We have all heard about shock loss in existing hair after a HT procedure. Some patients don't have any, yet some seem to have quite a lot. Does the chance (and degree) of shock loss increase with the number of grafts, or is it more dependent on the individual? Could any doctors comment on this?

Gary,
Unfortunately, there have been no really good studies of "shocking" to hair during hair transplantation. The best we can do is to pool our collective experiences of when this happened and look at the particulars of those patients and sessions. Obviously, "shocking" only occurs in patients who have some remaining hair on top, which in most of our practices is the majority of our patients. If that remaining hair is very "weak" and vellous (thin, wispy, and limited in how long it will grow to), then it is far more vulnerable to this occurring than if it is relatively strong hair with good caliber and length. I would say that "shock" to the degree that either the patient or I notice it, occurs in less than 10% of cases in which there is pre-existing hair on the patient's head. Remember that about 50% of hair has to be missing before it is fairly easy to notice that things have become thinner. Because of this, it is my gut feeling that some small degree of shocking probably occurs in every transplant (unless the patient is shiny bald), but it is neither noticed by the doctor nor by the patient. The hair then starts growing back three months later.
Factors during surgery, I believe, play a very important role. If the surgeon packs the grafts extremely close together, there is obviously more chance of direct trauma to the follicles of those remaining hairs, and such dense packing also increases the chance of blood supply embarassment to those remaining hairs, which most of us feels is the main cause. Using too high a concentration of epinephrine (Adrenaline) in our local anesthetic solutions and saline tumescent fluids can also play a role in transiently depriving some of those hair follicles of their full blood supply during surgery. Cigarette smoking has also been mentioned as a risk factor for shock, although I haven't noticed a relationship in my practice.
Most hair surgeons I have spoken to relate that "shock" is much more common in their female patients than in their male ones. The reasons for this aren't entirely clear, although usually the women that seek our services already have vellous hairs on top of their heads.
Severe "shock" with major dropout of a large amount of hair that was dramatically obvious has only occurred in my practice four times, in three men and one women.The only single factor that was present in all four was that they had all had at least two previous hair transplant procedures, and in all four instances, all of the hair that fell out, plus the new transplanted hair, all grew out later and was much fuller than before surgery. Since the last time this occurred two years ago, in my practice I have further reduced my concentration of epinephrine in our saline solutions and haven't noticed it since then. I hope that helps answer your question.

...what about shock loss along the donor scar? have any patients or doctors seen much shock loss along either side of the the donor strip removal scar? if so, does it usually grow back in?

Recently had transplants about 3 months ago. Didnt experience any shock loss at all in the donor area.

Transplantation was done in the temple areas. I personally was surprised at the amount of shock loss I experienced. On the top-sides (temples), where my hairline was busy receeding, I lost the entire area of which I could see was just starting to disappear which was about 1/2 an inch. In addition, it caused some transparancy in the very front which really had me in a panic!

The shock loss in the temples never recovered, but I personally think this is understandable since my hair was receeding there anyway. No surprise there. The grafts have not begun to grow yet but I have gotten used to the look.

I did recover nicely where I was getting transparancy in the front...it is barely noticable now and I'd say Ive grown about 98% of it back, which is a relief. Looks like I did before the procedure.

Hope this information helps someone. Definately expect shock loss. You have to toss up the risk of getting the transplants started early and experiencing shock vs. waiting till you are bald to start treatment. You have to take a step backward before you can go forward.

nw3

I had about 1100 grafts done BTW.

nw3

Shock loss can occur along the donor area incision, and seems to be more common when the person has had multiple procedures in the past. Most of the time, this hair seems to grow back in 4-6 months, but it can be a permanent loss. We seem to see it less now than in the days when we took bigger strips out, so it is likely related to the degree of tension in the closure.

Dr. McLellan,

You are suggesting that the donor strip size is the key factor in shock loss?

Dr. Bernstein said on thebaldtruth.com that it came from the making of recipient sites and the amount of epinephrine used.

