# Hair Transplants > Hair Transplant: Start Your Own Topic >  Reassurance about shock loss

## win200

I posted this in another thread, but that thread was on another topic, so I think it's worth starting a new one. The thread about my surgery can be found here:

http://www.baldtruthtalk.com/showthread.php?t=9370

I'd love a little reassurance re: shock loss, even though I know most of the info. I'm at 9 weeks now, and I'm definitely experiencing some shock loss. Before my HT I would find about 10-20 hairs on my hands between shampooing and conditioning, and now I'm at about 30-35 (sometimes as high as 50), although it varies a little every day. It's not freaking me out, but it does make me a little uncomfortable, and there's that nagging worry in the back of my head that, although I know native hairs typically regrow after exiting the resting phase, I'll somehow be the exception and end up worse off than before my HT. I'm a little reassured about the shower loss because my hair is pretty long and thick (see original pictures), so when I shed the normal ~100 hairs throughout the day, most don't leave my head and just stay trapped by the bulk (I also use a sticky molding paste). My hairline had been receding at the temples very, very slowly over the past few years (I'd say 3 millimeters tops since about '04). 

Anyway, I know that every says shock loss occurs within the first three months, but does that mean it usually stops in its tracks at three months, or that it should be tapering off around two month-ish? I.e., when does most of the shock loss typically occur within that window? And, most importantly, is there any risk that shock loss can make a person WORSE off than they were before surgery--i.e., that the surgery accelerates MPB even after the shock loss period ends? That's my worry now; I can handle loss that will grow back, but I'm concerned that I see a heightened level of shedding into the indefinite future.

As always, I really appreciate encouragement/comments/etc. You guys are great, and I'm thankful every day that I found this forum.

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## gillenator

It's more the number of hairs that still need to cycle through not as much as the time period that shockloss can take.  Some take longer than others but eventually it will subside as the hair passes from telogen to the growth phase.

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## Folly

Here's something a lot of people don't know, which happened to me after my FUE hair transplant. I appear to have many years of stability in terms of hair loss (i.e. normal shedding), but i then seem to have a period of mass shedding. What a lot of people don't realise is, if you are close to a mass shedding phase before your HT, the HT WILL trigger it. So after surgery you can experience mass shedding which isn't necessarily shock loss, it's just one of your extreme MPB shedding phases. I shed very aggressively straight after my HT, for over 9 months. I found out from a hair biopsy that 60% of the hairs on the top of my head were in shedding phase. So 60% of hairs on the top of my head in the shedding phase for 9 months equals a lot of hair loss. 

So under these circumstances, yes....you will end up worse after the HT. Unluckily for me, i also had poor growth from my procedure, which was a double kick in the nuts. Kind of makes me not want to ever have another HT.  :Frown:

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## win200

> Here's something a lot of people don't know, which happened to me after my FUE hair transplant. I appear to have many years of stability in terms of hair loss (i.e. normal shedding), but i then seem to have a period of mass shedding. What a lot of people don't realise is, if you are close to a mass shedding phase before your HT, the HT WILL trigger it. So after surgery you can experience mass shedding which isn't necessarily shock loss, it's just one of your extreme MPB shedding phases. I shed very aggressively straight after my HT, for over 9 months. I found out from a hair biopsy that 60% of the hairs on the top of my head were in shedding phase. So 60% of hairs on the top of my head in the shedding phase for 9 months equals a lot of hair loss. 
> 
> So under these circumstances, yes....you will end up worse after the HT. Unluckily for me, i also had poor growth from my procedure, which was a double kick in the nuts. Kind of makes me not want to ever have another HT.


 Yikes! That's obviously worrisome. I've always been told just to ride out shock loss, and that it will recover. I've been a very, very slow receder since as long as I can remember, and I've never had (to my knowledge) a heavy shedding phase. My shock loss so far isn't horrible, but there's definitely more scalp visible in the forelock that wasn't before, and the recipient area (the hairline) just looks scragglier and messier (partly because it's still a little red from the procedure). 

