After your surgery, there are several areas to pay attention to, including the proper care of your surgery sites in order to promote healing and improve the health of the transplanted hair follicles, as well as medication for discomfort, and activities to avoid. Your doctor may adjust these instructions based on your individual situation, in which case, please follow your direct instructions from your doctor.
Immediately After Surgery
At the time of surgery, your scalp will be thoroughly cleaned of blood and crusts, but these will tend to re-form soon after your procedure. Care should be taken while cleaning the transplanted site during the week following surgery, because it is during this period that the healing mechanisms of your body secure the grafts firmly in place. However, appropriate care of the recipient area will minimize crusting and make the transplant less noticeable and the healing more rapid.If a bandage was applied to your scalp at the time of surgery then this will be removed, although many surgeons prefer not to apply a dressing to the treated area.
You will be given advice about washing and shampooing your scalp, using antibiotics and returning to the clinic for the removal of stitches (if applicable).
You may have been given a sedative before surgery to help you relax. This takes time to wear off and during that time it is dangerous to drive or perform complicated or dangerous tasks.
First Night After Surgery
When you arrive home after your procedure, please stay in bed and rest for the reminder of the day/evening as the medications given to you during your procedure will make you tired.
To minimize swelling, apply an ice pack or frozen peas over the eyebrows for 15 minutes every hour, not on the grafts and at least one inch from the hairline if grafts were placed there.
Your scalp will be pink and feel ‘tight’ or itchy but this completely normal. The areas of your scalp where the donor hairs have been implanted will have crusted or formed small scabs which will fall off a few days later.
For your first night home after surgery, sleep in a semi-upright position and use a couple of pillows to elevate your head. Do this for the first three days after your surgery. Do NOT touch or pick at the newly grafted areas. There may be some itching or soreness but it is important that you do not touch these. If you pick or rub them then they will fall out before they have had a chance to grow new hair.
First Day After Surgery
The morning following surgery, remove your bandage and shower with comfortably warm, indirect running water. Lift up the hair in the back of your scalp so that water runs over the sutured areas as well. It is not necessary to remove all of the crusting during the first shower.
It is critical when shampooing or rinsing the transplanted area that you are gentle for the first ten days following surgery. DO NOT RUB, PICK, OR SCRATCH, as this may dislodge grafts.
If the grafts are soaked too long, they may swell and rise above the skin surface and appear as little white bumps immediately after showering. This is a problem more likely encountered the first few days after the procedure. It is not harmful to grafts, but indicates that you are soaking too much. As soon as you allow your scalp to dry, they will disappear.
You may dry your hair with a warm, NOT HOT, hair dryer. Hair spray should NOT be used for the first week.
Do not use tar shampoo (a dark-colored, medicated shampoo used for psoriasis) on the transplanted area for one month following your procedure, as this may interfere with the growth of the grafts.
First Week After Surgery
You should expect to see small “scabs” at many of the graft sites. These will usually fall off within 7-14 days. Please don’t pick them off; you may disturb the newly planted grafts.
Starting from the second day after the procedure, shower and shampoo daily and continue this regime for one week. This will remove any dead skin but more importantly, will clean the scabs which will have formed around the grafted hairs.
Place a small amount of shampoo on your finger pads, and gently apply the shampoo to the recipient area with a patting or rolling motion. Do not rub. As soon as the shampoo has been applied to the entire transplanted area, rinse the shampoo off with indirect running water. You may use your finger pads to assist in removing the shampoo, but be careful that you pat the area and do not rub. Stop soaking your head as soon as the shampoo is rinsed off.
If the scalp becomes too dry, you should switch to Baby Shampoo on the fourth day and continue showering using only the Baby Shampoo for the remainder of the week. Resume your normal shampoo after the first week.
Once the scabs have fallen off it will be followed by your newly transplanted hair. This hair will be shed but don’t worry; this is a normal reaction to the transplant known as ‘thermal shock’.
Thermal shock is where intense heat is applied to a hair follicle which destroys that follicle. However this doesn’t affect the actual stem cells which were transplanted at the same time so new hair will grow. What happens is that some of the follicles and grafted hairs fall out but the stem cells remain. These enable new hair follicles to grow.
Your wound may have been closed using a suture that will dissolve, loosen and fall out over the next 7-14 days and doesn’t need to be removed. The suture will appear to look like fishing line with a slightly yellow color and will most likely come loose while shampooing your hair. If you have undergone FUE and a dressing is applied, leave it in place until your first follow-up visit, at which time it will be removed by your doctor.
