What is the science behind the phenomena of shock loss?

[singh]

I'm trying to understand what induces shock loss, and what factors make it temporary or permanent. How does transection of native follicle affect it, and how does implantation between native follicles induce shock loss? Is shock loss simply Telogen Effluvium? 

What ways can be used to reduce shock loss? I've read about topical minoxidil, PRP and finesteride (for AGA cases) not only reducing shock loss but also helping in faster recovery and length.

Those of you who have gotten their HTs, did you guys experience shock loss in recipient area? Was it permanent? 

Here's some studies that touch this topic - 

https://martinelangsam.com/wp-content/uploads/2017/07/Cyclical-Medicine-Article-published-in-Forum-USA.pdf

https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0041-1739247

https://www.ishrs-htforum.org/content/15/6/197

Edited August 16, 2023 by singh

[StillAlive]

I believe that what little remained of my native hair in the frontal third was permanently lost due to shock loss after my HT. I was taking saw palmetto and not using finasteride or minoxidil and was aware that that might happen. 

Even though there have not been any extensive shock loss studies that I'm aware of, the general principle is that hair follicles that are already in the process of miniaturization ('sick' follicles to oversimplify, ones that would fall out due to MPB anyway) may not survive the shock of the operation or the 're-wiring' of the blood supply network post HT. When you implant healthy follicles next to some miniaturized ones, your body may opt to generate strong blood supply to the new, healthy follicles, neglecting the weaker ones.

Again, there are no studies and no definite way of saying 'Yes, I lost that hair due to shock loss' which is what introduces an element of randomness in ALL HT's, even with the world's most elite surgeons. You can minimize risk by doing your research and preparing, but never eradicate it entirely. 

[Emiry]

2 hours ago, StillAlive said:

I believe that what little remained of my native hair in the frontal third was permanently lost due to shock loss after my HT. I was taking saw palmetto and not using finasteride or minoxidil and was aware that that might happen. 

Even though there have not been any extensive shock loss studies that I'm aware of, the general principle is that hair follicles that are already in the process of miniaturization ('sick' follicles to oversimplify, ones that would fall out due to MPB anyway) may not survive the shock of the operation or the 're-wiring' of the blood supply network post HT. When you implant healthy follicles next to some miniaturized ones, your body may opt to generate strong blood supply to the new, healthy follicles, neglecting the weaker ones.

Again, there are no studies and no definite way of saying 'Yes, I lost that hair due to shock loss' which is what introduces an element of randomness in ALL HT's, even with the world's most elite surgeons. You can minimize risk by doing your research and preparing, but never eradicate it entirely. 

That’s not how it works. 

The body doesn’t neglect to wire hair follicles because they’re weaker or choose to give stronger or weaker blood supply. The scalp is extremely vascular and hair follicles or not, it is extremely high pressure “bloodied” due to housing the most important organ in the body. 

If what you said was true, bald people wouldn’t bleed at all 😂

[A_4_Archan]

@singh

Shock loss itself speaks for what is stands for...its a loss due to shock(trauma) caused by a surgery....

Due to trauma they directly gets into telogen phase and get miniaturized or fall off..Generally the loss is temporary and those hairs will grow back with time..but if the surrounded hairs are too weak to bear any trauma they may not grow back again and gets permanently damaged and this is called permanent loss due to shock..

Shock loss can happen at both places i.e. Recipient area as well as Donor area

Now this both can be contained with medication...there is a good chance that the effects of both type(temporary & permanent) shock loss at both the areas can be lessened with medication if they are started few months prior to surgery...but still if the surrounding hairs at both zones are too weak than some of them might not grow out again..

On this forum We already have some cases of both temporary as well as permanent shock loss happened at recipient area as well as donor area...

Now what surgeon can do is if he/she sees a graft which is very week in the area to be implanted than he/she should keep a certain distance while implanting new graft around it and when there are multiple such grafts in the zone which is to be worked upon than surgeon has to do a less dense work to save those grafts...though even if the surgeon tries the best possible way not to induce more trauma there is a chance that those weak hairs don't grow back and thats why when someone already have good amount of hairs than he is advised not to go for surgery so that he doesn't loose what he already has...shock loss is a natural phenomena which is not too much under control of a doctor...

Now transection is totally different thing and large part of it is under the hands of a doctor and this happens due to the surgical error..this can take place at recipient as well as on donor site...there are certain natural scenarios under which transections can take place but most of its part is affected by the skills and experience of a surgeon as well as other people involved in a surgery...

This is what i think is happening and i might be wrong....so you better off asking your own surgeon regarding this...or some doctors/experts in the community may shed a light on this..

I hope this helps you..

 

Edited August 16, 2023 by A_4_Archan

[StillAlive]

Fair point, but there has got to be some logical explanation for the many cases where we observe permanent shock loss to weakened native hair after an HT. 

