Today I will discuss shock loss in hair transplant procedures. Shock loss is the loss of native hair that can occur in hair transplant procedures. It varies greatly from one practitioner to another and from one individual to another. The exact etiology of shock loss is not know, but it is thought that it is related to a temporary injury or minimization of vascular perfusion to the scalp. Individuals with a large amount of miniaturized hairs are more susceptible to shock loss. This is because miniaturized hair is hair that has already shrunken and is in its last phase before it is lost forever. The act of the hair transplant may hasten the departure of this unhealthy hair that is destined to fall out in the near future regardless. Women can also more susceptible to shock loss than male patients. Patients with a large degree of transplanted hair are less susceptible to shock loss as it is thought that the transplanted hair is more durable and less susceptible to temporary vascular insufficiency.
In my hair transplant procedures I take certain precautions to minimize shock loss. By using smaller custom cut blades I am creating a smaller opening in the scalp and thus less injury to the vascular bed. I also use tumescence, which is the injection of saline into the scalp, which elevates the skin and expands it, thus widening the playing field for  transplanting, and it pushes the vascular bed lower, thus protecting it from the small incisions. In most patients I use a small amount of epinephrine in the tumescence fluid which helps to minimize bleeding throughout the procedure. In women and men with a large degree of miniaturization I withhold the epinephrine in an attempt to minimize shock loss in these individuals.
Shock loss is a part of hair transplant procedures. I always tell my patients to expect to look about 5-10% thinner for about 3 months after the procedure until the hair begins to grow in. The healthy hair lost as a result of shock loss will come back with the new transplanted hair, and the unhealthy miniaturized hair lost is on its way out regardless. With the proper precautions and techniques we can minimize shock loss in our hair transplant patients.
All the best,
Marc Dauer, M.D.