Hair Shock

Hair shock or anagen effluvium is a term used to describe the loss of preexisting hair that occurs during and after the hair transplant surgery.

The loss of hair occurs only in the recipient area and in this authors experience is confined to the grafted area.

Questions that commonly arise regarding this phenomenon are:

1. How much hair shock should I expect in the grafted area?
   
   In general hair shock can reduce the preexisting density around 30% but as much as 50% with regular dense pack follicular unit grafting.
   
   
2. How long before the shocked hairs regrow?
   
   The shocked hairs go into the resting phase of the hair cycle, which lasts, between 3-4 months. Usually the shocked hair will begin to grow back with the grafts at about 4 months.
   
   
3. Will some of the shocked hair never come back?
   The amount of preexisting hair that will be permanently lost depends on two main factors:
   
   
   • If the hair had undergone miniaturization to the extent that it would only survive another 6 months regardless of surgery, it will probably not survive the shock cycle.
   • If incorrectly made incisions had transected (cut across) neighboring preexisting hair, the hair follicle may have been killed and will not regrow.
     
     
4. Is there any way to avoid hair shock?
   
   Hair shock usually results from trauma of incisions made in the skin close to preexisting hair.
   
   Another and perhaps more important cause for shock loss is the repeated manipulation and tugging on preexisting hair in order to expose surrounding bald scalp and to assess the angle of the hair shaft with regard to the scalp. This angle must be exactly copied when making the recipient site incision.
   
   This cause of hair shock can be virtually eliminated by having the hair on the scalp approximately ½ cm long so that the surrounding scalp can be visualized without moving the adjacent hair, and the hair angle can be copied with precision.

At our clinic we encourage our patients to allow us to trim their hair. This will make the first 2-3 weeks post transplant difficult to conceal but will otherwise be of significant benefit to the patient (and surgical team).

top of page

Postoperative Redness

This phenomenon describes the appearance of the skin at the site of the recipient scalp. It is usually done to the presence of newly developed blood vessels, which form near the skin surface and to the mild inflammation, which occurs around the hair grafts.

The redness does not affect people who have olive or darker skin colour. It is more common in fair skinned individuals especially those people with very fair skin tone.

Light skin - Post Operative redness	Dark skin - Post operative redness

The redness can last from a couple of weeks to several months after surgery. It is sometimes difficult to predict how long it will last on a particular patient.

The best method to prevent this problem is for the patient to tan the scalp a week or two before the surgery. (DO NOT BURN THE SCALP) Even a light tan will mask the redness after surgery.

Donor Scarring

This is a consequence of removal of the strip of donor hair that occurs during the hair transplant process.

What determines the extent of donor scarring that occurs in a particular individual"?

The single most important factors in donor scarring is the ability of the surgeon to excise the strip and close the wound from the donor site correctly. The ability of the individual to "heal well" is much less important except for a very small percentage of individuals who either heal with keliod formation or have an abnormality of collagen formation.

The tension in the donor scalp should be accurately assessed before and during surgery. The elastic limit of the scalp should never be exceeded. This principle applies to both the first and subsequent surgeries. Scar formation after multiple surgeries will still be minimal if the elastic limit of the scalp is not exceeded. It is however after multiple surgeries that surgeons most frequently exceed the scalps elastic limit with resultant wide scars.

The method of closure i.e.: staples vs. sutures, is relatively insignificant and dependent on the surgeons capability. We however prefer the use of staple in the scalp as they are nonirritant and have superior mechanics over sutures. Staples are however more painful to have and remove, but ten days of mild discomfort is a small price for a virtually undetectable scar.

Article and images published with permission of Drs Hasson & Wong

Home  | Top of Page  | Contact Us