Can anyone else chime in on this? Anyone else experience an uptick in non-shock loss shedding due to a HT?

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## Tracy C

> Yikes! That's obviously worrisome. I've always been told just to ride out shock loss, and that it will recover.


 Shock loss usually does recover.  I went through a terrible bout of shock loss after my second procedure.  It was so bad I could see my hair blowing away in the wind as I was driving with my car windows open.  It took almost the whole year for my shock loss to recover.  As far as I can tell, it has mostly recovered but not completely.  Next months will be the two year anniversary of my second procedure.

The circumstances of your HT can have an effect on whether you experience shock loss or not.  In my first procedure the doctor was mostly filling in bare areas and I did not have any noticeable shock loss. My second procedure was mostly to build up density.  That is when I experienced shock loss.

Also, I am a natural red head.  I do believe at this time that natural red heads are a bit more susceptible to shock loss than others.

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## win200

> Shock loss usually does recover.  I went through a terrible bout of shock loss after my second procedure.  It was so bad I could see my hair blowing away in the wind as I was driving with my car windows open.  It took almost the whole year for my shock loss to recover.  As far as I can tell, it has mostly recovered but not completely.  Next months will be the two year anniversary of my second procedure.
> 
> The circumstances of your HT can have an effect on whether you experience shock loss or not.  In my first procedure the doctor was mostly filling in bare areas and I did not have any noticeable shock loss. My second procedure was mostly to build up density.  That is when I experienced shock loss.
> 
> Also, I am a natural red head.  I do believe at this time that natural red heads are a bit more susceptible to shock loss than others.


 Thanks, Tracy. My procedure was advancing my hairline forward (I was a NW2.5-3), and the doctor blended grafts back into the hairline a bit. I'm not sure anyone else would notice my loss, but I can definitely see thinness in the forelock that wasn't there before, and it's disconcerting. I had a relatively "hard" hairline before the surgery, and it's softer now; hopefully that resolves. Of course, I was also in the profile with the highest risk for shock loss (or so I've read): under 30 with active recession. I've receded very, very slowly, but I've had miniaturized hairs at my hairline for years and years now. I'd hate to permanently lose the density in my forelock in the course of getting a procedure.

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## win200

Thought I'd add a couple of pictures; these were just taken. The problem is that I didn't take "before" pictures without my hair pulled back and flattened, so it's not a _great_ comparison; the old pictures don't really give a sense of the density behind the hairline at the forelock. In the current ones, I tried to capture some of the exposed scalp at the front, which to my eyes wasn't there before.

Any thoughts? Should this be considered minor shock loss?

The pics labeled "Shock Loss" are the new ones, and "WMartin2" and "WMartin3" are the day before the procedure.

Thanks!

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## gillenator

Every HT patient will experience some level of shockloss post-op.

Some more than others, and there are variances and variables as to how much of it grows back.

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## Tracy C

> Any thoughts? Should this be considered minor shock loss?


 If this is shock loss at all, I certainly wish my shock loss was like yours.

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## win200

> If this is shock loss at all, I certainly wish my shock loss was like yours.


 Thanks for the encouragement, Tracy. And I'm very sad that you had such a nasty bout with shock loss--after all the time you spend sharing your knowledge here, you deserve as full a head of hair as anyone.

It was difficult to capture in the photo, but there's definitely a good deal more thinness in the forelock than pre-op. I usually styled my hair up, but now I feel self-conscious doing that, because scalp is visible in the front. That worries me, although if I have to endure it for half a year it isn't a big deal. 

The thing most worrisome to me right now is that I'm at week 10 and still apparently experiencing increased shedding. From what I understand, shock loss usually subsides before then. I'm nervous about what another commenter said--that surgery induced a massive, prolonged shed and he was left worse off than he started.

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## win200

I've posted about my procedure before, but I wanted to update and get everyone's thoughts.