It is very hard to make up one's mind when doctors within the same practice haven't made up theirs!

Seriously, it's time for good clinical studies. No one should be forced to take one step back to go two steps forward. Anecdotal evidence is really not enough for patients on a big issue like this. Clinical studies would be usedul, that is, unless you feel comfortable having the study commissioned by Merck to MHR of all places be the prevailing sentiment when it comes out.

-?er

I've had shock loss in the donor area twice. First time was on my 3rd procedure (1,200 first, 1,500 second, 1,800 third). I lost all the hair in a 3/4 inch by 2 inch strip surrounding a section of the donor incision behind my left ear. That never grew back, so after a year I had a scalp reduction procedure that reduced the bald spot by 50%. 5 weeks ago I had 102 grafts done to fill the remaining bald area, and an additional 180 grafts on my crown. Now, I have shock loss from the recent procedure, about 1/2" by 3" above my right ear. It does not seem as severe as the first time. I can feel some fine hair still growing, and I am hoping it is temporary. Psychologically, it sucks. This is my first post & visit to your site, and it helps to read about other guys who've gone through this.

Dear TomD,
I see that I commented over 6 years ago on this thread - so I might as well help finish it up.
Its pretty much a given among hair transplant doctors that, whenever shocking happens in the donor area above and below the donor scar, it is virtually ALWAYS the result of too much tension in the closure of the wound. It is one of the important reasons for a surgeon not to take too wide of a donor strip for a given patient. Each patient is different. Some patients can easily have a 1.5cm wide strip taken and for another, 1 cm might be too much. The scalp is clinically evaluated by the surgeon before each procedure. Needless to say, when you go to a second or third strip harvest, the width you can take becomes less than with the first session. The most precarious stretch of the strip is that portion where the rear parietal corner is turned in back, somewhat behind the ears and above the mastoid bone area. Many of us narrow the strip here, in order to avoid problems with wide scars or telogen hair loss.
Incidentally, Dr. David Seager, who passed away a year or so ago, was the one that taught all of us that, if for any reason you do find yourself in a situation where you can't bring the two edges of the wound together, it is far better to place the suture as usual but leave a gap between the two edges, and over time it will granulate and heal in fine. This is far preferable to "yanking" the two sides together with brute strength.
One other event in surgery that theoretically could make a sloughing of hair loss along the donor scar would be cutting some of the arteries that feed the scalp, either in a prior surgery or in the current one.
The wonderful thing about the donor area scalp is that, after you let 10 months or so go by, the scalp almost returns to the same laxity it had before the previous surgery. Having the patient do scalp stretching exercises(pushing and pulling the scalp together and apart in an up-and-down plane direction) can help a lot also.
Mike Beehner,M.D.

Dr. Beehner,

Thanks a lot for the information. It's more than my surgeon gave me.

TomD

Is donar shockloss permanent?

Man! if indeed donor shockloss is permanent then whats the point of doing a transplant? The same hair when transplanted would fall off eventually!

My sense is that in the majority of cases of donor shock loss, the hair mostly returns. I have had this happen three times in my career, none within the past 8 years, as I have gotten smarter with age, I hope. In all three cases the hair grew back and there did not appear to be any permanent loss. I have personally seen four cases of extensive permanent loss above and below the donor scar in work done at other clinics, and have heard of many others that colleagues of mine have seen come to them for repair.
One thing I have learned over the years is that, if at least one attempt has already been made by anybody to try and cut out the bare area, whether it's from permanent shock loss or a wide scar, it is fruitless to attempt another excision procedure. FUE into the scar is then the best option, even though the survival of grafts into this kind of tissue is less than the usual 90% we enjoy elsewhere.
Mike Beehner, M.D.

I had work done a few months and have experienced shock loss in the scarred area. I hope this is a temporary state, however I am worried because I have a big 'white spot' where I experienced bad scabbing the first 4-5 weeks after surgery. Is this common?