Hair loss after bariatric surgery: how to prevent it and how to stop it? [EXPLANATION]

Hair loss, as well as hair growth, is a regular stage in the hair follicles cycle, so everyone experiences it. Usually, 90% of hair is growing (it is called anagen phase) and only 10% is falling out (it is called telogen phase). People lose up to 100 hair a day, but at the same time the new hair is growing – no wonder, we do not notice any worrying hair loss. Sometimes, however, the proportions are changed and there is a much bigger percentage of hair that falls out. In this article, we focus on hair loss after weight loss surgery. 

It has been noticed that increased hair loss is a regular side effect of bariatric surgery. While some patients do not pay attention to hair loss and focus on losing weight, for others it becomes a major problem – not only physical but also a psychological one. Severe hair loss after bariatric surgery might happen and each bariatric patient should be informed and educated about it.

We hope this article will shed some light on the hair loss problem and will prepare bariatric patients to cope with it. 

Hair loss is a regular side effect of weight loss surgery that can happen to each patient. It is a normal body reaction to all the changes

Types of hair loss

There are several types of hair loss (alopecia) and even bariatric patients may suffer from increased hair loss for different reasons.

The hair loss types are described below:

Androgenetic Alopecia

It is a genetic condition that may affect men and women. The main characteristics of androgenetic alopecia is a receding hairline and crown baldness. Men can start suffering from androgenetic alopecia (male pattern baldness) in their 20s, while women usually may need androgenetic alopecia treatment after they reach 40.

Involutional alopecia

Involutional alopecia is a natural process where hair follicles get thinner over time. As a result, more hair is in a resting phase and the hair number diminishes. 

Alopecia areata

Alopecia areata is an autoimmune condition which concerns young people (children or teenagers). It results in sudden hair loss. Regarding the alopecia areata causes, it is the immune system that attacks the follicles. However, the good news is that in over 90% of people experiencing it, the hair re-grows within a few years.

Alopecia universalis

Alopecia universalis entails all hair loss including eyelashes, eyebrows, or pubic hair. The alopecia universalis causes are not known. 

There are different types of hair loss but the most common is telogen effluvium. The main reason for this hair loss is the change in hair growth cycles

Scarring alopecias

The scarring alopecias, also called critical alopecia, is a disorder that destroys follicles and replaces them with scar tissue, which causes permanent hair loss. Sometimes, hair loss is gradual and unnoticeable for a long time, but there are also people who experience a rapid hair loss that causes itching, burning, and pain. This hair loss is permanent because the scars (e.g. acne, lupus, or cellulitis scars) prevent hair regeneration. 

Telogen Effluvium

Telogen effluvium is a very common type of hair loss. The main reason for this hair loss is the change of hair growth cycles where telogen effluvium duration extends. It means that there are more follicles in a resting phase and less follicles which grow. 

What causes hair loss after bariatric surgery

Each bariatric patient experiences losing hair after weight loss surgery, but it is a normal body reaction to all the changes. In general, hair loss weight loss surgery is diagnosed as Telogen Effluvium, which means that it is only a temporary loss of hair. Bariatric surgery entails rapid weight loss, intense stress, hormonal imbalances, malnutrition, extreme diet, vitamin deficiency, medications, and nutrients malabsorption. No wonder the body needs some time to adjust to the new reality and hair loss is just one of the signs of major changes that have been made. Usually, the hair growth process goes back to normal within 6 months after surgery, so even if hair loss looks dramatic, it is only temporary and does not cause any serious harm. Patients should start to worry only when a noticeable hair loss continues for over a year after surgery – it may be a sign of nutritional deficiencies or health problems.

Reasons for hair loss

Hair loss is a natural condition that all people experience. Only when hair that falls out is not replaced with new hair, can we talk about the hair loss problem. There may be many hair loss causes including genetic, nutritional, or medical reasons for hair loss. Of course, it is important to diagnose which hair loss type we struggle with because it may help find its reasons, for example, the rapid hair loss causes may differ from temporary hair loss causes.

