Shock loss and how to prepare for it

[Pyrat]

I am pretty close to booking a date for my hair transplant with Dr Arika at Eugenix and will be documenting every step of the process.

During consultation, the doctor advised me against taking finesteride within the last month or so before the transplant because it might sprout small hair and could be misleading during the surgery. I also read in another thread that Probability of shock loss can be reduced by taking finesteride before the transplant.

Are there cases here where someone has undergone a hair transplant and experienced permanent shock loss, specifically when some of the transplanted hair is close to or between existing and slightly thinning native hair.

I am a little worried because I have thinning hair across the back 2/3rds of my head where I am not transplanting any hair. It isn’t miniaturized but is definitely thinner than it was 4 years ago. The plan is to get on finesteride immediately  after the transplant to maintain this hair for longer.

Could the hair transplant cause permanent shock loss across:

1, Areas where I am transplanting hair between thinning native hair (some of the front area of my forehead)

2, Areas in the back 2/3 of the scalp where hair is thinning but not getting any transplanted hair

 

Finally, what can I do before the hair transplant that can prevent the shock loss.

@Melvin-Moderator @Zoomster @Portugal25 @paddyirishman @Azzy US @ag120 @Raphael84

[Raphael84]

@Pyrat

Congratulations on your upcoming procedure. I like Eugenix.

I understand that you do not currently use Finasteride?

Interesting regarding not beginning Finasteride now (one month before surgery if I have understood correctly) as it may create "growth" that would be misleading. I dont believe that I have heard this idea before to be honest. Generally finasteride would take several months to be able to visibly see any effect/improvement. You would definitely be a lucky guy if you began growing new hairs after one months use of Finasteride. But I am not a physician, and considering you are intending to proceed to surgery with Eugenix,  then I would respect their advice. I would not suggest that beginning Finasteride would reverse miniaturisation significantly within one months of use in regards to help to prevent shock loss. Of course, each individual responds uniquely to medication, but studies suggest that this would not be a sufficient time frame to have sufficient effect.

Permanent shock loss can occur. If your native hair in and around the transplanted recipient area is in a weakened condition, and is therefore going through the miniaturisation cycle, it may not be strong enough to survive the "trauma" of surgery and with shockloss, this follicle may essentially be lost. 

I have had patients attend consultations that seem great candidates from their photos, but upon an in person magnification of their donor area that appeared healthy and strong, actually had significant miniaturisation present. If your vertex has thinned, it may have miniaturised hairs present.

1. Its possible if you have weakened native hair in this area. Depending on how much native hair you have retained in this frontal area, whilst we never want to accelerate the potential loss of hair, post procedure would this even be realistically visible?

2. There was a recent case posted on this forum, Im sorry I dont remember the name of the poster (perhaps somebody may be able to help), who had a frontal restoration and did not touch his vertex, but actually experienced shock loss in his vertex. This hair did grow back but it was interesting. However I cannot recall seeing this with any significance in previous cases and would not be something that I personally would be overly concerned with.

Shock loss is unpredictable and completely unique. Finasteride and Minoxidil pre procedure are the only real proven treatments.

[LaserCap]

10 hours ago, Pyrat said:

I am pretty close to booking a date for my hair transplant with Dr Arika at Eugenix and will be documenting every step of the process.

During consultation, the doctor advised me against taking finesteride within the last month or so before the transplant because it might sprout small hair and could be misleading during the surgery. I also read in another thread that Probability of shock loss can be reduced by taking finesteride before the transplant.

Are there cases here where someone has undergone a hair transplant and experienced permanent shock loss, specifically when some of the transplanted hair is close to or between existing and slightly thinning native hair.

I am a little worried because I have thinning hair across the back 2/3rds of my head where I am not transplanting any hair. It isn’t miniaturized but is definitely thinner than it was 4 years ago. The plan is to get on finesteride immediately  after the transplant to maintain this hair for longer.

Could the hair transplant cause permanent shock loss across:

1, Areas where I am transplanting hair between thinning native hair (some of the front area of my forehead)

2, Areas in the back 2/3 of the scalp where hair is thinning but not getting any transplanted hair

 

Finally, what can I do before the hair transplant that can prevent the shock loss.

@Melvin-Moderator @Zoomster @Portugal25 @paddyirishman @Azzy US @ag120 @Raphael84

It's a big step, congrats.

Dr. Arika suggested you don't take the medication? Since we know finasteride does not regrow hair, he must be talking about enhancement of the native hair.  And he does not wish you to experience this? IT WOULD NOT ONLY ALLOW FOR A FULLER RESULT, IT WOULD ALSO ENHANCE HIS WORK!!! Perhaps he does not believe nor understand the purpose of the medication.

