After Hair Transplant Surgery
What to Do (and What Not to Do!)
So you’ve finally had that long-awaited hair transplant, and you
are ready to go home and start growing hair! Well, that’s great, but
let’s slow down a bit and think about all the things that may help
in insuring the best possible outcome for this procedure. Above all, follow
the instructions you’ve been given; they are there for a reason, and
much energy has been put into developing a set of guidelines for
patients after FUT. After all, you have paid in money and time for the operation,
and the surgeon and his team have performed a meticulous and demanding
procedure.
Why not do everything in your power to tip the scales in your favor?
Read over the written instructions for post-operative care several
times; consider reviewing it again the following day until you
are familiar with all the points being emphasized. This is very important
because some
of the vital details may be forgotten, with the excitement of the
surgery, and also with the sedation you may have received, that can cause
the fine
points to be a little "fuzzy".
Pain medications will be prescribed, but it is unlikely that these
will be needed for more than one or two days, at the most. Sometimes a little
Extra-Strength Tylenol is all that is required. Sleeping medication may
also be used for the first night, or rarely the second or third. You may
also have medication to prevent swelling; sleeping with the head elevated
on pillows for the first week may also help prevent this common experience.
Regular washing of the hair is important after the surgery. There
is a tendency to think that this will disturb the grafts, but if
it is done as recommended, the chance of dislodging a graft is remote. The
shampooing
helps remove dirt, blood and oil, and will gently dislodge the "crusts" or
scabs that form over the recipient sites; these crusts should normally be
gone within a few days to a week at the most. If they are not, you may not
be shampooing effectively enough. Proper hygiene also helps prevent infection,
and promotes the normal shedding of the transplanted hairs that occurs before
they begin their new, "relocated" growth phase.
Keeping the recipient and donor areas moist promotes their healing.
GraftCyte, or even saline solution, sprayed on the grafts a number of times
a day assists in the process. GraftCyte makes a product especially designed
for use over the donor incision; any thick ointment, such as antibiotic-based
ones, will work well. These measures also will decrease the tendency of
healing tissues to itch. This is more important than it sounds. For the
first few days, you may experience significant itching in the donor and
recipient areas. Scratching the donor site in the back will cause little
trauma; in fact, it is beneficial to keep the donor incision free from debris,
crusts, and any accumulation of dirt and ointment. The graft sites, on the
other hand, are a different matter. They are the most susceptible to trauma
during the first three or four days, which is also the time when they may
itch the most! Keeping them moist with saline or GraftCyte is the single
most important factor in soothing and preventing this pruritis or itching
sensation. Vigorous rubbing and especially scratching with the fingernails
can easily dislodge grafts, which may cause mild bleeding, but more importantly,
loses one or more of those valuable hairs.
What to Expect
One of the most misunderstood aspects of FUT is the shedding of
the new hair. Many patients either aren’t told, or do not hear, that
the majority of the newly transplanted hairs will fall out, in a process
known as anagen effluvium, within the first 3 to 8 weeks. Often, this happens
in a wave at about weeks 3 to 4. Patients may be quite upset if the beard-like
stubble they have been proudly caressing many times a day is now becoming
absent. This is perfectly normal and to be expected for 90% of the FU grafts.
They return from about 3 to 6 months post-operatively; initially, they emerge
as finer hairs, and gain length and diameter as their growth continues.
By the end of the first year, the "new" hairs should be as robust
as the other, "native" terminal hairs. They will also gain length
at the same rate as non-transplanted hairs, which is roughly one
half inch per month.
Sometimes during this first month, the patient may notice small
hairs being shed along with their bulbs. They may even come out
along with the small "crusts" within the first week or two. All
this is normal, and it must be understood that the germinal material, which
will be the
source of the new hair, is still inside at the base of the follicle.
Unless there is bleeding at a graft site, there has been no loss of a viable
graft.
Infrequently, there is some textural change in the transplanted
hair. It may become curlier than it was, or even somewhat wiry; often the
luster of the hair is also diminished if this altered texture occurs. When
examined microscopically, these hairs reveal some changes in the cuticle,
or outer covering of the hair shaft. This phenomenon is temporary, and resolves
with the normal growth cycles of the hair often in 12 to 18 months.
The donor area is a much larger incision than the tiny slits in
the recipient area; therefore, it is often a bit more worrisome than the
transplanted regions. Remember, it has been sutured, and any sutures cause
some degree of inflammatory reaction. This reaction is characterized by
mild swelling and discomfort. Also, there will be an initial swelling and
soreness from the surgical trauma of excising the donor strip. The discomfort
and associated numbness usually decreases rapidly over the first 3 to 4
days; most of the soreness is gone at one week, but the numbness may persist
for several months. In the latter case, the numbness gradually decreases
as the nerves grow back until it is unnoticeable.
Another commonly misconstrued aspect of FUT is so-called "shock loss",
or telogen effluvium, in which hair close to the tiny recipient incisions
is irritated or "shocked", leading to temporary or permanent loss
of the hairs. If this does occur, it will happen at about 2 to 3 months
after the transplant, and consists of preexisting hairs in the recipient
area which go into the telogen, or resting stage, and are shed. This may
be cosmetically significant if many hairs are lost at once. However, miniaturized
hairs, which are programmed to be lost soon anyway, are much more susceptible
to shock loss than strong, terminal hairs. If terminal hairs are lost, they
generally grow back, just as they would after a normal resting phase. The
miniaturized hairs are less likely to return. So, in a way, the effluvium
simply "fast-forwards" the individual’s hair loss to the
state it would have been in with the inevitable loss of the fine,
miniaturized hairs.
Planning for possible telogen effluvium is important when transplanting,
especially in the case of younger men with a history of fairly rapid hair
loss. Adequate numbers of FU grafts must be placed when implanting through
areas containing high numbers of miniaturized hairs. If these hairs are
lost to shock, the patient may appear balder for several months, before
the terminal hairs grow in with adequate strength and length to provide
coverage. It is important for the patient to understand the natural process
of balding, and the concept of miniaturization, so that these events can
be seen in context.
Many patients will experience good coverage in just several months,
but the full cosmetic effect of the transplant may not be evident for up
to a full year, because of the factors mentioned above. Once the hair has
reached optimal styling length, then the patient can be assessed for a possible
second procedure, if that is even felt to be necessary. In the next section,
we will discuss the reasons for and goals of a subsequent procedure.
Credits
- Information Provided by John P. Cole, MD - International Hair Transplant Institute
Hair Transplant Adviser Blog
Provided by The International Alliance of
Hair Restoration Surgeons,
the Hair Transplant Adviser blog provides the opportunity for prospective
hair transplant patients to ask questions and find answers.
