Hair Restoration Blog

Hi everyone,

I had a somewhat funny call to me the other day from a past patient of mine and wanted to share his experience with this blog. Although we, at US Hair Restoration, are known worldwide for our quality results and affordable prices, there are some downsides to the remarkable effects that your hair restoration may bring you without prior notice.

One of our patients called over to our office the other day laughing and telling our front desk receptionist that his passport photo looks NOTHING like him. He was traveling out of the country the following day when he had glanced at his photo and realized that the previously taken photo in no way resembled his current image. He called to request that I write a general letter confirming his procedure in the event that there were any discrepancies in his change of appearance.

We would like to apologize in advance for any unexpected changes in your appearance that may make you look years younger or like a different person following your hair transplant procedure. We are 100% proud of our patient results and happy to hear that if nothing else, these are the only few negative aspects of a hair transplantation with US Hair Restoration. We thank our patient for the great laugh and hope that he made it through customs without a hitch!

To add to our growing selection of Video Testimonials online, here is the story of one of our female patients “thrilled with the results” of her hair restoration. Her end results are instantly recognizable when compared to her before photos and the confidence restored to her was well worth more than anything else gained. With no need to hide or cover her hair loss with different hairstyles, this patient can now freely live her life without cares of wind and styling that was always needed to be accounted for before.

** To see before and after pictures of this patient, please feel free to visit her Photo Gallery. **

Swelling is one of the common short term side effects of hair transplantation.  Most people who get a hair transplant in the front and top areas of their scalp experience some degrees of sweeling in the transplanted area and forehead.  Swelling or skin edema may last up to 3 or 4 days and typically disappears suddenly in days 4 or 5 following the hair transplant.

The cause of swelling is mostly due to the inflammatory reaction of healing incisions following a hair transplant and it is generally unrelated to intraoperative injection of anesthetic solutions.  Patients may not have any swelling for the first day or two after hair transplant, but may start to notice such swelling at day 3 or 4 after the procedure.

There are several methods to minimize the swelling such as:

1. Sleeping in semi-seated position for the first few nights after hair transpalnt surgery.  Keeping head above the level of chest can significantly help to minimize the rate of swelling.
2. Use of systemic anti-inflammatory medications such as steroids after a hair transplant.  We prescribe steroids for a short period to most hair transplant patients to minimize post op swelling.
3. Use of elastic bandage to wrap the forehead (should be only done if instructed by the surgeon).
4. Local infiltration of diluted steroid solutions into the recipient area during surgery.  This method can be used on selected patients.

There has been a recent study by Dr. G. Abbasi on the effect of diluted solution of steroid to minimize the rate of swelling after a hair transplant in the journal of Aesthetic Surgery recently that explain the result of the study of steroid injections on swelling after a hair restoration (Hair Transplantation: Preventing Post-operative Oedema).  We, at US Hair Restoration, use this option for patients who are known for their swelling side effects to minimize or eliminate the swelling after a hair restoration.

Q:

Hello,

My boyfriend just had a hair transplant with you two weeks ago.    It seems that everything is going perfect, but  I have two questions for you:

• When can he start taking vitamins?
• Can he use the sauna (jacuzzi)???

Thanks for everything, we are very satisfied with your surgery.

Best regards,

A:

I am glad to hear that you have had a good experience with us at US Hair Restoration.

Taking vitamins after hair transplant

Vitamins can be started immediately in the first few days after a hair transplant surgery, if for any reason they were discontinued prior to the procedure.  That is also true about most other medications that patients may have had to discontinue or prolong use of before hair restoration before surgery (i.e- blood thinners like aspirin or aspirin like medications).

Using Jacuzzi after a hair transplant

As for using the jacuzzi or immersing newly transplanted hair into water, one week after a hair restoration surgery is generally a good time.  Just be sure to be careful with sun exposure for a period of six months after hair transplantation.  If you have to be exposed to direct sun exposure, you can use a hat or sun block for that period after hair restoration.

Also see: Vitamins and Hair Loss

Hiccups may develop after a hair transplant surgery due to several factors. Some of these factors are due to the medication that patient takes, the possible local irritation of some nerve endings in the donor area (especially in strip technique hair transplant) and lastly, that patient’s diet.

