Two Months after Hair Transplant and No Hair Growth

Q:

Hello Doctor,

I hope you are well.

Just a few notes on my progress (which I don’t see at this point). Please keep in mind I know I should be patient up to 4-6 months. However, I do not see any of the implanted hair, especially on my temples and frontal area. Basically, all of the transplanted hairs have disappeared without any trace. Maybe this is good as I don’t seem to have redness, bumps or any indication of HT. Maybe my healing or your excellent job???

I have also suffered tremendous shock loss in the crown area and the frontal corners after the hair transplant procedure. Even though I am taking the prescription medicine as instructed my crown has never been so bare. Before, I was able to cover it up, now I have succumbed to using Toppik in order to cover this area until the new hair hopefully grows in and covers it up again.

I was just hoping for your thoughts, although I think I know what you are going to say.

A:

You guessed right and my answer is what you expect. All individuals react differently and approximately 10% of the individuals never completely lose hair after receiving a hair transplant. Most individuals lose every transplanted hair and don’t see any hair growth at all before 3 months.

As it comes to shock loss, some individuals will lose their native hair which is prone to baldness 2-6 months after receiving a hair transplant procedure. What you are experiencing in your crown area can be the beginning of shock loss. At this point, you are losing some of your pre-existing hair and your transplanted hair has not yet grown.

You should start seeing early hair growth when you come in for your 6 month follow up appointment, and remember full results will be seen somewhere between 10-12 months after your hair transplant procedure.

Shock Loss: Losing Hair after a Hair Transplant

Q:

Hello Dr. Mohebi,

My hair is slowly getting back to normal after my hair transplant but I am afraid I have lost most of the grafts. In addition, I think I am suffering from some real shock loss. My hair is not looking too good, it seems like I have less hair in the crown and temple area than I did before the hair restoration surgery. I really liked my new look after the 2nd day of the surgery when I had hair in the temples and frontal hairline. I understand that it is now a waiting game after the surgery but I am not seeing little dots where the implants were made on my scalp. I am looking for the dots in order to to give me hope that the hair will grow out. I would really appreciate hearing your thoughts and letting me know if I am worrying about hair loss for no reason.

A:

The loss of hair after a hair transplant is quite common and it is referred to as “Shock Loss”. In general, we can see two types of shock loss after a hair transplant:

  1. Shock-Loss after transplantThe transplanted hair will normally fall out in over 90% of patients after a hair transplant surgery. Hair fall occurs because the transplanted hair follicles go into a resting phase until they start growing new hair within a few months.  This is the most common type of shock loss that people experience after hair transplantation. Of course, this type of shock loss is temporary and a complete recovery is expected.
  2. Patients who receive a hair transplant before completing their hair loss may experience an accelerated loss of their native hair. Native hairs, which are generally prone to shock loss, are the hairs on the scalp that are supposed to fall out within the next few months to years.  Any physical or mental stress can accelerate the rate of this hair loss.  For example, a hair transplant as well as the inflammation from the healing of the skin can trigger this type of shock loss. A good portion of these follicles will start to grow hair again after their resting phase (which may last a few months). This type of shock loss may also be reversible to some degree and an experienced doctor can give you more information.

– MA

Hair Loss on Donor Area after Hair Transplantation AKA “Shock Loss”

Q:

Dr. Mohebi,

I am a woman and I had female hair transplant surgery about a month ago.  After the surgery, I noticed a “thumb size” hair loss on one side of the treated area and it is located around the closed wound on the donor area.  The size of this hair loss area has doubled in size over the last few weeks.

I am starting to get a little bit worried. 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 many grafts or when the patient’s scalp is tighter than normal.  This condition is more common among women due to the overall higher strip width to head circumference ratio.

This phenomenon is a type of telogen effluvium and the hair loss might last a few months, but it usually resolves completely with no need to have any type of treatment.

I really appreciate your question as questions like this one often help other readers of this blog.

The FUE procedure seems to be less involved with the shock loss if it is done with the proper size punch that we use for FUE graft harvesting. The older punches used to cause bigger holes that were increasing the risk of shock loss in the harvested areas.

Take Care,

Parsa Mohebi, MD

Concerns Regarding Shock Loss After Hair Transplant

shock loss after hair transplant
Shock Loss after Hair Transplant Surgery

Q:

Hello Dr. Mohebi,

I had a hair transplant surgery in the past and I am now considering having an additional hair restoration surgery. After my previous surgery with another doctor, I experienced a good deal of shock loss on my scalp.

The fact that this happened makes me a bit skeptical about having another procedure but I know I need an additional surgery to maintain the image I have now.

I will admit that I am a little confused about the shock loss I suffered after my earlier surgery. Is this a normal occurrence or did something go wrong on my scalp? Did I not properly take care of the hair grafts during the post-op recovery period?

Basically, why is shock loss such a problem? I look forward to your answer.

 

A:

Thank you for the question.

Yes, shock loss is a common occurrence after a hair transplant is performed on a patient.

In general, shock loss is an accelerated amount of hair loss following any stressful event. The stress that is experienced by a person might be the result of either emotional or physical trauma. The performance of a Los Angles hair transplant procedure, or hair restoration performed elsewhere in the country, is no exception.

Shock loss after a hair transplant surgery was not an uncommon issue for patients in the past. However, with the advanced medical treatment that is available today, shock loss can be significantly reduced or even eliminated. Using prescription medication around the time of your hair transplant can inhibit or minimize the overall risk of shock loss. The ability to greatly reduce the chance of shock loss is why this treatment is currently being used by most hair transplant surgeons across the country.

At Parsa Mohebi Hair Restoration, most of our patients start the hair transplant process by following a prescribed medication plan that begins several days before their hair transplant surgery. It will be necessary for them to continue the prescription medication intake plan for around six to eight months after their procedure to help minimize the overall impact that shock loss has on their recovery period. The combination of prescribed medications and surgical hair restoration provides our patients with natural, permanent and proven results.

Thank you for your question. If you would like to discuss the possibility of an additional hair transplant in further detail, please contact our office today to schedule a consultation appointment.

– MA

 

Cold Feet Before Hair Transplantation Surgery

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 than the medication 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 prescription medication after your hair transplant for a few months to minimize the shock loss.

4.      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.

Two Weeks After Hair Transplantation – What to Expect

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 original 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. 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.