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Hair Restoration Home > Hair Transplants > Overview > After Surgery > Shedding

Shedding after a Hair Transplant

Some shedding after a hair transplant is relatively common. The correct medical term is "effluvium" which literally means shedding. It is usually the miniaturized hair i.e. the hair that is at the end of its lifespan due to genetic balding that is most likely to be shed. Less likely, some healthy hair will be shed, but this should re-grow. Interestingly, if transplants are spaced less than one year apart, one often notices some shedding of the hair from the first transplant, but this hair grows back completely.

For most patients, if effluvium occurs, it is a minor issue and should not be a cause for concern. In the typical case, a patient looks a little thinner during the several month period following the transplant, when the transplanted hair is in its latent phase. The thinning is often more noticeable to the patient than to others.

In general, the more miniaturization one has and the more rapid the hair loss, the more likely will be shedding from the hair restoration surgery. Young, rapidly balding patients would be at the greatest risk. Older patients with stable hair loss would have the least risk.

It is important to differentiate the phenomena described above from shedding of the hair in the graft. This shedding is an almost universal characteristic of a hair transplant and occurs because during a hair transplant a graft is temporarily stripped of its blood supply. As a response to this insult, the graft sheds its hair. The shedding is noted beginning a week following the procedure and can continue for up to six weeks. A very small percentage of patients do not shed and the transplanted hair continues to grow. In others, the transplanted hair remains on the scalp for months until a new hair pushes it out. Whether a patient sheds or not has no bearing on the outcome of the hair restoration.

There are a number of ways to minimize the effects of post-operative shedding: the first is using medication, the second is timing the transplant properly, and the third is performing a procedure using a sufficient number of grafts.

• Medication
Finasteride 1mg reverses or halts the miniaturization process in many individuals and its use may decrease the risk of shedding following a transplant. Its ability to do prevent shedding, however, has not been proven in controlled studies.

• Timing and the size of the transplant
It is important to wait until a patient is ready to have a transplant, and then to perform one of sufficient size so that if there is some shedding, the procedure will more than compensate for it. A problem that patients often run into is that they seek a hair transplant when they have very early actual hair loss, but have a significant amount of miniaturization. The doctor performs a small procedure that does not take into account possible shedding or the progression of the hair loss. The result is that the patient is thinner than he/she was before the procedure. The doctor rarely blames the problem on the fact that the procedure was too small or that there the miniaturization was not taken into account, but only that the patient continued to bald. The better solution is to treat early hair loss with medication and once you make the decision to begin surgery, have a procedure large enough to make a significant cosmetic improvement.

As a final point, it is a fallacy that some doctor's techniques are so “impeccable” that they can avoid effluvium or that very small procedures will avoid shedding. Of course, bad techniques and rough graft handling will maximize effluvium, but effluvium is what hair naturally does when the scalp is stressed and it is stressed during a transplant from the anesthetic mixture and the recipient site creation, regardless of the technique, so that it cannot be totally prevented. Despite claims to the contrary, Follicular Unit Extraction has no bearing on this process of shedding as it is a harvesting rather than a placing technique.

In sum, the best way to deal with effluvium is to treat with Finasteride when hair loss is early, perform a transplant only when indicated and finally, to perform a hair transplant with skill and to use sufficient a number of grafts.