Category: Post-Operative

First of all, a great blog – so thanks and I hope you get lots of patients from it!

I’m a 35 year old male. I had a hair transplant 10 days ago (1400 grafts) and am due to have my stiches out on day 12 (the doctor said that 10 days is ideal – but today’s a Saturday).

I’m a regular gym-goer and would like to know when I can hit the gym to my usual intensity. My doctor said that I should exercise only lightly initially. But I’d like to get back to my usual heavy weights. When would you generally say is safe to lift heavily?

Many thanks!

Exercise after hair transplant surgery is a concern for many people who are physically active and want to get back to their normal routine. You are facing two risks after a hair transplant:

1. The risk of losing new hair grafts from scratching or rubbing the skin of the recipient area. If the hair and scalp are washed well after surgery, the risk of graft loss after 3-5 days is small, as the risk occurs as long as the scabs are present.
2. The incision in the donor area, which is primarily closed by sutures or staples. The body takes 3 weeks on average for the wound to be reasonably secure. The healing of the incision of the donor area follows a general wound healing process that is standard no matter where the wound occurs. The process of healing starts from the moment the wound is closed. The body lays down the supportive infrastruture of fibrin from which the stroma for a secure would builds. Any vigorous activity should be avoided within the first week and then any aerobics can be done as long as the wound is not stressed (no heavy weights at all). After 2 weeks, the strength of this newly healed skin is not anywhere close to its final level, but between weeks 5 and 6 it reaches better than 80% internal strength. You can probably start your regular aerobic activities after the first week (the sutures should hold the wound together), but no weight lifting should be undertaken for 4-6 weeks. The process of wound maturation takes up to six months after the surgery.

I have a related diabetic question and would like your opinion… I am diabetic, and I had a 1000 graft procedure done at a reputable shop. I had a severe complication, my scalp ulcerated, the “skin” just disappeared and left me with a large hole. I then had to have balloons placed under my scalp to stretch the skin and two surgeries under general to close the hole. Do you have any knowledge or experience with such a disaster?

I generally tell my diabetic patients that they are no more at risk from a hair transplant than any other person. I would want to know more about the surgery and what happened at the time of the surgery. This complication is one I have seen before when poor decisions were made at the time of the surgery by inexperienced doctors. I am not saying that this is your situation, but if your doctor was a good and experienced hair transplant doctor, I would probe more about why this happened to you.

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I had really bad swelling three days after my hair transplant. My right eye closed completely. Is this usual?

The swelling we see three days after a hair transplant is dependent swelling, working its way down from the scalp to the face. Clearly it takes time to work its way down.

The other day, a patient called me on the evening of the third day telling me that one ear was an inch away from his head, had shifted in position and was pointing downward. I told him that I did that intentionally so that he would be able to hear ground termites in his older house. I’m joking! Actually, I found out that he slept on the side where his ear had the problem. I blessed him, told him to take two aspirin and it would be better in the morning. Indeed, by morning his ear was fine. Dependent edema!

A few years ago, we did a study on the use of steroids, with small, medium and large dosages used. As the dose went up, the swelling came down both in frequency of occurrence as well as the amount of swelling seen. At the dose we use today (40mgs prednisone daily starting the morning of the surgery and going out 4 days) swelling is rare and significant swelling is even rarer. It was so obvious, the study was stopped and the higher dose became our routine.

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Hello,
I am a 34 year old male and it’s been 16 days since my Hair Transplant of 1200 grafts. I still have scabs. I have been very gentle with washing, but am currently allowing the full pressure of the shower head. I have not scrubbed my scalp the way I normally would prior to surgery. Today, I lightly rubbed and picked a scab with the hair attached. It came off pretty easily. Was this the graft? Did I lose the future hair?

Can I start scrubbing my scalp at this point? My doctor recommended waiting 1 more week (3 weeks total) before washing and combing my hair as I did prior to surgery. What is your recommendation? And did I lose my hair graft? I am eager to get back to normal life. Thank you for any help.

Patients may generate scabs after surgery. It is best to wash them off before they get ‘rooted’. When they are not washed off immediately, they may last for days. I have even seen patients who do not wash well and have their scabs last for weeks. Pulling off scabs during washing and styling is one of the most common causes of losing a graft after transplant, although I would doubt that it would occur 16 days out. We did a careful study to determine when the vulnerability of graft loss ends and we found out that the existence of scabs parallels that risk. Study shows that pulling grafts can remove the whole graft any time during the first 10 days, at which time the scabs usually fall off with reasonably vigorous washing.

When fully healed, the follicle becomes part of the recipient skin and will keep its ability to generate new hair. You are well beyond day 10 and it is unlikely that you will lose your graft at this point in time. Let shampoo stay on your wet hair for 10 minutes or so, then rub the scabs gently with your fingers and the scabs will fall off.