These main causes of hiccups after hair restoration surgery are:

Medications: Some medications that are given to the patient after a hair transplant surgery (i.e. – steroids) may increase the chance of developing hiccups.

Local nerve irritation:The local irritation of some nerve endings, such as the posterior auricular nerve or the other branches of cervical plexus may stimulate the phrenic nerve thus also causing hiccups.

Diet: In the case that the patient developes hiccups due to eating or drinking, his/her diet needs to be controlled.  Alcoholic beverages, carbonated beverages or taking in large volumes of food may also increase the chance of developing hiccups.

If the hiccups persist severely or beyond a few hours you are urged to contact your hair transplant surgeon for medical treatment.  You doctor may prescribe chlorpromazine (Thorazine) and you may need to continue taking the pills for a few days to avoid re-occurance of the hiccups.

Q:

Hello Dr Mohebi. I am about 16 days post op and had my trichophytic sutures removed about 5 days ago. The wound has healed nicely with no scabs left -but I still experience sensations in the donor area during my sleep which eventually causes me to sleep sideways or my stomach. Are these sensations unusual this many days post operation? Thanks for reading and responding.

A:

Having slight pain or tenderness following the first 2 days from hair transplant surgery is not unusual.  However, if the pain is to the point that it is affecting your life style or to the point that you have to continue to take pain medications after the first few weeks, I recommend that you go back to your hair transplant surgeon and let him/her re-evaluate you.  Development of folliculitis, especially if you had trichophytic closure, may cause pain.  Minor pain or unusual sensations (paresthesia) after any wound closure could be due to the irritation of small nerves that are in the vicinity of the healing wound and may last to a few weeks after surgery, but will eventually go away.  Having said that, it is not a bad idea for you to be evaluated by a specialist in-person to be on the safe side.

Q:

Hello Doctor Mohebi,

I hope all is well and that Orlando was a success.

I am now creeping on 3 weeks post operation and just as you expected the en masse shedding commenced at right around the 2 week mark.  The good news is that I still have a sizable number left, which goes to show a large number of grafts are the way to go, but I did have a couple of more questions I thought were valuable and perhaps worthy of your blog.

1)  Even though I am at my 3rd week post op and many hairs have already been shed, many more seem to be sticking around — at least for now.  I am wondering if there’s any kind of benchmark to assess when I can expect the shedding to stop.  I would like to be able to clip all of my hair short so as to not have to keep “covering up” with hats and the alike, but I am not sure how much more shedding will take place.  Should I just wait til new hairs start to grow (1-3 months post operation, as I’ve been told) or is it relatively safe to assume that most of the hair which has not been shed after approximately a month will stick around (hang in there)?

2) For a more long-term question, what happens to the new transplants that have fallen out?  Given that telogen effluvium has taken place, I am assuming that the new hair will sprout once anagen takes place.  But here’s the dilemma:  If the front of my head contains transplants that ALL FALL OUT (for the sake of the argument, as you have stated that 90% or so of patients experience this) then that would suggest that all of this hair would be hitting CTR+ALT+DEL (or restart!) at about the same time.  If that is true, then all this hair should be hitting catagen and then telogen again at relatively about the same time, say between 2-3 years for most people.  Am I then to assume that my forehead will become synchronously thin at about 3 years only to become very full again a few months later????

Thanks Doctor.

Anonymously Yours,

A:

These are very clever questions and I will happily post them on our Hair Restoration Blog for others to see.  I will try to answer your questions in the order you asked them.

Hair Shedding After Hair Transplant

Losing hair shafts of newly transplanted hair generally occurs in most transplant cases and only a small percentage of them will continue growing the transplanted hair from the day of surgery.  Even if you are one of those lucky people who never loses their hair after surgery, you still may lose a significant number of hair shafts and only some of them will continue growing without going through shock loss.  It is not always easy to predict the timing of hair shedding in transplanted grafts, but if you have kept them for the first month after hair restoration surgery, it is likely that they will not shed.

As far as clipping your hair, you could have done it at any time after the first week following your hair transplantation.  Just be careful about the length of hair on the donor area.  You don’t want to expose your wound on the back and clipping your hair short tends to do this.  The transplanted hairs are part of your scalp at this stage and you cannot dislodge them even if you try.

