After FUE Hair Transplant Surgery
The night of your hair transplant and for the next few nights, you are encouraged to sleep with your head elevated on pillows. Medication is given for sleep and pain (if needed). Antibiotics are generally not required. The morning after your hair transplant surgery, you will remove the headband and shower and shampoo your scalp three times – just for the first day. We’ll call you the next day to make sure that everything is OK. You won’t need to come into the office at this time, but are welcome to do so.
For the remainder of the week, you should shower twice a day. When showering, you will be instructed to gently clean the transplanted area with a special shampoo. The follicular unit grafts are made to fit snugly into the recipient sites and will not be dislodged in the shower, if you follow the instructions given to you. After your first shower, no further bandages are required.
Although you must be very gentle for the first week after hair loss surgery, normal shampooing, brushing and hair care can be resumed after ten days since, by this time, the grafts are firmly in place. You can also have a haircut at this point. You are able to dye your hair, if you choose, four weeks after the hair transplant.
You should avoid alcohol for three days following your hair replacement procedure and abstain from smoking for two weeks. When in strong sunlight, you should wear a hat. After two weeks you may use a sunscreen with a SPF of 30+.
Generally patients can resume normal daily routine almost immediately. Exercise can be started the second day following your procedure. For the first 10 days, you should avoid any activities that rub or put direct pressure on your scalp.
We ask you to return to the office for a ten day follow-up visit, but for those who live at a distance from our facilities this can generally be handled by phone.
What To Expect After Your Hair Surgery
If the post-operative instructions are followed carefully, in most patients, the hair transplant is barely detectable after ten days. Patients are given medication for swelling at the time of hair loss surgery, but some still experience swelling of the forehead that settles across the bridge of the nose and around the eyes. If this occurs, it is almost always gone by the end of the first week.
The newly transplanted hair begins to grow at around 10 weeks. It is long enough to be groomed in about 6 months and, in most cases, will be fully grown in at one year. In the few months following hair surgery, before the new hair starts to grow, there may be some shedding of your original hair so that the transplanted area may temporarily appear slightly thinner. This is a transient phenomenon and will be corrected when the new hair begins to grow. It should not be a cause for concern.
The following table describes the usual course for persons having Follicular Unit Hair Transplantation. There will generally be significant person to person variability, so if you do not follow the course exactly, do not be concerned.
| POST-OP | THE TRANSPLANTED AREA | THE DONOR AREA |
| The Day Following Surgery | Patients are instructed to wash their hair gently, but thoroughly, so that the scalp is free of any blood. | Expect some soreness and possibly some numbness. |
| Days 2-3 | Some scabbing is present as well as moderate redness. Swelling may appear on the forehead. | Soreness in the donor and recipient areas should be gone. Some numbness may continue. |
| Days 4-6 | If there is significant swelling, it may settle across the bridge of the nose and around the eyes and cheeks. | In the donor area only, any residual crusting can be removed with directly running shower water. |
| End of Week 1 | Swelling usually has subsided. Redness is faint or absent. The hair transplant looks and feels like a week-old beard. | There may be some residual crusting that can be gently scrubbed off (donor area only). |
| Day 10 | The grafts are permanently in place and cannot be dislodged. Any residual crusting may be gently scrubbed off. Patients may return to normal shampooing, brushing and combing. Patients are seen in follow-up. | The area should appear normal other than the closely cropped hair. |
| End of Week 2 | The transplanted hair begins to shed. | Length of hair in donor area approaches that of a “crew cut”. |
| End of Week 3 | The transplanted hair continues to shed. Patients may get haircuts. | Donor hair length approximates that of a short hair cut. |
| End of Month 1 | The follicles enter a resting phase. You will look very much like you did before the procedure. Patients may dye their hair. | |
| Months 2-5 | The newly transplanted hair starts to grow, initially as very fine hair. Some or all of the original hair that was shed begins to grow back. | |
| Months 6-9 | Hair is groomable, but it continues to grow and thicken. Slight textural changes in hair are occasionally present. | |
| Month 10 | Patients are seen in follow-up. If a second session is considered, it will be discussed. | |
| 1 Year | The final appearance of the hair transplant can begin to be appreciated. | |
| 1-2 Years | There may be additional fullness. Any textural change in hair usually returns to normal. |
Shedding After Surgery
Some shedding after a hair transplant is relatively common. The correct medical term is “effluvium” which literally means shedding. It is usually the miniaturized hair i.e. the hair that is at the end of its lifespan due to genetic balding that is most likely to be shed. Less likely, some healthy hair will be shed, but this should re-grow. Interestingly, if hair transplants are spaced less than one year apart, one often notices some shedding of the hair from the first transplant, but this hair grows back completely.
For most patients, if effluvium occurs, it is a minor issue and should not be a cause for concern. In the typical case, a patient looks a little thinner during the several month time period following the hair transplantation, when the transplanted hair is in its latent phase. The thinning is often more noticeable to the patient than to others.
In general, the more miniaturization one has and the more rapid the hair loss, the more likely there will be shedding from the hair restoration surgery. Young, rapidly balding patients would be at the greatest risk. Older patients with stable hair loss would have the least risk.
It is important to differentiate the phenomena described above from shedding of the hair in the graft. This shedding is an almost universal characteristic of a hair transplant and occurs because during hair transplantation a graft is temporarily stripped of its blood supply. As a response to this insult, the graft sheds its hair. The shedding is noticed beginning a week following the procedure and can continue for up to six weeks. A very small percentage of patients do not shed and the transplanted hair continues to grow. In others, the transplanted hair remains on the scalp for months until a new hair pushes it out. Whether a patient sheds or not has no bearing on the outcome of the hair restoration.
There are a number of ways to minimize the effects of post-operative shedding: the first is using medication, the second is timing the hair transplant properly and the third is performing a procedure using a sufficient number of grafts.
Medication
Finasteride 1mg reverses or halts the miniaturization process in many individuals and its use may decrease the risk of shedding following hair transplants. Its ability to prevent shedding, however, has not been proven in controlled studies.
Timing and Size of Hair Transplant
It is important to wait until a patient is ready to have hair transplantation surgery, and then to perform one of sufficient size so that if there is some shedding, the procedure will more than compensate for it. A problem that patients often run into is that they seek a hair transplant when they have very early actual hair loss, but have a significant amount of miniaturization. The doctor performs a small procedure that does not take into account possible shedding or the progression of the hair loss. The result is that the patient is thinner than he/she was before the procedure. The doctor rarely blames the problem on the fact that the procedure was too small or that there the miniaturization was not taken into account, but only that the patient continued to bald. The better solution is to treat early hair loss with medication and once you make the decision to begin surgery, have a procedure large enough to make a significant cosmetic improvement.
As a final point, it is a fallacy that some doctors’ techniques are so “impeccable” that they can avoid effluvium or that a very small procedure will avoid shedding. Of course, bad techniques and rough graft handling will maximize effluvium, but effluvium is what hair naturally does when the scalp is stressed and it is stressed during hair restoration surgery from the anesthetic mixture and the recipient site creation, regardless of the technique, so that it cannot be totally prevented. Despite claims to the contrary, Follicular Unit Extraction has no bearing on this process of shedding as it is a harvesting rather than a placing technique.
In sum, the best way to deal with effluvium is to treat with Finasteride when hair loss is early, perform a transplant only when indicated and finally, to perform a hair transplant with skill and to use sufficient a number of grafts.
