Postoperative Alopecia

Postoperative alopecia refers to hair loss that occurs after surgery. It is a relatively uncommon but distressing complication that can occur in both men and women of all ages. Postoperative alopecia can be temporary or permanent and can have various causes. In this article, we will discuss the main definition and types of postoperative alopecia in detail.

Definition: Postoperative alopecia, also known as surgical hair loss, is a form of hair loss that occurs after surgery. It can be classified as a type of telogen effluvium, which is a condition characterized by the shedding of hair in the telogen (resting) phase of the hair growth cycle. Normally, about 10-15% of scalp hairs are in the telogen phase at any given time, and they are shed and replaced by new hair growth. However, various factors, including surgery, can disrupt the normal hair growth cycle, leading to an increased number of hairs entering the telogen phase and subsequent hair loss.

Types of Postoperative Alopecia: There are several types of postoperative alopecia that can occur after surgery. These include:

  1. Telogen Effluvium: This is the most common type of postoperative alopecia. It is characterized by a diffuse shedding of hair from all over the scalp, and it usually occurs 1-3 months after surgery. The exact cause of telogen effluvium is not well understood, but it is believed to be related to the physical and emotional stress that surgery puts on the body. The stress can disrupt the normal hair growth cycle, causing an increased number of hairs to enter the telogen phase and subsequently shed.
  2. Anagen Effluvium: This type of postoperative alopecia is characterized by the sudden and rapid loss of hair during the anagen (growth) phase of the hair growth cycle. It is usually caused by the toxic effects of medications used during surgery, such as chemotherapy drugs or certain anesthetic agents. Anagen effluvium can occur within days to weeks after surgery, and it can lead to complete baldness if not managed promptly.
  3. Traction Alopecia: This type of postoperative alopecia occurs due to the tension and pulling of the hair during surgery. It is more common in surgeries that involve the scalp, such as facelifts or hair transplant procedures. The constant pulling of the hair can damage the hair follicles and lead to hair loss, which may be temporary or permanent depending on the extent of the damage.
  4. Scarring Alopecia: This type of postoperative alopecia occurs when surgery causes scarring or damage to the scalp, which can result in permanent hair loss. Scarring alopecia is more commonly associated with invasive procedures, such as scalp surgeries or removal of tumors, where the hair follicles are directly damaged or destroyed. The extent of hair loss depends on the size and depth of the scars and the ability of the hair follicles to regenerate.
  5. Psychological or Emotional Factors: Surgery can also trigger psychological or emotional stress, which can disrupt the normal hair growth cycle and lead to hair loss. The stress and anxiety associated with surgery, especially major surgeries, can cause an increase in the production of stress hormones, which can affect the hair follicles and lead to hair loss.


While the exact mechanism behind postoperative alopecia is not fully understood, there are several main causes that are believed to contribute to this condition. In this article, we will explore these causes in detail, explaining the underlying mechanisms and risk factors involved.

  1. Physical stress: Surgery is a major physical stressor on the body. The stress of surgery can trigger a physiological response in the body, leading to an increased production of stress hormones such as cortisol. Elevated cortisol levels can disrupt the normal hair growth cycle, leading to increased shedding of hair. This disruption of the hair growth cycle can result in telogen effluvium, which is the type of hair loss associated with postoperative alopecia.
  2. Anesthesia: Anesthesia is a common component of surgery, and it can also be a contributing factor to postoperative alopecia. The use of anesthesia during surgery can disrupt the normal functioning of the hair follicles. Anesthesia can inhibit the activity of hair follicles, leading to hair shedding. The type and duration of anesthesia used during surgery can affect the severity and duration of postoperative alopecia.
  3. Nutritional deficiencies: Surgery can disrupt the normal dietary intake and nutrient absorption in the body. Poor nutrition, especially during the recovery period after surgery, can lead to nutritional deficiencies that can contribute to postoperative alopecia. Nutrients such as vitamins, minerals, and proteins are essential for healthy hair growth. Deficiencies in these nutrients can disrupt the hair growth cycle, leading to hair shedding.
  4. Hormonal changes: Hormonal changes can also play a role in postoperative alopecia. Surgery can cause fluctuations in hormonal levels in the body. Hormones such as estrogen and progesterone, which play a role in hair growth, can be affected by surgery. Changes in hormonal levels can disrupt the hair growth cycle, leading to hair loss.
  5. Inflammation: Surgery can trigger an inflammatory response in the body as part of the normal healing process. Inflammation can disrupt the normal functioning of the hair follicles and affect the hair growth cycle, leading to hair shedding. The degree of inflammation and the duration of the inflammatory response can influence the severity of postoperative alopecia.
  6. Genetic predisposition: Some individuals may have a genetic predisposition to postoperative alopecia. If there is a family history of hair loss or alopecia, an individual may be at a higher risk of developing postoperative alopecia after surgery. Genetic factors can influence the sensitivity of hair follicles to various triggers, including surgery, and affect the hair growth cycle.
  7. Medications: Medications used during and after surgery can also contribute to postoperative alopecia. Certain medications, such as antibiotics, anti-inflammatory drugs, and pain medications, can disrupt the normal hair growth cycle and lead to hair shedding. The duration and type of medications used during surgery can influence the risk of postoperative alopecia.
  8. Psychological stress: Surgery can also be a psychologically stressful event for many individuals. Psychological stress can disrupt the normal functioning of the body, including the hair growth cycle. Increased psychological stress during the perioperative period can trigger telogen effluvium, leading to postoperative alopecia.
  9. Infection: In some cases, postoperative alopecia can be triggered by infections that may occur after surgery. Infections can cause an immune response in the body, leading to inflammation and disruption of the hair growth cycle. In addition, infections can also cause physical stress on the body, further contributing to postoperative alopecia.
  10. Other factors: Other factors that may contribute to postoperative


