Post surgery effluvium

Anesthesia induced effluvium

Blood loss induced effluvium

Pressure induced effluvium

Surgery related effluvium references

Major surgery is an extreme physical shock to the body. After surgery your body is struggling to repair itself. Most nutrients are diverted to repairing essential organs and reorganizing the structural integrity of the body. Hair follicles are not vitally important for survival so they often lose out as nutrients are diverted elsewhere. Without a good supply of nutrients the hair follicles slow down or even stop activity completely. This may lead to a telogen effluvium type of progressive hair loss noticeable up to three months after the surgery has taken place. Surgery can also cause hair loss by other mechanisms as shown below.

Systemic anesthesia has a profound effect on the body. As you would expect, it pushes the individual into a state of unconsciousness and relaxes muscles. Anesthesia also affects hair follicles. Hair follicles contain cells that are some of the fastest dividing and developing cells of the body. They have to divide fast to maintain the growth of hair fiber. Anesthesia blocks this rapid cell division. While the application of anesthesia to an individual may only be for a few hours, the hair follicles may be affected to such a degree that they shut down hair fiber production and enter a telogen resting state. A telogen effluvium type of hair loss is the result.

Major surgery may involve a lot of blood loss. As blood is lost the body recognizes the drop in blood pressure and knows something is seriously wrong. The body reacts by reducing the blood supply to nonessential areas such as the skin and hair follicles. The blood is diverted to key organs in an attempt to maintain the blood pressure and keep these key organs supplied with the nutrients they need to stay alive. The reduced blood flow to the skin means the hair follicles do not obtain all the nutrients they need to keep dividing and growing. The hair follicles may shut down activity and enter a telogen resting state in an attempt to survive until the nutrient supply is restored.

Prolonged pressure on an area of skin effectively cuts off the blood supply to that region. Such prolonged pressure may occur when an individual is on the operating table for several hours. During surgery the individual is rarely moved and the head often stays in the same place. In addition the anesthesia relaxes muscles so the full weight of the head is pushing down on the skin at the back of the scalp. Without any sensation of pain or numbness under anesthesia, the individual is not aware of any lack of blood supply and even if they were they would be unable to move their head.

Other areas of skin on the body may also be under prolonged pressure on the operating table. The lack of blood supply means the hair follicles are not receiving nutrients in the area of skin under pressure. As a result, the hair follicles enter a telogen resting state to wait for the supply to be restored. This may result in a localized telogen effluvium at the site where pressure was applied.

Any risk of localized telogen effluvium due to applied pressure could be reduced by simply moving the head to different positions during the operating procedure. Some, but not all, surgeons do this in prolonged operations.