Q: I have heard that shock loss can occur after a hair transplant. Do women experience less shock loss than men? — N.R. ~ Mineola, N.Y.
A: Actually, the risk of shock hair loss is usually greater in women than in men since women generally have a more diffuse pattern of thinning. This is because females often have more miniaturized hair, the hair that is most subject to post-op shedding.
Posted byQ: I had an FUE hair transplant three weeks ago and some of my existing non-transplanted hair has fallen out. I was a Norwood 3V, but now I look more like a 4 or 5 without the hair that used to help cover up my thinning area. Am I destined to look balder for the next few months? When can I expect to look like before? — T.M., New Haven, CT
A: You are describing shedding that is pretty typical following a hair transplant. The hair which is shed generally grows back together with the transplanted hair beginning at about three months. You should expect hair that is shaved for the FUE procedure to grow back right away at the normal rate of 1/2mm per day.
The shedding (also called shock hair loss) doesn’t mean permanent damage to the hair follicles. What it refers to is a physiological, or normal, response to trauma to the scalp which is caused by the hair restoration procedure. In general, only miniaturized hair (the hair that is affected by androgens and that has begun to decrease in diameter) is shed after a transplant. This hair would be lost in the near term anyway. Existing healthy hair is unlikely to shed, but if it were to shed, you could expect it to grow back as the transplanted hair grows in.
Posted byQ: I have seen through forums that a hair transplant gives severe shock loss in the donor zone (especially behind ears) after the surgery. Doctors say it is temporary and can last about six months or more. Frankly, do you believe in this? Will the donor shocked hair recover? — M.D., Darien, C.T.
A: It depends if you are speaking about follicular unit hair transplantation using strip harvesting (FUT) or Follicular Unit Extraction (FUE). With FUT, it is extremely uncommon to have any shock hair loss in the donor area. This could occur if the hair transplant procedure was done improperly, i.e. the donor area was closed too tightly. In this case, some hair loss may be permanent. This is one of the reasons that very large hair transplant sessions are unwise. Shock hair loss in FUE is more common, but is generally not significant and should eventually recover completely.
That said, some shock hair loss in the recipient area is quite common with either hair restoration procedure (FUT or FUE). This is particularly the case if there is a lot of existing miniaturized hair (hair that is starting to thin) in the transplanted area.
Posted byQ: I have been reading various articles and forum postings and it would seem that a person utilizing Propecia might experience increased “shedding” of hairs (outside of the normal hair cycle) around the 12 week mark after a hair transplant and lasting around 2-4 weeks. The forum postings suggest that one will not only see the miniaturized hairs being lost, but also normal terminal hair in greater than expected levels. Does an explanation exist to explain this increase in shedding hairs? — B.T., Manhattan, NY
A: Our understanding is that finasteride only affects miniaturized hairs — i.e. hair affected by DHT — and that this is all that should be shed. Remember, however, that much of the thinning a bald person experiences is due to thousands of partially miniaturized hair, and these can look very much like a full terminal hair in its early stages.
See our page on Shedding After A Hair Transplant.
Posted byQ: What does the hair transplantation process do to your existing hair? — R.V., London, UK
A: When we perform hair transplant surgery, we transplant into an area that is either bald or has some existing hair. The hair that is existing is undergoing a process called miniaturization. What this means is that the hairs are continuing to decrease in size – both in diameter and in length. When we perform a hair transplant, we don’t transplant around the existing miniaturized hair on your scalp, we transplant through it. And the reason why we do that is because the miniaturized hair, the fine hair that is being affected by DHT, is eventually going to disappear, so you don’t want there to be any gaps.
So the question is, does the hair transplant actually destroy the existing hair? The answer is that it doesn’t destroy, but it can “shock” it. In other words, creating recipient sites (that the grafts are placed into) will temporarily alter the local circulation of the scalp and this can cause some of the hair in the area to be shed. The reason why hair may be shed is that hair is naturally cyclical. In other words, hair is normally growing, shedding, and then regrowing again. When you stress the scalp, the growing hair may be shed prematurely, but then it regrows.
If you think about the process of electrolysis, it makes sense that you don’t damage follicles from making recipient sites during a hair transplant procedure. In electrolysis used to treat unwanted hair, you stick a needle in the follicle, and you turn on an electric current. And you burn it. And then what happens to the hair? It usually comes back and you need to do it a few more times, even though we are applying an electric current via a needle placed directly in the follicle. So it makes sense that by just inserting a fine needle – the tool commonly used to make a hair transplant site – into the skin, one would not destroy hair follicles. However, the cumulative effect of making hundreds or thousands of recipient sites does shock the follicles and, as a result, some may shed their hair.
It can occur with general anesthesia – when the scalp is not even touched – and it can occur with oral medications, from pregnancy, or after psychological stress. So if you have hair restoration surgery and there is shedding, and it takes six months to a year for the transplanted hair to grow in, during this time hair transplant patient will experience some thinning. Since miniaturized hair is going to eventually disappear anyway, some of the miniaturized hair that is shed may not return. But if it is healthy hair, and it is shed, it will grow back. And, of course, the transplanted hair will be growing in as well during this time.
I am often asked to describe how much can be expected to be shed. The answer is that it is an amount that is often noticeable by the patient, but not noticeable by anyone else.
