This question was posed by a hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Ricardo Mejia of Jupiter, FL who is one of our recommended hair restoration physicians. His professional answer is below.
I do not believe there is “permanent” hair loss from transection of hair follicles in the scalp. There is Iatgrogenic or doctor induced baldness when the hair shaft is cut below the scalp, and falls out, but it will regrow. This is not strictly due to poor placement. There are other factors involved. I am not aware of any studies that have proven permanent hair loss. You may recall our previous hair restoration forum thread discussing this very issue. I would recommend readers review this carefully.
“Shock loss” can have many definitions as I have explained in the thread above. Most patients view it as the apparent loss of hair density after a procedure in existing native hairs that results in a thinner look usually within three months after a hair transplant. In general, the hairs will regrow as I have explained in my other thread. For all hair transplant practices that shave the recipient site, you are getting 100% immediate shock loss. The hairs are gone visually! For all practical purposes, can not tell whether you really experienced true “shock loss” or not because the hairs are no longer there. Therefore it is a moot point in practices that shave the recipient site. Most of my professional patients do not want that type of experience, which is why I do not always do it, and work around the native hairs.
“Shock loss” is a lay term for telogen effluvium which can be multifactorial and a result of the stress from surgery, antibiotics, postoperative illnesses, medications, weight loss diet etc. Therefore it is not strictly due to trauma or poor placement. This type of shock loss and Itrogenic shock loss can affect miniaturized and terminal hairs equally. I am not aware of any study that states shock loss ONLY preferentially affects only the weak miniaturized hair. It is probable and perhaps Dr. Beehner has added insight from his years of research activity in this field. However, I see lots of patients with telogen effluvium and they are losing good terminal hairs not just miniaturized weak ones. I agree with Dr. Beehner, It is true if a weak miniaturized hair was on its last leg and was “shocked” out, it will not regrow.
When transplanting at higher densities within existing hairs and with shaven recipient sites, there is a higher risk of transection of the hair follicles, especially if you are using a multibladed handle which makes several recipient incisions sites at the same time and you are doing it fast. It is alot harder to try to align all the blades to be perfectly parallel to the hairs of varying densities, and the exit angle of the hair is not always the same under the epidermis. If you shave the recipient site very close with no superficial hair, you can not tell very well what the exit angle is and thus even harder or impossible to avoid native hairs with multibladed recipient site handles, especially in native hairs with pretty good density such as early diffuse thinners. I use a single bladed recipient handle to maneuver within existing hairs to minimize the possibility of Iatrogenic trauma. It is unpredictable. The good news, is “permanent” shock loss is a term that is used too loosely. Review the previous thread. We need to understand and define the multitude of factors involved and the definitions and type of shock loss one is referring to. In summary, the hairs will regrow even if doctor transected without a permanent loss and even hairs lost due to the myriad of factors with telogen effluvium, with the exception of the miniaturized hair on its last leg. There is a higher risk of transection in native hairs with higher density recipient sites and high dense packing sessions, yet they are not permanently damaged. Patients will get 100% shock loss when they shave the recipient site.
Dr. Ricardo Mejia