Hair Restoration Blog

Q:

I started the hair medication finasteride. Will this help stop me losing more hair? I was concerned that if you restored my hairline would I need to do another surgery in years to come if my hair continues to thin and fade behind where the restoration was done? There are many stories on the internet of people that have had multiple surgeries (other doctors) and they are still not satisfied so I just wanted to take the opportunity to gather as much information and ask the appropriate corresponding questions so I can make the most educated decision.

A:

While reviewing your miniaturization study (the microscopic evaluation you had in our office), it indicated that you have some hair loss activity on the top areas of your scalp as well, but it is very minimal. If you continue using medication, your hair loss will range from none to very minimal in the next few years. One hair transplant procedure in combination with medical treatment with Propecia (finasteride) can maintain your look for many years to come.

Losing hair post hair transplant surgery – “Shock Loss”

Q:

Dr. Mohebi,

I am a woman and I had a hair transplant surgery about a month ago.  I noticed a thumb size hair loss on one side around the closed wound on the donor area.  That has been doubled in size over the last few weeks.  Is my hair loss permanent in that area?

A:

Shock loss around the donor area is not an uncommon complication after a hair transplant surgery particularly in hair transplants that require a large number of grafts or when the patient’s scalp is tight.  It is more common among women due to the overall higher strip width to head circumference ratio.

This phenomenon is a type of telogen effluvium that may last a few months, but usually resolves completely with no need to any treatment. Here is additional information on post surgical ‘Shock Loss.’ I really appreciate your question they often help other readers of this blog.

Take Care,

Parsa Mohebi, MD

Shock Loss after Hair Transplant Surgery

Q:

Dr. Mohebi, I am considering an additional hair transplant surgery. With my previous surgery elsewhere, I experienced a good deal of shock loss. This makes me a bit skeptical but I know I need an additional surgery to maintain the image I have now.

Why is shock loss such a problem?

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A:

Shock loss, is the accelerated hair loss following any stressful event. That stress may be due to emotional or physical trauma. Hair Transplant procedure is not an exception.

Shock loss after a hair transplant surgery was not uncommon in the past. However, today with proper medical treatment, shock loss can be significantly reduced or even eliminated. Using finasteride or Propecia around the time of hair transplant can inhibit or minimize the risk of shock loss. That is why this treatment is being used by most hair transplant surgeons.

At US Hair Restoration centers, most of our patients start a regimen of finasteride several days before their hair transplant surgery and continue the intake six to eight months after their procedure. The combination of medication and surgical hair restoration provides our patients with natural, permanent and proven results.

Q.

Dr Mohebi,

I hope you are well. As we get closer to my surgical date I have put together some questions for you.

I have been reading a lot on the hair restoration network and found this 1 individual called Megatron with a similar makeup to myself.

I have looked at his very detailed journal and find many similarities to myself. Because of this I have several concerns.

If you look through his journal you will notice that he has a similar hair type to myself. It appears he got acne throughout the donor and recipient area that looks horrible at about 2 months after hair transplant and continued for several months. I was very prone to acne as a child and as I mentioned in our consultation I have incredibly sensitive skin and very thin tissue. If I went to a spa and received a facial not only would my face become very red and inflamed but the benefit of the facial would not be realized for sometime due to the fact that I would most certainly get a breakout the following day. Seems like my skin does not like to be touched, squeezed etc. It also appears that he was treated for several infections around the 2 month mark as well which may have affected or increased his shock loss.

I am also concerned about the level of shock loss that he had. What are the common reasons for this and is there a way to minimize this other that the propecia you have already prescribed? It appears as if he lost a good portion of the density at about 2-3 months in the recipient area. I am not sure if I am ready to go through that even for the greater good. I understand that everyone is different and will react differently to the surgery. I have always been on the side of having the most and weirdest reactions to everything that messes with my bodies natural makeup!

When would you say that a return to normal sleeping patterns is likely?

I am not sure if this can be considered a random case of cold feet but I just wanted to get some additional reassurance from you prior to finalizing everything today

A:

It is great to hear from you. I will be answering your questions in the order you asked:

1.      What is generally seen a few months after a hair transplant procedure in some individuals is called folliculitis. This happens due to an accumulation of sebum, oily secretions, of the hair follicles.  They are not seen in every patient and do not generally have to do with having a history of acne in the past.

2.      Having sensitive skin may indicate more swelling and redness for the first few days after surgery, but this might be controllable with steroids that we already give to most patients.

3.      Shock loss is most often seen in the areas where you have significant miniaturization, which in your case we know exists based on our microscopic evaluation.  However, we recommend using finasteride after your hair transplant for a few months to minimize the shock loss.

4.      You may want to add minoxidil after hair transplant to the finasteride, to minimize the risk of shock loss even further.

5.      You can go back to your normal sleeping pattern after the 4th day after hair transplantation. Within the first four days you need to sleep in semi-sitting position, but there is no problem with putting pressure on the closed donor area.

