Hair Restoration Blog

Q:

I am planning to have my hair transplantation with you soon and I have a few questions about the few days after hair transplantation.  I’ve been letting my hair grow so that I’ll be able to push it forward to cover the frontal work, but I’m concerned with how much swelling there might be, or if there’s a lot of shock loss, so that the hair I was going to use to conceal, fell out.
How many days is it again that the scabs usually persist? And how long would it be until I could get back into the gym or doing some other kind of exercise?

Also, I have been taking finasteride (1mg) and cutting the tablets into quarters. Is that correct? I haven’t kept up with the scalp massaging though. It was taking so long I was starting to wonder if was going to happen at all. But I could start doing that again now.

Thanks in advance, for your answers!

A:

These are great questions and I will be happy to answer them!

• Swelling
  Generally speaking, swelling after hair transplant surgery may occur 1-5 days following the procedure. It is usually moderate with certain exceptions which might be more noticeable and involve some area around the eyes as well. Not everyone experiences swelling, but I must always describe the worst case scenario: you may have an elevation (due to fluid) on your forehead which is alleviated by the medication we provide and elevating your head during the first few days after hair transplant.
• Bruising
  You may have some bruising or discoloration on the transplanted area, forehead, and occasionally around eyes which is even less likely, but necessary to mention. Wearing a baseball cap usually conceals your hair transplant for the following week. I’m sure your existing hair will do an adequate job as well (of course that is only for individuals who have some existing hair to cover the transplanted area).
• Shock loss
  The medication finasteride, or minoxidil in women, will help to lighten the shock loss (acceleration of the loss of native hair in balding area). Most of those shocked hairs usually go into a temporary resting phase and come back with your new transplanted hair.
• Scabbing
  The scabs are simply tiny crusts that dry up and flake off within a week.  They are hardly noticeable, and if you wear a cap no one can see anything.
• limitations in physical activities
  Exercise can be resumed two days following your surgery. Try to keep the blood pressure down (no squats, dead lifts, bent rows, etc) for the first four days after hair transplantation. If you can do some light machine work for a week, that would be best. Try to keep your head elevated/upright. You can do the treadmill or cycle, but just keep the intensity moderate. After 4 days post op, the grafts are pretty much locked in.

Rub your scalp before the hair transplantation. It helps! Your procedure size is rather small so scalp laxity will be a minor issue. However, do the scalp exercises! They are good for the delts also! And yes, you are correct in dividing the finasteride into 1/4′s!

Q:

I am on my day 4 after my hair transplant surgery. I’m a little concerned that I may have pulled out a few grafts accidentally. They sure look like grafts. But then, the hairs are all dry and brittle, with no moisture at the ends, and that gel-like substance is also dry. Could they have just broken off, or are these grafts that didn’t take?

Thanks again for all of your help and support. I really appreciate it.

Best wishes,

A:

That is an excellent picture! The most important question is whether you lost a graft or hair with scabbing after or before day 4 from your hair transplantation.  Looking closely at the photo you submitted shows that you may have lost the entire graft and it may have happened before then and you have found it now.

Remember that follicular units (a unit of one or a few hairs and their appendages) are very fragile in the first 4 days after hair transplantation.  If you accidentally scratched or rubbed the transplanted area during the first few days you may have dislodged the grafts and lost it completely.  However, any loss of hair after day 4 might be just a telogen (resting) hair with its attached scabbing and you still will grow normal hair from the remaining follicle.

Q:

Hi Dr. Mohebi,

First off I wanted to thank you for the job you did. You and your whole staff are just wonderful and I am very excited to see what will happen in the coming months.

I was looking online and saw that spraying a saline solution on the transplanted area is supposed to promote healing and help the scabs come off easier. I was wondering what was your opinion on that?

I am having some itchiness in the transplanted area. I’m guessing that’s normal. I can keep from scratching but was wondering if there was something I should do about it or will it subside on it’s own.

Thank you,

A:

I am glad you had a good experience with your procedure and our staff at US Hair Restoration during your hair transplant surgery.  Spraying Normal Saline solution to transplanted area is not necessary after a hair transplant surgery.  You need to wash off the scabs with tap water and the shampoo we have provided after your hair transplant.  The reason you need to wash transplanted area is to get rid of the scabbing that may harm the growth of transplanted grafts.

Itchiness for a few days to weeks after hair transplantation is normal in either transplanted or donor area of scalp.  Occasionally the itching after hair transplantation may become more uncomfortable and a prescription of a mild steroid might be required.  I will be in our Los Angeles Hair Transplant office for your follow up appointment. I will examine your transplanted and donor area and will address this issue.  However, please don’t wait till then and contact us if there is any questions or concerns before your next appointment.

