Mitigating permanent shock loss before HT

[RTC]

Hi all,

I'm scheduled for a HT in June with Dr Mwamba.

I've had a previous HT (largely a botch), but the hair on the first 2/3rds of my scalp is pretty strong according to Dr Mwamba. My vertex is however starting to miniaturise. I have started topical dutasteride and microneedle weekly.

Is it worth starting Minoxidil before the procedure to strengthen the hairs and minimise the risk of permanent shock loss of some of the surrounding hairs?

Ideally, I don't want to take Minoxidil long-term, but if it mitigates the risk of permanent shock loss I'm happy to take it before the procedure.

[RTC]

Also, one of the things Dr Mwamba says regarding shock loss is: 

Quote

Factors that promote it:
-No respect of hair angle while making incisions sites. ( you must stay parallel to the existing hairs to avoid any damage )
-Dense packing
-Fragile hairs ( hairs in end phase of anagen cycle )

But he will also be implanting some grafts to camouflage badly angled grafts (i.e. planting the new ones at the correct angle compared to old ones). Has anybody had this before? I hope it will not damage the older badly angled grafts (I do not want a bare area, despite them not being angled correctly).

[NARMAK]

Just also to add that if you begin Minoxodil, it will cause its own shedding phases too which can make things look bad. 

Personally i would say Finasteride or in your case Topical Dutasteride should hopefully help even after the hair transplant to keep your hair as healthy as possible and possibly stop further loss. 

[RTC]

Any other insights from anyone

[Rahal Hair Transplant]

Aslitarcan,

The first thing I want to address is the title of your post.  Most shock loss is actually temporary, not permanent. This is referred to as telogen effluvium which by definition is a temporary hair loss created by some kind of stressor. Once the stressor is removed, any hair lost via telogen effluvium typically returns. 

In cases of surgical hair restoration, trauma to the scalp during surgery is the stressor.  It usually takes several weeks before the hair actually falls out but most if not all of the hair will return between 6 to 12 months after the date of the procedure.

Now, permanent shock loss can occur if the hair that’s shocked and falls out is already miniaturized and/or is on its way out anyway due to genetic male pattern baldness.  Minoxidil isn’t going to do much to change this result at least not long term.

Let’s say that you use minoxidil a few months before the procedure and any miniaturized hairs actually thicken and become “terminal“.  I put the word terminal in quotes because any hairs that have improved due to minoxidil will only stay in its “terminal” state with continued use of the medication. Once you stop using it, the hair will fall out.  So let’s say you avoid permanent shock loss of some of these hairs because they were strengthened due to minoxidil, as soon as you stop using it they will fall out anyway. So if you’re not planning to use minoxidil long-term, personally, I don’t think there’s really any point.

I hope this helps.

Rahal Hair Transplant

[RTC]

Thank you sir, great response

[RTC]

Would your opinion change if using Dutasteride? That's a more solid plan right