Tuesday, December 9, 2014

Caring for Your Hair after Surgery : Heading home with your new hair , Understanding possible complications and Deciding when (and if) to do it again

Caring for Your Hair after Surgery

In This Chapter

  • Heading home with your new hair
  • Understanding possible complications
  • Deciding when (and if) to do it again

Going home after your hair transplant can be nerve-wracking:

What if you do something to destroy your expensive new hair? Relax. Caring for transplanted hair isn’t that complicated. In this chapter, we tell you what to do and signs to look for in case problems do occur.

Homeward Bound with a New Head of Hair

Postoperative care for hair transplant surgery is minimal; your doctor will explain most of the key points in writing. The most important thing is to keep your hair and scalp clean and free of crusting.

The hair grafts you received should be stable after one day and should be fixed into your scalp, becoming relatively permanent in the few days following the surgery.

You may notice a small amount of blood from the donor or recipient area after the first day. Just apply direct pressure with clean gauze (which your doctor should provide you with) or a clean towel until it stops. If it doesn’t stop with simple pressure, call your doctor.

By the end of the first week you should be back to your old routine, going about your day-to-day activities as if you never had the surgery. If you have enough hair to cover the transplanted area, styling alone may hide the grafts. From this point forward, it’s a hair-raising waiting game, as it will take three to six months to see new hairs coming through and about eight to nine months to see 80 to 90 per- cent of the hair grow to styling length of two to three inches or so.

Recovering after anesthesia

A hair transplant is performed under local anesthesia, just like the dentist uses to fill cavities. Local anesthesia is often supplemented by some form of sedation to keep you relaxed during the surgery. The use of sedatives is a good practice because, like a long air- plane ride, sitting in a chair can be difficult for a typical six hour hair transplant surgery.

After your surgery, you won’t need to go to a recovery room, but can stand upright and walk out of the office. The effects of the sedatives will last for much of the day after you leave the office, so driving yourself home is out of the question. You need a driver for the rest of the surgery day.

When you’re ready to leave the office, a nerve block is put into the scalp; this should keep you comfortable for between four to six hours, after which some feeling and possible discomfort occur. The greatest amount of discomfort occurs the first night after the surgery.

The fear of pain reflects the fear of the unknown. If there’s pain, it usually is most intense the first night after the surgery. Your doctor should provide you with medications that help you manage any pain you have.

Keeping your head crust-free

Some patients are afraid to even touch their grafts after a trans- plant surgery for fear that they may dislodge or damage their investment. But key to good post operative care is keeping the area clean, and that involves some touching.

If your surgeon uses small needle holes for the recipient sites, crusting is minimized and the wounds hold on to the grafts by mechanical means. If crusting or small scabs appear after a few days and persist, this may reflect poor washing techniques, recur- ring crusting can be minimized by good scalp washing.

Most of the crusting can be removed in the first two days with diligent washing techniques. Here are some of the key points to remember:

� Never rub the transplanted area.

� Shampoo once or twice daily. The use of a sponge filled with water mixed with shampoo should be used on the grafted area. The sponge is rolled over the grafts. This rolling motion squeezes the soapy shampoo onto the recipient area. Ask your surgeon for a surgical scrub brush that has no soap in it as this sponge is ideal for washing the grafted areas.

Never go over the grafts with a back and forth motion as this may pull out the grafts. A back and forth or side to side motion is safe to use on the donor area as there are no grafts there.

� Washing the donor area can be done more forcefully, removing all blood from the scalp, the first day after surgery. Once all the blood is washed off, the area should stay clean. A back and forth or side to side motion is safe to use on the donor area as there are no grafts there

� Don’t spray water from the shower directly on your head to rinse off the shampoo. Put your hand between the shower and your head and let the water run off your hand until all of the shampoo is off. Pat dry with a clean towel.

� If the grafts are wet for too long, they may swell and look like they’re rising above the skin surface. This will look like little white bumps. This isn’t dangerous, but indicates that you’re soaking too long. As soon as you dry your scalp, these ‘raised bumps’ will disappear as the grafts settle down and the swelling goes away.

� If the crusts appear larger than the grafts because of bleeding that may have occurred the first night, try to get these crusts off by rolling a moist cotton swab over the crust. Don’t wipe it, just roll it, as the cotton fragments will gently pull pieces of the crust off. You need to be very gentle, so repeat the process over and over again until the crusts disappear. You don’t want to force any of the grafts out.

� The grafts are usually securely locked in place by the fifth day if the areas has been kept crust free. If the crusts last longer than five days, it means that you haven’t washed vigorously enough. Vigorously pulling or scrubbing crusts that remain after five days can cause the crusts to pull the grafts out.