I had 1,450 grafts placed into my hairline on June 20. I was probably a NW2. Almost immediately after the procedure, I started to shed heavily. This didn't bother me, because I simply attributed it to shock loss. Some very visible thinness in my forelock resulted. My doctor looked at it and told me it was shock loss, and would recover.

Even as the three-month shock loss window closed, though, the heavy shedding persisted. I'm at 19 weeks now, and shed constantly, and at a higher rate than I ever did before the procedure. ~40 hairs in the shower, ~10 on the pillow, etc. Worse, while I had been a receder before the surgery, my hair is thinning out all throughout the top of my head. At this point, the forelock has an extremely ragged edge and is very thin throughout; that ragged edge gives my hairline the look like it's disintegrating. I'm terrified that the hairline is going to continue to pull back from behind the transplant, leaving me almost immediately with a gap. To make matters worse, the transplanted area looks really, really thin--not even a remote approximation of natural density. I know, though, that 4.5 months is still early.

I started on Propecia on September 30, Nizoral shortly thereafter, and Rogaine around October 10. I have no idea if I'm seeing shedding due to them, because the shedding was high even before that.

If anyone has heard of this before or has any insight, I'd be grateful. I'm generally pessimistic that any of this will recover, and I'd say there's virtually no chance that I'll look as good as I did before the procedure when I hit the one-year mark. I have a better hairline location, but the hair behind it is now thin and wispy. I usually have a pretty good equilibrium about these things, but I'm starting to freak out. At 4.5 months, this should _not_ be happening.

I'm at work, so I don't have pics. I'll upload tonight, though. Earlier pics are included in the threads below.

Thanks, all.

http://www.baldtruthtalk.com/showthread.php?t=9370

http://www.baldtruthtalk.com/showthr...ghlight=win200

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## gillenator

win200,

Your situation is not new with the continues shedding.  Although you may have started the shed before the transplant, I would have recommende to wait on your procedure until the shedding subsided.

Introducing finasteride, minoxidil, and Nioxin post-op can and may have induced the level of shedding in your case.

These meds and scalp invigorators can cause the hair follicles both exisitng and the transplanted ones to cycle to the resting phase (telogen) causing further and prolonged shedding.  As in your own situation, I have observed it countless times when HT patients begin these products almost immediately post-op.  

And even then, starting all three so early post-op may even potentially hold these follicles in the resting phase longer than desired.  Only time will tell.  If your regrowth and/or yield is negatively inpacted, wait it out.  Give your follicles a chance to resume normal cycling before starting these  In other words, allow your procedure to first regrow and mature.  That's my opinion for whatever it's worth.  Have you contacted your doctor?

I always advocate starting finasteride and/or minoxidil one year before any procedures.  And although many HT docs will want their patients to pull off minoxidil before surgery, your body and scalp is already acclamated to the meds and IMHO, can greatly reduce the likelyhood of starting a shed post-op.

It is still very early to make any final conclusions.  If it were me, I would talk to my doctor first.  The doctor may not want you to momentarily stop finasteride however the Nioxin and minoxidil can wait IMHO.

Best wishes to you!   :Wink:

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## win200

> win200,
> 
> Your situation is not new with the continues shedding.  Although you may have started the shed before the transplant, I would have recommende to wait on your procedure until the shedding subsided.
> 
> Introducing finasteride, minoxidil, and Nioxin post-op can and may have induced the level of shedding in your case.
> 
> These meds and scalp invigorators can cause the hair follicles both exisitng and the transplanted ones to cycle to the resting phase (telogen) causing further and prolonged shedding.  As in your own situation, I have observed it countless times when HT patients begin these products almost immediately post-op.  
> 
> And even then, starting all three so early post-op may even potentially hold these follicles in the resting phase longer than desired.  Only time will tell.  If your regrowth and/or yield is negatively inpacted, wait it out.  Give your follicles a chance to resume normal cycling before starting these  In other words, allow your procedure to first regrow and mature.  That's my opinion for whatever it's worth.  Have you contacted your doctor?
> ...