Symptoms of Postoperative Alopecia:

  1. Hair Shedding: One of the main symptoms of postoperative alopecia is increased hair shedding. After surgery, individuals may notice more hair falling out than usual when they brush, comb, or wash their hair. This shedding can be diffuse, meaning it occurs all over the scalp, or it can be localized to specific areas.
  2. Thinning Hair: Another common symptom of postoperative alopecia is thinning of the hair. Individuals may notice that their hair appears thinner than before, and they may be able to see more of their scalp through the hair strands. Thinning hair can occur in different patterns, depending on the underlying cause of the postoperative alopecia.
  3. Reduced Hair Volume: Individuals with postoperative alopecia may also experience a decrease in hair volume. The hair may feel less dense and appear less full, making it difficult to style or manage as usual. This can be particularly distressing for individuals who have previously had thick, voluminous hair.
  4. Delayed Hair Growth: Postoperative alopecia can also affect the rate of hair growth. Individuals may notice that their hair takes longer to grow back after surgery compared to their usual hair growth rate. This can be frustrating, as it may take several months or even longer for the hair to return to its pre-surgery length.
  5. Changes in Hair Texture: Changes in hair texture can also be a symptom of postoperative alopecia. The hair may become dry, brittle, or frizzy, and may be more prone to breakage. This can make the hair feel rough or coarse to the touch and may require additional care and conditioning to manage.
  6. Scalp Sensitivity: Some individuals with postoperative alopecia may experience increased sensitivity of the scalp. The scalp may feel tender or sore to the touch, and individuals may experience discomfort or pain when combing, brushing, or styling their hair. This sensitivity can be temporary or persistent, depending on the underlying cause of the postoperative alopecia.
  7. Changes in Hair Color: Postoperative alopecia may also result in changes in hair color. Some individuals may notice that their hair appears dull or lacks its usual luster. In some cases, the hair may even turn gray or white prematurely. These changes in hair color can be distressing for individuals who are used to a certain hair color or who associate their hair color with their identity.
  8. Emotional Distress: In addition to the physical symptoms, postoperative alopecia can also have emotional and psychological impacts. Hair loss can be emotionally distressing for many individuals, leading to feelings of embarrassment, self-consciousness, or decreased self-esteem. These emotional impacts can further contribute to the overall burden of postoperative alopecia.
You Might Also Read  Eruptive Lingual Papillitis

Explanation of Postoperative Alopecia:

Postoperative alopecia can occur for various reasons and can affect both men and women of all ages. The underlying cause of postoperative alopecia can vary depending on the type of surgery, the individual’s genetic predisposition, and other factors. Some of the common causes of postoperative alopecia include:

  1. Telogen Effluvium: Telogen effluvium is a type of hair loss that occurs due to a disruption in the normal hair growth cycle. During the normal hair growth cycle, hair follicles go through a growth phase (anagen), a rest phase (telogen), and a shedding phase (ex


Diagnosis of postoperative alopecia involves a thorough medical history, physical examination, and specific tests to rule out other potential causes of hair loss. In this article, we will discuss the main lists of diagnoses and tests for postoperative alopecia in detail.

Diagnosis of Postoperative Alopecia:

Diagnosing postoperative alopecia requires a comprehensive evaluation of the patient’s medical history, including a detailed inquiry about any recent surgeries or traumatic events that may have preceded the onset of hair loss. The patient’s medical history should also include information about any existing medical conditions, medications, and nutritional status, as these factors can contribute to hair loss.

A physical examination of the scalp and hair is a crucial step in diagnosing postoperative alopecia. The dermatologist or healthcare provider will carefully examine the scalp for signs of inflammation, infection, scarring, or any other abnormality that may be contributing to hair loss. The pattern of hair loss, the presence of broken hairs or “exclamation mark” hairs (short, tapered hairs with a widened base), and the overall density of the hair will be evaluated during the physical examination.

You Might Also Read  Green Nails

In addition to the medical history and physical examination, specific tests may be ordered to rule out other potential causes of hair loss and confirm the diagnosis of postoperative alopecia.