Anyway, we present the most common reasons for hair loss below. 

It is very common that bariatric surgery patients are losing hair. It is a body reaction to the changes after a weight loss procedure

Genetic hair loss

Genetic hair loss is known as androgenetic alopecia. As the name suggests, it is the genetic condition which limits the time of active hair growth, so naturally, the hair loss genetics is leading. People with genetic hair loss start noticing the signs in the hairline, temples, and crown – the hairline is receding and the crown gets much thinner. After some time, the hairline reaches the crown, which makes the scalp totally bald. 

Illness hair loss

There are some diseases that directly or indirectly influence hair loss. The hair loss illness examples are thyroid disease, scalp infections (e.g. ringworm), autoimmune diseases (e.g. alopecia areata), lichen planus, lupus, or trichotillomania. What is more, hair loss may result from hormonal changes connected with pregnancy, menopause, childbirth, or birth control pills. 

Stress hair loss

Stress hair loss is very common. It may happen to people who experience chronic stress lasting for a long time as well as those who experience a single, yet traumatic and stressful event. The hair loss resulting from emotional trauma is usually temporary and the hair condition normalizes within a few months. Examples of situations triggering hair loss are extreme and rapid weight loss, the death of a family member, very high fever, serious financial problems, domestic violence, or an accident.

Nutritional hair loss

Nutritional hair loss is a problem that many people struggle with. Following a fast-food diet, eating poor quality food, following experimental diets that are just trendy, and refraining from vegetables in any form always result in hair loss. The modern world is soaked with easily accessible junk food, highly processed products, or meals that pretend to be healthy – which combined with a sedentary lifestyle and chronic stress makes the hair fall out rapidly. Generally, these are proteins, zinc, iron, and Vitamin D which may prevent or speed hair loss.

Medications that cause hair loss

There are certain supplements and medications that cause hair loss. They include medications for cancer, depression, arthritis, gout, heart problems, and hypertension. Besides, radiation therapy has a harmful effect on hair – the hair falls out and never grows back in the way it did before.

Reasons for hair loss after bariatric surgery

Bariatric patients should always be informed that one of the side effects of weight loss surgery is hair loss. It cannot be predicted whether you will experience moderate or extreme hair loss after bariatric surgery, so you need to be aware of any scenario. Such hair loss is usually temporary and should stop within a few months. But why is there hair loss after bariatric surgery?

Below, we present the common causes of hair loss after bariatric surgery.

Surgical trauma hair loss

Hair loss after surgery may be a symptom of a surgical trauma, which is both physical and emotional. Regarding the physical aspect, the body deals with cutting, incisions, sometimes it has a device left in (like a gastric balloon or gastric band), scars – so it is understandable that all the nutrients aim at healing the affected body area and hair follicles need to wait to get nourished. As for the emotional aspect, surgery triggers much stress that is accumulated for weeks and revealed on the surgery day. The heavy and dominant thoughts about the surgery and its outcome may cause major psychological trauma. So, hair loss after surgery how long does it last? Well, usually patients notice hair loss a few weeks after the surgery, but for the most part, the loss stops after 5-6 months (sometimes it may be up to a year). Even if such a hair loss is temporary and should not do much harm, patients should know how to prevent hair loss after surgery.

General anesthesia hair loss

General anesthesia and hair loss are linked. The hair loss from anesthesia is telogen effluvium type

It is known that general anesthesia and hair loss are linked. The hair loss from anesthesia is telogen effluvium type, which means that it should be temporary. A weight loss surgery is a major, often life-saving surgery that may last a few hours and requires applying general anesthesia. The idea of general anesthesia is blocking nerves, which results in losing consciousness and awareness. Naturally, somebody’s functions are also blocked (e.g. digesting or swallowing). But what is the connection between hair loss and anesthesia? Hair follicles are surrounded by nerves and when the nerves are blocked, the growing hair can automatically transform to the telogen phase. The hair loss after surgery anesthesia is usually short-term, but there are single cases of permanent hair loss afterward.

