The only time this may not be true is when the patient has a fair
amount of existing hair in the recipient area prior to surgery.
In fact, for patients interested in hiding the early stages of the
transplant, I will often recommend that they allow their hair to
grow out more. Many patients mistakenly presume that the preexisting
hair in the recipient area is shaved during a transplant. The only
area that is actually shaved is the thin donor strip that is excised
The area of the scalp where the hair is implanted will have numerous,
single, 1 to 4 stubble hair follicular units with small crusts on
top of each graft protruding from the skin. These crusts, or miniature
scabs, will fall off in seven to fourteen days depending on the
patient’s rate of healing.
Unless the patient develops swelling around the eyes, this is the
most noticeable aspect after a transplant. Within the first month,
the transplanted hair will fall out except in a small minority of
patients. The follicular root system remains in place under the
skin, however, and will regenerate a hair in three to five months.
This is similar to what happens when a hair is plucked. After the
crusts are off and the hairs have fallen out, the scalp will have
numerous pinpoint, pink dots. These are the healing, needle hole
The pinkness usually resolves two to six weeks later and is not
particularly noticeable unless the patient has no preexisting hair.
Even then, it tends to look like a sunburned area.
If a patient wants to use one of the many topical camouflaging agents
available to balding men, I ask for them to wait until the crusts
come off. Similarly, if a patient is transitioning from a hairpiece
to a transplant, I ask him not to wear the hairpiece until after
the crusts have fallen off. Although I have not experienced this
with my patients, some surgeons firmly believe that wearing a hairpiece
after a transplant can lead to poor growth. Wearing a hat after
surgery is the easiest way to hide what has been done. In fact,
I send my patients home wearing a baseball cap. The patient begins
shampooing the first morning after surgery. Many patients are scared
to shampoo, but it is actually very important to cleanse the area
and remove any excessive, dried blood. Patients who do not shampoo
tend to develop a large, confluent scab that retards healing and
makes the area more prone to infection. Shampooing is performed
in a very gentle fashion for the first ten days. Rather than scrubbing
the scalp, the patient gently lathers and then pats the scalp. Instead
of washing the lather off under the showerhead, a cup of water is
repeatedly poured over the area until the shampoo is rinsed out.
Each surgeon will have his favorite way to treat the recipient
area after shampooing. Some will ask the patient to apply a variety
of ointments. Others will ask him to perform
repeated soaks and keep the area misted with saline spray. Still
others will have the patient do nothing to the area except shampoo.
Patients may style their hair as they like, but are cautioned about
running a comb or a brush too roughly through the scalp for fear
of pulling out grafts before they are healed. I ask patients not
to use hair sprays, gels, or Rogaine on the transplants for the
first week. I also ask them to use their blow dryers on lower settings
both in regards to heat and force.
It is not at all uncommon for a few follicular units to “pop
out” the first few days after the procedure. If so, the patient
might notice fairly brisk bleeding. The patients are instructed
to simply hold pressure over the spot with gauze wrapped around
a finger for about fifteen minutes. I stress that they should not
try and re-implant that follicular unit for fear of causing other
nearby ones to fall out too. I remind them that losing a few will
not hurt the final results.
For the first two weeks after a transplant, patients are instructed
to avoid heavy lifting, running, or swimming. Walking for exercise
is fine. If their work is not strenuous, most will take one or two
days off just to be sure they are feeling good before going back.
A variety of medicines are frequently provided after surgery. A
steroid such as prednisone may be given to help reduce the frequency
and severity of swelling. Antibiotics are used to help prevent infection.
Finally, pain pills are provided for use as necessary.
In regards to pain after the procedure, in general, patients are
pleasantly surprised. The recipient area is usually not particularly
painful at all. The excision site in back is what is frequently
tender for a few days. That is only natural as it is like any other
surgery site. Many patients either use no pain pills or just use
them for a few days.
If a patient is interested in trying to hide the fact that he has
had a transplant during the regrowth stage three to five months
after the procedure, one trick that helps is to change the hair
style at about three months. A man, especially, may want to cut
his hair very short and keep it short as the new hair grows in.
Then, after most of it has grown in, he can let it grow to the length
he wants to keep it. Most people will have forgotten what he looked
like before he cut his hair short (i.e. before the transplant grew)
so that the change in his appearance is usually explained as him
just letting his hair get longer.
It is common for the patient to want to judge the results of his
transplant as soon as the hair starts growing in. There are several
problems with judging too soon. First, some hairs may be slower
growers. Sometimes it takes these hairs longer than five months
to start to grow. Second, the hair will appear more dense the longer
it grows. It is not infrequent to have a patient want a second transplant
six months after the first. If I can get him to wait another six
months so that his new hair has some length and he becomes accustomed
to styling it, many times he will realize he does not need another
On occasion, I will have a patient who does not believe that the
new hair actually grew. This only occurs when a transplant is performed
within preexisting hair. When it grows on the scalp with someone
who was completely bald, there is no question. The fact that a man
might question whether it grew is an attribute to its naturalness.
Since the transplant does not begin to grow for three to five months
and since it may come in a little at a time, when it actually has
grown in, the change may have occurred so gradually the patient
may not remember what he looked like at baseline. At these times,
it is helpful to show the patient how an expert can tell the difference
between a natural and a transplanted follicular unit. With a natural
occurring follicular unit, there is a very a small amount of skin
present between the hair shafts when they exit the skin. This small
amount of skin is absent between the hair shafts of a transplanted
follicular unit because of the compression of the graft during healing.
The difference can only be distinguished with very close observation.
7-1. Differentiating original and transplanted follicular
units A) Most original follicular units will have a very small
piece of skin between the hairs as they exit the scalp. B) Transplanted
follicular units will not have skin between the hairs.