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The Bald Truth

About This Resource:
Understanding Hair Transplants is designed as a simple, patient-friendly introduction into the confusing world of hair transplants. A hair transplant performed with the latest techniques is virtually undetectable, but many hair restoration consumers are unaware of these improved methods. This online hair transplant resource teaches men and women the essentials so that they can make the right decision.

hair transplant patient
After The Hair Transplant

Patients are rightly concerned about how they will look immediately after surgery. The area where the strip is removed from the back of the scalp will not be visible because the overlying hair shingles over it unless the patient wears his hair in a very close cut. The recipient area in front or on top is the area that will be noticeable to others.

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 in back.

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 sites.

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 transplant.

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.

follicular unitsFigure 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.


Understanding Hair Transplants provided Courtesy of Dr. Blaine Lehr, The Dermatology Clinic Inc.