Instructions After Your Graft Excision
Care of Transplanted Area
At the time of surgery, your scalp was 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.
When you arrive home (or your hotel) after your procedure, remove your bandana and surgeon’s cap, but not the headband. 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.
The morning following surgery, remove your bandage and shower with comfortably warm water.
Allow the shower water to flow gently over the transplant area. You may partially block the flow of the water with your hand so that the scalp is not subject to strong, direct pressure. Lift up the hair in the back of your scalp so that water may irrigate the sutured areas as well.
Place a small amount of shampoo that we have provided to you, on the sponge that we have given you or 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 the rinsed sponge or 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. It is not necessary to remove all of the crusting during the first shower. Repeat the showering and gentle shampooing three (3) times the day following surgery.
On the second day after the procedure, shower and shampoo twice daily and continue this regime for one week. 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 and/or when the shampoo we have given you, runs out.
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.
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.
At one-two weeks you can expect that some transplanted hair will begin to shed. 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.
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.
Care of Sutured Area
After the shower, pat the area dry and apply a very THIN LAYER of BACITRACIN to the sutured areas. You should reapply sparingly throughout the day if the area feels like the sutures are becoming dry. You should continue applying the ointment for 1-2 weeks. It is not necessary to use ointment after that.
If at any time there is bleeding, do not be concerned. Apply direct pressure with a dry cloth until the bleeding stops. This may take several minutes in the transplanted area and up to 20 minutes in the sutured area. If you have any concerns what so ever, please contact us.
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 ANY SCALP OR HAIR COLORING AGENTS FOR AT LEAST 14 DAYS AFTER YOUR PROCEDURE.
Medications You May Need
Sleeping Medication: You have been given Valium 5mg (generically known as Diazepam) or Xanax 0.5mg (Aprazolam) tablets to help you 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.
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, PAIN or HICCUPS.
Pain Pills: You have been given Vicodin (generically known as Hydrocodone) for pain. Take 1-2 tablets every 4-6 hours as needed for the first 48 hours. After 3 days, you may take Alleve, Extra Strength Tylenol, Aspirin, Motrin, Naprosyn or Advil, during the day and save the Vicodin for bedtime. Vicodin may cause drowsiness, therefore driving under the influence of Vicodin is not recommended.
Cortisone: You have been 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 cortico-steriods 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 caused, or if the itching is persistent, please contact the office, as this may require specific treatment.
Minoxidil (Rogaine): 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 call our office.
Other Post-op Issues
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 over the area that is swollen, as long as it is not placed over the implants. 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. Rarely, some bleeding may occur after the procedure. If bleeding occurs put firm, continuous pressure on the area. 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, call us at the above numbers and follow the directions given. If you are unable to contact us through this beeper, then go to the nearest Emergency Room and show these instructions to the physician on duty.
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.
Exercise, Alcohol and Other Restrictions
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 normal daily activities for the next three days and moderate exercise for the next 14 days. After two weeks, you may resume your normal daily activities. Avoid direct trauma to the head for two weeks after the procedure. Abstain from sexual intercourse and alcohol for THREE days following the procedure.
EXERCISE: 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 judgement, but call us if you have questions. Active swimming may be resumed 2 weeks after your procedure. Exercise such as jogging, lifting very light weights and isolated leg exercises may be started within a few days after your procedure, if you feel up to it.
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. Although it is not known exactly how long one should avoid smoking before and after a hair transplant a common recommendation is to abstain from 1 week prior to surgery to 2 weeks after the procedure.
Please avoid unprotected exposure to sunlight for 3 months. Wear a hat when you are going to be outside or use a strong sunscreen with a SPF of 30+.
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 redness, swelling, or tenderness increases after the second day, call us. 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 a low-grade inflammation or infection of the hair follicle. This presents as small white pustules or redness around individual hairs. This may occur up to three months after your transplant. If this should occur, please contact our office. This may require antibiotic treatment.
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 the office.
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 generally disappears quickly as nerve endings re-grow.
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 7 days following your procedure. When applying the cosmetics, or washing them out, be very gentle through day.