Reassurance about shock loss

[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

[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!

[win200]

Originally Posted by 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!

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...

[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!