Dr Jagdish M jyoti - Cosmetic Surgeon,Apollo Hospitals, Hyderabad, India.

Pre and Post HT Care

Pre Transplant Instructions

Follicular unit transplant is a planned surgery and it is in the interest of the patient to confirm the date of the transplant at least three weeks in advance, the idea being to start pre operative preparation. Depending on the type of hair, Dr JMJ may advise medication for improving quality of the donor hair and to reduce postoperative shedding. If flaking or scaling is present you may advised to use medicated shampoo for a couple of weeks before the transplant. If you are using Minoxidil it should be discontinued ten days before transplant.

If you are on any blood thinners like Aspirin, Clopidogrel, Heparin, Warfarin etc, vitamin supplements, anti depressants, these should be discontinued atleast a fortnight before the transplant. Any long-term medication you are taking should be discussed in detail with Dr JMJ in the first consultation. Any major illness or episode of fever in the recent past should be disclosed to Dr JMJ.

Smoking or tobacco in any form delays wound healing and should be stopped a fortnight before surgery and if possible discontinued permanently as it may play a role in hair loss. No alcohol 48 hours before surgery.

Do not cut your hair (before the transplant) without prior discussion with Dr JMJ, as you need to have hair, at least one inch long in the donor area. This helps to hide the operated area post operatively.

Report to the hospital at the scheduled time and make sure to have a light breakfast before your transplant.

Post Transplant care and Advice

Having got the transplant done, it is very important to review the postoperative instructions with Dr JMJ before you leave the hospital. Read the instructions carefully and make sure you understand them properly. Following this advice will go a long way in insuring the best possible outcome of the procedure.

On the first night, sleep in semi upright position, taking 2-3 pillows or sleep in a semi reclining chair. Elevation of your head lessens the chance of swelling or bleeding. Make sure to take all the prescribed medications. The painkillers relieve mild painful discomfort, which is usually present for the first 2-3 days. Ice bags or cold compresses in the donor area and over the forehead (not over the grafts) will also help in pain relief and reducing the swelling.

Do not wet hair for 72 hours after the transplant. You may shampoo in a limited fashion after this. Dr JMJ will give detailed instructions regarding this to you after the transplant. Tap the grafts dry, do not rub the graft sites until ALL the scabs have fallen off. Ten days later, you may gently massage the hair in the grafted area and two weeks later, you may resume normal shampooing. Scabs/crusts form, which cling to the grafts during the healing phase. These will fall off in 7-10 days. DO NOT pick at them. After 14 days, gentle massaging while shampooing will speed their removal. The odd graft may be dislodged accidentally and fall out. This is not a matter for concern and will not significantly affect the overall result of your hair transplant.

Avoid strenuous activity and exercise for three weeks. Do not bend or lift heavy weights as this may cause bleeding from the transplanted areas or increased swelling. It is better to avoid exercise and swimming for three weeks. Do not expose the scalp to direct sunlight, use a loose fitting cap.

There will be some mild swelling and this is quite normal. It usually starts over the grafted area and tracks down over the forehead, 2-4 days after the transplant, which may in another day or two cause swelling and bruising on the lower eyelids. Elevation of the head and limiting activity, will reduce chances of swelling occurring around the eyes, but if it does occur it will last generally for 24-36 hours, before disappearing.

Some slight bleeding occurs occasionally. Elevation and compression will generally stop the bleeding. Ice packs may be used on the back of the scalp (donor area) but not over the grafts. Normally with these measures it stops but if it does not then you can call Dr JMJ on +91 9849377810

Sutures used are usually of absorbable type, so do not require removal, but if non-absorbable sutures are used then they are removed by 12th day.

Minor symptoms like itching, decreased sensation (mostly on the top of the head), infection (rare), scarring etc may occur but rarely are a problem. Dr JMJ will prescribe an ointment to reduce the itching if it is troublesome. Decreased sensation corrects itself in 6-12 months.

Shedding (telogen effluvium) or mild "Shocking" of nearby existing hair occurs when there is weak existing hair in the transplanted areas of the scalp. This effect, in general, is noticed in about 1 in 10 patients and is seen anywhere between 2-4 weeks to 3-4 months post transplant, after which the hair grow back along with the new hair. If a particular hair that is "shocked" was on one of its last life cycles, then it may drop out permanently. It is important to realize that surgery does not stop further loss of non-transplanted hair.

Another type of shedding is that of the transplanted hair, most of which will fall out within the first 3 to 8 weeks ( anagen effluvium). This is perfectly normal and to be expected for 90% of the FU grafts. Growth starts at about 3-6 months after the transplant. In the initial phase of growth the hair are fine but as time passes by (8-12 months), they gain length and diameter. By the end of one year, the "new" hair should be as robust as the surrounding non-transplanted terminal hair and growing at the same rate.

If you notice anything unusual, other than that mentioned above or have any queries feel free to call Dr JMJ on +91 9849377810

You may shampoo in a limited fashion starting 48 hours after your transplant. Take a plastic container into the shower and use it to pour water over your head several times. Then put a couple of capfuls of the shampoo, a pH balanced shampoo, into the bottom of the pitcher or cup. Add a slight amount of water to make a sudsy solution. Pour this over your scalp and shampoo by working your hair between your fingers and thumb. You may shampoo daily in the limited fashion. On the fifth day following the procedure you may let the shower stream hit your scalp. After 7 days, you may gently massage the hair in the grafted area and after 10 days, you may resume normal shampooing.