Category: Post-Operative

Haemorrhage, vascular and nerve damage is a risk of strip excision?? can we see some of these implications in patients? what are the chances of this to happen?

I can reflect on these from only experience in my practice:

1. Bleeding after surgery — I sometimes see some wound ooze beyond a day after a surgery (I would guess 1 in 300 patients). I handle this with a simple pressure dressing over the donor wound. Bleeding is never a problem beyond a day in the recipient area.
2. Bleeding significantly during a surgery (by “significantly”, I mean enough to impact blood pressure – more than a few ounces of blood) — Risk for this is close to zero. Every patient bleeds during the surgery as the scalp is very vascular (might lose a few ounces of blood), but it should not be meaningful bleeding that risks anything. Bleeding may be a problem if a patient is on anticoagulants, Aspirin, or if they might have a clotting/bleeding disorder that stops blood from coagulating (this last one should be known by taking a good history from a patient for hemophilia).
3. Vascular damage — There is no risk of direct vascular damage in a normal person unless the patient has had many scalp reduction procedures or many hair transplant procedures, or the surgeon does not have experience in doing this type of surgery.
4. Nerve damage — There are two types of nerve damage that may follow a hair transplant. The fine cutaneous nerves are cut in almost everyone both in the recipient area and the donor area. This might leave some numbness above the wound and this usually disappears in days or weeks. The second type of nerve injury occurs when and if the surgeon accidentally cut a major nerve (’greater or lesser’ occipital nerves). This is a surgical error in technique when it occurs. In my practice, I have never seen it in a surgery I have done, but I have seen this injury in patients who came to me from other doctors who may not have been skilled surgeons in the first place.

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Hi Dr. R!

Captain Forehead here. I’m one week post-op. Staples are good so far. Not too much discomfort.

Wow, there is SO much different info online about what you can and can’t do after surgery. I found this elsewhere on baldingblog.com, a very helpful guide.

Patients…

* Can lie flat
* Can have full aerobic exercise in 1 week (even run a marathon if they want)
* Should limit weightlifting greater than 25 lbs for 4 weeks and keep the back straight
* No sit-ups or pull-ups for 4 weeks
* May play with pets in 1 day (but no licking the transplants by your dog until the crusts are off – it had to be said)
* Smoke and dust in the environment are not a problem unless you are not clean
* Passive sex is ok for the first 2 nights, then everything after is a go

It’s just weird ’cause sometimes I feel more tension while yawning than I do after the pushup I just tried, of course while keeping my head totally back!

I guess I’m just writing to say, I wish I knew for sure how “zombie-like” I have to remain after surgery and how much of my history of widened scars is due to junky genetics.

Thoughts?

P.S. See ya at the Open House in L.A. this Saturday!

You don’t have to be a zombie after a hair transplant surgery. The precautions are so that it protects and minimized the donor area scarring and most of the rules are to protect the people who are not generally careful and do unsafe things. I am generally open to shortening all of the time lines with more careful people. To simply think about it, the more tension you put (sit-ups, etc), the more there is a risk of widened scarring when your neck muscles are pulled. You will know that if you put your hand on the back of the neck and see how much pull you get from what you are doing.

I’m a female, 41 years old.I underwent hair transplantation 10 days ago.Everything was fine, but 2 days ago I started with a clear discharge from the site of the implants. It is oozing non stop now and red. I saw my Dr.yesterday.He assured me it was not infected…How so ????? If it is draining it could not be right.I’m worried sick…Should I be taking antibiotics ?????

You are doing the right thing by seeing your doctor. It is impossible for me to give you any medical advice without examining you myself. Please follow up with your doctor and ask him these questions or if you are not satisfied, get a second opinion. Certainly, recipient sites should not be draining at any time, especially 10 days out of a hair transplant surgery.

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Please talk about shock loss to grafted hair as I lost a lot 10 days ago in my second operation. What can I expect generally in this situation?

Shock loss is the state of losing miniaturized hair as a result of stimulation from surgery or any other stress. It is most commonly seen after the first hair transplant in patients who have significant miniaturization in the area. Younger patients are more susceptible to this condition. Widespread use of finasteride has significantly minimized the occurrence of this condition within the last few years.

Grafted hair is considered permanent and is resistant to shock loss. If you lose any of your hair at all, it would be the native miniaturized hair in the recipient area, not the transplanted ones. In my 16 years of doing this, I saw transplanted hair lost due to shock loss about 5 times and each and every time the hair came back. This would not necessarily be the case if the hair was impacted and miniaturized, and that is why the risks are there for the first transplant, not the subsequent ones.

Dear Doctor:
I have had two hair transplants, the latest one being last year. After each one, I had and still have skin flakes that shed off my scalp everyday. Is this a side effect of the transplants? And what can I do to stop it? An ordinary dandruff shampoo won’t work.

I also have a habit of picking the small oil deposits out of my scalp which sometimes is accompanied by a hair. The hair club for men told that that the oil deposits sometimes cut the blood/oxygen flow to the hair follicle. Nevertheless, I probably should stop doing this right? Are there any bad consequences to it?

Thanks!

If you do not wash your hair vigorously after a hair transplant, you will have crusting that may last for a month or more. Dry skin that may follow a hair transplant requires good skin care. Good hygiene is also critical. In over 90% of my patients, I get the crusts off in the first day following a hair transplant.

You should get advice on the scalp treatments from your hair transplant doctor, who should be interested in your recovery. The same goes for the picking you are doing, which is dangerous because it sets you up for folliculitis, particularly after a hair transplant when the skin is fragile. See your doctor!