Anyone know what is Shock Loss?

[John P. Cole, MD]

shock loss does not always occur. it is a reaction to surgery that can occur in the recipient area and less commonly in the donor area. The only sure thing is that you will not be happy if you get shock loss. What causes it? Trauma can cause a temporary shedding of terminal hair making you appear thinner. You just have to wait it out. The hair will return. Another option in the recipient area is a sudden loss that is programmed to happen. This will not return. Shock loss begins 2 to 3 weeks after surgery. Loss after a month is progressive hair loss that is programmed. Shock loss is not as common with the addition of regenerative products such as good quality PRP or cytokine-rich plasma, but it can still occur. Limiting the density of grafts can help to eliminate shock loss, but some people seem super sensitive to surgery and still experience shock loss with low-density grafting.

[nhtco771]

shock loss does not always occur. it is a reaction to surgery that can occur in the recipient area and less commonly in the donor area. The only sure thing is that you will not be happy if you get shock loss. What causes it? Trauma can cause a temporary shedding of terminal hair making you appear thinner. You just have to wait it out. The hair will return. Another option in the recipient area is a sudden loss that is programmed to happen. This will not return. Shock loss begins 2 to 3 weeks after surgery. Loss after a month is progressive hair loss that is programmed. Shock loss is not as common with the addition of regenerative products such as good quality PRP or cytokine-rich plasma, but it can still occur. Limiting the density of grafts can help to eliminate shock loss, but some people seem super sensitive to surgery and still experience shock loss with low-density grafting.

Can low-density grafting really help to avoid shock loss? If it really helps then can you please explain how limiting the density of grafts can prevent shock loss?

[John P. Cole, MD]

High-density and low-density grafting have never been studied in relation to their effect on shock loss. It is rather an observation I've had over the years. In cases where I transplanted a higher density on occasion, I had significant shock loss. This is not to say that high-density grafting always produced shock loss. It didn't. Furthermore, on occasion, a lower density can produce shock loss. I have thought for years that some people are very sensitive to surgery and more likely to have shock loss. Thus, the answer is that shock loss is perhaps more likely with high-density grafting, but there is no way to avoid shock loss in some people.

I have seen far less shock loss in the past five years with the use of very high concentrations of growth factors from concentrated high-density PRP and more recently my sonicated cytokine-rich plasma. Yet, I still see some shock loss. Shock loss can also occur in the donor area.

I have been especially careful in women with hair loss because shock loss in this group is very difficult to accept. I can still remember a woman where I transplanted a high density. She had shock loss and it was devastating for her. I will never forget sitting with her and having her cry. I have always limited densities in women since this incident and fortunately, have never seen another severe case of shock loss in women.

The benefit of high-density grafting is that you have far more hair in four to five months. Usually, the risk of shock loss in my hands is low so I generally go for a higher density.

No one likes to see shock loss. Not the patient for sure, but the physician does not enjoy this scenario either. Shock loss is often a devastating thing.

[nhtco771]

High-density and low-density grafting have never been studied in relation to their effect on shock loss. It is rather an observation I've had over the years. In cases where I transplanted a higher density on occasion, I had significant shock loss. This is not to say that high-density grafting always produced shock loss. It didn't. Furthermore, on occasion, a lower density can produce shock loss. I have thought for years that some people are very sensitive to surgery and more likely to have shock loss. Thus, the answer is that shock loss is perhaps more likely with high-density grafting, but there is no way to avoid shock loss in some people.

I have seen far less shock loss in the past five years with the use of very high concentrations of growth factors from concentrated high-density PRP and more recently my sonicated cytokine-rich plasma. Yet, I still see some shock loss. Shock loss can also occur in the donor area.

I have been especially careful in women with hair loss because shock loss in this group is very difficult to accept. I can still remember a woman where I transplanted a high density. She had shock loss and it was devastating for her. I will never forget sitting with her and having her cry. I have always limited densities in women since this incident and fortunately, have never seen another severe case of shock loss in women.