In closing, be aware it is normal to have some level of anxiety before any type of procedure.  Please contact me if you have any other questions.

Q.

Hi Dr. Just got back from my vacation in XX, had a good and relaxing time. While I was gone for 2 weeks all the scabbing from my hair transplantation is pretty much gone in the donor scar and the implanted areas. Also I noticed that I did lose hairs as you mentioned would most likely happen. the hairs that fell that looked like the grafts were just the hair shaft that I saw fall. I did not see skin attached to the end of the hair shaft so I assume the follicle survived in the skin where it was implanted. not all have fallen but I did notice a good amount. I also notice small dark hairs sprouting in the implanted area. I assume these are coming from where the originial grafts shed?
 
Its almost a month post op and I feel no pain and have all feeling back on my scalp. I pretty much wash and style my hair as usual.
 
Is all this normal progress after the surgery?
Thanks.A.

It is good that you had a nice vacation! 
 
One month after hair transplant surgery is the general time which you should have lost most of your transplanted hair shafts.  The follicles are now part of your scalp and will be growing new hair in 2-3 months.  Your inflammation should be subsided on both the transplanted and donor areas.  Minor itching might be noticed at this time which is a good sign of the scalp wound healing.  You may have lost or will soon lose some of the bulk of your existing hair due to the shock loss.  Using finasteride can significantly minimize it.  You will be noticing new hair growing in 2-3 months from now and the hair shafts will continue getting longer and thicker till about one year from the time of your hair transplant.

Q:

Permanent shock loss- in the front center mostly and also areas in the temples. Is it likely from your experience that hair like mine will survive?

A:

Although could be seen in some patients for the first few months after surgery, taking finasteride will minimize or, in most cases, eliminate that risk in the majority of patients.  However, if you do experience shock loss, it won’t be for more than 2-3 months and after that time, your transplanted hair will begin to re-grow. It is by then that your hair should look much better than it did before.

Q:

I am planning to have my hair transplantation with you soon and I have a few questions about the few days after hair transplantation.  I’ve been letting my hair grow so that I’ll be able to push it forward to cover the frontal work, but I’m concerned with how much swelling there might be, or if there’s a lot of shock loss, so that the hair I was going to use to conceal, fell out.
How many days is it again that the scabs usually persist? And how long would it be until I could get back into the gym or doing some other kind of exercise?

Also, I have been taking finasteride (1mg) and cutting the tablets into quarters. Is that correct? I haven’t kept up with the scalp massaging though. It was taking so long I was starting to wonder if was going to happen at all. But I could start doing that again now.

Thanks in advance, for your answers!

A:

These are great questions and I will be happy to answer them!

• Swelling
  Generally speaking, swelling after hair transplant surgery may occur 1-5 days following the procedure. It is usually moderate with certain exceptions which might be more noticeable and involve some area around the eyes as well. Not everyone experiences swelling, but I must always describe the worst case scenario: you may have an elevation (due to fluid) on your forehead which is alleviated by the medication we provide and elevating your head during the first few days after hair transplant.
• Bruising
  You may have some bruising or discoloration on the transplanted area, forehead, and occasionally around eyes which is even less likely, but necessary to mention. Wearing a baseball cap usually conceals your hair transplant for the following week. I’m sure your existing hair will do an adequate job as well (of course that is only for individuals who have some existing hair to cover the transplanted area).
• Shock loss
  The medication finasteride, or minoxidil in women, will help to lighten the shock loss (acceleration of the loss of native hair in balding area). Most of those shocked hairs usually go into a temporary resting phase and come back with your new transplanted hair.
• Scabbing
  The scabs are simply tiny crusts that dry up and flake off within a week.  They are hardly noticeable, and if you wear a cap no one can see anything.
• limitations in physical activities
  Exercise can be resumed two days following your surgery. Try to keep the blood pressure down (no squats, dead lifts, bent rows, etc) for the first four days after hair transplantation. If you can do some light machine work for a week, that would be best. Try to keep your head elevated/upright. You can do the treadmill or cycle, but just keep the intensity moderate. After 4 days post op, the grafts are pretty much locked in.

Rub your scalp before the hair transplantation. It helps! Your procedure size is rather small so scalp laxity will be a minor issue. However, do the scalp exercises! They are good for the delts also! And yes, you are correct in dividing the finasteride into 1/4′s!

Q:

What is the average hair loss after hair transplants? I.e. The number of grafts lost? I am sure that also relies heavily on techniques of hair transplantation.

A:

The survival of transplanted hair grafts should be over 95%.*

We do not expect to lose any grafts after hair restoration surgery.  There may be a 1-5% transection experienced with microscopic follicular unit transplants, but we have aimed to minimize this rate by enhancing the quality of our hair transplant techniques.

* According to some studies that were done on microscopic follicular unit transplant methods, 95-99% of newly transplanted grafts should take and hold.  We expect that the hairs should grow healthy hairs within a few months after hair transplant surgery.