The whole idea of medical therapy is to help you retain hair.  In some instances it can help enhance the native hair.  It looks like regrowth but it isn't.  Understanding the donor is limited in everyone, we need all the help we can get to achieve the fullest result possible.  Propecia is meant to be a long term med.  If it works, it will continue doing so for as long as you take the medication.  Stopping only results in losing all the hair you saved...and you will resume losing.  So, it is a difficult decision to make as you'll practically be on medication for the rest of your life.  Starting/stopping only leads to waste of money and time.

To help with the shedding I would encourage you to research Rogaine/Minoxidil.  

Something to also keep in mind is the fact that all modalities available to treat this condition work in different ways and are thus synergistic.  Propecia, Rogaine, Laser and PRP.  Perhaps doing more than one would help you achieve your goals.

During a procedure the doctor uses a very sharp instrument and inadvertently, can cut the native hair.  It looks like shedding but it isn't.  And, if the hair does shed due to the trauma of the surgery, that hair typically returns along with the transplant.

Talk to the doctor about getting on Rogaine 2 weeks prior to transplant.

[Pyrat]

5 hours ago, LaserCap said:

It's a big step, congrats.

Dr. Arika suggested you don't take the medication? Since we know finasteride does not regrow hair, he must be talking about enhancement of the native hair.  And he does not wish you to experience this? IT WOULD NOT ONLY ALLOW FOR A FULLER RESULT, IT WOULD ALSO ENHANCE HIS WORK!!! Perhaps he does not believe nor understand the purpose of the medication.

The whole idea of medical therapy is to help you retain hair.  In some instances it can help enhance the native hair.  It looks like regrowth but it isn't.  Understanding the donor is limited in everyone, we need all the help we can get to achieve the fullest result possible.  Propecia is meant to be a long term med.  If it works, it will continue doing so for as long as you take the medication.  Stopping only results in losing all the hair you saved...and you will resume losing.  So, it is a difficult decision to make as you'll practically be on medication for the rest of your life.  Starting/stopping only leads to waste of money and time.

To help with the shedding I would encourage you to research Rogaine/Minoxidil.  

Something to also keep in mind is the fact that all modalities available to treat this condition work in different ways and are thus synergistic.  Propecia, Rogaine, Laser and PRP.  Perhaps doing more than one would help you achieve your goals.

During a procedure the doctor uses a very sharp instrument and inadvertently, can cut the native hair.  It looks like shedding but it isn't.  And, if the hair does shed due to the trauma of the surgery, that hair typically returns along with the transplant.

Talk to the doctor about getting on Rogaine 2 weeks prior to transplant.

The doctor told me that I should use finesteride and rogaine but would prefer me to not start using it if I was going to have a transplant in a month or so. If my transplant would be more than 2 months away, she did mention me to start using finesteride. She said that starting now could cause baby hair to sprout before the surgery and that could be a little tricky. I had consulted with Dr Bhatti as well a while back and even he had not asked me to take pre-op medication.

I plan to get on it as soon as the surgery is done and will continue to use it as long as the side effects are not too bad.

I had tried minoxidil foam a while back and it just causes my scalp to itch very bad and turn a little red.

[LaserCap]

The suggestion should always be to get on the meds ASAP.  A day without them just means the possibility of more loss.

Doctors work under magnification and can easily work around the native hair.  This truly is a sad excuse not to use a modality.

As far as side effects go, you will know immediately.  If you never had them, you never will.  Are you experiencing any?  What exactly?

Minoxidil contains alcohol which dries the scalp.  The medication is systemic.  This allows for you to put it on any one spot.  You can change the spot the next day.  Regardless of where you put it - it is working.  No need to rub it all over.  Do it once a day - at night before going to bed. See if that helps.

 

[elduterino]

take fin all the time, and start oral minox a week after the HT, then switch to topical minox a month or so later once its ok to apply it on scalp

I took 5mg a day and had no major side effects

Edited February 28, 2020 by elduterino

[Pyrat]

I will be starting finesteride in 3 days ave would have taken it for  around 2 weeks by the time my transplant happens.

I have not seen people with too much shock loss let alone permanent shock loss from the clinic and hope everything goes fine for me as well.

[pkipling]

As far as I know, it's inconclusive as to whether or not taking fin can prevent shock loss - but it is typically recommended to take it prior to a procedure as a safeguard. 

I'm confused as to how any sprouted hair would negatively impact the procedure though. Finasteride doesn't impact the donor area, so it doesn't seem like it should be an issue in regards to it misleading them about your hair during surgery. If you're gonna start taking it anyway, I honestly don't see why you can't go ahead and start now.