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In this technique, a strip of skin is taken from the back of head (permanent area). The donor area is closed with dissolving stitches, leaving a fine linear wound (later a scar) on the back of scalp. Hair follicles are then carefully removed from the strip, under microscope. These follicles are separated into single, double and multi-hair follicles. This is necessary, as requirements for different types of hair loss is different. Whilst these follicles are being removed by our experienced technicians, surgeon makes tiny incisions at the previously agreed and marked area in the scalp. Once these incisions are made, the extracted follicles are put in these incisions. See pictures below of different stages. All this is done under local anaesthetic cover. After infiltrating local anaesthetic, the patient does not feel any pain. Depending upon the size of transplant and patient’s anxiety levels, sometimes pre-op sedation is given. Generally, this is a painless and pleasant experience. Some patients do become very emotional when they see hair in the scalp, after being bald for so many years! Every step of the way, we’ll be there for you. During the procedure we take breaks to mobilise and feed our patients. We’ll make sure that you are happy and that it is safe for you before you are discharged home.
There are some minor preparations before your Follicular Unit Hair Transplant procedure at Harris Hair. The following instructions are organized according to the days and weeks before your procedure.
Keeping the follicles in place
The implants most susceptible to falling out are the ones implanted last in the procedure, but the transplanted hair follicles almost always stay in place of their own accord. The little bleeding at the edges of the incision wound cut for the graft help to “glue” the graft in place. By the time the hair implantation procedure is complete, those follicles implanted first in the hair line are pretty much fixed in place by this blood glue. Of course this is exactly what blood is supposed to do. By bleeding the blood is exposed to air. This activates a cascade of events in the blood that results in blood coagulation. This is to seal an open wound and close it as quickly as possible. It also activates the formation of fibrin that builds up a meshwork in the wound site. This helps glue the wound together and provides a scaffold on which cells from the edges of a wound can grow into the wound and heal it. With larger wounds it takes longer for the blood to clot and seal the wound and it takes longer for the wound to heal over. With micrografting and follicular unit grafting each individual wound is so small that the blood can clot in a couple of minutes and the wound starts to heal within a few hours.
Never the less, you should be extremely gentle with all of the grafts for the first 24-48 hours after implantation. It is very rare for grafts to fall out. If they do and they don’t look dried out, it may be possible to just pop them straight back in if you are still in the clinic. If they fall out after you have left the clinic it is unlikely much can be done to save the grafts. The biggest issue in the first 24 hours after a hair transplant is probably how best to sleep without disturbing the implants. We shall advise on what we think is best depending on whether your head is bandaged or not, and which area has been transplanted. We shall provide you with a list of do’s and do not’s to follow before you get the transplant and after you make it home.
The First 72 Hours after Hair Transplant Surgery
About 8 hours after the implantation procedure the local anaesthetic injection will start to wear off. This is when you, as a hair transplant recipient, will experience most mild discomfort.
Most often the discomfort is in the donor area rather than the recipient area as the donor area is, in effect, a much bigger wound. You will be sent home after the procedure with a few acetaminophen and codeine tablets or their equivalent. This is usually enough to keep the discomfort to a minimum, but you should expect some discomfort After 48 hours the discomfort should more or less disappear. If not, then you need to contact the clinic. Prolonged discomfort may suggest an infection has entered one or more of the wound sites. The clinic needs to deal with this quickly.
A rather crusty looking scalp is to be expected for the first 24-48 hours. It is of no concern, it happens to everyone undergoing a hair transplant. However, if you continue to bleed some hours after the procedure and certainly after 24 hours, then call us. The grafts heal quicker if they are exposed to the air. Further crusting is likely in the next three days, but you should not wash your hair with shampoo until after 48 hours.
A loose fitted baseball cap may be the answer if you want to stop anyone from seeing the new hair transplants in the first couple of weeks or so. Try to find a hat with holes in it to avoid heat build-up under the hat. However, a hat or cap is only to be used when absolutely necessary. Your grafts will heal much quicker and better if they are open to the air but avoid getting sunburnt as this will hinder the healing process.
