Good question. What causes shock loss? Is it the density of the grafts placed, the density of the incision sites, indvidual characteristics, or free radicals? No one really knows. i've always felt that density played a role. If you make more incision sites, shock loss is more possible. Then again, if you place a higher density of grafts that have been sitting in an an anaerobic environment for a longer period of time, then you have more free radicals in a small space. One thing i've noted over time with FUE is that my same high densities produce a lower rate of shock loss. Never the less, shock loss still rarely occurs in some patients. Still it is not as common.
Therefore, my conclusion would be that because my grafts with FUE are left out of body for less time, this is the reason my FUE grafts rarely produce shock loss. My FUE grafts have less time to build up free radicals due to anerobic metabolism. They sit in a controlled cool environment because i invented a stable cold storage for my grafts. My grafts sit in a cold storage medium with free radicals. My grafts consume only 6% of the energy they require at room temperature. I bath my grafts in a liposomal ATP solution that costs me $1.34 per cc (there are 5cc in a tsp). The ATP provides energy to the cells outside the body. Maybe the low temp, free radical scavengers, minimal incision site diameter, and the ATP play a role. one thing i can say is that shock loss has become uncommon in my clinic. It might occur, but i can't recall the last time.