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Shockloss Info

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This is a very common question - SHOCKLOSS - Hopefully this can help patients wanting answers to their questions regarding Shockloss. Below is a culmination of a few posts by posters on the topic of shockloss - Hope it helps - They have been copy/pasted from a variety of places so may not flow..





1.Shockloss is something that can be experienced when transplanting into existing hair although highly unpredictable. Shockloss occurs when the native hair is weak and isn't strong enough to resist the trauma that's going on around it. More often than not the hair that has gone into shock will grow back but after 3/4 months - after the resting phase

Hair that goes into shock and doesn't return is hair that was inevitably on its way out anyway and wasn't strong enough to return.

Increased trauma to a localised area will increase the chances of shockloss

Shockloss is unpredictable and there is no hard and fast rule to avoiding it - especially if you are transplanting into existing hair.



2. There are risk factors that either heighten or lessen someone's risk. Diffuse thinners seem more prone to shockloss than receders because the hair in a diffuse area is often less stable than that of a receder. Very often, a lot of the hair in a diffuse area is "on its last legs" and in the latter stages of the miniaturization process.


3. Shock loss tends to occur both in the recipient and in the donor areas as far as I know. It's a normal response to trauma to the scalp which is surgery. However, permanent shock loss, while it can also happen if the hair that was shocked was going to fall out anyway due to MPB, sucks and can be a sign of a bad HT.






4. Any time hair is transplanted in between or around existing natural hair, there is a risk of temporary "shock loss" or telogen effluvium. This is even more common in women, but is almost always temporary. Only follicles that are transected (which won't happen in the hands of a skilled physician) or miniaturized hairs on their way out anyway may be permanently shocked.



5. An unfortunate possibility in hair transplantation is a phenomenon known as shock loss. This is mostly a temporary condition where native hairs are “shocked” due to trauma of the scalp during hair transplantation surgery, creating an additional but mostly temporary hair loss condition. Though nobody likes to experience this, fortunately, this is normal.


Shockloss can occur both in the donor and recipient area a few weeks to a few months after having hair transplantation surgery. There are two forms of shockloss, temporary and permanent.


Permanent shockloss, though rare, can occur in one of two ways:


The physician transects existing hair follicles (the risk is significantly lessened in the hands of a skilled physician; however, it is risky if you are in the hands of a clinic using older technology, using larger instruments to make incisions and inserting plugs, mini-grafts, or micro-grafts).

It can occur to hairs that have entered the miniaturization process…but these hairs would have fallen out eventually anyway. This is why getting on medication such as Propecia (Finasteride) is very important, to hopefully strengthen existing hairs and turn miniaturized hairs back into healthy hairs.

Temporary shockloss is more common and seemingly unpredictable - varying from person to person. In other words, there is no pattern or understood reason why some patients experience it drastically and others do not. Temporary shockloss occurs due to scalp trauma from surgery. But within several months, the hair grows back.


There are ways, however that temporary OR permanent shockloss can be minimized.


Using ultra refined follicular unit transplantation, the recipient incisions are much smaller and refined, using custom cut blades as small as .6 mm which causes less trauma to the scalp. This in itself can mimimize shockloss to the recipient area.

Conservative placement around existing hairs without super dense packing can also minimize shockloss to an existing area.

Finasteride, also, is known to help minimize the risk of shockloss.

I might add that if any of the three listed items above are missing, the risk for shockloss increases.






6. Shockloss is unpredictable, however, Propecia since it can strengthen hairs that would have otherwise been on their way out, can make it more "shock" resistant. It is not a definite...but it can help. At the very least, it helps minimize permanent shock loss.




7. Keep in mind that the risk of permanent shock loss only exists for native hair that is currently in a weakened state due to hair miniaturization (or if the native hair follicles are transected, but this is rare in the hands of a qualified surgeon). This means that this hair would have eventually fallen out and leave you bald anyway. Temporary shock may occur due to scalp trauma but will return.




