Understanding Shedding After Hair Transplant

A hair transplant is a cosmetic surgery in which a person chooses to get more hair on the scalp to get rid of a balder look or to get more density in cases of diffuse pattern hair loss. In the post-operative phase, when he/she sees the shedding of hair, it leads to anxiety and may give a feeling of the failure of the procedure. So, some questions regarding shedding that come to mind are-

1. Is shedding after hair transplant a normal phenomenon? Will it affect the result of Hair Transplantation?

In the process of hair transplant surgery, when hair root is transferred from the donor to the recipient area, the blood supply to the hair follicle is cut off for some period, and this leads to an insult to the hair follicle after transplanting blood supply is regained, and hair follicle starts getting nutrition again. But due to that minor insult, the hair may shed in the first few weeks of the surgery, and the hair root will start regrowing again. There is no permanent loss of hair root; this is a physiological response of transplanted hair follicles.

2. Does all transplanted hair shed in the immediate post-operative phase?

The answer is Not necessarily. The shedding of transplanted hair will depend on

• Stage of the growth phase in which the hair follicle was.
• Type of Graft holding solution used.
• Time out of the body of the hair root.
• Implantation technique used.
• The amount of trauma they had tolerated during the surgery.

3. Is there any effect on the existing hair, too?

Not commonly, but sometimes existing hair may also fall in the first few months of the hair transplantation surgery. Doctors refer to this as “shock loss”. Though shedding the existing hair in males is uncommon, it is pretty possible in female hair transplantation. In males, if the hairs are in the miniaturized stage, then there are likely chances of fall. High-density hair transplants also cause insult to existing hair and may lead to shock loss.

Fortunately, this stage is temporary, and these hairs will start growing again after 3-4 months in both males and females. Due to the shock loss phenomenon after hair transplantation surgery, there will be visible thinning of the scalp in the initial months of the post-operative phase. This leads to very much distress to the patient. Counseling will play an essential role in this period. For hair transplants in females, shock loss shall be explained in detail before surgery.

It should be clear in the mind that this is a temporary phase, and all hair will grow within 4-6 months of shock loss.

4. Can we control shedding and shock loss after a hair transplant?

Yes, to some extent, shedding and shock loss can be controlled by quality control of hair transplantation at each step of the surgery. To begin with –

• Before selecting a patient for hair transplantation, correction of nutritional deficiency, medical treatment like minoxidil (both male and female) and finasteride (Male) will help to reduce shock loss.
• You should perform a proper assessment of the donor and recipient areas. If the donor and recipient areas show poor conditions, the medical treatment should be given for a minimum of 4 months before surgery. It will help to convert vellus hair to terminal hair, miniaturized thin hair to thick hair. This will reduce the chances of shedding.
• During hair transplant surgery, too much use of adrenaline in local anesthesia also precipitates shedding. So, use adrenaline in recommended doses only. Avoid the use of adrenaline in tumescence solution in females; it will help in reducing shock loss.
• Use of proper size of good quality punch in an experienced hand will reduce trauma to the hair follicle, and it will also contribute to reduced shedding.
• Time out of the body is the most important factor. Therefore, simultaneous implantation along with the excision helps a lot to decrease post-op shedding of hair follicles. Try to implant follicles within two hours of extraction.
• Trauma to hair follicles during implantation will again increase hair shedding. This can be explained by the fact that nowadays, using the “no-touch-to-root” technique and implanters reduces post-operative shedding.
• Graft holding solution also plays its role. We use Plasma as a graft-holding solution, and the split scalp study shows less post-operative effluvium on the plasma side as compared to the Normal saline side. The paper finds its publication in Hair Transplant Forum International.
• Using minoxidil solution 7-10 days after the surgery helps reduce shedding and shock loss. Combining it with other nutritional supplements is also beneficial.

Conclusion

To conclude, shedding after hair transplant is a normal phenomenon that can be controlled to a certain extent if pre, post, and intra-operative care is taken. Shedding can delay the result of hair transplantation to appear, but it usually does not affect the overall result of hair transplantation. If the patient and doctor can control it early, the result of hair transplantation brings happiness.

Shock loss in female hair transplantation can be controlled by taking care of dose of adrenaline and by giving pre and post-operative medical treatment and use of minoxidil.