Stress hair loss

Stress and hair loss are strongly related. The more stressed we are, the bigger the probability of long lasting hair loss.

In general, stress may cause 3 types of hair loss:

• telogen effluvium (the follicles are pushed into the resting phase and ultimately fall out) 
• trichotillomania (it is called a compulsive hair pulling where a person pulls out hair as a response to stress)
• alopecia areata (the immune system attacks follicles).

Regardless of the type, emotional stress and hair loss can be stopped. When you control your stress, the hair starts growing back. 

Vitamin and mineral deficiency hair loss

Vitamin deficiency hair loss and mineral deficiency hair loss are very common for bariatric patients. The strict weight loss diet that needs to be followed especially in the first months after the surgery does not provide all necessary nutrients and vitamins and hair loss belongs to the most obvious vitamin and mineral deficiency symptoms. Usually, however, bariatric surgeons or dieticians recommend to patients how to cover vitamin and mineral deficiency with supplements. When patients strictly follow the diet plan made by a dietician, their vitamin mineral deficiency hair loss should be only temporary, and after they reach the last stage of a diet, which is a protein-rich balanced diet, the problem should disappear.   

Hormone problems hair loss

Any hormone fluctuations, not to mention more serious hormone problems, may cause hair loss. Of course, there are different symptoms of hormone problems for men and women, however, hair loss concerns both groups.

Below, we present the hormones that may trigger hair loss:

• Oestrogen – a female hormone, however, the tiny quantities are also found in men. When balanced, it helps hair growth and improves hair quality, but when there is too much or too little estrogen, the hair becomes much thinner (pregnant women experience rapid growth of this hormone, which rapidly falls after giving birth, the fall is also when women stop taking contraceptive pills).
• Testosterone – a male hormone, but women also produce its tiny quantities. Over time, testosterone turns into DHT, which prevents the hair growth mainly on the head. The conditions caused by this hormone are male pattern baldness and female pattern baldness. 
• Insulin – a hormone which regulates the blood sugar level. It influences many processes in the body including hair growth and loss. It is proven that people with insulin resistance are more likely to experience female/male pattern baldness or androgenic alopecia than those who have insulin levels under control.
• Thyroid – when people have thyroid-related problems, all the energy and nutrients are directed to coping with them and less important processes, such as hair growth, are put aside. 

Diet, calorie restriction hair loss

It is very important to keep a healthy diet after bariatric surgery so enough proteins, vitamins, and minerals are provided. Very often wrong diet and hair loss are linked

Diet and hair loss are inextricably linked and especially bariatric patients should realize that. The diet after weight loss surgery is very specific – starting from pure liquids, it evolves into pureed food, then soft and mashed meals, and only after weeks, solid food can be implemented. The change is also in the amount of food that can be eaten – these are only tiny amounts of food. It causes severe calorie restriction hair loss. It is very difficult to provide oneself with enough proteins, vitamins, and minerals when there are such restrictions. Thus, it is really important that bariatric patients strictly follow the individual diet and take recommended supplements with no exceptions.

Medications hair loss

We described the medications and hair loss aspect earlier in this article. So, knowing that there are some medications that cause hair loss, bariatric patients should inform the surgeon about any meds they take regularly and get to know whether they may enhance hair loss. If yes, patients may be advised to take more supplements or modify their post-op diet. 

How to stop hair loss after bariatric surgery

It is certain that bariatric patients experience hair loss, so they should be prepared for this. The hair loss does not mean they will go bald at all, it might be dramatic but it is usually temporary. If hair loss is long-lasting, it means that it is not the surgery that causes it, but more serious reasons. Also, there are some ways of dealing with hair loss – below we describe the most effective solutions of how to stop hair loss after weight loss surgery.

Treatments for hair loss

Nowadays, there are dozens of hair loss treatment methods available, some of which are certified, some are just experimental and far-fetched. Before opting for the best hair loss treatment, you need to do some research and check whether the method you choose has the evidenced results. Also, hair loss treatment for men may differ from hair loss treatment for women. 

