What is Shock Hair Loss? Is it Permanent?
Hair loss after surgery often termed “shock loss”, is the loss of hair after surgery. Procedures such as follicular unit hair restoration, hairline lowering (AKA scalp advancement), or indeed any significant scalp surgery (especially those requiring general anesthesia) can cause this temporary shedding of hair. This condition occurs in about 10-15% of patients, typically within 2 to 6 weeks of surgery and significantly resolves 3-6 months after the surgery (although full regrowth can take up to a year).
The areas potentially affected by shock hair loss can be in the area of the incision – or in the case of direct hair restoration – in the area where the new hair grafts are placed. Shedding around the incision is usually limited to a band approximately an inch or less wide, on either side. Shedding in the area of restorated grafts is more diffuse and typically not all the hairs are shed.
Generalized “whole head” shedding is more commonly associated with significant surgeries requiring general anesthesia, and is less common with scalp surgery by itself. Any of these “sheds” are likely caused by a combination of temporary blood supply disruption during surgery, local tissue inflammation, and the intrinsic “shed-rest-regrowth” cycle of the hair itself.
It is usually difficult to tease out which factor causes the most shedding in each individual patient’s situation, but not all patients experience this “shock loss,” so no definitive prevention or treatment exists, although many helpful options are available.
Is shock hair loss permanent?
Shock loss is a temporary condition, but it can cause a significant amount of psychological stress. Patients commonly relate their frustration with the paradox that they are attempting to add hair rather than lose hair. Usually, scalp surgery patients are trying to remedy hair loss associated with aging, pattern hair loss conditions (aka androgenetic alopecia), or they may be undergoing the cluster of procedures that comprise facial feminization surgery. Thankfully, shock hair loss is almost always temporary and the hair eventually grows back, although regrowth may take from several months to a year after surgery.
A good basic understanding of shock hair loss can help to calm any stress or fear around this condition when considering hairline lowering–or other types of scalp surgery. Shock hair loss should not be confused with alopecia areata, which is an unrelated autoimmune disease that also results in hair loss and is medically treatable.
Why does shock hair loss happen with scalp surgery or FFS?
The exact reason why shock hair loss happens is not scientifically known but it is safe to deduce that it is a result of a combination of factors. With FFS surgery, the surgical trauma to the scalp, stress from the surgical incision, along with the pulling on the scalp and the injections that go along with surgery, are sufficient to trigger the hair’s natural shedding and regrowth cycle. Regardless of the cause, it is a reasonable precaution to choose a surgeon who has significant experience with scalp surgery and is adept at suturing the scalp in such a way as to reduce trauma.
How long will it take for my hair to grow back?
In nearly all cases of shock hair loss, the loss is temporary and will eventually start to grow back. Most patients report initial regrowth at between 3-6 months. There is always a lag as the hair re-enters the growth phase so regrowth may appear patchy at first (because the hair follicles often grow back at varying rates). It may take 12-18 months to mature into the previously normal hair thickness and texture, particularly if a patient is choosing to wear their hair long. Patience with the healing process is the key.
How can shock hair loss be prevented?
The mechanism of shock hair loss is not well understood and therefore it is difficult to predict and prevent. There is some data that both Rogaine (Minoxidil) and Finasteride started one month before surgery and continued for a year afterward can decrease shedding from shock loss as well as speed recovery and hair regrowth. Low-Level Laser Therapy (LLLT), also known as Photobiomodulation, has benefits for healing and regrowth as well.
Patients should ensure that your surgeon has plenty of skill and experience with scalp surgery to reduce the other factors that may contribute to shock hair loss. Before your surgery, ask your surgeon to show you case studies of surgeries they have performed. Be sure that the results obtained include data from within the 2 to 6-week postoperative window.
And most importantly, make sure that all candidate surgeons are board-certified.
Want to know more about hairline surgery? Read our popular article on hairlines and scalp surgery: Demystifying 3 Common Myths About Feminine Hairlines also by Dr. Sara Wasserbauer, a Surgical Hair Restoration Specialist.
Dr. Deschamps-Braly is a board-certified plastic and craniofacial surgeon specializing in facial plastic surgery, orthognathic (jaw) surgery, and craniofacial surgery for adults and children. He is also one of the world’s foremost leaders and innovators in facial gender confirmation surgery.