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Cysts and pimples occur fairly frequently within the recipient area,
especially in patients with more oily complexions. If they occur,
typically they begin the first month after surgery. The patient
may experience just a few isolated breakouts or, in some instances,
frequent breakouts over a three to four month course. These can
usually be easily opened with a sterile needle and gentle pressure.
After opening the small pockets of inflammation, the areas tend
to heal uneventfully. This is thought to be caused by fragments
of skin or hair getting caught underneath the skin surface. It eventually
clears and does not interfere with the ultimate hair growth. If
the patient is bothered by these, antibiotics may be prescribed
just as in teenage acne. Occasionally, an ingrown hair will form
a cyst. As above, the hair may be easily picked out with a sterile
needle and gentle pressure.
Another fairly frequent complication is swelling on the forehead
and around the eyes starting 24 to 48 hours after surgery. Just
like with any surgery, swelling is possible, but rather than affecting
the scalp, it tends to affect the softer tissues of the face like
the lower forehead, brow, and especially the eyelids. This is not
dangerous, just embarrassing. In the milder forms of simple brow
swelling, the patient might note fullness across the lower forehead
and between the brows. In the more severe forms, the patient could
develop swollen, black eyes. He could notice this swelling for just
a day or two, or he could have two black eyes for a week. Certain
patients will be more prone to it, especially those in whom significant
work is done in the hairline. It is impossible to predict with any
reliability who will develop it. In fact, it is not uncommon for
the same patient to develop swelling during one procedure but not
the next. Very rarely, patients may swell enough that they
cannot open their eyes. Again, I stress to my patients this is not
dangerous, but it can certainly be a social inconvenience. My patients
are given steroid pills prior to surgery and several days after
surgery to help combat this problem. Ice packs are utilized during
and after surgery also. For the majority of patients, those measures
will prevent the
problem.
After a transplant, it is possible for the preexisting hair in
the recipient area to go into a resting phase and then fall out
due to the shock of the surgery. If this occurs, it is usually in
the first several months. Since the transplanted hair has not yet
had time to grow, the hair in that area could look even thinner
than before the patient presented for a hair transplant. If the
preexisting hair that fell out was healthy, it will regrow, but
not until four to eight months after surgery. If the hair that was
lost was already miniaturized and destined to fall out permanently
within the next year, it likely will not regrow. This complication
affects only 5 to 10% of men, but it affects a much higher percentage
of women. This “shocking”
phenomenon is discussed again in more detail in the women’s
chapter.
When the donor strip is excised from the back of the scalp, the
small sensory nerves that supply the sensation to the top and back
of the scalp may be transected as they pass superficially in the
skin. If so, the patient will note a numb feeling in this area of
the scalp. Usually after six months, that sensation begins to return.
A transplant design which is not compatible with the progressive
nature of male pattern baldness is one complication that the patient
can help prevent by thoroughly educating himself and by only seeking
realistic changes. This is addressed more thoroughly in the section
“Considering a Transplant”.
The last complication is patient dissatisfaction due to misunderstandings
which usually fall into two categories. The first is the patient
expecting more density than transplants can provide. The second
is not understanding that it may require multiple procedures depending
on the patient’s expectations and the progression of his male
pattern baldness. Again, I urge my patients to become knowledgeable
about hair transplants before they undergo a procedure. An educated
patient knows what questions to ask, what to realistically expect,
and how to find the right surgeon.
Next Topics:
Women's Hair Transplant
Scalp Reductions
Hair Transplant Repair
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