DrTBarghouthi

5 weeks is a relatively short period when it comes to healing after any surgical procedure. Just give it time for the whole area to heal. For any scar to mature, it can take months to years. Nonetheless, it does seem you have some pimples/ folliculitis. This generally resolves on its own or with some warm compresses. In some cases, antibiotic ointments or even oral antibiotics may be needed- rarely though. 

Best of luck going forward- remember it is a waiting game. 

On 4/20/2019 at 6:38 PM, Gabreille Nelson Mukhia said:

1. Spray saline water on your recipient area for every 2 hours periodically for approximately 7 days. The saline water keeps the scalp clean, moisturized and free of infections. It also soothes itching to some extent which one experiences when the skin is exfoliating or healing. Since one is not allowed to wash the scalp or touch it.

I totally agree that saline spray every 2 hours in the first few days is useful. I do recommend it for 5 days only on both the donor and more importantly recipient areas. It keeps the area clean and avoids scab formation which in turn can reduce the blood flow to the follicles in the immediate post op period. However, I advise that it should be dried using gentle dabbing of the area immediately after as to not have excessive salts building up. I have also come to notice that after 5 days, the saline spray contributes to the itch that starts to develop or at least makes it worse. Therefore I recommend stopping it at day 5. 

 

2. Take antibiotics, antacids and painkillers for 3 times a day for 7 days.

In my opinion 7 days is a bit too long. In my experience, 3-5 days is more than enough. The use of antibiotics post HT is rather controversial. Scalp blood supply makes it extremely rare for infections to develop, which is a huge relief.

3. Wash the donor area with Betadine scrub (antiseptic solution) and spray it off with saline water. Apply Fucidin cream after the washing and drying of the donor area.

I recommend saline spray on the donor, gentle drying and then an antimicrobial ointment after. 

4. Sleep in the right posture. Usually the mind is aware and the body follows suite. You cannot run the recipient area while sleeping. It can be difficult for patients who have had he frontal as well as the crown area done at the same time.

5. Remain away from dust or polluted areas for at least 7 days. Wear a surgical cap and a loose baseball cap or a bandana for 7 days when leaving an enclosed safe environment.

6. Stay away from pets and children who could accidentally rub the recipient area.

i like this one!

7. Avoid heavy exercises.

usually for 4 weeks. This also includes swimming pools, saunas, jacuzzis for the same period of time. Sea water swimming can be resumed earlier. 

8. Avoid staying in a reading position with the head tilted forward. It could cause he anaesthetic fluid to come down towards the face due to gravitation and cause swelling. The swelling shall persist for a day or two if it appears. However, it can be avoided by continuously pushing the fluid away from the center of the eyebrows towards the cheekbones wherein the fluid gets absorbed or distributed this reducing swelling. The swelling is not painful.

Very important: Swelling from all the fluids injected can be at its worse during days 2-4. So if the next day you feel and look good, dont rush into leaning forward for hours (laptop, phone etc) for the first 5 days. 

9. Head wash should be done after a specified time, approx 7 days.

I recommend washing the head 24 hours after surgery but in a special, low pressure way without touching the grafts. Normal scrubbing wash on day 10. 

10. Eat healthy. Have a good intake of proteins.. 

11. Manage stress. It is not possible to avoid stress but one must learn to prioritize and deflect.

12. Stay happy and share pictures with the doctor everyday or check up with the doctor every day. 

13. Opt for any measure suitable to prevent further progression of baldness on the pre existing hair.

Thank you Gabrielle for sharing a rather comprehensive after care instructions. Please allow me to comment on few things in Bold. I really hope that one day we reach a rather universal protocol on this. 

On 4/20/2019 at 6:38 PM, Gabreille Nelson Mukhia said:

 

I just had a look at your old post and I do think you do like the option of having your hair short? In that case FUE would probably be favorable. I do think your first transplant was good, but looking at the pre op photos, I do think 2200 would’ve been a home run for you. Are you on any maintenance therapy?

1. Ice early on after extraction.

2. Paracetamol when needed/ Ibuprofen 

3. Aloe Vera/ Almond oil/ olive oil for the itch later on. 

Normal washing and scrubbing the recipient area is normal by 7-10 days (different preferences exist). A month is way beyond safe. A hair cut is also fine by now.

I strongly urge you not to tap into your crown at this age. You will need to be on finasteride to slown down your loss. However, with a crown that still looks unstable in terms of margins, I would leave it alone to save the grafts for other areas. You can also consider things like a hair system to cover the crown and save your donor area for the front and mid scalp. 