The hair loss treatment options for men include:

• medications
• hair transplant
• laser treatment
• lifestyle changes (e.g. a balanced diet, no smoking, scalp massages, reducing stress)
• cosmetics (e.g. oil, special shampoo, and conditioners).

The hair loss treatment options for women include:

• medications
• topical tretinoin
• topical anthralin
• Corticosteroid injections
• PRP therapy
• laser therapy
• lifestyle changes (e.g. a balanced diet, no smoking, scalp massages, reducing stress)
• cosmetics (e.g. oil, special shampoo, and conditioners).

Below, we will describe the two most effective methods, which are medications and hair transplant. They are highly effective, but they should not be the first choice. Bariatric patients should start with modifying their diet, adding recommended supplements, and using dedicated cosmetics. Usually, it is effective and no further steps are needed. Only when hair loss continues, some more serious treatments can be implemented. 

Hair Loss medications

The market offers both OTC and prescription hair loss medications. FDA approved only two meds that are effective in treating hair loss problems.  

• Rogaine (Minoxidil) – it is the OTC drug in a form of liquid or foam. It needs to be applied to the scalp two times a day. This medication is dedicated to both men and women suffering from androgenic alopecia or alopecia areata. The results can be seen after a few months of applying Rogaine, so it is important to use it regularly and do not give up even if the effects are not visible in the beginning. 
• Finasteride (Proscar, Propecia) – this medication is dedicated for men. It can be obtained only when prescribed by the doctor. The studies show that after 6 months, the hair loss diminishes by 30%. It not only prevents hair loss but also strengthens follicles and provokes hair growth. What’s interesting, this drug was tested on women, but it was ineffective. 
• Aldactone (spironolactone) – is a medication for women and although FDA has not approved it as a hair loss treatment method, it is widely used and brings the expected effects. It must be prescribed by the doctor. Generally, Aldactone addresses the hormones – it mainly decreases the testosterone processing in the woman’s body. When the androgenes production is reduced, the process of hair loss is also significantly reduced.

Hair transplant

A hair transplant is a cosmetic procedure for restoring hair. There are two main hair transplant methods – FUE (follicular unit extraction) and FUT (follicular unit transplantation). In FUE hair transplant, each hair is extracted individually, while in FUT the whole strip of skin is extracted, and only then are the hairs separated. Below, there is a short comparison of these hair transplant types. 

In general, hair transplant is surgery for men experiencing androgenetic alopecia or male pattern baldness. As for women, they are qualified for hair transplant very rarely. The reason for that is that hair loss in women looks differently – all hairs get thinner, the volume is lost, and the donor areas are affected by DHT. Men, on the other hand, have hair loss usually at the top of the head and back hair is still strong. Yet, some women may get hair transplant, so we advise to consult the specialist to get the individual answer.

How to prevent hair loss after bariatric surgery

It is always much easier, cheaper, and stressless to prevent or postpone the hair loss process than stopping it once experienced

Having explained what to do to stop hair loss, we need to stress that there are also methods for preventing hair loss. It is much easier, cheaper, and stressless to prevent or postpone the hair loss process than stopping it once experienced. Knowing how to prevent hair loss after weight loss surgery is very helpful especially for bariatric patients who are very prone to hair loss after the surgery. Against all appearances, the most effective methods for preventing hair loss are nothing more than a proper diet, vitamin intake, and avoiding stress. 

Diet for hair loss

There are numerous diet plans and products that are recommended to people who struggle with hair loss. However, regarding bariatric patients, they need to keep to the diet plan for weight loss after the surgery. It is a very strict and limited diet, so it is almost impossible to get all the necessary nutrients especially at the beginning, so hair supplements are advised.