 Thanks a lot! My doc encouraged me to start minoxidil after the procedure, and I started Nizoral on my own, although I'm thinking of dropping it. I'm just very frustrated that my doctor didn't even mention trying to stabilize the loss before doing surgery. I mean, I was 29 and active receding; that's a risky situation.  

And the post-surgery loss definitely wasn't entirely due to the meds, because I didn't start fin until 3 months after the surgery, and I started it specifically to try to stop the shedding. Ugh. I don't mind the shedding now if it recovers, but if this is PERMANENT loss, then I'm going to wind up significantly worse off than before I started the procedure.

Do you think minoxidil/Nizoral would cause any permanent shedding, or just push things into a resting stage at a higher rate? And do you think dropping minoxidil after three weeks would do any damage?

If the meds aren't going to cause any shedding that won't grow back, then I'm fine with enduring them. I'm just worried about what I could look like in a year if this doesn't go well...    :Frown:

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## gillenator

win,

No I do not think the meds or Nizoral will cause any permanent shedding but you may want to consider waiting until your regrowth takes place.  In other words, I am more of the opinion to allow time and the patients' own healing and regrowth to occur naturally.

The initial starting of hairloss drugs like finasteride and minoxidil can induce a shed and so can stopping them.  I advocate pulling off of the meds over a short period of time by weening off of them rather than starting/stopping them immediately.

A dramatic or immediate change is what can send mixed signals to the hair follicles and cause them to retreat into the resting phase and then shed.  IMHO, introducing too many products at the same time can also cause the follicles to retreat into telogen.

I have observed countless guys go through this experience post-op and even though you waited three months before starting finasteride, that potentially could be the culprit behind the prolonged shedding.  Just a thought.

Still, I think you're going to be just fine by again allowing time to take its natural course.

Best wishes to you my friend!

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## drybone

Ok guys I need some help here. 

I am 7 months into my first procedure. I only did 1300 to rebuild the hairline but the density is not where I want it. 

I have been on fin for 4 months and I think I have finally noticed the difference. 

I am ready to go get 2500 more grafts to 'dense pack' the area that I did my first procedure and behind it a bit. I am scared of the 'shock loss' I may encounter. 

What is your guy's take on 'shock loss' when trying to dense pack in between the hairs ? 

 :Confused:  I am quite nervous and could use some advice.

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## gillenator

drybone,

A couple of things.  Some doctors are of the opinion that being on finasteride and experiencing stabilization will also help in lowering shockloss levels.  There is not clinical proof of this to my knowledge, but may have some degree of validity.

Be sure that the surgeon doing the dense packing is experienced with it and has proven results regarding the yield and overall result.

Many surgeons will want to shave down the recipient area when there is a fair amount of native hair existing within the proposed recipient area.  The recipient incisions must be done acutely in order to avoid and minimize transection of the existing hair.  It is then critical to follow the natural direction and angulation of the existing hair and why some surgeons want to first reduce the length of the hair shafts when working between them.

Probably many of your grafts from the first procedure were singles if that much hairline work was done.  Chances are there will be more multiple hair bearing grafts used in the next procedure thereby providing more coverage and visual gain.

Best wishes to you in planning your next procedure drybone!  :Smile:

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## Squidgy

I had a ht 4 months ago to cover my front temples since then I have noticed heavy shock loss and the front of my head where healthy hairs have now gone and I'm 4 months in with no signs of new hairs growing I am only 22 and really scared that this will be permanent can anyone help me out thankyou.

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## Louish

There is nothing to be done, most likely the unethical surgeon that operated on a 22 years old is an incompetent as well...

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## Squidgy

So will none of the hair I have lost come back ??

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## Louish

Maybe none, maybe all of it will come back, only time will tell.

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## Squidgy

This is ruining my life :Frown:  thanks for the replies though

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