hair loss

Bariatric Surgery and Hair Loss

September 29, 2016

One of the most common questions that I get with my patients before bariatric surgery is the issue with hair loss after bariatric surgery.  Unfortunately, this is a common complaint of many post-operative patients.

Hair loss is quite common after surgery, occurring in about 40 percent of our post-operative patients.  Most of the hair loss is not severe, but there is a noticeable temporary thinning of hair.  Most of the hair loss begins about a month after surgery.  It is at its worst during the first 6 months, with gradual improvement soon afterward.  Even though many patients feel great with the weight loss experienced with bariatric surgery,  hair loss can be an emotional issue. This article will shed some light as to the cause of hair loss (called telogen effluvium), and ways to help with hair loss after surgery.

The Cycle of Hair Growth

Hair growth undergoes several different cycles.  The active growth cycle of hair is called anagen.  The rest phase of hair growth is called telogen. Most of our hair is in the anagen phase, which is about 90%.  Only about 10% are in the telogen phase.

Hair in the telogen phase is shed after about 4 to 6 weeks. In telogen effluvium, about 10-30% of hair normally in the anagen phase suddenly shift into the telogen phase.  The result of that is after a month, this hair falls out.  That is why most patients notice hair loss beginning about a month after surgery.   The reason this occurs and the way the transition occurs is still poorly understood; it is commonly thought that this change occurs immediately though following a particular cause.  There is no way of switching back to the anagen phase.

Common health factors that are associated with hair loss:

  • Acute illness
  • High fevers
  • Anesthesia and Surgery
  • Pregnancy
  • Rapid weight loss
  • Calorie and protein restriction
  • Anemia
  • Zinc, Biotin, Folate and other nutrient deficiencies
  • Thyroid and other hormonal disorders
  • Acute emotional stress
  • Infections
  • Medications
  • Excess Vitamin A

All of our bariatric patients fit into a few of these categories. All of the patients are undergoing general anesthesia and surgery, and undergoing rapid weight loss and relative calorie and protein restriction.  Additionally, even the best patient may have emotional stress due to the changes that occur with surgery.  And because of the alteration in anatomy from the procedures, people can develop several nutritional deficiencies.

Causes and Treatments of Hair Loss

So, what happens next?  Typically, most patients fit the classic picture of hair loss beginning at 1 month post bariatric surgery.  Hair loss typically is at its peak during the first six months. Hair loss is typically diffuse, but more pronounced at the sides near the temple. No diagnostic tests are typically necessary, as for most patients, this is self-limiting.   During this time, the most important thing that one can do to help prevent the worsening of hair loss is appropriate caloric and protein intake.

Additionally, routine labs are important to check nutritional and vitamin levels.  Keeping on top of routine post-operative care is the most proactive thing that most patients can do. Hair loss can also have a negative psychological impact on most patients, so sharing thoughts with a bariatric support group or with a mental health professional is encouraged.

After the first year, most patients have a cessation of hair loss and then recover fully after a year. But, sometimes there can be a persistent loss of hair.  Most commonly, nutritional deficiencies are to blame. If that is the case, most common abnormalities that can lead to hair loss can include:

  • Iron – Iron is the most common deficiency associated with hair loss. Even normal iron studies can be associated with hair loss.   Additionally, women of child-bearing age who are menstruating need to be careful of iron deficiency.  Very rarely are patients that are anemic. It has also been shown that people with chronic hair loss respond to iron therapy, even if their blood levels are within normal limits.  The thought is the treatment for hair loss will occur at higher levels of serum iron.
  • Zinc- Zinc supplements have been shown to help some patients with hair loss.We know that zinc deficiency that is found with extreme weight loss procedures such as a Duodenal Switch directly is associated with hair loss. Most bariatric surgeries do not run the risk of malnutrition as a Duodenal Switch.    Even if zinc levels are normal, some studies to show that supplementation with zinc can be beneficial for some patients. It has not been shown that supplementation with zinc before hair loss occurs is of any benefit for patients.
  • Protein – Persistent low protein intake can be a source of hair loss. Most patients should be consuming a minimum of 60 grams of protein per day.  Lower than this, especially after a year post-op, would be a cause for hair loss.
  • Hypothyroidism - An abnormally high TSH level, indicating hypothyroidism, can also be a common culprit leading to hair loss. Thyroid studies should also be looked into if hair loss is persistent, as this can easily be treated by adjusting thyroid hormone supplementation.

Hair loss prevention has been looked into, but unfortunately, only data exists in animal studies for some supplements such as biotin. Some patients swear by them, but there is no true science behind supplementation before hair loss occurs.  Also, topical treatments with minoxidil will sometimes work for some patients. This medication helps prolong the anagen phase and shorten the telogen phase.  The effectiveness of this medication in patients with telogen effluvium has not been evaluated.  Patients who do respond to this medication will need to continue it indefinitely.  Use of this medication for at least a year is recommended to see if it actually helps or not.  Increased shedding of hair is also common during the first few months of treatment.

In summary, hair loss is common after bariatric surgery.  The benefits of weight loss surgery outweigh the risks, as patients lose weight, get the quality of life back and reversal of major comorbidities. Hair loss is disconcerting, but should not be a reason to not get surgery, as it is typically self-limiting.

Romeo A.Lainez

ABOUT THE AUTHOR

Dr. Romeo A. Lainez is a Bariatric Surgeon at Southwest Bariatric Surgeons and received his Bachelor’s degree in biology at Loyola University in New Orleans. He then received his Medical Degree from University of Southern California in Los Angeles, California. He continued his training in general surgery at the Ochsner Clinic Foundation in New Orleans, LA, where he would receive the Chief Resident and Teacher of the Year Award. After residency, Dr. Lainez was fellowship trained at the Houston Northwest Medical Center and Memorial Hermann as part of the UT Houston program in Houston, Texas.