8. Shock Loss Shed - affects native hair - likely to be noticed within the first month of your HT. Sometimes experienced around donor area. More evident if you don't shave down for HT...IMO. The may or may not return. I had some with each HT. I noticed for HT #2 that shocked native hair started to return at the 2 month 1 week time period. I could tell the difference between it and HT hair as the shocked native hair came in coarse like beard stubble versus HT new growth being very fine.




9. Shockloss is not losing the transplanted hair. Shock loss is when you lose the pre existing hair in the transplanted area.




10. If you make it to 4 weeks post op, then more than likely you will not have shock loss.




11. Shock loss also has a great deal to do with the skill of the surgeon and trauma to the scalp.




12. There is a much higher chance of shockloss with increased tension. You can still get shockloss simply from the surgical trauma induced. Other factors include trauma to underlying vessels arteries with reduction of blood supply, infection, wound dehiscence, hematoma formation.






Shock Loss can be as a result of the following:Ricardo Mejia MD


1. Telogen Effluvium: this is a physiologic process which is multifactorial and can affect "weak" minituarized hairs as well as good terminal hairs as well. Telogen effluvium is a reactive process caused by a metabolic or hormonal stress or by medications. Readers need to understand the hair growth cycle in order to understand telogen effluvium. All hair has a growth phase, termed anagen, and a resting phase, telogen. Catagen is an intermediate stage between the two which lasts only a couple of weeks. On the scalp, anagen lasts approximately 3 years, while telogen lasts approx. 3 months. There can be wide variation in time with patients. During telogen, the resting hair remains in the follicle until it is pushed out by growth of a new anagen hair. This process occurs independent of hair transplant surgery. It may also occur as a result of surgical trauma. What is concerning to patients is looking thinner or losing hair after a hair transplant. This is temporary and the hairs will regrow. This type of shock loss is not permanent except for the minituarized hair on its last cycle.


2. Iatrogenic or Doctor induced during hair transplant surgery via transection of the hair shaft during creation of the recipient sites. This is surgical trauma. In this case the hair shaft will fall out immediately in some cases or as early as a month after surgery. It is possible if the hair shaft is cut, the hair follicle will continue to grow in anagen phase without being shifted into a telogen stage. Consequently not all hairs that are surgically traumatized go into telogen. However, patients will lose hair and can look thinner after surgery. Obviously this is of most concern in men and women who have hair and we are transplanting around existing native hairs or repeat transplant procedures. This type of shock loss is not permanent.


3. Shock loss due to apparent loss of hair. In general, during most consultations with patients with existing native hair and in women especially, they are concerned about the apparent loss of hair or thinness after surgery. Doctors explain the above possible risks. If you had your 4th procedure and left your hair intact and not shaven and subsequently in the next 1-3 months lost everything in the recipient site, I would assume you would say you experienced 100% shock loss either due to telogen effluvium and or Iatrogenic. Fortunately, I have never heard of this case happening, but the hairs will regrow. If you shave your head in anticipation of a surgery, you have a 100% sudden hair loss. You will not see any apparent loss of hair in the next 1-3 months of surgery because you have altered the equation and removed the visible factor to evaluate shock loss or not. You may still experience the same telogen or iatrogenic shock loss but there will be nothing to show. For many patients, having to shave their head completely is a big shock and if you shave 100% of the recipient site, it is 100% hair loss to the patient whether or not any follicles truly experienced iatrogenic and or telogen following the transplant.

4. Permanent Shock Loss as a result of invivo follicle surgical trauma. I have not experienced this in my practice and do not believe it is a big factor based on the studies that have been performed previously. If you cut a hair follicle with any instrument ultra refined or not, you are still transecting the hair follicle. IF this was a real problem, I would expect clinics that are doing 4000-6000 grafts with high dense packing in native hairs to experience more problems. As of yet, we have been getting very good growth and results. Keep in mind the worse case scenario is taking a hair follicle out of the body, crushing the bulb and cutting the bulb directly and reimplanting it into the scalp. In some of the studies that have been done, the hairs still grow although perhaps not as good quality. The probability of permanent shock loss in the right hands is extremely rare. Perhaps some of the consultants or other physicians will comment whether they have experienced many cases of permanent shock loss .