Second Week After Surgery and Beyond
You may experience the hair in the grafts falling out over the first few weeks after the procedure. This is a normal process and should not be a cause for concern. The healthy hair follicles are firmly in place by this time and will not be affected. If there is still any residual crusting at this time, do not try to physically remove the crusts, instead, let the crusts fall off naturally as the hairs are shed.
Please note that when hairs are shed, there may be a crust at the top and a bulb at the bottom. Remember the bulb is not the root (the growth part of the hair follicle). It is normal for the hair, bulb and associated crust to be shed and this does not represent a lost graft. If a graft is actually lost (something that may occur the first few days following the procedure) there will be bleeding at the site of the lost graft. Therefore, if you don’t see any bleeding, don’t be concerned.
If you have non-dissolvable stitches then these will be taken out approximately 14 days after surgery.
Your new hair will start growing approximately 4-6 months after your procedure, and will then follow the normal growth/loss cycle. It’s a case of being patient and allowing your new hair grafts to spring into action. In rare instances, additional hair in the area of the transplant may fall out due to the stress of the transplant. This hair will re-grow along with the transplanted hair.
The most important medication to use when trying to sleep is the pain medication; be certain that the pain is under control before using any additional sleeping medication, as the additional pill will often not be necessary. DO NOT DRIVE under the influence of Valium or Xanax. DO NOT DRINK ALCOHOL WHILE TAKING ANY MEDICATIONS GIVEN TO YOU FOR SLEEP OR PAIN.
You may be given sleeping medication to help you fall sleep. If the pills are too strong and you are very tired the next day, you can break the tablets in half. If they are not making you sleepy, you may take up to two at bedtime.
Once the anesthetic has worn off – which is usually 3 to 4 hours after surgery then you will experience some pain and discomfort. There may be some minor swelling and soreness of your scalp but painkillers such as paracetamol can help. You may be given medication for pain. Take this as directed for postoperative discomfort. After 3 days, you may take Aleve, Extra Strength Tylenol, Aspirin, Motrin, Naproxen or Advil, during the day and save the prescription medication for bedtime. Be careful of any drowsiness which may arise from the pain medication.
You may be given oral cortisone to minimize swelling after the hair transplant. This medication should not be taken by diabetics. A rare complication of degeneration (aseptic necrosis) of the hip joint from taking corticosteroids has been reported.
Medication for Itching
You may experience some itching either in the transplanted area or in the sutured area following your procedure. In general, itching is part of the healing process and should not be a cause for concern. A common contributing factor may be dryness. You may also experience itching as the new hairs grow in. If the itching is bothersome to you, purchase hydrocortisone ointment 1% in 30 gram tubes which may be bought over the counter (it must be in ointment form, not a cream). This may be applied locally to the areas that itch, as needed, up to four times a day. It is also possible that you may be using too much shampoo or shampooing too long which can dry the scalp. If you feel that this is a factor, please cut back on the shampooing. DO NOT SCRATCH THE SCALP as this may dislodge grafts.
Less commonly, itching may be a sign of a skin infection or an allergy to the Bacitracin ointment or the shampoo. In the transplanted area, this may present as small pustules and/or redness. If you suspect that the itching is due to either of these causes, or if the itching is persistent, please contact your doctor, as this may require specific treatment.
Rogaine may cause severe irritation to the scalp. If this occurs after a hair transplant, it can interfere with hair growth. If you choose to use Rogaine after your procedure, you should wait a minimum of one week after surgery. If any sign of redness, irritation, itching, or burning occurs, stop the medication and contact your doctor.
Some discomfort after the surgery is normal. However, contact your doctor if you develop any of the following: Fever (higher than 100 degrees F), pain not relieved with prescribed pain medication, redness at the incision site, unexpected swelling (some forehead swelling is not unusual), heavy bleeding, foul drainage, persistent nausea and vomiting, infection, or any other concerns.
If there is swelling, it usually occurs around the 3rd or 4th day, in the lower forehead and eyelid area. The swelling is harmless and generally lasts only a day or two and will resolve by itself. The swelling does not require any special treatment. If you would like, you may place cool compresses or ice packs over the area that is swollen, as long as it is not placed over the implants. Place it either on your forehead or at the back of your head. It is also a good idea to take a few days off from work to allow this bruising and swelling to subside. If the swelling is associated with pain, tenderness, chills, or fever, call our office. Sleep with your head raised at a 45-degree angle for the first 3 nights after the procedure; this may help to prevent swelling. You may use a recliner chair or 3-4 pillows.
