Shock loss broadly refers to the loss of hair in either the donor or recipient areas after surgery. Procedures such as follicular unit hair transplantation (FUT or FUE), hairline lowering (AKA scalp advancement), or indeed any significant surgery (especially those requiring general anesthesia) can cause this temporary shedding of hair. This condition occurs in a small subset of patients about 2 to 6 weeks after surgery and starts to resolve 3-6 months after the surgery (although full regrowth can take up to a year).
The areas potentially affected by shock hair loss can be in the area of the incision or into the area where the new hair grafts are placed. Shedding around any linear incision is usually about 1-2cm on either side or in a smaller patch. Shedding in the donor area after FUE is usually a broad patch or several patches of diffuse loss. Shedding in the area of transplanted grafts (i.e. recipient area) is also diffuse and typically not all the hairs are shed.
Generalized “whole head” shedding is more commonly associated with significant surgeries requiring general anesthesia and is less common with scalp surgery by itself.
Any of these “sheds” are likely caused by a combination of temporary blood supply disruption during surgery, local tissue inflammation, and the intrinsic “shed-rest-regrowth” cycle of the hair itself.
It is usually difficult to tease out which factor causes the most shedding in each individual patient’s situation, but not all patients experience this “shock loss,” so no definitive prevention or treatment exists, although many helpful options are available.
Is shock hair loss permanent?
Shock loss is a temporary condition, but it can cause a significant amount of psychological stress. Patients commonly relate their frustration with the paradox that they are attempting to add hair rather than lose hair! The good news is that shock loss is almost always temporary, although regrowth may take from several months to a year after surgery.
Why does shock hair loss happen with scalp surgery or FFS?
The exact reason why shock hair loss happens is not known but it is likely a result of a combination of factors including; surgical trauma to the scalp, injections during surgery, interruption of blood flow, and the natural tendency of hair to react to changes by going into the hair’s natural shedding and regrowth cycle. Regardless of the cause, it is a reasonable precaution to choose a surgeon who has significant experience..
How long will it take for my hair to grow back?
In nearly all cases of shock hair loss, the loss is temporary and will eventually start to grow back. Most patients report that there is always a lag in regrowth so hair may appear patchy at first. It may take 12-18 months to return to normal and get some length. Patience at this point of the recovery process is most important.
How can shock hair loss be prevented?
The mechanism of shock hair loss is not well understood and therefore it is difficult to predict and prevent. There is some data that both Rogaine (Minoxidil) and Finasteride started one month before surgery and continued for a year afterward can decrease shedding from shock loss as well as speed recovery and hair regrowth. Low Level Laser Therapy (LLLT), also known as Photobiomodulation, has benefits for healing and regrowth as well. Hair supplements like the HelpHair Shake and Help Hair vitamins have done limited studies on their own product which show earlier healing and hair regrowth after surgery. Anecdotal evidence supports all of these options as well.
Patients should ensure that their surgeon has plenty of skill and experience with scalp surgery to reduce the other factors that may contribute to shock hair loss. Before your surgery, ask to see case studies of surgeries like the one you are planning to do and make sure that they have appropriate board certification (like at www.abhrs.org).