Tests for Postoperative Alopecia:

  1. Pull Test: A pull test is a simple diagnostic test that involves gently tugging on a group of hairs to assess the shedding rate. In postoperative alopecia, an increased number of hairs will be easily pulled out with minimal effort. This test is performed by grasping a small bunch of hairs and gently pulling with steady pressure. If more than 10% of the hairs come out with this test, it is considered positive for postoperative alopecia.
  2. Scalp Biopsy: A scalp biopsy may be performed to obtain a small sample of the scalp tissue for microscopic examination. This test can help identify any underlying scalp conditions, such as inflammation, infection, or scarring, that may be contributing to hair loss. A biopsy may also reveal changes in the hair follicles, such as miniaturization or increased telogen (resting) hairs, which are characteristic of postoperative alopecia.
  3. Blood Tests: Blood tests may be ordered to assess the patient’s overall health and screen for any underlying medical conditions that may be causing hair loss. These tests may include a complete blood count (CBC), thyroid function tests (TFTs), iron levels, vitamin D levels, and hormonal profiles, including levels of estrogen, progesterone, and testosterone. Nutritional deficiencies, hormonal imbalances, and thyroid disorders are known triggers for hair loss, and identifying and addressing these underlying conditions is important for managing postoperative alopecia.
  4. Trichoscopy: Trichoscopy, also known as dermoscopy or videodermoscopy, is a non-invasive imaging technique that allows for the examination of the scalp and hair using a handheld dermatoscope. Trichoscopy can provide detailed information about the hair shaft, hair follicles, and scalp, helping to identify specific patterns and characteristics of hair loss. In postoperative alopecia, trichoscopy may reveal an increased number of telogen hairs, broken hairs, and a decrease in hair density, which are consistent with the diagnosis.
  5. Phototrichogram: A phototrichogram is a specialized test that involves the plucking of hairs from


However, there are several treatment options available for postoperative alopecia, which can help to mitigate the condition and promote hair regrowth. In this article, we will explore the main lists of treatments for postoperative alopecia in detail.

  1. Medications: There are various medications that can be used to treat postoperative alopecia. These medications are typically prescribed by a dermatologist or a hair restoration specialist and may include:
You Might Also Read  Vesicular Pemphigoid

a. Minoxidil: Minoxidil is a topical medication that is commonly used to treat hair loss. It works by stimulating hair follicles and promoting hair regrowth. Minoxidil is available over the counter and can be applied directly to the scalp. It is generally well-tolerated but may cause skin irritation in some individuals.

b. Finasteride: Finasteride is an oral medication that is used to treat hair loss in men. It works by blocking the conversion of testosterone to dihydrotestosterone (DHT), which is a hormone that can contribute to hair loss. Finasteride is available by prescription only and should be used under the guidance of a healthcare professional.

c. Corticosteroids: Corticosteroids are anti-inflammatory medications that can be used to treat postoperative alopecia. They can be applied topically or injected directly into the scalp to reduce inflammation and promote hair regrowth. Corticosteroids are typically prescribed for short-term use due to their potential side effects.

d. Platelet-rich plasma (PRP) therapy: PRP therapy involves drawing a small amount of the patient’s blood, processing it to extract the platelet-rich plasma, and then injecting it into the scalp. Platelets contain growth factors that can stimulate hair follicles and promote hair regrowth. PRP therapy is a relatively new and promising treatment option for postoperative alopecia.

  1. Hair transplant surgery: Hair transplant surgery is a surgical procedure that involves harvesting hair follicles from one part of the body (usually the back or sides of the scalp) and transplanting them to the affected areas. This procedure can be effective in treating postoperative alopecia, especially if the hair loss is permanent. There are different techniques used in hair transplant surgery, such as follicular unit transplantation (FUT) and follicular unit extraction (FUE), and the choice of technique depends on the patient’s individual needs and the surgeon’s expertise.
  2. Scalp micropigmentation (SMP): SMP is a non-surgical cosmetic procedure that involves tattooing tiny dots or lines onto the scalp to create the illusion of hair follicles. This can be a useful treatment option for postoperative alopecia, as it can camouflage the areas of hair loss and create a more natural-looking hairline. SMP is typically performed by a trained technician and may require multiple sessions for optimal results.
  3. Low-level laser therapy (LLLT): LLLT is a non-invasive treatment option that uses red light therapy to stimulate hair growth. It is thought to work by increasing blood flow to the hair follicles and promoting cell metabolism. LLLT can be performed using a handheld device or a laser cap, and it is typically used for several months to see results.
  4. Lifestyle modifications: Making certain lifestyle changes can also help in managing postoperative alopecia. These may include:

a. Balanced diet: Eating a balanced diet that is rich in vitamins, minerals, and protein can support healthy hair growth. Foods like eggs, fish, nuts, seeds, leafy greens, and fruits can provide essential nutrients