I recently had my second follicular unit extraction (FUE) hair transplant in Istanbul with a total of 9000 hairs on two 1 day sessions. It went smooth except that I am experiencing extreme thinning in my donor area. I am wondering whether it’s shock loss or maybe they just extracted too much from my donor.
Is it possible that shock loss happened during the procedure? Especially that I found myself in this situation immediately after the procedure and I can’t see any falling hairs since then.

shockShock loss or “telogen effluvium” is a very real possibility in both the donor and recipient areas several days to several months after hair transplant surgery. This condition where the surrounding hair temporarily falls out occurs as a result of trauma to the scalp during surgery. That said, I know you expressed concern as to whether or not you are experiencing shock loss or just a general thinning appearance as a result of too many follicles being harvested. Typically, physicians will not harvest too many follicular units in order to preserve the thicker appearance of the donor area. However, 9000 hairs is a lot.

Ultimately, I think you have to determine whether or not your donor area looked as thin as it does now immediately after surgery or not. That said, the best thing you can do is be patient at this point and wait it out. Any “shocked” hairs will grow back 4 to 12 months after the procedure. Plus, as the hair grows in, it will become thicker looking and show less scalp. Buzzed hair always makes an area appear thinner than it really is.

I have just done a follicular unit strip surgery (FUSS) hair transplant almost two weeks ago. The surgery seems to be successful in almost every aspect. The only thing that is bothering me now is that I still feel tightness on the donor area.

My hair restoration physician told me he took a strip 7.5 cm long by 1.5 cm wide and got 1200 grafts. Is it considered to be a large area? I feel the tension force from the scar especially when I drive a car and try to turn my neck to clear the blind spot, or when I nod deeply.

My question is that if this discomfort permanent or will disappear shortly?

23072_2_fullGood density in the hair transplant donor region is typically about 100 grafts/cm^2. Multiplying the length and width of your donor strip gives us a total area of 11.25cm^2. Dividing 1200 grafts by the the total area means that your donor strip yielded more than 106 grafts/cm^2.

According to Coalition hair restoration physician Dr. William Lindsey, the average width of a donor strip in his practice is between 1.6 and 1.7 cm or “about the width of a stick of gum”. The length will vary depending upon factors such as scalp laxity and target number of grafts.

For more details from Dr. Lindsey see the following article form our Hair Loss Q&A Blog, “What is the Average Width and Length of a Hair Transplant Donor Strip?

The following response was posted to our Hair Loss Social Community and Discussion Forums by Ailene Russell, Clinical Supervisor for Dr. Jerry Cooley who is a member of the Coalition of Independent Hair Restoration Physicians:

I’m hoping someone can help me. I had follicular unit extraction (FUE) 16 days ago. This morning I woke up with loads of grafts on my pillow (or maybe they weren’t grafts but hairs with dead skin on them). I also had them in my fingernails, so I’d obviously been scratching. There is no blood on my head though.

I’m trying to make myself feel better by telling myself that when I wash it, I’m effectually washing out the hair that’s ready to fall out in the shedding phase….but somehow this just feels wrong.

I’ve I lost all those grafts that were on my pillow, or did I just speed up the shedding phase with my scratching?

1_month_shedI am not sure if you were instructed on what happens after surgical hair restoration regardless of the harvesting method. In most cases the implanted grafts will “sit” and passively absorb oxygen and food from the surrounding tissue. They adapt and take root usually over the first 6 to 7 days. Sometime around the 10 day time frame, the hair shafts will extrude and shed. Because of the solutions used in numbing, there can be a little swelling or a “sunburn” type effect to the recipient area and this skin can peel off.

I went to my doctor today and got a finasteride prescription. Now I’m reading that dutasteride may be more effective. Does anyone have any comparative experiences? Have you seen any people actually regrow hair by getting on finasteride (or dutasteride)?

avodart-propeciaMost guys are using Propecia (finasteride) for hair loss. Avodart (dutasteride) is typically reserved for the day when finasteride is no longer sustaining hair growth and hair loss once again begins to advance.

There are probably a number of reasons for this. First, dutasteride is not FDA approved as a hair loss treatment so many physicians won’t prescribe it. Second, dutasteride tends to be more expensive and, lastly, as it inhibits both the type 1 and type 2 alpha-reductase enzyme (the enzyme associated with the conversion of testosterone to DHT), side effects can be more severe.

In terms of the effectiveness of Propecia in the treatment of androgenic alopecia, there are three potential outcomes. The first potential outcome is that it regrows hair. This is pretty easy to assess and document photographically.

The second potential outcome is that is slows the progression of male pattern baldness, allowing you to retain more of your existing hair over a longer period of time. This outcome is not so easy to measure. If you take the drug for five or ten years and still have most of your hair, how could you know for certain that you wouldn’t have had the same outcome without the drug?

The following thorough response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member “Gillenator”.

I’m three days post-op and just now starting to scab up. I know scabbing is a common part of the hair transplant process, however I’m unsure if scabbing around the transplanted hairs in the recipient area will harm the outcome and/or health of said hairs.