The rule of thumb we use is that grafts must be crust free to be considered secure. Grafts can come out for up to 12 days after surgery if crusts are present and you scrub them or pick at them. This is an important rule because patients are worried that they will pull out the grafts by something that they do.

The photo on the left in Figure 14-1 was taken an hour after a hair transplant surgery of 1500 grafts (note that there’s no crusting or bleeding present, because the recipient site holes were very small).

The photo on the right was taken 11 days after the surgery. At no time did the patient have scabs or crusting on the recipient area. This is the typical post-operative appearance of our patient surgeries. This patient went to work on the second post operative day without any detection by his colleagues because he managed the washing properly.

imageHiding your head

It’s always nerve wracking walking into a crowd with a new look, and it’s especially nerve wracking when you’re worried that every- one is going to be whispering behind your back, “Did he or didn’t he?” While it’s normal to be self conscious at first, there are ways to detract attention from your head and to hide your surgery from the curious and the nosy!

If you have enough hair to cover the transplanted area, styling alone may hide the transplants. From this point forward, it’s a hair raising waiting game, as it will take three to six months before you see new hairs coming through, and about eight to nine months to see 80 to 90 percent of the hair growth to styling length of two to three inches or so.

If you’re very bald and concerned that someone may notice your transplant, try growing out your beard! Don’t shave starting the day prior to the transplant and let your beard take on a stubbly look. The change to your face will divert eyes from your scalp; even a very bald man can hide the transplant with this technique.

For men with beards or mustaches, try shaving them off. This will always produce comments about your new look and again will divert attention from the top of your head!

Keeping your hair long before surgery is very important because long hair can be styled to hide all of the wounds on the back and side of the head (where the donor was removed).

As the recipient graft site will initially feel like beard stubble and will grow over the next day and thereafter, the short transplanted hairs will hold all of the long hair that is combed over it in place without hair spray.

The beard-like recipient hairs will look like they’re-growing out for the first two weeks or so and then they usually fall out. Don’t panic at this! It doesn’t mean that you’ve lost these precious hairs, but that the hair has entered its telogen (rest) cycle, which may last up to five months before the hair begins to reappear.

Limiting your amount of exercise

With regard to strip harvesting, you can play golf or tennis by the second day after surgery (your swing may be off because of the pull of the sutures or staples), or you can even run a marathon one week later. The main concern with postoperative exercise is the stress on the donor areas on the scalp from which grafts were taken. For example, straining or stretching the back of the neck (e.g. pull-ups or sit-ups) may lead to a wider scar and should be avoided.

It’s good to walk and exercise within a few days after a transplant. Because the impact of exercise varies greatly from person to person, we can’t make hard and fast recommendations; be sure to discuss your particular concerns with your doctor.

With regard to FUE harvesting wounds, there are no exercise restrictions after a week. (See Chapter 12 for more on the types of hair plant surgeries.) The same washing techniques discussed above, must be applied to the recipient area and the donor area can be washed vigorously after the third day. The donor area, how- ever, can be scrubbed vigorously after three or four days.

Sutures or staples can be removed between 9 and 17 days after surgery depending upon the surgeon’s assessment of your healing. Staples tend to be more uncomfortable than sutures, but they may produce better wound healing than sutures in the long run.

For strip harvesting wounds, exercises that don’t flex the neck or put pressure on the back of the neck are usually okay. You may resume swimming three weeks after your procedure, but you shouldn’t soak the donor wound for a full month.

In general, exercises such as sit-ups (especially with your hands clasped behind your head), squats, heavy weight-lifting, and bench presses strain the back of the neck and should be avoided for at least four weeks following surgery. If the back of the scalp feels tight after four weeks, or if you have a tendency to heal with wide scars, you should avoid these activities for three to six months.

For FUE harvested areas, you can resume swimming in one week provided that the wounds are all closed by that time; there are no restrictions for any other form of exercise.

The donor wound won’t regain its full strength from strip harvesting for at least three to six months after the surgery, so use a reasonable degree of caution during this period. Use good judgment, and call your surgeon if you have questions.

Handling Complications

As with any surgery, hair transplantation can have complications even past the normal postoperative period. This section reviews some of the potential problems to be aware of following your surgery.

Post operative brow and facial swelling

With all head and scalp surgery, swelling is common. At times the swelling can be very significant, causing an eyelid to swell shut. When swelling appears, it usually occurs on the third or fourth day and lasts only one or two days.

Most post operative swelling can be eliminated with the judicious use of large doses of steroids started the day of surgery and taken over four to five days. The use of steroids, however, must be care- fully weighed since certain medications or medical conditions may prohibit their use, such as diabetes, which tends to be aggravated with steroid use.

