Weeks 2 through 4 after a hair transplant are defined by two key events: scab separation and the onset of shock loss. Both are normal and expected parts of the healing process. By the end of week 4, the transplanted grafts are fully anchored in their recipient sites with a 90-95% survival rate, even though the visible hair shafts will be shedding.
Week 2: Scab Shedding and Donor Healing
By day 10 to 14, the small scabs that formed around each transplanted graft begin to loosen and fall off during washing. This is one of the most anxious periods for patients because the scabs may contain visible hair shafts, making it look like grafts are falling out.
What is actually happening: The hair shaft above the skin surface detaches from the follicle. The follicle itself remains embedded 3 to 4 millimeters below the skin surface, intact and alive. The shaft that falls out is the original transplanted hair, not a sign of graft failure.
Week 2 Milestones
| Day | What to Expect | Action |
|---|---|---|
| Day 8-10 | Scabs feel dry and tight | Continue gentle washing per surgeon instructions |
| Day 10-12 | Scabs begin detaching during washing | Do not pick or pull. Let water and gentle fingertip pressure do the work |
| Day 12-14 | Most scabs have fallen off | Recipient area appears pink with small dots where grafts sit |
| Day 14 | FUT sutures/staples removed (if applicable) | Follow-up appointment with surgeon |
Donor area at week 2: For FUE patients, the tiny dot scars in the donor zone are healing well by this point. Redness may persist but is typically concealable with existing hair at a length of 3mm or more. For FUT patients, the linear incision is healing but may still feel tight or tender. Suture removal at days 10 to 14 provides noticeable relief.
Week 3: Shock Loss Begins
Shock loss, also called telogen effluvium, is the shedding of transplanted hair shafts that occurs as the follicles shift from the active growth phase into a temporary resting phase. This happens because the trauma of extraction and reimplantation triggers the follicle to reset its growth cycle.
How shock loss works
- The transplanted follicle experiences trauma during extraction and placement
- The follicle enters the catagen (transition) phase within days of transplantation
- By weeks 2 to 4, the follicle enters telogen (resting phase) and releases the hair shaft
- The shed hair shaft falls out, leaving the dormant follicle beneath the skin
- After 2 to 3 months of rest, the follicle re-enters anagen (growth phase) and produces a new hair
This cycle is the reason there is a gap between surgery and visible results. The follicle is alive and healthy the entire time. It simply needs to reset before producing new growth.
Shock loss of native hair
In some patients, shock loss also affects existing native hairs near the transplanted area. This occurs because the surgical trauma (needle punctures, anesthesia injections, swelling) temporarily disrupts the growth cycle of nearby follicles. Native hair shock loss is more common in:
- Patients with diffuse thinning
- Areas where grafts were placed between existing hairs
- Women undergoing transplant surgery
Native hair shock loss is also temporary. The affected native hairs regrow within 3 to 6 months. For more detail on distinguishing normal from abnormal shedding, see our guide on shock loss: normal vs abnormal signs.
Week 4: The Transition Point
By the end of week 4, the recipient area has healed on the surface. The pink coloration from surgical trauma fades to a lighter shade, though some residual pinkness may persist for another 2 to 4 weeks depending on skin tone and individual healing speed.
What the scalp looks like at week 4
- Recipient area: Most transplanted hairs have shed. The area may look similar to or slightly worse than before surgery, which is psychologically challenging but completely normal
- Donor area (FUE): Tiny dot scars are fading. Existing donor hair is growing over the extraction sites
- Donor area (FUT): The linear scar is healing into a thin line. Some patients report intermittent tightness or numbness along the scar that resolves over the following months
Activity restrictions at week 4
By week 4, most surgeons clear patients for:
| Activity | Typically Cleared | Notes |
|---|---|---|
| Light cardio (walking, stationary bike) | Week 2-3 | No heavy sweating |
| Moderate exercise (jogging, weights) | Week 4 | Avoid exercises that cause head-level blood pressure spikes |
| Swimming | Week 4-6 | Chlorine and bacteria risk earlier |
| Contact sports | Week 6-8 | Risk of graft trauma if hit |
| Full sun exposure | Week 4 with SPF | Use SPF 30+ or wear a loose hat |
| Hair styling products | Week 4 | Gentle products only, avoid heavy waxes |
Managing Expectations During Weeks 2-4
Research shows that 84% of dissatisfied transplant patients cite unmet expectations as the primary cause of their dissatisfaction. The weeks 2 to 4 period is when unmet expectations are most likely to develop because the scalp looks worse before it looks better.
Key facts to remember during this phase:
- Shedding does not mean failure. Shock loss affects the majority of patients and is a normal biological response
- The "ugly duckling" phase is temporary. Between weeks 3 and month 3, the transplanted area can look thinner than before surgery
- Donor area heals faster than recipient area. This is normal. The donor wounds are smaller and have better blood supply
- Numbness can persist for weeks to months. Sensation gradually returns as nerves regenerate
If you documented your week 1 post-op guide recovery with standardized photos, compare them to week 4 photos to see healing progress objectively rather than relying on daily mirror assessments, which tend to amplify anxiety.
Medication and Supplementation During Weeks 2-4
Most surgeons prescribe the following during this recovery period:
Antibiotics: Typically completed within the first 7 to 10 days. Do not extend antibiotic use beyond the prescribed duration.
Finasteride: If prescribed as part of your long-term treatment plan, most surgeons recommend starting (or resuming) finasteride within the first 1 to 2 weeks post-surgery. Finasteride helps protect native hair from continued miniaturization while you wait for transplanted follicles to begin producing new growth.
Minoxidil: Some surgeons recommend resuming topical minoxidil at week 2 to 4. Others prefer waiting until week 4 to 6. Follow your surgeon's specific protocol. Minoxidil can help support the native hairs through the shock loss period and may promote faster entry into the new anagen phase for transplanted follicles.
Biotin and supplements: There is limited clinical evidence that biotin supplementation improves transplant outcomes. However, ensuring adequate zinc, iron, and vitamin D levels supports overall hair health. A blood panel before or shortly after surgery can identify any deficiencies worth addressing.
What Comes Next: Months 3-6
The period from month 1 to month 3 is sometimes called the "dormant phase" because there is very little visible change. The follicles are resting beneath the skin. This is the hardest period psychologically, but it is the expected biological timeline.
New growth begins for most patients between months 3 and 4. The next phase of the timeline covers what to expect during the months 3-6 early growth phase, including early hair texture, growth rate benchmarks, and how to assess whether your transplant is on track.
Upload recovery photos at myhairline.ai/analyze to track healing progress with consistent, standardized measurements.
This article is for informational purposes only and does not constitute medical advice. Always follow your surgeon's specific post-operative instructions.
FAQ
When will I see results after hair transplant?
Most patients begin seeing new hair growth between months 3 and 4. The hairs emerge thin and fine at first, then gradually thicken over months 6 to 12. Full density and final results are typically visible at 12 to 18 months post-surgery.
Is shock loss after hair transplant normal?
Shock loss is completely normal and affects 50 to 70% of transplant patients. It typically starts during weeks 2 to 4 and can continue through week 6. The transplanted hair shafts fall out, but the living follicle remains embedded in the scalp and will produce new growth within a few months.
How do I know if my hair transplant is working?
During weeks 2 to 4, you cannot assess whether the transplant is working because this is the shedding phase. The real indicators come later. Look for fine baby hairs appearing around months 3 to 4. By month 6, visible density improvement confirms the grafts have taken successfully.