Post-Surgical Hair Loss
Post-surgical hair loss, although rare, can arise from two etiologies: accelerated hair loss and post-surgical effluvium. There is a theoretical risk of post –surgical shock loss. It is logical that attendant with surgery there may be an increase incidence of hair loss after surgery. After all, there is an increase in blood flow to the surgical site post procedure. That is why the recipient area is red or erythematous after surgery. This bathes the area with DHT along with the necessary oxygen and nutrients required for healing and life of the tissue. This however, technically is not post-surgical shock loss, but accelerated hair loss. The risk of this occurring is dependent on the genetic predisposition of the hair in the recipient area and the extend of miniaturization of these hairs.
What then is post-surgical shock loss or effluvium? This type of post-surgery hair loss can result after the procedure and arises from trauma to the miniaturized hair. It usually manifests about 3 months post procedure. This trauma to the weaken hair in the recipient area occurs when the angling of the sites is off. It is imperative that the angle and direction of hair growth be fallowed accurately.
Significant post-surgical hair loss in the post-surgical period is at best a rare event; in fact, I have not seen it for the last 4-5 years. The reasons are related to advances in surgical techniques and pharmacologic therapies. First and foremost is the creation of precise angles of the recipient sites, while fallowing the exact direction of hair growth. Secondly, the use of very small needles and cut to size blades, that minimize the size of the sites created, hence the extent of tissue and possible follicular injury if there is native hair remaining. Lastly, the use of finesteride diminishes the DHT by 70% hence protecting the native and transplanted hair from any post-surgical increase in circulating DHT. The use of minoxidil 5% acts synergistically to further protect the native miniaturized hair and possibly stimulate the growth of the transplanted hair. Furthermore, the growth of the transplanted hair with its increased caliber is of greater contribution to the hair mass and volume than the native thinner caliber miniaturized hairs. I do recall one patient about 6 years ago that had some shock loss post-surgically. He was managed with finesteride, minoxidil 5%, reassurance, and time. He of course not only recovered but also had an outstanding hair restoration outcome. The patient got his smile back in about four months post-procedure as his hair transplant commenced to grow in.