What Helps with Hair Loss after Gastric Sleeve Surgery

Hair loss after gastric sleeve surgery is quite common. It’s a normal consequence as the body reacts to the quick, massive weight loss after surgery. This kind of hair loss is also called ‘telogen effluvium’, which is usually temporary (not permanent). So there should be nothing to worry! Here are pieces of information to help deal with.

How does this hair loss occur?

Telogen effluvium is a kind of hair loss in which there are more hair follicles that go into telogen (resting) phase.

The hair follicle is at rest completely during telogen phase. This is followed with a club hair and then the new hair growth cycle starts over again. Typically, telogen phase will last for about 100 days or longer for hairs elsewhere on your body (e.g. leg, arm, eyelash, and eyebrow).

After telogen phase, the hair follicle will go into anagen and catagen phase:

1. Anagen is the phase when the hair follicles grow actively. The hair cells divide rapidly, stimulating your hairs for growth (about 0.4 inch every 28 days). Most of hairs on the scalp are going with anagen phase. This phase will last in years (about 2-6 years).
2. Catagen is the transition phase between anagen and telogen. At any time, it accounts about 3 percent of all hairs and lasts for about 2-3 weeks [1].

There are usually only about 6-8 percent of hair follicles on the scalp going into telogen phase at any time. But certain conditions can drive more hair follicles turn into telogen phase, resulting in a massive loss of hair. These include physical trauma (such as surgery), pregnancy (hormonal changes), certain medications, and nutrient deficiency.

Telogen effluvium is common after surgery, affecting about half of all people in the year following surgery [2]. So how does gastric sleeve surgery factor into hair loss? There are a number of possible answers. The main ones are as follows.

Gastric sleeve surgery – before, during, and after the operation — could be stressful a lot. And stress does have to do with hair loss. Even it is one of main factors in bariatric surgery-related hair loss.

The body is likely to shunt more nutrients to vital organs (e.g. the heart, lungs, and muscles) during stress. On the other hand, your sensitive hair growth system is not part of vital organs for survival during stress or at a time when all resources concentrated on healing & recovery after a major surgery. As a result, the normal cycle of hair growth is shut down temporarily [3].

In general, weight loss is not a risk factor of hair loss (especially if you drop your extra pounds gradually). But in case after bariatric surgery, a massive of weight loss occurs in a short period of time. This may cause a shock to your system and hormones, resulting in alarming side effects such as hair loss.

We know that, anecdotally and clinically, rapid weight loss is associated with hair loss. The good news, again it’s temporary. Once the system gets back to normal (balance), hair loss will resolves on its own naturally.

Although hair loss is common after a major surgery, it’s not always easy to understand. Because it could be attributed by a large variety of things!

1. Anesthesia. It’s not fully known whether anesthesia for surgery has a role to factor into hair loss. But some doctors and patients believe there may be a connection, especially for high dose of anesthesia that last several hours. It’s thought that anesthesia may affect (slow down) cell division.
2. Certain medications may affect your hair follicles, including some of which are probably necessary for gastric sleeve surgery procedures.
3. Surgery increases the risk of infection. If you have infection, the problem could be severe enough to affect your hair follicles.

What else? Gastric sleeve surgery is one of new innovations. It’s quite practical if compared to other types of bariatric surgeries. Typically, it requires 2-3 days of hospital stay. But whatever it is, it’s likely to drive you to take more days of bed rest. And prolonged period of bed rest will cause more pressure on back of your head scalp, making positional alopecia more likely.

Positional alopecia is not common after gastric sleeve surgery. But it might occur if you have sensitive scalp.

What helps with the problem?

Actually, there is no specific instruction to deal with hair loss after gastric sleeve surgery. The hair usually will grow back several weeks or months afterwards. However, there are also a number of ways to make your hair regrow more quickly.

You need more nutrients during recovery. Eat foods high in nutrients to support your healing optimally. This is also important to make sure that your hair follicles get what they need to keep them healthy.

For more guidance what to eat right after surgery, work with a registered dietitian! There are probably specific instructions you need to follow.