Are all transplanted hairs entering the resting phase at the same time?

When hair shafts fall out due to telogen, the follicles enter their resting (or telogen) phase.  In this phase the grafts lose their shafts, the follicles shrink and become dormant for a short period of time (usually 4-6 weeks).  Following telogen comes another anagen phase in which new hairs sprout from the same transplanted hair follicles.  The initial hair grown is short and fine almost similar to vellus hair, but unlike vellus hair, it becomes longer and thicker over time.

For some reason, the biologic timer of your hair follicles are not quite synchronized.  The shedding of the transplanted hair won’t happen at the same time and therefore you won’t have to experience baldness again in the transplanted area a few years from now.  You should have some of your hair growing while a small portion of them remain in resting phase the whole time.

Q:

It is now 4 days following our procedure and everything seems to be going quite smoothly.

I have been taking care to wear a hat during the day outside and shampoo as I was instructed twice a day.  I have experienced no bleeding thusfar and the swelling has dissipated and gone.  The redness is diminishing and I now have sensations back in the back of the head.  Actually, the sensitivity there was back within 12 hours or so.  The pain is minimal and I have only taken generic Tylenol twice for it.

I am VERY happy with your work thus far and please feel free to quote any of my questions on the blog, anonymously.  I have attached two pics for you to see my status: 1 from last night and 1 from today with my hair styled.  No swelling!

Now, for my questions:

1) I go back to work tomorrow, the 5th day post op.  You instructed that I can begin to shampoo and normally style my hair then, correct?  Does this apply to any leave-in conditioners or should I wait on those?

2) A few pesky blood-caked scabs aren’t washed off and dry, flaky skin is forming around the middle of the sagittal.  I believe this is all normal and part of the mitosis process.  Right?

3) Can I start applying over-the-counter ointments like neosporin to my hairline to aid with the elimination of the tiny red dots of incision?

4) The back of my head feels quite tight.  Will the procedure on Saturday help with this or is this just a process of healing?

5) And finally, I know this is a really really silly question, but it seems fairly obvious that the grafts are growing.  I know more than likely this is actually just them getting ready to shed and go into dormancy.  But, I wonder, if you think, given that I have been on finasteride since the beginning of December and the hairline and temples were the first areas worked on, if there’s a good chance I get to keep most of them?  I also hope that I will experience little to no “shock loss” with the ‘native hairs’ so they should not theoretically go into a ‘dormant’ phase, correct?  The problem is that it would be very hard to conceal the growth I have with my longer hair if it wasn’t for something to work with, as it were.  The tiny hairs provide an anchor to rest longer hairs on.

I apologize for the length and perhaps detail of my questions but as I’m sure you know, this is a VERY personal procedure.

THANK YOU SO MUCH.

A:

I am glad you had a smooth post-operation period after your hair transplant surgery.

Here are the answers to your questions in the order you asked them:

How to use shampoo and conditioner use after hair transplant?

Yes,  anytime after day 4 you can go back to your normal routine in terms of using shampoo and conditioner and combing your hair normally.

How to deal with scabbing, dried blood removal after hair transplant?

Flaky skin could be seen any time in the first few days to weeks following a hair transplant surgery.  Dried blood due to some oozing in the first few hours after hair transplant should be dealt with carefully for the first 4 days and if still present after your instructed hair wash in the immediate post op period, it needs to be washed off more efficiently.  After day 4, you can shampoo your scalp and keep the foam for about 10 minutes each time.  This will allow the dried blood to become loose and come off easily with the soft brush that was provided to you after your hair transplant.

Do I need antibiotic ointment after hair restoration surgery?

Neosporin and any other antibiotic ointments are not necessary after hair transplant.  You have medications that were provided to you after your hair restoration which are used to help minimize the redness following surgery.  The small red spots that have been seen from the incisions or local anesthesia injections will be gone in 4 to 7 days following the day of surgery.

How about tightness of scalp after hair transplant?

The donor area is closed with staples that might be felt a little bit before we remove them at day 10 after hair transplant.  We also removed a strip from your scalp with significant number of grafts.  That stretches the skin, but the tightness that you feel know will be gone in a week or two after hair transplant.

Am I going to keep the hair or lose it?