In the mean time, have a great week and I look forward to seeing you next time.

Q:

Hi Dr. Mohebi,

I hope this email finds you well. I’m still waiting for a date to open up for me to come in, but in the meantime I was looking once again at the before and after photos on the site. I have a question regarding a couple of them.  In some patients in whom their after photos taken 8 months after the procedure, but it looks like his scalp is still rather red.  So I’m wondering for how many months could I have redness, scabbing or other telltale signs of the procedure?  Thanks very much for taking the time to answer my question!

Best wishes,

-

A:

The process of healing and hair growth is usually not complete before a solid 10 to 12 months after the hair transplant.  In fact, some people do not see their best result until month 18 after their hair transplant surgery.  Redness and inflammation of skin usually resolved after the first few weeks, however some patients may continue to have some remaining inflammation and slower disappearing, pinkish discoloration for months, yet they eventually resolve.

Q:

I had a hair transplant procedure a week ago and now I am having itching on transplanted area. The itching from the transplant is keeping me up at night.  I read on your blog this morning that an ointment might be available to alleviate that. If at all possible, I would like to have the name of the medication to use it. 
Thanks!
–

A:

Itching after a hair transplant surgery may happen as a result of an inflammatory reaction from the healing process.  This type of itching can be present after any type of wound healing.  Itching after hair transplant is generally very mild and most patients can tolerate this with no medications needed.  However, if itching is beyond comfort and is keeping you up at night, you can alleviate that with some medications. 

We recommend a mild topical steroid like hydrocortisone 1% that could be obtained from any pharmacy without a prescription.  If the itching does not improve after steroid use for a day or two, you need to be evaluated by your hair transplant surgeon.  Other medications might be needed based on the other conditions you may have, and your doctor needs to be involved with prescribing those.

The other factor that might increase the itchiness is dryness of scalp due to excessive washing. If this is the primary reason, you should limit your hair washing to once a day and not use cleansers in order to minimize dryness.  This may possibly be the primary change needed to minimize your itching.

Q:

Hello,
I wanted to get more information like FUE transplantation vs. FUSS. I have been doing a lot of reading. How do you know if one is best and using a FOX test? I like the idea of the FUE but hear many claims that it is not good. However, I am not a big fan of getting a piece of my skin taken off. There is so much different information. Also all the normal questions that come with the procedure. I hope to hear from you.

Thank you for taking the time to read this,

A:

Great question! I realize that there is so much conflicting information on the Internet, especially relating to new technology and surgical techniques.

Follicular Unit Extraction (FUE) is a method we use to remove hair follicular units individually rather than taking a strip of the scalp and dissecting it into follicular units.

The truth of the matter is, there are many hair restoration centers which may promote one method vs. the other, strictly because they are capable performing it. They may lean towards recommending one particular one as oppose to another.

If performed correctly, FUE transplantation is a great solution for some hair loss sufferers, especially those with minimum hair loss or those avoiding a scar on their scalp. We also use FUE for people who suffer from significant pain or donor complications with previous strip procedure, and those with violated donor area for which removing more hair through strip is impossible.

With that said, most of hair transplant surgeries are still done through strip for many reasons:

• Strip hair transplantation gives liberty to the surgeon to maximize the quality and viability of the hair follicles. We anticipate some number between 1-5% as the highest for a trans-section of hair follicles in microscopic strip hair transplantation. This is because the grafts are all harvested under 3-D magnifications with stereotactic microscope.
• In FUE cases patients may have a high trans-section rate, meaning that some of the grafts are cut or damaged in the process of graft harvesting and may never grow into healthy hair. The trans-section rate might be very low in most people, with an average of 0 to 10%. However, in some people it might be significantly higher based on their hair’s characteristics. FOX test that should be done in for some people with curly hair, the FOX test can determine the patients who are not good candidates for FUE procedure. It is basically a small FUE transplant that determines the levels of a trans-section.
• In FUE Transplantation, we can harvest –up to 2000 grafts in one session. Sessions larger than that keep hair grafts outside of body for a long period of time that may jeopardize the grafts’ survival.
• These days, we have several methods, such as trichophytic closure, to minimize the visibility of the hair transplant scar.
• The cost of FUE is higher since it is more labor intensive.

I highly recommend having an evaluation by a hair transplant surgeon who is skilled in both FUE transplantation and strip method before you decide which procedure is right for you. A qualified hair transplant surgeon can discuss all your options so you can make an informed decision.