Most patients develop some mild swelling 1-4 days after the operation. For some Patients this can last for up to a week or so. In a very few cases the swelling can become very bad such that the individual is unable to open their eyes properly. Sleeping in propped up position or with two pillows can help reduce the swelling. A bag of frozen peas or similar applied to the swelling can also help reduce it. The frozen peas/ice should not be directly applied to the implants, rather apply it to your forehead. In the first 1-2 weeks there is an increased chance of infection. You should minimize this by avoiding dirty environments and polluted air as much as possible. Don’t go swimming in public pools or dirty water for at least two weeks after the implant procedure.
You must start washing your hair gently after 48 hours. Normally it is better (gently) to do the washing in a sink rather than under the shower head. It also helps to soak the crusting a little with the water before shampooing to help dissolve the crusts. After gentle washing, allow your hair to air dry. Avoid hair dryers. If you do any exercise or live in a hot climate where you perspire a lot then you need to wash your hair as soon as possible after sweating. Bacteria grow in moist conditions so sweating increases the chances of developing an infection. We suggest washing your hair every day so that the crusting can be removed fairly quickly.
1st Week after your Hair Transplant
The crusting over and around the grafts should start to fall of 1-3 weeks after the procedure. Crusts will separate from the grafts more quickly if they are kept moist. There are different ways to do this and we will tell you our preferred method. We shall give you a saline solution to use every two hours for a week
The transplanted hair follicles will usually shed their hair from 2-6 weeks after the hair implantation. The transplantation procedure involved cutting off their nutritional supply for a few hours. This shock to the hair follicle usually sends then into a telogen resting state. As a result the hair shaft falls but the living follicle is still intact and in place. It stays in this state for 3 to 4 months before starting to produce hair shaft. It is almost inevitable and there isn’t much you can do about it. New hair growth will begin to be visible from about 10 weeks after surgery. Not all grafts will begin growing hair at the same time so don’t worry if the initial hair growth looks a bit patchy. This is normal. As hair only grows at a rate of at most 0.35mm a day, it will take time for the hair to grow long enough for you to comb and style it properly. By 6 months after the surgery the hair should be growing well enough for you to gauge the result of the transplant, though it will be 10 months after the surgery before the full effect will be realised. The hair fibre that initially grows in the first few months may be duller and more fizzy than normal. However, the follicles should settle down and start making better quality hair fibre by 14 months after the procedure.
To help things along and speed up the hair regrowth process, we advise on applying Minoxidil from one week after the transplant. This is a direct hair growth stimulant so it should speed up the hair follicle recovery. However, some people are allergic to the ingredients in most minoxidil formulations so it is not for everyone.
Recovery times following hair transplant surgery will vary from patient to patient and will be affected by the length, complexity and type of each particular surgery. Many patients are able to return to work and resume normal, light activities within several days following the procedure. Though we will provide you with specific guidelines for gradually resuming your normal activities, you will generally need to avoid strenuous activity as it increases the blood flow to the scalp and may cause the transplants or incisions to bleed. Vigorous exercise and contact sports should be avoided for at least two weeks following surgery, and we also advise you to avoid sexual activity for at least 07 days. Within six weeks following surgery, the “new” hair may fall out, but new hair growth will usually resume within another five to six weeks.
Please place a heavily water-soaked hand towel or a flannel on the area where the grafts have been implanted. Leave the towel for a couple of minutes so the water runs through the transplanted area. Then take the towel off and apply Johnson’s Baby shampoo to the wet towel. Rub the towel to make plenty of lather before placing it gently on the transplanted scalp. Make sure you DO NOT rub the towel. After two minutes, take the towel off, rinse it and place it back (without the shampoo) on the grafted area. Gently pour some clean water with a glass or jug over the towel to wash the shampoo off the skin. It is important NOT to rub, but to run water through the transplanted area. You can gently use a comb, but make sure that the comb does not touch the transplanted skin. After 7 days you do not need the towel, but gently dab the transplanted area with baby shampoo, and rinse it off by pouring water over the transplanted area. After two weeks you can gradually go back to your normal washing routine.
NOTE: Please note the washing must start after 48 hours and on daily basis for two weeks as described above.
Harris Hair Transplants” is a trading name of “Harris Surgical Limited”, registered with Companies House UK under registration number 08173772 and registration address 367 Derby Road, NG7 2EB, Nottingham, UK.