|
Bandages
There seem to be three basic approaches to care after a hair implantation
procedure is complete. Traditionally, the individual had a bandage
applied to the scalp to cover the implant wound area. The patient
would then be sent home and returned to the clinic the day after
to have the bandages removed and the implants examined. The alternative
is to apply saline soaked gauze to the implant area and bandage
it. The patient stays in the hair transplant clinic like this for
a few hours before the patient is unbandaged and sent home. In
each of these scenarios several layers of gauze are applied over
the implantation site and then a long bandage is wound around the
head to hold the gauze in place. The bandage applies some pressure
to the scalp skin to help reduce any potential bleeding. More recently
though, especially since the development of micrografting and follicular
unit grafting, patients are not having their scalp bandaged at
all. To use or not to use bandages after an implantation procedure
is a topic of hot discussion among hair transplant surgeons. Some
do some don’t and whether or not you have a bandage applied
to your scalp will depend largely on the personal preference of
the surgeon.
There are advantages and disadvantages to a scalp bandage. The
obvious advantage is the bandage protects the implants while they
heal into the scalp and any blood that bleeds out will be soaked
up. The disadvantage is that the bandage “marks” the
individual as having had surgery. However, at most the bandage
only stays on for 24-48 hours and can be readily hidden by wearing
a hat or cap when in public. The better answer may be to put aside
the first two days after surgery and just to stay at home until
the bandages come off. Depending on which approach is used, bandage
or no bandage, the clinic should give you the relevant advice on
what to do for the next 24 hours until they see you again – usually
the next day.
Keeping
the follicles in place
The implants most susceptible to falling out are the ones implanted
last in the procedure, but the transplanted hair follicles almost
always stay in place of their own accord. The little bleeding at
the edges of the incision wound cut for the graft help to “glue” the
graft in place. By the time the hair implantation procedure is
complete, those follicles implanted first in the hair line are
pretty much fixed in place by this blood glue. Of course this is
exactly what blood is supposed to do. By bleeding the blood is
exposed to air. This activates a cascade of events in the blood
that results in blood coagulation. This is to seal an open wound
and close it as quickly as possible. It also activates the formation
of fibrin that builds up a meshwork in the wound site. This helps
glue the wound together and provides a scaffold on which cells
from the edges of a wound can grow into the wound and heal it.
With larger wounds it takes longer for the blood to clot and seal
the wound and it takes longer for the wound to heal over. With
micrografting and follicular unit grafting each individual wound
is so small that the blood can clot in a couple of minutes and
the wound starts to heal within a few hours.
Never the less, you should be extremely gentle with all of the
grafts for the first 24-48 hours after implantation. It is very
rare for grafts to fall out. If they do and they don’t look
dried out, it may be possible to just pop them straight back in
if you are still in the clinic. If they fall out after you have
left the clinic it is unlikely much can be done to save the grafts.
However, you could try to put the grafts in a saline solution (salt
water mixture), keep it cool at about 4-8 degrees centigrade and
call the clinic to see if they can put the graft back in – it
may be possible, but there are no guarantees it will be successful.
Again though, a graft falling out is an extremely rare event. The
biggest issue in the first 24 hours after a hair transplant is
probably how best to sleep without disturbing the implants. The
clinic should be able to advise on what they think is best depending
on whether your head is bandaged or not. People may sleep in a
sitting position for the first night and maybe longer, so that
the head does not come into contact with a pillow. In general,
you will not wash your scalp for the first 24 hours, indeed avoid
touching it at all. Usually you do not wash the scalp with shampoo
for the first 3 days after the operation. Your scalp will be cleaned
at your next clinic appointment.
The
first seventy two hours post surgery
About 8 hours after the implantation procedure the local anesthetic
injection will start to wear off. This is when you, as a hair transplant
recipient, will experience most discomfort. Most often the pain
is in the donor area rather than the recipient area as the donor
area is, in effect, a much bigger wound. In many clinics you will
be sent home after the procedure with a few acetaminophen and codeine
tablets or their equivalent. This is usually quite enough to keep
the pain to a minimum, but you should expect some discomfort. You
might also be given some sleeping pills to use for the first couple
of days. After 24 hours the pain should more or less disappear.
If not, then you need to contact the clinic. Prolonged pain may
suggest an infection has entered one or more of the wound sites.
The clinic needs to deal with this quickly.
A rather crusty looking scalp is to be expected for the first
24-48 hours. It is of no concern, it happens to everyone undergoing
a hair transplant. However, if you continue to bleed some hours
after the procedure and certainly after 24 hours, then the clinic
will probably apply a compression bandage that you wear for another
24 hours until the bleeding subsides. If this is the case you will
be called back to the clinic the next day to have the bandage removed.