Faculties: Drs. Suddleson, Mohebi and Perez in OLSW-17

Orlando Live Surgical Workshop (OLSW 17) of International society of hair restoration surgery (ISHRS) was held one more time in beautiful city of Orlando last month.  Hair transplant surgeons participated from different parts of the world.  We had many great lectures from the leaders of hair restoration surgery to cover basic information about hair restoration methods for new hair transplant surgeons and to refresh and update the more experienced ones.

We had lectures every morning and in the afternoon went to surgery center for hands on procedures to teach the techniques of hair transplant surgery.  I have to congratulate the the whole staff involved with this workshop for the great work they have done this year, coordinating a large group of doctors from all over the world and putting together a great set of lectures to cover a wide variety of subjects about modern hair restoration procedures and medical treatments.

Dr. Mohebi and Dr. Leavitt in OLSW-17

We had lectures about new methods of hair restoration surgery such as robotic hair transplant surgery.   The most updates on robotic surgery was shown to the audience.  There is a hope that the practical model of robotic hair restoration be available within a few months.

There is a woman behind every successful EVENT - Dr. Mohebi and Valarie Montalbano

I had two lectures that were both emphasizing on the techniques of removal of follicular units in hair transplants with large number of grafts using Laxometer.  I also demonstrated the applications of Laxometer in sequential strip removal techniques in live surgical workshop.

Technician training: Patrick Tafoya teaching hair transplant technicians

My second lecture was on Scalp Scars and the methods to revise them.  The lecture was focused on making surgeons more familiar with the proper techniques of scar revision and indications of each particular technique.

I went over trichophytic closure methods for a variety of different scars.  I discussed the implications of Follicular Unit Extraction (FUE) to revise scalp scars.  I presented a variety of several scalp scars treated with FUE methods.  I went over the pros and cons of FUE to revise scalp scar and provided a guideline that hair transplant surgeons can decide what method should be used for each type of scar.

Q:

What is the average hair loss after hair transplants? I.e. The number of grafts lost? I am sure that also relies heavily on techniques of hair transplantation.

A:

The survival of transplanted hair grafts should be over 95%.*

We do not expect to lose any grafts after hair restoration surgery.  There may be a 1-5% transection experienced with microscopic follicular unit transplants, but we have aimed to minimize this rate by enhancing the quality of our hair transplant techniques.

* According to some studies that were done on microscopic follicular unit transplant methods, 95-99% of newly transplanted grafts should take and hold.  We expect that the hairs should grow healthy hairs within a few months after hair transplant surgery.

Q:

Dr. Mohebi, I have already made an appointment for hair transplant surgery on Wed April 20th per your recommendations and paid the deposit. If you don’t mind I have a quick question.

Do you think it’s realistic for me to see patients on Monday following my procedure? I have clinic that day and OR the next (will need to wear surgical cap), is this okay in the week following?

A:

Because we will be transplanting a large number of hairs in the frontal area of your scalp, we expect significant swelling until day 4-5 after surgery.  Occasionally patients may experience swelling until day 6-7, but your surgical cap use is okay and should easily cover it.

In addition, some patients occassionally get swelling and bruising around their eyes (which may be difficult to cover). Probability of bruising/swelling around the eyes is minimal but its possibility should still be notated.

Q:

I had a hair transplant back on October 31, 2009. I started getting red boils along my transplanted area (suspected to be folliculitis) in January and I have been taking Accutane for the last complete month.

My question to you is, why did it happen? Was it due to infected surgical equipment used in the surgery? I was advised to get such a heavy drug which has effected the overall tone of my face somewhat like getting severe dryness. Lastly, sir what do u think there are few patches in the infected area who are now like bald patches. Do you have any suggestions or medicine for the future?

A:

Pimple-like scalp lesions that develop after hair transplant surgery are typically folliculitis.

Folliculitis can typically be seen after hair transplant surgery in both the implanted and donor wound areas in the few weeks to month after hair transplant.

The development mechanism of folliculitis is similar to acnea.  It is usually due to blockage in the exit pores of the sebaceous gland (skin oil glands).  Following obstruction of those pores that can occur after hair transplant surgery, sebum (skin oil) cannot be emptied to the skin surface and instead begins accumulating underneath the skin surface.  The result is red or white head-like pimples.

Recovery is generally spontaneous. Although, if too many of these lesions develop, or if there was any sign of secondary infection (i.e.- redness or swelling around the area), the lesions may need to be drained by your physician and the patient may occasionally be recommended to use antibiotics.

Thanks to the generous vascular supply of scalp skin, the infection of scalp skin after hair transplant surgery is extremely rare.