Physician’s Hair Institute

Treatment-induced hair shedding, or “dread shed,” is an often discussed yet poorly defined phenomenon in androgenetic alopecia (AGA) management. Shedding was most consistently reported with topical and oral minoxidil, attributed to premature anagen induction or stress-induced telogen effluvium. Evidence for shedding with antiandrogens is limited, while platelet-rich plasma with microneedling and light based therapies were rarely associated. Nutraceutical trials generally showed improved hair parameters without a clear shedding phase, though early shedding may be underrecognized due to delayed efficacy assessments. Despite its prevalence in social media, “dread shed” remains underrepresented in literature, highlighting the need for further research to guide patient counseling.

BACKGROUND Since it is not known precisely how long it will take for grafts to be securely anchored after a hair transplant, the advice that the medical profession has offered patients regarding postoperative care has been somewhat arbitrary. OBJECTIVE This study attempts to provide scientific data that can be useful in refining postoperative hair transplant protocols. METHODS Forty-two patients participated in the study. During their postoperative period, each had several grafts pulled to determine at what point they could no longer be manually dislodged. RESULTS For the first 2 days, pulling on a hair always resulted in a lost graft. By the 6th day, pulling on a hair no longer dislodged the graft. Pulling on an adherent scab always resulted in a lost graft through day five. At 9 days postoperatively, grafts were no longer at risk of being dislodged. CONCLUSION The presence of crusting extends the interval that grafts are at risk of being dislodged postoperatively. If one can prevent crust formation following a hair transplant, this would both shorten the time patients are at risk of losing their grafts and enable them to return to their normal hair care routines more quickly.