Posted byQ: I am about 3 months post-op after my hair restoration procedure. I have noticed some hair shedding in the frontal part of my scalp. I have continued both Propecia and Minoxidil. Is there anything I can do and should I be concerned? — M.B., Chicago, IL
A: Shedding of some of the patient’s existing hair in, and around, the area of a hair transplant is a relatively common occurrence after a hair transplant and should not be a cause of concern. The mechanism appears to be a normal response of the body to the stress of the hair restoration surgery -– i.e., site creation, adrenaline in the anesthetic etc. Some doctors claim that their hair transplant techniques are so “impeccable” that their patients do not experience shedding. This is a false claim. Although using very small recipient sites and limiting the use of epinephrine may mitigate shedding somewhat, shedding is a normal part of the hair transplant process and the risk is unavoidable.
It appears that a person’s normal, non-miniaturized hair, as well as transplanted hair, is somewhat less subject to shedding than hair that is actively miniaturizing (thinning from the effects of DHT). In addition, if transplanted hair or non-miniaturized hair is shed, it will grow back. If miniaturized hair is lost, however, it may or may not return.
Since both finasteride and minoxidil reverse the miniaturization process, they should decrease the amount of hair at risk from shedding after hair transplant surgery. This has been our clinical experience, but it is important to note that as yet there have been no scientific studies to support this view.
At this time there is not much you can do except to be patient and wait for the newly transplanted hair to grow in and for the shed hair to return. Of course, make sure you continue to take finasteride and/or minoxidil if the doctor has prescribed it for you.
Read more on the topic of Shedding After a Hair Transplant.
Posted byQ: After my hair transplant procedure I had some shock loss, and then after about 4 1/2 to 7 months I had tremendous growth — really thick. I was amazed actually. Now, at 8 months it has thinned again, quite a lot compared to the growth I had before. I just wondered if this was a normal growth pattern and whether further growth could be expected? — N.T., Brooklyn, NY
A: This is not the most common situation, but should not be a cause for concern. The newly transplanted hairs are initially synchronous when they first grow in — i.e. they tend to all grow in around the same time (with some variability). This is in contrast to normal hair, where every hair is on its own independent cycle. Sometimes the newly transplanted hair will shed at one time before the cycles of each hair become more varied asynchronous.
For continued discussion of this topic, visit our page on hair growth and the growth cycle. Or read posts in the topic of Growth after a Hair Transplant.
Posted byQ: Hi! I wanted to ask if after hair restoration surgery the transplanted hair will eventually fall out? Because the surgery is to restore hair mainly for people with genetic hair loss which results from DHT, won’t the DHT make the new follicles implanted fall out as well? — B.C., Stamford, C.T.
A: Hair loss is due to the action of DHT (a byproduct of testosterone) on hair follicles that cause them to shrink and eventually disappear (the process is called miniaturization). The follicles on the back and sides of the scalp are not sensitive to DHT and therefore don’t bald (miniaturize).
When you transplant hair from the back and sides to the bald area on the front or top of the scalp the hair follicles maintain their original characteristics (their resistance to DHT) and therefore they will continue to grow.
Posted byQ: My first hair transplant was a breeze. Will a second procedure be any different than the first? — B.B., Murray Hill, N.Y.
A: Generally in a second procedure, a patient can expect less swelling post-up although the reason for this is not known.
There will also generally be less shedding in the second hair transplant session since the weak miniaturized hair that will be shed is often lost in the first session and the previously transplanted hair is generally more resistant to shedding.
In a second session we generally, but not always, transplant fewer numbers of grafts.
If the old scar in incorporated into the new incision, then there will be slightly less hairs per graft since the density in and around the scar will be slightly altered.
For those who are bald, the second hair restoration is sometimes less dramatic than the first since the second is used for fine tuning rather than taking the person from completely bald to having hair.
Posted byQ: I had my first hair transplant of 1100 grafts five months ago. The hair has been growing in well and I am very satisfied with the progress, but the new growth appears to occur in different cycles. Some of the hair never fell out and started growing within weeks. At around three months, a lot more started to grow, and now there seems to be even more growth of new hair coming in its finer stages. Is it normal for transplanted hair to begin growing at different times? Why does some hair come in looking thick and other hair start off finer and then gradually thicken up? — E.R., Bushwick, N.Y.
A: You are describing accurately how hair grows after a hair transplant. After the hair restoration procedure, the transplanted stubble is shed and the hair goes into a dormant phase. Several months later, growth begins as fine, vellus hair that thickens over time. The hair usually does not have its original thickness right away.
Typically, growth occurs in waves so that initially some areas will have more hair than others. Over the course of a year the cycles will even out and the hair will thicken to its final diameter.
Posted byQ: Will the shock of a hair transplant make me lose my existing healthy hair and is it permanent? G.S. – Westport, C.T.
A: In general, only miniaturized hair (the hair that is affected by androgens and that has begun to decrease in diameter) is shed after a transplant. This hair would be lost in the near term anyway.
Existing healthy hair is unlikely to shed, but if it were shed, you could expect it to grow back.
Posted byQ: I had a hair transplant two weeks ago and I just started noticing that some grafts were in my baseball cap at the end of the day. Am I losing the transplant and what can I do to keep this from happening? – Weston, C.T.
A: The follicles are firmly fixed in the scalp 10 days following the hair transplant. Hair is shed from the follicle beginning the second week after the procedure. This is perfectly normal and does not represent any loss of grafts.
What you are seeing is the root sheath that is shed along with the hair shaft. This looks like a little bulb, but is not the growth part of the follicle and should not be a cause for concern.
Two weeks following the hair transplant you may shower and shampoo your scalp as you normally did before the procedure without any risk of losing grafts.
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