Hair Loss after Bariatric Surgery

While bariatric surgery has become routine, with relatively rare serious risks and considerations, one of the potential side effects patients are most concerned about is hair loss. Before we continue, it is important to understand that any hair loss you may experience after surgery is most likely temporary unless there are other factors that come into play such as a genetic predisposition for balding or male pattern baldness. We expected about three quarters of patients will experience noticeably thinning hair over the course of the first year after surgery. And while it can be shocking, this hair usually begins to grow back around the 6-9 month mark.

So, what are the causes of hair loss after bariatric surgery?

The most obvious cause is the significant reduction of calories and nutritional intake after surgery. No matter how many calories you were consuming before surgery, they will be significantly limited after the procedure – that creates a shock to your body. It is within the first six months that the biggest changes will occur. Beyond calorie restriction, hormones may begin to rebalance, and the stress of surgery and new lifestyle will be at its peak. This causes telogen effluvium, a form of hair loss.

A primer about how hair grows

All of us have growth, transition and resting hair cycles. These are known as anagen, catagen and telogen, respectively. Growth periods last up to five years at a time, followed by an approximately 10 day transitional phase with the resting lasting about three months for most people. During the resting phase, our hair follicles may fall out – they are then replaced during the growth phase. Just as with any bodily function, there are several reasons for any of these phases being disrupted – shortened or lengthened. Almost all include abnormal function of or trauma to the body and include:

• You guessed it, surgery or any other significant trauma
• Acute or chronic disease
• Hormonal fluctuations caused by diseases including obesity
• Nutritional deficiencies
• Certain medications
• Toxicity from heavy metals or chemotherapy

Any of the above, and especially bariatric surgery can lengthen the resting or telogen phase of the hair cycle, leading to greater hair loss. Bariatric surgery essentially combines trauma to the body in the form of surgical intervention with hormonal fluctuation (for the better, but fluctuation nonetheless) and nutritional limitations. It’s a trifecta for hair loss.

What can we do to minimize hair loss?

The degree to which hair loss will affect you is a bit of a gamble and mostly based on your body’s reaction to the significant changes after surgery. We also have to balance caloric restriction with preventing hair loss. More calories may minimize hair loss, but slow weight loss and vice versa.

The best way to manage potential hair loss after surgery is to follow the postsurgical dietary plan very closely. This is the culmination of information from thousands of bariatric procedures over the years. You will want to take your multivitamin as well as any other supplements prescribed by Dr. Henke based on your blood work at follow-up appointments. Common deficiencies can include zinc and biotin, which can help with hair loss, vitamin B12, calcium, iron and vitamin D.

Proper protein intake will also make a big difference, both in recovery and minimizing hair loss. While it will be difficult to consume enough protein from food alone, you will have the help of protein shakes and meal replacements that will get you to the magic number.

Dr. Henke does not recommend pursuing over-the-counter or prescription hair loss medications or supplements that are not specifically in the postoperative packet as these may complicate recovery and are often unnecessary due to the temporary nature of this hair loss. If it any point you are concerned that your hair is not re-growing, we encourage you to speak to Dr. Henke either during our weekly online support group or at one of your follow-up appointments. Working together, we can figure out the best way forward when treating hair loss and determine and eliminate any hidden causes of hair loss that may be affecting you.