[A_4_Archan]

@StillAlive

Imo the logic is when something is so weak and you give shock to this than ofcourse it would damage permanently....when a living thing is too weak at a certain point and thn if it gets sudden high trauma than it dies and when something dies it never lives again...that's what i think it should be and that's how i think nature works...

[singh]

21 hours ago, A_4_Archan said:

@StillAlive

Imo the logic is when something is so weak and you give shock to this than ofcourse it would damage permanently....when a living thing is too weak at a certain point and thn if it gets sudden high trauma than it dies and when something dies it never lives again...that's what i think it should be and that's how i think nature works...

Damn this confuses me even more. I don't have MPB (have traction instead), and I have some baby hair and some strands of hair of slightly low caliber but I wouldn't call them miniaturised. Makes me scared about permanent shock loss. I can't locate it right now but I found a study which showed that post HT, topical minoxidil pretty much made 90% of patients skip the shock loss stage and almost skip the shedding of most transplanted hair as well. It also showed the new hair achieving way longer lengths than non minox patients. 

I'll link it if i find it again.

[A_4_Archan]

@singh i am.on oral minoxidil and it seems it helped me...if you are sure of getting a HT thn you should start medication even if you don't have mpb and don't wanna take meds later on..its jst that it can help with permanent shockloss and even shedding...so take start medication and thn you can go for a surgery after 6 to 8 months

[singh]

On 8/17/2023 at 5:23 PM, A_4_Archan said:

@singh i am.on oral minoxidil and it seems it helped me...if you are sure of getting a HT thn you should start medication even if you don't have mpb and don't wanna take meds later on..its jst that it can help with permanent shockloss and even shedding...so take start medication and thn you can go for a surgery after 6 to 8 months

Hey man, I was told by the clinic to not take minoxidil post op since I don’t have progressive baldness. But anyway when I tried minox for 3-4 months 2x a day, I didn’t notice a shed or gain of hair. When I quit cold turkey my hair didn’t fall out either 

[A_4_Archan]

@singh

Yeh there are few % of people who don't go through shed ...and if your surgeon told you not to take it than its fine you can skip it...anyhow minoxidil isn't useful in stopping or slowing down hairloss...it is jst helpful to make your hairs fuller and thicker ...

[gillenator]

Trauma from the surgery causes many hair follicles to retreat into the resting phase…transection is something totally different.

[singh]

9 hours ago, A_4_Archan said:

@singh

Yeh there are few % of people who don't go through shed ...and if your surgeon told you not to take it than its fine you can skip it...anyhow minoxidil isn't useful in stopping or slowing down hairloss...it is jst helpful to make your hairs fuller and thicker ...

There area surgeons who claim minoxidil eliminates shock loss. I did find a great research journal on this but I can't find it anymore. I remember that it clearly stated that patients on minoxidil post-op pretty much skipped the shock loss stage and the ugly duckling phase. And at 12 the 9 month mark had longer hair than their non minox counterparts.

https://www.hairtransplantfue.org/blog/minoxidil-after-hair-transplant#:~:text=Minoxidil Eliminates Shock Loss&text=Shock loss refers to the,removes the shock loss period.

https://www.dentalhairclinicturkey.com/blog/minoxidil-rogaine-before-and-after-hair-transplant/

 

[A_4_Archan]

@singh

Yeh the same thing i earlier explained in my above post that the shock loss can be contained with medication....but you said that your surgeon told you not to take it so i am not a doctor tht i can counter a doctor's advice...

Edited August 20, 2023 by A_4_Archan

[singh]

9 minutes ago, A_4_Archan said:

@singh

Yeh the same thing i earlier explained in my above post that the shock loss can be contained with medication....but you said that your surgeon told you not to take it so i am not a doctor tht i can counter a doctor's advice...

Yeah same, I think I'll take my doc's advice too. But from what I've read about hair loss I've seen that even the claim that hair fall of after minoxidil is pretty disputed among doctors. Many doctors claim that this only happens in AGA because minox is what maintains your hair, and for example when it is prescribed to women for post partum hair loss or TE, they don't notice a shed after quitting minox. In my experience, I didn't experience a shed either.

And the guys with AGA who noticed this shed on discontinuation of minoxidil don't shed their hair that wasn't falling off either. And most guys on r/minoxbeards also retain their beard from minoxidil since DHT isn't against them in that area.

I think hair loss, just like other fields of medicine has no clear consensus  

[A_4_Archan]

@singh

There will always be varying opinions and reports on any field be it medical or any other field ....to be specific about Hair loss related medication the same varying opinions and reports has been published so imo you should trust your surgeon and follow his/her advice as he/she is the sole responsible person to perform a successful surgery on you and that's why the choice of doctor plays an important role in this thing too regardless of his/her surgical skills...

Plus i think all this things are trial and error kind of things ...what works for you may not work for other and vice versa ....its you who have to figure out what works best for you...what we can do is use all the weapons we got in our armoury with doctor's consultation and after weighing their effects/side effects....