5. Vascular Blood supply. The use of ultra refined tools and other techniques that have helped minimize trauma to the vascular supply can minimize permanent hair loss. This is a separate factor that is independent of transection of hair follicles. There have been cases of poor growth due to the underlying damage to the vascular blood supply. This is a more critical issue than transection of the hair follicle itself. In this case, patients can experience hair loss and possibly permanent if the underlying blood supply has been badly compromised by poor technique. This is a whole separate issue of poor growth rather than shock loss due to direct damage of the hair bulb itself.


Ricardo Mejia MD





The area below was copied from "calling all docs Diffuse thinners"


Keep in mind that the risk of permanent shock loss only exists for native hair that is currently in a weakened state due to hair miniaturization (or if the native hair follicles are transected, but this is rare in the hands of a qualified surgeon). This means that this hair would have eventually fallen out and leave you bald anyway. Temporary shock may occur due to scalp trauma but will return.



A few points I would like to clarify.


I do not believe there is "permanent" hair loss form transection of hair follicles in the scalp. There is Iatgrogenic or doctor induced hair loss when the hair shaft is cut below the scalp, and falls out, but it will regrow. This is not strictly due to poor placement. There are other factors involved. I am not aware of any studies that have proven permanent hair loss. You may recall our previous thread discussing this very issue. I would recommend readers review this carefully.


Transection risk with megasessions and shock loss


"shock loss" can have many definitions as I have explained in the thread above. Most patients view it as the apparent loss of hair density after a procedure in existing native hairs that results in a thinner look usually within three months after a transplant. In general, the hairs will regrow as I have explained in my other thread. For all hair transplant practices that shave the recipient site, you are getting 100% immediate shock loss. The hairs are gone visually! For all practical purposes, can not tell whether you really experienced true "shock loss" or not because the hairs are no longer there. Therefore it is a moot point in practices that shave the recipient site. MOst of my professional patients do not want that type experience, which is why I do not always do it, and work around the native hairs.


"shock loss" is a lay term for telogen effluvium which can be multifactorial and a result of the stress from surgery, antibiotics, postoperative illnesses, medications, weight loss diet etc. Therefore it is not strictly due to trauma or poor placement. This type of shock loss and Itrogenic shock loss can affect miniaturized and terminal hairs equally. I am not aware of any study that states Shock loss ONLY preferentially affects only the weak minituarized hair. It is probale and perhaps Dr. Beener has added insight from his years of research activity in this field. However, I see lots of patients with telogen effluvium and they are loosing good terminal hairs not just minituarized weak ones. I agree with Dr. Beener, It is true if a weak minituarized hair was on its last leg and was "shocked" out, it will not regrow.


WHen transplanting at higher densities within existing hairs and with shaven recipient sites, there is a higher risk of transection of the hair follicles, especially if you are using a multibladed handle which makes several recipient incisions sites at the same time and you are doing it fast. It is a lot harder to try to align all the blades to be perfectly parallel to the hairs of varying densities, and the exit angle of the hair is not always the same under the epidermis. If you shave the recipient site very close with no superficial hair, you can not tell very well what the exit angle is and thus even harder or impossible to avoid native hairs with multibladed recipient site handles, especially in native hairs with pretty good density such as early diffuse thinners. I use a single bladed recipient handle to maneuver within existing hairs to minimize the possibility of Iatrogenic trauma. Spex is right, it is unpredictable. The good news, dakota is "permanent" shock loss is a term that is used too loosely. Review the previous thread. We need to understand and define the multitude of factors involved and the defintions and type of shock loss one is referring to. In summary, the hairs will regrow even if doctor tansected without a permanent loss and even hairs lost due to the myriad of factors with telogen effluvium, with the exception of the minituarized hair on its last leg. There is a higher risk of transection in native hairs with higher density recipient sites and high dense packing sessions, yet they are not permanently damaged.

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Indeed, common question shockloss so hopefully some will fine the info helpful B)

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