Shock loss or Reactive loss or Post surgery effluvium

Shock Loss , Reactive Loss or Telogen effluvium, Shock fall out:
It is reaction to the surgery esp. that on the scalp because the scalp is stressed by surgery and some of the hairs may fall out in 2 to 12 weeks some are permanent and some can be temporary. Most likely the miniaturized hairs are likely to fall out.  This can happen mostly in recipient area but can rarely also happen in the donor area esp. in the FUT or strip method and less commonly in FUE method due to its minimally invasive nature. The Shock loss is unpredictable although factors to be considered are:

Age: young ( <30) more with active inadequate stabilization of hair loss it is common but in Older age patients with stabilized hair loss has les chances of shock loss.
Sex: male more common than female but it is more significantly visible in females
            Male more likely to be permanent in female more likely to regrow
Miniaturized hairs (i.e. the hair that is at the end of its lifespan due to genetic balding): more likely to be permanently lost unless Finasteride supported
Terminal Hairs ( Healthy) : more likely to grow back in 4-6 months
Transplanted hairs: shock loss is less common but can grow back in 4-6 months
Temporary Loss: The terminal or healthy hair shock fall out is usually tempoaray and they grow back by 4-6 m9onths
Permanent loss: usually of the miniaturized hairs or of the terminal hairs that is damaged or transected while making the incision for grafting in between the hairs.
Protection: by starting Finassteride 1mg ( or Dutaseride 0.5mg) per day at least 2 weeks before until the at least 6 months post op in males. In females Finasteride is useless and Minoxidil may be useful to some extent.
How can one minimize Shock loss:

1         by using smaller incisions for recipient area ( using smaller grafts rather than using minigrafts)

2         Limiting the depth of incisions

1.       Minimizing the adrenaline use in recipient area

2.       Reducing the packing between the existing hairs

3.       Minimizing the tension of the donor area

4.       Using Finasteride from at least 2 weeks before the procedure and for 6 months after the procedure.

5.       Spacing the 2 sessions of transplant at least 1 year apart

6.       Avoid operating on the young patients who are in the actively losing state and have high miniaturization. Put them on Finasteride & or Minoxidil for a few months before contemplating transplant.

7.       Plan to use enough FU and transplant through the highly miniaturized hairs rather than avoiding that area so that in case of shock loss of highly miniaturized hairs the area is sufficiently compensated with the healthy transplanted hairs. In areas of extensive miniaturization, it may be appropriate to transplant follicular units in the same density as one would if the area was totally bald ass the miniaturized hair may be lost by the time transplants grow.

However, regardless of the “claims” of a particular surgeon, the process is a natural response of hair follicles and the risk cannot be eliminated completely.