Before you leave the office, all bleeding will be controlled. If at any time there is bleeding, do not be concerned. It is normal to bleed slightly overnight. To protect your linens, you may want to put a towel over your pillow for the first few nights after the procedure. If bleeding occurs put firm, continuous pressure on the area with a dry cloth until the bleeding stops. We suggest using a rolled up, clean towel and lying your head on top of it. APPLY CONTINUOUS PRESSURE FOR A FULL 20 MINUTES. If the bleeding does not stop, contact your doctor and follow the directions given.
Rarely, a graft may become infected. Slight redness, swelling, and tenderness is to be expected for the first few days after a procedure. If the sutured area becomes infected, swelling, pain, or tenderness may be present in this area. Fever and/or chills are also indications or infection as well. There also may be a discharge or puss in the suture line. If any of these conditions should occur, please contact your doctor. Occasionally, swelling with or without tenderness may develop over a graft that was done several months earlier. Ingrown hairs may cause a cyst to develop in the area of a graft. We can treat these easily in the office.
Folliculitis is one or more ingrown hairs that cause low-grade inflammation or infection. This can appear as pimple-like lesions, or redness around individual hairs. Occasionally, a patient may develop this as the new hair is beginning to grow through the surface. This may occur up to three months after your transplant.
If this happens, apply a warm, moist cloth to the area for several minutes, three times a day. If the area does not improve after a few days of treatment, please contact your doctor. This may require antibiotic treatment. Folliculitis will not affect your outcome.
Numbness, tingling or similar sensations may occur temporarily on your scalp. These are the results of cutting small nerve endings in the skin during the course of harvesting the donor grafts and creating the recipient sites. This is normal and generally will begin to disappears in six to eight weeks as nerve endings re-grow. Some patients may notice small areas that will remain numb for up to one year.
Lost or Dislodged Grafts
There is little you can do if a graft is dislodged. This occurs with approximately one graft for every 1,000 placed.
The day after your hair transplantation, take it easy. You will be tired from the sedatives given the day of your surgery. If possible, spend this day at home, or in a comfortable place, and concentrate on showering properly and following the post-op instructions.
You may perform light daily activities for the next three days. Abstain from sexual intercourse for three days following the procedure. Avoid bending, lifting and straining for 1 week after your procedure. Avoid strenuous activity of any kind for 1 week. Try to avoid leaning forward or blowing your nose violently. Too much activity could cause swelling, bleeding, and loss of grafts. Keep activity VERY minimal. Bend at the knees instead of at the waist when picking up objects and tying shoes. After two weeks, you may resume your normal daily activities. Avoid direct trauma to the head for two weeks after the procedure.
Since the impact of exercise will vary greatly from person to person, “cookbook” recommendations are not possible. Try to “go easy” after your procedure. You should use your own good judgment, but contact your doctor if you have questions. Active swimming may be resumed 2 weeks after your procedure. If you play sports or exercise, exercises such as jogging, lifting very light weights and isolated leg exercises may be started a week after your procedure, if you feel up to it.
If you are a smoker then don’t resume this until a month later. It is even better if you can give up smoking.
Smoking causes constriction of blood vessels and decreased blood flow to the scalp, predominantly due to its nicotine content. The carbon monoxide in smoke decreases the oxygen carrying capacity of the blood. These factors may contribute to poor wound healing after a hair transplant and can increase the chance of a wound infection and scarring. Smoking may also contribute to poor hair growth.
The deleterious effects of smoking wear off slowly when one abstains, particularly in chronic smokers, so that smoking puts one at risk to poor healing even after smoking is stopped for weeks or even months.
Do not drink alcohol for one week after surgery.
Hair Coloring and Cosmetics
Do not dye your hair for 4 weeks following the procedure. Do not use cosmetic camouflage agents (such as Toppik) for at least 14 days following your procedure. When applying the cosmetics, or washing them out, be very gentle.
Please avoid unprotected exposure to sunlight or using a sunbed for 3 months. Wear a hat or other covering that is not knit or tight and will not compress the grafts when you are going to be outside.
If you are suffering from slow or rapid hair loss and your hair thinning is becoming noticeable, or if you have balding that you wish to cover with new hair growth, we invite you to contact our hair restoration service today. You can find the answers to the most frequently asked questions here. Your doctors in Korea will provide a comprehensive medical and hair loss history, and scalp and hair analysis that will allow them to provide each patient with an accurate diagnosis so that a patient-specific treatment plan can be put into action. Contact us now.
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