Your surgeon will need to make the call on whether steroids are worth the potential complications in your particular case in collaboration with your medical doctor.

Failure of transplanted hair to grow

As with all surgical procedures, results from hair transplants can’t be guaranteed. It’s possible that some or all of the transplanted hair may fail to grow (this occurs in less than one percent of cases). Every effort will be made to give you the maximum yield from your transplanted hair.

Alopecia Areata (AA), or spot baldness, can in rare cases exist in a diffuse form that resembles genetic balding. The diffuse form of this disease, when it occurs, is more frequent in women than in men, and can be a cause of a transplant failure if your body’s immune system attacks the hair follicles (<0.1 percent chance). AA can be diagnosed by multiple biopsies.

Failure of the transplants to grow can be caused by other factors such as technical failures by the surgical team, due to inexperience and/or sloppy surgical methods. We call this the H (human) factor. As this surgery is a team effort, the team is only as good as its weakest member. Inexperience in the surgical team is the most probable cause of graft growth problems.

On rare occasions, the grafts may not all grow, even though your surgeon and the surgical team do everything perfectly. The hair transplant industry has called this the X factor, which simply means that there’s no identifiable cause for the problem.

Clearly X factor is an additional set of factors beyond the patient’s scalp condition or the surgical team. The chances of failure to grow from X factors should be less than one percent in the hands of an experienced surgical team.

When hair fails to grow, it may be helpful to biopsy the scalp in the areas where the failure occurred, but because this type of failure is so unusual, biopsies are not recommended in advance of the transplant.

Hair loss

Hair loss can occur at both the recipient site and the donor site. For men, hair loss at the recipient site is related to genetic induced miniaturization of the existing hair and minimized by taking finasteride (1 milligram daily). This drug is effective fairly quickly (in the first 24 hours).

Young men are at greater risk for post operative hair loss so a daily dose of finasteride is important to prevent what is referred to as shock loss or accelerated thinning secondary to the genetic balding process. (The next section explains shock loss.) If you’re a man under 35, planning hair transplant surgery, you should talk to your doctor and begin taking finasteride at least two weeks prior to the procedure.

Men over age 35 have less chance of shock hair loss after a hair transplant because their genetic hair loss has usually slowed by that age.

When hair loss occurs in the recipient area in a young man with genetic hair loss who has not been on finasteride, the loss may be permanent. This type of loss usually occurs in the first six months post surgery. When hair loss occurs in women in the recipient area, the loss is rarely permanent, but it may take four to six months for hair to regrow in the recipient area.

Hair loss can also occur around the donor area; this is most often the result of a wound closure that’s too tight. When hair loss occurs in the donor area, it usually starts at about ten days after surgery and completes its course over the following six weeks.

When hair falls out in the donor area, it usually re-grows over the ensuing four to eight months. The hair that is shocked is forced into its sleep (telogen) phase, but will usually recover.

Hair loss acceleration: Shock loss

While hair loss after transplant is always a shock, shock loss refers to a specific type of post surgical hair loss. Turn to Chapter 13 for more about shock loss, what it is, how often it occurs, and what can be done about it.

Surgery and the anesthesia associated with the surgery can stress hair so that the hair might continue its loss on an accelerated time- line. We see this in men and women (see Chapter 13).

Sun damage

After your transplant, you must protect your scalp from the damaging rays of the sun, particularly for the first three months. Although sun will not prevent the new transplanted hair from growing, it can damage the healing process. Ultraviolet light damages newly formed collagen. If you have a history of skin cancer or sun-damaged skin, you should follow up regularly with your dermatologist.

It’s possible that significantly sun-damaged skin may hinder hair growth because the blood vessels of the scalp can be damaged.

Wear a hat to protect yourself in the sun. After the scabs or crusts have fallen away, you can (and should) apply sunscreen to the scalp.

Doing It Again

If you feel that you need more hair, more fullness, you may want to consider another surgical hair transplant. You should wait a mini- mum of eight months after the previous procedure, when 80 to 90 percent of the transplants will have grown out. You need to see the results of your transplant before making a decision to have another. Ask yourself the following questions as you ponder a second surgery:

� Have you achieved your goals?

� Did the hair transplants cover the balding area you wanted to cover?

� Is the hair full enough?

� How did the wound heal? Is it detectable?

Many fairly bald patients or those with fine hair should expect to have more than one procedure for the best results. Still, it’s possible that you’ll feel that you’ve achieved your goal in one session and don’t feel that more hair will add value to your results. See Chapter 13 for more.