The objective is to have the bandage on for as little time as possible.
The grafts heal quicker if they are exposed to the air. Most clinics
give patients an antibiotic solution or cream to gently apply over
the donor and recipient areas for the next few days. Further crusting
is likely in the next three days, but you should not wash your
hair with shampoo until after the third day.
In general, you will be called back to the clinic the day after
the procedure. The surgeon will examine the wound site and the
grafts to make sure they are all in place, correctly orientated,
and that they have not been pushed in too deeply as this can cause
problems with healing. The area is usually fairly crusty and bloody.
It is usually washed gently with a sterile solution using cotton
tipped swabs and gauze pads. The hair may then actually be shampooed
very gently in the clinic, combed, and dried. With this done, usually
the grafts are pretty well hidden unless you look closely. You
will not be given another bandage unless you still have some bleeding.
A loose fitting cap or hat may be the answer if you want to stop
anyone from seeing the new hair transplants in the first three
days or so. Try to find a hat with holes in it to avoid heat build
up under the hat. However, a hat or cap is only to be used when
absolutely necessary. You grafts will heal much quicker and better
if they are open to the air, but avoid getting sunburnt as this
will hinder the healing process.
Seventy
two hours plus post surgery
Most patients develop some swelling 1-4 days after the operation.
This can last for a week or so. In a few cases the swelling can
become very bad such that the individual is unable to open their
eyes properly. Sleeping in a sitting position or sleeping at a
45 degree angle can help reduce the swelling. A bag of frozen peas
or similar applied to the swelling can also help reduce it. The
frozen peas/ice should not be directly applied to the implants,
rather apply it to your forehead. In the first 1-2 weeks there
is an increased chance of infection. You should minimize this by
avoiding dirty environments and polluted air as much as possible.
Don’t go swimming in public pools or dirty water for at least
two weeks after the implant procedure. Your clinic should give
you an antiseptic/antibiotic solution or cream to apply to the
donor and recipient areas to help limit the chances of infection.
Most clinics suggest you can start washing your hair gently after
three days. Normally it is better (more gentle) to do the washing
in a sink rather than under the shower head. It also helps to soak
the crusting a little with the water before shampooing to help
dissolve the crusts. After gentle washing, allow your hair to air
dry. Avoid hair dryers and especially hot hair dryers. If you do
any exercise or live in a hot climate where you perspire a lot
then you need to wash your hair as soon as possible after sweating.
Bacteria grow in moist conditions so sweating increases the chances
of developing an infection. Most clinics suggest washing your hair
every day so that the crusting can be removed fairly quickly. Consult
with your clinic for their particular hair care recommendations.
Seven
days plus post surgery
Most clinics use permanent sutures that will need to be removed
form the donor site. Usually, an appointment is used 7 to 10 days
after the surgical procedure for their removal. You can go to the
hair transplant clinic or, if you live far away, your family doctor
may do the suture removal.
The crusting over and around the grafts should start to fall of
1-3 weeks after the procedure. Crusts will separate from the grafts
more quickly if they are kept moist. There are different ways to
do this and your clinic will tell you their preferred method. Some
will give you a saline solution to use, others provide things like
vitamin E containing oils. These are applied to the skin before
gently washing the scalp with shampoo.
The transplanted hair follicles will usually shed their hair from
2-6 weeks after the hair implantation. The transplantation procedure
involved cutting off their nutritional supply for a few hours.
This shock to the hair follicle usually sends then into a telogen
resting state. The hair fibers the follicles were growing gets
shed over the subsequent few weeks after the surgery. It is almost
inevitable and there isn’t much you can do about it. New
hair growth will begin to be visible from about 10 weeks after
surgery. Not all grafts will begin growing hair at the same time
so don’t worry if the initial hair growth looks a bit patchy.
This is normal. As hair only grows at a rate of at most 0.35mm
a day, it will take time for the hair to grow long enough for you
to comb and style it properly. By 6 months after the surgery the
hair should be growing well enough for you to gauge the result
of the transplant, though it will be 9 months after the surgery
before the full effect will be realised. The hair fiber that initially
grows in the first few months may be duller and more fizzy than
normal. However, the follicles should settle down and start making
better quality hair fiber by 14 months after the procedure.
To help things along and speed up the hair regrowth process, some
hair transplant surgeons advise on applying minoxidil form the
third day after the transplant. This is a direct hair growth stimulant
so it should speed up the hair follicle recovery. However, some
people are allergic to the ingredients in most minoxidil formulations
so it is not for everyone. Your clinic should advise.
|
