushed me but i am hoping i am through the worst of it now.

[Mikey1970]

Another couple of months has passed & it does seem to be improving slightly. There is no real area of significance that now has a completely bald patch but rather my left temporal area is quite diffused & id say quite a bit of the hair appears to be on the road to miniaturization. That said, a few months ago it was probably completely bald. When i style my hair wet it is almost undetectable now but i can't walk around with a spray bottle all day lol. When it is dried it looks diffused.

 

My surgeon has said he can thicken it up with 100 grafts but i am obviously now worried about further shock. My trichologist seems to think it might keep improving but it is now 10.5 months since the last surgery and 7.5 months since i noticed the shock loss so i dont know how much more improvement could be to come. Also wondering if PRP could be worth a try?

 

I keep recalling Dr Feller's clip on shock loss & he said it can take 1.5 years for shock loss to fully recover so maybe i might be lucky.

 

Not embarrassed to admit that this has really crushed me but i am hoping i am through the worst of it now.

[Dutchie]

Does this mean I shouldn't check into getting product from overseas? I have some friends who swear by the minoxidil they get from a supply house overseas. I was thinking about buying some but now I'm thinking I should stay local so I can consult with a local doctor in case I have issues

You can get minoxidil on Ebay for about $5 a bottle: minoxidil | eBay

Edited December 29, 2015 by Dutchie

[hsrp10]

I read the first two posts but not the entire thread so have a few questions.

Who was the doctor and was it FUT or FUE?

Do you think it would have been a better outcome if you would have shaven the recipient area? (or did you shave down)

 

Also do you think it was ultimately doctor error caused by transection of existing hair that led to the shock loss? Or was it other factors?

 

I'm contemplating a small "tweak" of 100-200 grafts in my frontal third possible next year so am curious about your case. I plan to shave the immediate area just in case.