Each post-op diet consists of 5 stages:

• week 1 – clear liquids (e.g. water, juices, broth)
• week 2 – full liquids (e.g. milk, shakes, yogurt, sorbet)
• week 3 – pureed food (e.g. mashed fruit, scrambled egg, humous)
• week 4 – soft food (e.g. soft fish, well-cooked poultry, cooked vegetables)
• week 5 onwards – a balanced diet with solid food.

The first weeks when only liquids are allowed and the food portions are so small are very difficult for patients, so they should focus just on this diet and try to get used to the new reality and new diet regime. When they reach stage 5, they may start modifying their diet in a way that it contains healthy foods important for hair condition. 

The products that are necessary for the diet for hair loss include:

• eggs (they are a perfect source of biotin and proteins)
• sweet potatoes and carrots (they contain beta-carotene)
• spinach (it is rich in vitamins C and A, iron and folate)
• berries (they contain many vitamins and antioxidants)
• seeds (they provide vitamins B and E, selenium and zinc)
• fatty fish (they contain omega-3 fatty acids)
• avocado (it contains vitamin C and E and healthy fats)
• nuts (they are rich in vitamin E and B group vitamins)
• shrimps (they are rich in proteins, Vitamins B and D, iron, and zinc)
• oysters (they are the best source of zinc)
• pepper (it is the best source of Vitamin C)
• meat (it is a source of proteins).

Bariatric patients can implement all the above products to their diet starting from week 5-6. It is important that the products are healthy, rich in nutrients, and diversified. Such a diet should be the first step in preventing hair loss. At the same time, we should remember not to make hairy mistakes such as extensive sun exposure, frequent changes of shampoo or conditioners, using hair gels, sprays, or creams. 

Protein for hair loss

Proteins play important role in hair growth. If there are not enough proteins to supply all body cells, they are directed to support only the most important functions

Nutrient deficiency almost always results in hair loss. Proteins are particularly important for hair growth. Once there are not enough proteins to supply all body cells, they are directed to support only the most important functions, which is not hair growth obviously. 

The protein that is crucial for hair follicles condition is keratin. This protein for hair is responsible for elasticity, thickness, and condition of hair. Once it is missing, follicles enter the resting phase and fall out after some time. 

There are 3 groups of people who are particularly prone to have a deficiency of protein for hair growth: people on a diet, vegans, and vegetarians, and bariatric patients. They need to pay great attention to their diet components and make an effort to get enough protein for hair loss prevention.

The best protein sources are:

• chicken and red meat
• fish
• beans
• dairy products
• kale and asparagus.

These products are not only rich in proteins but also contain biotin and amino acids. The recommended intake of proteins a day is 45-55 grams a day for adults. Bariatric surgery patients may have a different dose, but after achieving the final results, they should gradually reach the regular protein intake.

Vitamins for hair grow

The most important vitamins responsible for hair condition are vitamin A, Vitamins B group, Vitamins C and D as well as iron, zinc, and proteins

Having strong and healthy hair is not as difficult as it may seem. Apart from a balanced and healthy diet, proper supplementation is important. However, random hair loss vitamins, magic vitamins for hair growth, or uncertified vitamins for hair are not a good solution. To get the right vitamin supplements, you need to know which vitamin deficiency you have. It would be best if you visit a doctor who will tell you what vitamins are good for hair and do all necessary medical tests – they will show any deficiencies you have. You need to know that both deficiency and overdose of vitamins may be harmful and only a specialist may choose the best vitamins for hair loss for an individual. 

The Vitamins that play a great role in keeping hair condition are Vitamin A, Vitamins B group, Vitamins C and D as well as iron, zinc, and proteins. 

Zinc

Zinc is a very important mineral that supports hormones and enzyme production. It also helps the body process proteins, fats, and carbohydrates. The use of zinc for hair loss or skin problems is medically proven. As for zinc for hair, it does not influence hair growth but can prevent hair loss. 