The benefit of high-density grafting is that you have far more hair in four to five months. Usually, the risk of shock loss in my hands is low so I generally go for a higher density.

No one likes to see shock loss. Not the patient for sure, but the physician does not enjoy this scenario either. Shock loss is often a devastating thing.

Okay, so low-density grafting can lower the risk of shock loss. Thanks for adding such information to my knowledge.

[Raphael84hair]

Great write up Dr Cole. Thank you.

Patient Advisor for Bisanga & Cole Hair Transplant Clinic - Athens, Greece
http://www.bchairtransplant.com
bc2@bchairtransplant.com

[John P. Cole, MD]

Okay, so low-density grafting can lower the risk of shock loss. Thanks for adding such information to my knowledge.

it is theoretically possible that low density reduces shock loss. However, some are super sensitive. Suppose you drop a plate. It might break depending on how high you drop it. It also might break when you drop the plate from a low level, though less likely at a low height. The risk of breaking increases as you increase the height. The same is true for graft density and shock loss. A more dense packing increase the risk of shock loss, but a low density does not eliminate the risk of shock loss.

[narnia]

Hi Dr. Cole,

I'm a woman and I just had FUE via Neograft for 1500 grafts on crown area, and I'm experiencing shock loss. It started from week 2 and ended a little after week 3. It's devastating to see the balding spots and I wanted to ask you that from your experiences, how many (or %) of those experiencing shock loss eventually had their hairs grow back? (And how long did it take?) In my case it was the recipient area and the shock loss happened around the transplanted hairs. What can I do to help with the situation (since it's not falling out crazy like after week 2 I feel there's not much I can do)? Thank you.

[John P. Cole, MD]

Narnia, I am very sorry to hear about your situation. Isolated crown loss in females is not common. Typically, hair loss in females begins in the front behind the hairline and progresses backward while retaining the frontal hairline. Only later does the loss involve the crown area. I wonder if something else is going on in your case.

Neograft usually goes together with an assistant doing the entire surgery. Seldom does the physician get involved in the case. Most physicians, who use Neograft have no idea how to perform a transplant. Many are plastic surgeons, who consider this very complex surgery simplistic. In fact, a hair transplant surgery takes many more hours than any surgery these plastic surgeons perform.

The first thing to ask your surgeon is who did the surgery? If it was an assistant, I'd start by asking for a full refund.

Before I go further, it is important to answer your primary concern. Your hair should grow back over time in full. Shock loss is temporary. Progressive hair loss is not. Progressive hair loss tends to occur in waves like falling of one plateau and landing on another one that lasts for a period of time. Then you fall off that plateau and land with less hair again. This sort of hair loss does not return. Shock loss does return. Your history does suggest shock loss.

I learned something many years ago in females. Don't maximally pack grafts because this predisposes individuals to shock loss. Shock loss in females is devastating. It is bad in men. It is devastating in women.

What can you do? There is no data to suggest that you can do anything. We could try many things such as high-quality PRP or lysed platelets, amniotic membrane, fat stem cells, and exosomes. There is no data to support any of these in treating shock loss. You could try topical minoxidil or oral minoxidil. Again, no data to support this. I do think you will feel better doing something. I do know that high-quality products other than minoxidil do promote faster regrowth of grafts. You might do the same with shock loss and I'd expect this.

The real issue is hat your hair will regrow at a slow rate of 1/4 inch per month once it starts. It will not be until the hair is of a stylable length that you will see increased fullness. So, no matter what you need to wait it out.

The maximum graft count I shoot for in women is 1000 grafts. Above this, shock loss seems more common in women. I will say that I see much less shock loss pre-conditioning the scalp with high concentrations of growth factors from lysed platelets.

I would be very interested in trying some regenerative protocols on you to see if we can return you to a more normal state faster. Having said this, you should be ok in about one year from now without these protocols.

I'm sorry to hear what you have been through. I know this is traumatic for anyone, but especially for women.

Dr. Cole

[Braveheart]

Are you experiencing true shock loss or did your surgeon knock out your hairs via the neograft technique?