I hope you are among the small group of people who does keep their transplanted hair and begins growing from the day of surgery.  However, the general rule is “Don’t count on them”.  We put most of our patients on finasteride after their hair transplant, but still about 80-90% shed all transplanted hair.

What is the chance of shock loss after hair transplant?

Shock loss is a different story and considering that you have been on finasteride before and will continue it after hair transplant, you have a good chance to prevent and significantly reduce the chance of shock loss.

I look forward to seeing you soon for your post operation visit at day 10 after hair transplant.

Q:

I have curly hair and underwent hair restoration surgeries to increase the density of hair on the front and top areas.  It’s been about 7 months since my hair transplant procedure and I haven’t noticed any difference in thickness compared to before.  I understand it could take up to 10 months after hair transplant to see the result, but at the current ‘rate’ I’m not hopeful.

I am diabetic and I know that after the surgery, my glucose levels were unexpectedly high, and the only explanation I could come up with was that it was because of the steroids I was given. After the surgery I monitored my glucose levels frequently, every 2 hours (which is more than normal) and they were far higher than normal despite the fact my diet was the same and so were the insulin dosages.  I can’t help but think I’m not seeing much of a difference because of my high glucose levels causing the hair follicles to die.  Is this possible?
A:
Elevated blood glucose may affect the healing of the surgical wounds after any surgical procedures.  Although we always recommend to keep the glucose within the normal range around the time of a hair transplant surgery for better healing of the wounds, there is no study to evaluate the exact impact of elevated glucose on growth of transplanted hair follicles after hair transplantation.

Since you hair is curly, it will be difficult to evaluate your final growth at this time.  It may take even over 10 to 12 months to see the final growth of transplanted hair.

Q:

Thanks Dr. Mohebi,

Your input is much appreciated.  The shock loss you had mentioned has been my concern, as a few of my frontal hair seem lighter than before.  You had mentioned that the shock loss might be visible for a few weeks to months – will it be the case that after that shock loss stage, the hair will likely return back to original form?

There’s a very important question that i would like to ask you, and was thinking the it would be great for the blog to have.  Basically, when you saw my before and after picture, i feel like i changed a bit.  The “after” picture seems like i have more redness, and i’m hoping it’s not the case where the hair transplant affects the circulation (e.g., tight donor area/scalp affecting the blood flow to my head).  My surgeon told me before the procedure that i will eventually be back to the way i was before (i.e., the “before” picture), but just have a new scar and more gafted hairs.  That’s the ultimate question: would you agree that a patient who does a hair transplant will relatively return to the condition that he was before the particular sugery (w/ of course, a new scar and more hair)?  This is what keeps me up at night, thinking perhaps my scalp has worsened, or i am now more prone to lose hair.  I hope that’s not the case, and every patient should be aware about before she or he gets a hair transplant done.

Thanks again for your help.  If I see you in person at your office, I might be interested in discussing about future scar work.

A:

What is hair transplant shock loss

Some of the hair shafts that fall off due to shock loss might come back. Especially if the shock loss happens in an area with permanent hair like back of the head. However, losing hair in the frontal area because of shock loss might not be completely reversible. But, you have to understand that falling hairs are the ones that were supposed to fall off anyway and a hair transplant just accelerates the loss.

How to prevent shock loss

Again, using finasteride can significantly reduce the extent of shock loss. After surgery, in the transplanted area, the tightness should not affect the circulation of the scalp. After a few days to weeks, on the donor area, the tightness goes back to normal.

Donor scar in strip hair transplant

And to answer to your last question, I do not agree you go back to the condition before surgery with only a new scar and some more hair. What I personally do in a repeat surgery is remove the old scar; the patient at the end has only one scar that at times may be even better than the initial scar.

How to improve the appearance of the scar

I perform trichophytic closure when I think it is the final surgery that the patient may need.  Trichophytic closure is when we close scalp skin on the back in a way that hair can grow through the scar.  Trichophytic closure reduces the contrast between donor scar and surrounding areas that eventually improve the appearance of the scar, so you are not more prone to hair loss because of your hair transplant.

In some cases and when we are looking for even less visible scar, the scar may get filled with FUE into the scar in a few months from the initial surgery.

Be patient and you should be able to see results in the coming months.