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Question about Shock loss , and if i should have HT now or postpone it ??


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Hi , 

 i was planning to have HT soon , i had multiple consolations with below doctors "grafts estimations highlighted"

kesser "2200 grafts"  ,  HLC "2200" , bicher "2600 grafts",pikner "3000 grafts" , ASMED "3500 grafts" , Acar "1800 grafts" , dr Kul "advised  to wait as hair shed usually continue at age 36-38 and then slow down"

I'm NW3 , 36 years , don't use minoxidil or finasteride , my original hair line is flat , my hair line is receding  but in irregular pattern , also i have bald spots in randomly distributed  fashion behind the hair line , i believe donor area is good , but i didn't have an analysis at a clinic . 

so my concern is about shock loss during the procedure  , as i understand terminal/strong follicles will recover after the procedure , but miniaturized/weak follicle can be permanently lost  , also  i understand that transection "cutting through original follicles" is not a concern with a good surgeon who uses proper magnification tools . but my concern is about the weak/miniaturized follicles which can shed from time to time and regrow , will they be visible enough during procedure with magnification ??  my other concern is that in HT the surgeon might have to implant extra follicles in bald spots , which might look not natural "if hair receding continue" 

On the other hand i feel so impatient about having a transplant , specially in my case i've never shaved my hair before , low density and bald spots  make it impossible to style my hair , or put any hair product "even if it's waterish" .. receding hairline and big forehead combo makes things even worse .. 

Sorry about the long thread , appreciate your help ... 

 

 

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If you don't plan on getting on Fin, you shouldn't worry about losing miniaturized hairs. They really aren't providing density now and they aren't coming back on their own. If you are open to Fin, hopping on six months prior to surgery will ensure you hang onto as many miniaturized hairs as possible, some of which could regrow into mature hairs after enough time. 

In terms of waiting until your hair loss settles, I don't think any doctor can definitively say when that will happen. Most responsible doctors won't do major surgeries for patients in early 20s without a long term plan, but at 36 I think you're okay, personally speaking. 

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Can you share some pictures?

I do not provide medical advice, recommendations, all responses are my opinion.

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Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

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If you do sustain shock loss, it usually occurs approximately 3-6 weeks post-op.

Gillenator

Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians: Dr. Robert Dorin: True & Dorin Medical in New York, NY

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I attached Old photo to show original hair line and density  , in addition to new photos from different angels , i have big forehead , which make hair recession look far worth than it's actually is .. 

To be clear , i'm NOT concerned about Temporarily shock loss that may affect "New transplanted  , EXISTING  strong/terminal hair" ..  i'm concerned about PERMENANT shock loss that may affect Weak/miniaturized follicles ..

Besides my additional  concerns are

- Shall i proceed with HT at Age of 36 or postpone "i'm not willing to use finasteride , but open to use breezula which may not appear before 2023/2024 i believe  " 

- I usually keep my hair long so i may not do the crown now , but i'm not sure whether to go with conservative HT and hair line or go up to 3000/3500 grafts" 

Currently hair loss is not completely stopped but is noticeably  more stable than before .. 

@Melvin-Moderator I just watched your videos on YouTube recently , Nice work .. 

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I don't understand how anyone goes over 2000 grafts recommendation for you. You have a very solid head of hair and just need a little work up front. 1500 or so by my estimation. Unless you are looking to go into the crown too which I don't think would be advisable as still a good amount of hair (albeit thin) in there and you'd probably have a good amount of it shocked during the procedure. 

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1 hour ago, SD1984 said:

I don't understand how anyone goes over 2000 grafts recommendation for you. You have a very solid head of hair and just need a little work up front. 1500 or so by my estimation. Unless you are looking to go into the crown too which I don't think would be advisable as still a good amount of hair (albeit thin) in there and you'd probably have a good amount of it shocked during the procedure. 

The Estimations for consultations i did is at the beginning of the thread .. i believe that long/curly hair kinda mask the full real situation , that's why they go to a higher grafts estimations , 2 surgeons including Dr keser "advised not to work on crown for now" .

currently i can't use any product even  a light one  like sea salt spray   as it will show the bald spots and i can't style my hair hair because low density  makes it more curly .

so i really stuck between having the HT now and risk permanent shock loss of weak follicles  ,  or live with current situation "maybe until breezula is out" or until hair loss is stabilized .

 

 

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Risk of Shockloss is present whether you do a hair transplant procedure now or in the future.  The greater the number of grafts needed for harvesting the higher the chance of shock loss as it means a longer procedure, more micro trauma to the scalp, greater stress on the body etc. 

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2 hours ago, Dr. Neil Verma said:

Risk of Shockloss is present whether you do a hair transplant procedure now or in the future.  The greater the number of grafts needed for harvesting the higher the chance of shock loss as it means a longer procedure, more micro trauma to the scalp, greater stress on the body etc. 

I mean isn't shock loss more possible when hair is transplanted in area where there's still existing weak/miniaturized follicles ?

 Anyway of minimizing risk of permanent shock loss "not including using finasteride"  , does having multiple smaller sessions which some surgeons do increase or decrease shock loss possibility ? 

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1 hour ago, H.K said:

I mean isn't shock loss more possible when hair is transplanted in area where there's still existing weak/miniaturized follicles ?

 Anyway of minimizing risk of permanent shock loss "not including using finasteride"  , does having multiple smaller sessions which some surgeons do increase or decrease shock loss possibility ? 

Not really.  There is always going to be some amount of miniaturized follicles.  Shock loss is temporary and doesn’t occur in everyone.  Multiple sessions need to be spaced out by many months 6+ to allow the scalp to have adequate time to heal from the previous procedure.  So in summary very large sessions >3500 grafts and frequent sessions within a short time of one another increase risk of shock loss, which is still temporary.  

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Thanks for your input , what i meant with multiple sessions is that some surgeon do the surgery on 2 or 3 consecutive days .. 

i was under the impression that miniaturized hairs have more change of permeant damage , either way it's clear to me now that either way  those follicles is going to be lost in near future "unless finasteride is used" , I believe that Minoxidil is useless in this case as well . 

I guess also , it's useless to wait further as it's hard to predict when hair loss will stabilize , so probably i will proceed with a conservative/Medium  operation 2000-2600 grafts and follow it with a smaller procedure later if necessary .. 

is it feasible to give a rough estimate of my donor capacity "grafts that be extracted not just the overall capacity" 

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Dutasteride is also an option to minimize chance of permanent miniaturized hair loss. From the photos provided 2500 grafts seems appropriate to restore the hairline and match the surrounding density. From the pics rough estimate of grafts that can be harvested safely from the donor region is >6500 grafts so plenty of capacity for a repeat procedure in the future. 

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Shock loss occurs as a result of how the scalp responds to a high level of trauma from the surgery including the fluids injected into the scalp.

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Gillenator

Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians: Dr. Robert Dorin: True & Dorin Medical in New York, NY

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You definitely need to discuss this with your doctor if you have high blood pressure.

Gillenator

Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians: Dr. Robert Dorin: True & Dorin Medical in New York, NY

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@gillenator i actually have low blood pressure , not high .. stemoxydine was causing me dizziness that's why i distributed the dose through the day .. minoxidil as i understand lower blood pressure .

I found that link https://www.belgraviacentre.com/blog/can-i-use-minoxidil-if-i-have-low-blood-pressure/ it mention that low blood pressure users can use minoxidil with cut-off point of 90/60 ... so i know it's going to cause dizziness in my case as i'm usually 100/70 

 

 

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