Gastric sleeve surgery is one of the restrictive bariatric (weight loss) surgeries available for the treatment of morbid obesity. It is often done by laparoscopic approach. The size of the stomach is reduced to one-fifth of its original size. Weight loss is achieved via a reduction in food intake as a result of small stomach and early satiety. Many complications are associated with this group of surgeries. One of them is alopecia (hair loss).
Hair loss following bariatric surgery can occur in up to 41% of patients. It is often associated with deficiencies in protein and micronutrients such as zinc and iron. However, it is temporary starting about 3months after the procedure and lasting for about 3-6months. The surgery itself is a stressful condition that is accompanied by various hormonal responses, which in addition to the physical and psychological stress of bariatric surgery, may affect hair growth. The degree of hair loss differs from patient to patient. Preoperative hair density and a male pattern of hair loss before surgery may significantly influence the quantity of hair loss.
Patients with gastric sleeve surgery have a low incidence of hair loss as the surgery is purely restrictive with no malabsorptive components. Micronutrient deficiencies may, however, occur due to inadequate intake rather than poor absorption. In this group of people, hormonal and psychological stress may also be responsible for hair loss.
Anatomy and physiology of the hair
The hair is one of the skin appendages. It grows out of the hair follicle (hair bulb) which is located in the dermis and extends to the skin surface. It is made up of keratin majorly. Keratin is a fibrous protein that is insoluble in water and organic solvent and rich in sulfur-containing amino acids.
Each hair follicle undergoes a growth cycle. The cycle consists of 3 phases: anagen, catagen, and telogen. The anagen is the phase of active hair production. Catagen is the phase of conversion from active growth to resting phase. During this phase, nascent hair is under development. Telogen is the resting phase at the end of which the club hair is shed off.
The length of these phases varies from one part of the body to another. On the head, anagen may continue for five years, the catagen phase lasts for two weeks, while telogen takes about three months. Up to 100 hairs may shed from the scalp on a daily basis in a healthy individual.
Each hair follicle undergoes its cycle independent of others. If however many hair follicles enter the resting stage at the same time, shedding may ensue at the end of the resting phase (3months), a condition known as telogen effluvium.
Why hair loss after gastric sleeve surgery
Protein malnutrition is one of the causes of hair loss. Keratin is a protein rich in disulfide bonds, and deficiency of sulfur-containing amino acids such as cysteine and methionine leads to the formation of brittle and fragile hairs and subsequent shedding. Following gastric sleeve surgery, patients must be encouraged to take more protein in order to prevent a deficiency state.
Researchers have shown that nutritional deficiencies shorten the anagen phase causing a large number of hairs to enter telogen at the same time. a leads to thinning of the hairs and subsequent shedding. A study found a low serum zinc concentration in 312 patients with hair loss compared to controls. Studies have also shown that zinc supplement can help hair regrowth due to its role in protein and nucleic acid synthesis in hair follicles and other body cells. Another study also recorded low serum ferritin (iron) in all 113 females with hair loss and in 22.7% of 97 males with hair loss in a total of 210 patients compared to controls.
Biotin is another micronutrient whose deficiency has been associated with hair loss. It is one of the water-soluble B-complex vitamins (also known as vitamin H or vitamin B7). It serves as co-enzyme in many metabolic reactions in the body and helps in maintenance of healthy hair and skin. However, it is produced by the bacteria in the intestine and deficiency rarely occurs except in people with an inborn error of metabolism. Other B-complex vitamins play a significant role in maintaining healthy hair as they function as co-enzyme in various metabolic reactions in the body.
Prevention of hair loss after gastric sleeve surgery is by way of ensuring a nutritional adequacy before and after surgery. As hair is made up of keratin which is a fibrous protein, adequate protein intake will prevent deficiency of the necessary amino acids (cysteine and methionine) and reduce the risk/severity of hair loss following gastric sleeve surgery. Nutritional supplements with micronutrients such as zinc, vitamin B12, folic acid, etc. before and after surgery will prevent a deficiency state and reduce the severity of hair loss.
You should, however, prepare your mind that this complication may occur despite taking all necessary preventive measures. Psychological preparation before the surgery will help you cope with hair loss should it occur.
Related: Gastric Sleeve Surgery Side Effects
- Kil MS, Kim CW, Kim SS. Analysis of Serum Zinc and Copper Concentrations in Hair Loss. Annals of Dermatology. 2013;25(4):405-409. doi:10.5021/ad.2013.25.4.405.
- Glynis A. A Double-blind, Placebo-controlled Study Evaluating the Efficacy of an Oral Supplement in Women with Self-perceived Thinning Hair. The Journal of Clinical and Aesthetic Dermatology. 2012;5(11):28-34.
- Park SY, Na SY, Kim JH, Cho S, Lee JH. Iron Plays a Certain Role in Patterned Hair Loss. Journal of Korean Medical Science. 2013;28(6):934-938. doi:10.3346/jkms.2013.28.6.934.