Shock loss after a hair transplant is the shedding of transplanted (and sometimes native) hair shafts that occurs between weeks 2 and 6 post-surgery. It happens in 50 to 70% of patients, is a normal part of the follicular cycle reset, and does not indicate graft failure. The follicles remain alive beneath the skin and begin producing new hair within 2 to 4 months.
What Is Shock Loss and Why Does It Happen?
Shock loss, clinically known as telogen effluvium, occurs when hair follicles are traumatized by the extraction and reimplantation process. The trauma pushes the follicle from the anagen (growth) phase into the catagen (transition) phase, and then into telogen (resting phase). Once in telogen, the existing hair shaft detaches and falls out.
The follicle itself is not damaged. It is simply resetting its growth cycle. After 2 to 3 months in the telogen resting phase, the follicle re-enters anagen and produces a new hair shaft.
Two Types of Shock Loss
Transplanted hair shock loss: The grafted hairs shed as the transplanted follicles reset. This affects nearly all patients and is the most expected form of shock loss.
Native hair shock loss: Existing hair near the transplant zone sheds due to surgical trauma (local anesthesia injections, needle punctures, swelling). This affects a smaller percentage of patients and is more concerning because it temporarily worsens the appearance of the transplanted area.
Normal Shock Loss Signs
The following are expected during the shock loss phase and do not require medical intervention:
| Sign | Timeline | Details |
|---|---|---|
| Transplanted hair shafts falling out | Weeks 2-6 | Hair shafts detach during washing or naturally throughout the day |
| Hair on pillow or in shower drain | Weeks 2-6 | Increased shedding volume is normal during this window |
| Scalp appears thinner than before surgery | Weeks 3-8 | The "ugly duckling" phase where density looks worse temporarily |
| Scabs contain visible hair shafts | Weeks 2-3 | Hair shafts attached to shed scabs are surface hair, not follicles |
| Native hair near transplant zone thins | Weeks 3-8 | Temporary native hair shedding from surgical trauma |
| Itching during shedding | Weeks 2-4 | Mild itching is part of the healing process |
The key point: shock loss involves the hair shaft above the skin, not the follicle beneath it. The follicle remains anchored 3 to 4 mm below the skin surface, intact and alive.
Abnormal Signs That Require Attention
While shock loss itself is normal, certain signs during this period indicate a potential problem that should be evaluated by your surgeon:
Persistent redness or warmth at graft sites beyond week 3: Normal post-surgical redness fades within 2 to 3 weeks. Increasing redness, warmth, or tenderness after this point may indicate infection.
Pus or discharge from graft sites: Any yellow, green, or foul-smelling discharge is a sign of infection and requires prompt medical attention.
Fever above 38C/100.4F: Post-surgical fever beyond the first 48 hours may indicate a systemic infection.
Raised, hard bumps at graft sites: Small bumps (folliculitis) can occur as hairs begin growing beneath the skin. Mild cases resolve on their own, but persistent or painful bumps should be evaluated.
Extensive native hair loss beyond the transplant zone: If hair is shedding in areas far from the surgical site (back of the head, sides of the scalp where no surgery occurred), this may indicate a systemic cause unrelated to the transplant. For more on warning signs, see our guide on when to contact your surgeon.
No new growth by month 5: While not a shock loss issue, zero new growth 5 months after surgery is uncommon enough to warrant a follow-up appointment.
Shock Loss Timeline
| Phase | Weeks Post-Surgery | What Happens |
|---|---|---|
| Onset | Weeks 2-3 | First transplanted hairs begin shedding |
| Peak shedding | Weeks 3-4 | Maximum daily hair fall from transplanted zone |
| Tapering | Weeks 4-6 | Shedding decreases, most transplanted shafts already shed |
| Dormancy | Weeks 6 to Month 3 | Follicles resting beneath skin, no visible activity |
| New growth | Months 3-4 | First new hair shafts break through skin surface |
| Full regrowth | Months 6-12 | Progressive density increase as all follicles reactivate |
How to Manage Shock Loss
Shock loss cannot be prevented, but you can minimize its impact on native hair:
Continue or start finasteride: If your surgeon has prescribed finasteride, maintaining it through the shock loss phase supports native hair retention and may reduce the severity of native hair shock loss.
Low-dose minoxidil: Some surgeons recommend applying minoxidil to the transplanted area starting at weeks 2 to 4 to encourage faster transition through the telogen phase. Follow your surgeon's specific guidance on timing.
Avoid stress: Psychological stress can worsen telogen effluvium. While this is easier said than done during a period of visible hair shedding, maintaining normal sleep, nutrition, and activity levels supports the recovery process.
Take progress photos: Documenting the shock loss phase with standardized photos provides an important baseline for measuring future growth. The worst-looking photos from weeks 4 to 8 will become your most satisfying "before" images when compared to months 6, 9, and 12.
For context on what happens immediately before shock loss begins, see the weeks 2-4 healing phase guide.
Track your recovery through the shock loss phase and beyond at myhairline.ai/analyze. Standardized photo comparisons help separate anxiety from reality.
This article is for informational purposes only and does not constitute medical advice. Contact your surgeon directly if you experience any abnormal symptoms during recovery.
FAQ
When will I see results after hair transplant?
New growth from transplanted follicles begins between months 3 and 4 after surgery. The shock loss shedding phase, which occurs during weeks 2 to 6, is temporary. The follicles remain alive beneath the skin and re-enter the growth cycle after a dormant period of 2 to 3 months.
Is shock loss after hair transplant normal?
Shock loss is completely normal and occurs in 50 to 70% of hair transplant patients. It happens because the trauma of extraction and reimplantation causes follicles to enter a temporary resting phase. The shed hairs are replaced by new growth starting around month 3 to 4.
How do I know if my hair transplant is working?
During shock loss (weeks 2 to 6), it is impossible to judge whether your transplant is working. The shedding phase looks alarming but is a normal biological process. Wait until month 4 to assess. If fine new hairs are emerging by month 4 to 5, the grafts have survived and the transplant is on track.