For example, it’s normal to feel much sooner than before since you now have smaller stomach. So don’t eat foods too quickly! You need to chew each food slowly — easily digested foods are more recommended, especially for diet right after surgery. You may also need to avoid dairy products for a while until you’re ready to get used to your new stomach, this is particularly true if you have lactose intolerance.

And to help deal with hair loss after surgery, here are a few things to remember:

#Protein first

We know well that protein is one of the most important nutrients for the body.  The body can do all it can if you’re lack of protein. If you are being at deficiency, your body may break down muscle. This makes you feel tired, irritable, or nauseous. And if the deficiency continues, this will cause other problems such as skin problems, weakened immune system (increased risk of infection), and hair loss.

That’s why you need to get a lot of protein from your diet (60-80 grams a day or more). But with new smaller stomach, it’s not always easy to get enough it. Even many bariatric patients probably don’t get enough protein after surgery, according to one study [4].

Your physical capacity to take in food after surgery could be extremely limited. Acid reflux, GERD, heartburn, or whatever you want to call it – can also affect your dietary protein as can diet restrictions (such as restrictions for dietary products due to lactose intolerance, fatty foods and sugary drinks several weeks after surgery). Furthermore, controls around the timing of drink and food also don’t exactly make things any easier.

But whatever it is, getting enough protein is a must to deal with bariatric surgery-related hair loss. To help absorb your dietary protein optimally, protein should be eaten as the first part of your meal.

We know there are lots of foods containing protein. But certain foods are probably not allowed by your doctor until your stomach is ready to digest them. In case when you’re dealing with a tough time getting enough, protein supplement may be necessary (ask your doctor for prescription).

#What else?

1. Essential fatty acids.  They are a good nutrient that plays a role for your skin and hair health, particularly omega-3 fatty acids. You can find them in fatty fish (such as tuna and salmon), almonds, walnuts, and flaxseed oil.
2. Vitamins, especially B6 and B12. B vitamins are involved to help carry nutrients and oxygen to the scalp. Leafy greens, spinach, fish, and whole grains are good sources for B vitamins.
3. Folic acid, the synthetic form of folate — a kind of B vitamin. It is also responsible in the health of your nails, skin, and hair. Try to get about 400 microgram of folate a day, according to OWH [5]. Some good natural sources of folate are broccoli, beans, nuts, and citrus fruits.
4. Trace minerals, especially zinc, iron, biotin, and magnesium. All these minerals are good for hair growth. The good news the deficiency of these minerals (probably except iron) are uncommon since they can be easily found in a variety of foods, such as; fruits, vegetables, and many other common foods.

If necessary, it’s not bad idea to get help from the pharmacy. Try a hair growth product to help you recover from post-surgical telogen effluvium more quickly!

There are several choices to choose from, such as minoxidil (Rogaine, has been approved by FDA), vitamin supplements (like Arnica Montana to help minimize inflammation), special shampoos (e.g. Nioxin shampoo), or low level laser therapy (if possible). Which is the best one? This can vary – but to keep safe, it’d be better to ask your doctor /dermatologist first!

When you’re going with telogen effluvium, your hair is fragile to fall out. So you need be gentle and extra careful when styling your hair. Avoid any risky behaviors that provoke the problem (e.g. coloring, blow-drying, extreme curling, or straightening).

So avoid heat tools, dyeing, or tying your hair up until your hair is ready enough. Also, brush your hair carefully with a good brush (it should detangle your hair without pulling on it too strong). Never brush the hair when it’s wet, when it’s most fragile!

Physical trauma and restrictions on foods you can eat a few weeks after gastric sleeve surgery are probably enough to affect your hair life cycle which then may end with hair loss (telogen effluvium). And this could get worse if your stress is unmanageable afterwards.

Stress is a traumatic factor for hair loss. Your stress hormone, called cortisol, activates the emergency response of your body. As a result, all resources in your body are likely concentrated for fight /flight response, distorting your normal hair life cycle.

Unfortunately, times of stress are quite common after surgery. But it should be manageable. If necessary, consider counseling to help manage and improve your emotional health. It’s also recommended to join support groups.

What’s more?