Generally, zinc is found in most products, so following a balanced diet would ensure enough amount of this mineral. The thing is that our body cannot store zinc, so it needs to be provided from food every day – only then can it prevent hair loss. The food that is rich in zinc includes beef (including liver and kidneys), lamb, crab, oyster, peanuts, cheese, milk, wheat germ. We must remember that zinc would not be absorbed once eaten with food that contains phytic acid (e.g. beans, pulses). The vitamin zinc for hair loss should be taken only if there is a zinc deficiency. 

Vitamin D

Vitamin D is responsible for the immune system, bones strength, skin health, cell growth, and creating hair follicles. Our bodies cannot produce Vitamin D on their own, it is obtained through sun exposure, some food, or supplements. The agreed dose of Vit D for hair growth for adults is at least 600 IU, the doses for children or elderly people may be different, yet still recommended. 

One of the roles of Vitamin D is stimulating follicles growth and protecting existing follicles, so in case of deficiency, the hair growth is stunted and hair loss is provoked. 

The food that contains Vitamin D includes fatty fish (e.g. salmon or mackerel), animal fats and fish liver oils, some types of milk or juices, certain cereals. Apart from food, Vitamin D can be obtained through sun exposure – even a 15-minute exposure of any body part to the Sun guarantees enough Vitamin D. The last resort are supplements, they are widely recommended – we just need to pay attention that they contain at least 600-800 IU (the more, the better).

Iron

Iron plays a very important role – it enables hemoglobin production. When there is iron deficiency, hemoglobin is not produced and the cells are damaged, including cells stimulating hair growth. Hair loss caused by iron deficiency is usually temporary, so it is enough to restore the proper intake of iron for hair growth. The diet should be rich in spinach, salmon, pork, peas, dried food, or other iron-fortified products. The iron for hair loss is absorbed better once accompanied by Vitamin C.

Stress is one of the factors that may lead to hair loss. Managing stress can be very difficult but it is crucial to try to avoid it

Avoiding stress

Stress is an environmental factor that may provoke hair loss. Both long, chronic stress and extreme stress caused by a single situation are very dangerous for our health.

The stress may cause 2 types of hair loss:

• telogen effluvium – it is a common, yet moderate hair loss where hair follicles stop growing and move to the resting phase; these follicles usually fall out after 2-3 months, but grow back again after 6-9 months;
• alopecia areata – it is a condition where white blood cell attack hair cells in response to stress; the follicles fall out within several weeks – it concerns head hair, eyebrows, eyelashes or other body hair; sometimes the hair grows back, but it is not a rule and there are cases where hair loss treatment needs to be implemented. 

The other condition related to stress is trichotillomania. It is a hair-pulling disorder where people compulsively pull their hair as a reaction to stressful situations. For any type of hair loss, people may either avoid stress or learn how to manage stress. There are stress and hair loss supplements or vitamins for stress and hair loss – which we recommend, but firstly, you should try some stress-management techniques, which include:

• exercising (including walking or dancing)
• deep, controlled breathing 
• meditation (e.g. yoga or relaxation exercises)
• hobbies
• writing down any emotions and feelings.

Managing stress may be very difficult, especially if it is caused by a traumatic experience or situation, hence it is a great idea to visit a psychologist or other certified therapist who will find a way of dealing with stress before dramatic hair loss takes place. 

Speak to the hair loss specialist

Finding a hair loss specialist is the best choice for those who want to prevent hair loss. Such a specialist may be a trichologist or dermatologist – they have all instruments and expertise that would allow for finding the source of hair loss or finding the proper hair-care program. 

Summary

Hair loss is a problem for the vast majority of bariatric surgery patients. Yet, we need to note that it should not occupy their mind because the most important thing is focusing on the recovery after weight loss surgery including a diet and exercise plan. Hair loss is just a temporary side effect and usually following all dietary instructions and taking recommended supplements help avoid or reduce hair loss. 

If you want to get prepared for the possibility of hair loss after the surgery, you may visit a trichologist who can prevent your hair loss by taking all preventive measures such as supplements, right cosmetics, or more serious treatments – and if you add a healthy diet afterward, you have a great chance to avoid hair loss at all. 

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