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.
