Bernstein Medical - Center for Hair Restoration - Smoking

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Q: What is the most common cause of necrosis (death of tissue) in the recipient area? — A.Q., Los Altos Hills, C.A.

A: Recipient site necrosis is one of the worst complications of a hair transplant and results in skin ulceration and scarring. Usually it is caused by a combination of a few or many of the factors listed below. Each by itself should not present a risk.

Pre-existing conditions in the patient such as:

  1. smoking (the big one)
  2. diabetes (juvenile more than adult onset)
  3. photo-damage (alters the collagen and vasculature)
  4. long-standing baldness (less blood supply when there are no follicles)

Poor surgical techniques:

  1. recipient sites that are too large
  2. recipient sites that are placed too closely (too dense)
  3. too many grafts placed at one time
  4. too much epinephrine used in the procedure
  5. multiple procedures in one session — i.e. FUE and FUE in same session, or large FUT and Graft excision, scalp reduction, etc.
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Q: I had my hair transplant done 10 days back, I was a regular smoker (8-10) cigarettes every day from last 10 years. I have stopped smoking from the day of my surgery, how long should I stop smoking after surgery? — E.D., Glendale, N.Y.

A: I would wait a minimum of 10 days, but the longer the better. The nicotine in the smoke constricts blood vessels and decreases the oxygen to the tissues and the carbon dioxide in smoke displaces the oxygen. Both chemicals retard healing.

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Q: Is it true that smoking is bad for a hair transplant and why? P.P. – N.Y., N.Y.

A: Smoking causes constriction of blood vessels and decreased blood flow to the scalp, predominantly due to its nicotine content. Also, carbon monoxide in smoke decreases the oxygen carrying capacity of the blood.

These factors both 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 harmful effects of smoking wear off slowly after one stops. In particular, chronic smokers are at risk of poor healing after smoking has 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 hair restoration procedure.

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