Shock loss in the donor area after FUT (Photo)

Your photos and description suggest Telogen Effluvium("shock loss") following donor harvesting.Most of the hair surrounding the scar should grow back with time(3-6 months).Minoxidil applied directly to this area twice daily might expedite growth.

Shock loss is due to the loss of normal hair whether it is from donor site or recipient area.  It can occur with both FUE and strip procedures.  Usually if it occurs it will take place in the recipient area.  
Shock loss from hair transplant can occur due to the following:
Anesthesia-  excessively long procedures taking longer than 12 hours can induce shock loss more likely.  the repeated use of lidocaine, marcaine, and perhaps most importantly epinephrine can affect nourishment of the hairTraumatic harvest-  In strip surgery, traumatic harvest can induce shock loss.  Recipient area trauma- during the incision making process the hairs are either crushed or cut and damaged during the process. 
Ways to minimize shock loss are as follows:
Improve recipient bed and donor area environment.  Make your recipient environment improved by addition of growth factors and/or PRP to help reduce incidence of shock loss to native hairs.Use of Rogaine and Propecia- can help miniaturized hair become more stable and less likely to fall out during procedure9xRobotArtas-  The latest version of the robot can make recipient sites and can determine angle of existing hair and help ensure that the angle will not damage existing hair.  Especially helpful in patients where you are transplanting hair to create densityMinimize anesthesia time and procedure time- We limit number of grafts to a safe number per session.  Extended anesthesia periods and harvest times can cause patients to have a higher chance of shock loss.  The 9x Robot harvests between 1000-1500 grafts per hour making it superior to previous additions and traditional FUE approaches.Best,
Anil Shah

Thank you for your question. You submitted a photo showing the area where you’ve had hair grafts harvested, with a question stating you’re 20 days after having follicular unit transplant or FUT or strip surgery of 1200 grafts. You’re on Propecia, and noticing what you describe as shock loss in this area. You want to know if there’s anything that can be done to help this area regrow the hair.
I can give you my perspectives on this situation. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Hair transplant has been a significant part of my practice. In fact, I’m the founder of TrichoStem™ Hair Regeneration Centers, a system of non-surgical solutions for hair loss using Acellular matrix and platelet-rich plasma (PRP) for men and women with thinning hair which was originally derived from doing hair transplants. We developed a process that can regrow and thicken hair, which actually works as an alternative to surgical hair transplantation.
To give you an overview of what you’re going through and the journey ahead ,and I’m sure you’re transplant surgeon discussed this with you, understand that when you harvest from this area at the back of the scalp, the goal is to take out as much hair as you can to get the best coverage in transplant areas. For the surgeon, there is a balance that has to be achieved to minimize the degree of tension on that incision so it closes very well so the scar heals well. For the future, it should be closed in a way so there’s minimal tension so there isn’t permanent loss of hair, so it’s a balancing act. When we talk about numbers of grafts, the length of the strip of hair, and the width, that’s basically the global intention. Sometimes colleagues have been very aggressive, myself included, where a patient needs a lot of hair, so you try to push the limits. I’m not saying that’s what happened here, but understand the concept of doing strip surgery, which has been the goal standard for many years.
In our practice, to help facilitate the healing of this area and to deal with problems such as shock loss, we started using a material called Acellular matrix. This is a material derived from pig bladder to help stimulate the stem cell activity to facilitate healing. This doesn’t mean you absolutely have to use this, but just describing what we do in our practice to ensure maximum healing.
This is an area which has a long time ahead to heal, and chances are the hairs lost from shock loss, which is referred to as telogen effluvium scientifically, may temporarily shed. However, the roots remain and the hair typically regrows in 3-4 months.
With hair transplant, there are a lot of phases you’re going to go through, so understand the final result takes about a year, and in some people even longer, so this is an evolution and process. For the possibility of facilitating regrowth, if someone asks, “Okay, I’m 20 days out of my hair transplant and I want to facilitate regrowth”, I would probably say there’s some potential, and at least no harm in applying a little topical minoxidil. Although it’s unlikely it’ll make an impact, there is no harm in doing that. As far as other options such as platelet-rich plasma (PRP) injection, platelet-rich plasma (PRP) with Acellular matrix, I think that there’s some potential value, but I would caution you because I think this is an area already relatively well covered - if you grow your hair long enough, it’ll just flap over.
In patients who come to us who have had hair transplant done elsewhere and want to maximize their yield, we do Hair Regeneration injection treatment which is a combination of Acellular matrix and platelet-rich plasma (PRP). I developed this over several years and what I’ll do is inject the area where they’ve had grafts placed. Generally speaking, if we do it in the first 3 months, we can benefit the area of the grafts. I can’t say we’ve had much calls for treating the donor area, so I can’t say specifically we’ve treated this many donor areas and they healed that much better. I think it’s kind of a tricky thing to really establish what would’ve been natural healing, or healing with a type of stem cell-based technology.
If this was you first hair transplant, you will probably get the best yield, and the area of skin will have the least tension. I think it’s alright to just leave it alone and let it grow. There’s always time to do some potential scar revision, or if you undergo a second transplant to revise the area. As far as shock hair loss, you have 3-4 months just to allow regrowth. Chances are, you may not even realize there’s been regrowth, so before you know it, it’s going to be as good as it can be. Again, you’re looking at a wound healing process that’s going to be months to about a year. Pacing yourself is probably the take home message. It is natural to examine areas which have been treated, but to look at something so critically is probably more exhausting than fruitful. It’s appropriate to ask these question, but I think you should seek the guidance of your operating surgeon on what to do because no one is going to know this area better than the doctor who did the surgery. It is also important to understand s that anyone who gets a second look can certainly give their perspective from their clinical experience, but the doctor who performed the surgery is naturally going to do the best job they can to get the best results from their clinical experience.
To summarize, from just this one photo and this question,  doing nothing would likely result in whatever hair that should grow, will grow. Allow a year for the full expression of the transplanted hair, as well as the full maturation of the donor area. Continuously follow-up with your doctor to get a sense of how you are progressing, and if there’s any intervention your doctor feels would be useful for you. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.