Should I try to avoid scabbing by misting the recipient area with saline water, as this might ensure a better outcome for future hair growth, or is scabbing merely a cosmetic nuisance, in that people dislike scabbing because it is makes the recipient area ‘ugly’ and stand out? Or does scabbing have no impact on the outcome of the procedure, so long as you perform all the post-op instructions ordered by hair restoration physician? Thanks so much, this website was so helpful in picking out a surgeon!

day7frontScabbing is a normal aspect of the healing process and really cannot be avoided but can at times be managed successfully. What I mean by that is many hair loss doctors/clinics will advise their patients to keep their grafts or the recipient area moist by spraying the area with saline or some other form of post-op healing spray such as Graftcyte to facilitate the healing process. The idea is that “the more the healing process is facilitated”, the sooner the scabbing and crusts can be removed. Water in itself can help facilitate the healing. Saline is often recommended because of its sterile solution and can be purchased at very little cost.

The following thorough response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member “Gillenator”.

So this morning, after a shower, I found a graft. There is a hair coming out of the thicker end of the white thing. It’s definitely a graft, and the white thing is obviously the dead skin.

There was no blood. The only way I can explain it myself is that it had been in my hair since the hair transplant and I found it today, but it had been out a while. Otherwise there would be blood, right? Or is it possible for dead grafts to still be anchored in the scalp and then eventually come out?

graftIt’s unusual to lose a follicular unit graft 13 days after hair restoration surgery. And, it’s true that when a complete graft does come out in whole, there is a steady stream of blood that oozes from the recipient site where the graft was placed. So, if you did not see a strong trickle or stream of blood oozing down your scalp, you have nothing to worry about.

Conversely, dead graft tissue (crusting) does shed roughly 2-4 weeks post-op.

Supporting Hair Restoration Physicians: Dr. Glenn Charles, Boca Raton, FL – Dr. Jerry Cooley, Charlotte, NC – Dr. Jim Harris, Denver, CO – Dr. Robert True & Dr. Robert Dorin, New York, NY

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Carlos Wesley:

Is it standard practice for hair transplant surgeons to leave follicular unit grafts in PRP/ACell? If so, how for how long?

Dr_Wesley_photoI cannot speak for every hair restoration physician, but it is standard operating procedure in our practice to use a combination of platelet rich plasma (PRP) and ACell as a storage solution for follicular units when they are out of the body in both our follicular unit extraction (FUE) and follicular unit strip surgery (FUSS) cases.

The upside: It has been demonstrated to generate a statistically significant improvement in survival and caliber (thickness) of transplanted hair follicles. I’ve also found the hair growth to occur earlier and the redness to be minimized.

The downside: It demands a large, dedicated staff as the process requires a staff member to focus on the isolation and creation of the PRP as the surgical procedure is taking place.

Dr. Carlos Wesley
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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The following hair loss article was written by Coalition surgeon Dr. Alan Feller, and presented on our Hair Restoration Social Community and Discussion Forums:

I’m 8 days post op. Ran out of saline solution today, so started using tap water in its place. In the post-op care instructions it says this is OK.

I’ve noticed a tingling sensation when I spray water on the recipient (maybe even a very very low level mild burning sensation). I never noticed this with the saline solution. Should I stop altogether with the spray, or just carry on with the water?

Water_tapI usually have my patients wash with shampoo and tap water the day after their hair transplant surgery. It’s not a problem for the grafts. The issue isn’t the potential drying out of the grafts, if that were an issue a few sprays per day of saline would not help.

The point of spray moistening the scalp post-op for the first few days is just to soften the crusts a bit to allow them to come off a bit easier. But it’s not necessary. A shower once per day with shampoo will do the same thing and provide the mechanical cleansing necessary to encourage those scabs to come off.

By the way, the tops of the follicular unit grafts are not alive. So when it falls off in the form of a crust it is meaningless.

The following thorough response to a question from the Hair Restoration Social Community and Discussion Forums, was written by forum member “Gillenator”.

It’s been four months since my hair transplant. I had work done in the hairline and in the crown. It seems as though the hair in-between the crown and hairline that had no work done has thinned substantially since my procedure. It just looks extremely thin in direct sunlight where as before the surgery it was thick, which is why it wasn’t addressed in this surgery.

Is it possible to have shock loss in non-transplanted areas post-op? I have been on Propecia, Rogaine and Nizoral for years as well.

hairYes, it is possible to experience shock loss in the adjoining areas where there is no natural hair loss. And when grafts are placed both ahead and behind of the mid-scalp, it’s not totally unusual for the untouched area to undergo some level of shock loss.

The good news is that the area should thicken up again but may take 3-4 months from now to occur. Are you starting to see some hair growth in the recipient areas? That should be occurring just about now.

Supporting Hair Restoration Physicians: Dr. Glenn Charles, Boca Raton, FL – Dr. Jerry Cooley, Charlotte, NC – Dr. Jim Harris, Denver, CO – Dr. Robert True & Dr. Robert Dorin, New York, NY

In the following hair transplant video,  Coalition hair restoration physician Dr. Alan Feller of Great Neck, NY demonstrates how follicular unit extraction hair transplantation (FUE) causes traction damage to the grafts during harvesting.

He also provides tips on how to minimize or completely avoid this damage when extracting these delicate grafts.

For more information or to join the discussion, read *VIDEO* FUE ‘Plastic’ surgery- Dr. Bloxham and Dr. Feller on our popular hair loss discussion forum.
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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