Thanks for the great video Melvin. Realistic /ethical is a big one. I am sure most surgeons who see a lot of hair consults can give you a figure of how many patients they refuse performing surgery on because of unmatched expectations. We do see a lot of advanced NW or poor donors that we reject simply because their expectations are high and can not be changed. It says a lot when a surgeon turns down a case because they think it is not going to deliver the client their desired results.

Ofcourse the other points are extremely as important

You should really shave the donor area as it matches the current styling you have. It will be shorter than what is in the photos but it will grew fairly quickly. The front doesn’t need shaving much. 

Hi,

SMP is a powerful weapon. It can be utilized in different ways:

1. If a donor is average and the pattern of baldness is advanced, you can get a decent coverage and then possibly add density in the frontal zones with SMP to hide scalp reflections and minimize the see-through effect. This is usually done a year after your last HT so as to see the full growth and use the SMp to hide as much as possible of the scalp. 

2. The other way is to do a full shaved look SMP for a NW 6 but use few hundreds upto a thousand of FUE grafts all over the scalp in order to give the shaved hair feel. What annoys some people about SMP is that it can shine in the light despite the fact that buzzed hair doesn't show a shiny scalp. The other thing that clients notice is that you visually have a full head of what looks like a shaved head, but when you run your hand over it- or someone else-  then the sensation is quite smooth and unnatural. Hence, having some dispersed FUE grafts transplanted all over can remove these limitations. 

Hope this helps clear your options. 

May I ask about your age??

There is one basic rule in hair restoration: what’s lost over the years cannot be fixed in a day.

4000 grafts in one day and the fact that your crown is also being considered is quite worrying. Farjo’s plan sounds like the one I will go with or even provide. I assume you’re a NW 3V/4? 

It is always wise to leave the crown until you’re happy with the more important areas, until the crown stops expanding and until we make sure that you’re not progressing in your hair loss to other more aesthetically important areas like the mid scalp for example. There is nothing worse than a transplanted crown that starts expanding on the outside. 

I’m sorry to hear that and I understand your concerns. Please share some photos so we can provide you with some feedback. How long ago was the procedure done?

RT 1640 is an interesting compound made of minoxidil, cyclosporine A and a newly formulated compound called RT175. lled RT175. RT175 is supposed to promote the recruitment and differentiation of follicular stem cells. The three drugs act on different pathways in hair regeneration  synergistically to promote the growth and maintenance of hair in men and women with androgenic alopecia. Interestingly enough, the hair grows back with RT1640 in the color that you had before it turned gray and fell out. 

Ofcourse RT stands our for River Town, which is a startup pharmaceutical company founded in 2015. The results seem too good to be true. They did FDA sanctioned studies on 600 participants and from my understanding they are raising funds for a phase 2 trial, if not already in one. I guess in theory, having three compounds working together is fantastic. However, only time will tell if this becomes the next big thing or not. I came to realize not to get too excited too early, as hair physiology is quite a complex matter. 

I believe it is safe to use concealers 10 days post surgery. By that time, the grafts are in place and have established their own blood supply. Moreover, normal washing is possible by that time. Some docs advise a shorter time, but I have set day 10 as a safety net. Anything before that can act like crusting around the grafts, which can technically compromise the blood supply to them. This is the reason behind the importance of washing daily. Washing helps wash off and dissolve crusting, and makes it easier for surrounding blood to reach the grafts. By day 10 the blood supply for each graft is now established and they wont be dependent on the blood supply of the scalp for nourishment. 

I agree with the informative previous replies. Both are synergistic. Minox works on keeping hairs in a growth stage of the cycle, while finasteride targets against DHT-the hair loss hormone. Finasteride is therefore more effective and addresses the core of the problem. Therefore if using one go for finasteride. 

@s14a yes we do stop minoxidil 2 weeks prior to surgery and resume it 4 weeks after. 

Hi @det9925

I suggest you start a new thread with your query so as not to deviate from OP query.

Good question. Donor area recovery is usually amazingly smooth. The scalp is a very accommodating area in term of healing and recovery. However, I usually prefer Saline sprays on both recipient and donor areas for 5 days post op. I prefer to leave the donor exposed immediately after surgery. We use antimicrobial ointment once a day for the first 5 days after each wash. It is important to keep the donor clean daily at first. If someone has a LLLT pre surgery, I prefer that they use it daily on the recipient and donor areas for the first month. LLLT technology was based on healing wounds before it existed for hair thickening and maintenance. Therefore it is a good thing to use if already purchased. 

I tend to find that the most annoying thing is the itch 7-10 days after surgery. For this, we tend to advise using olive oil, or almond oil, tea tree oil or aloe vera. It is mainly itching and healing contraction of thousands of wounds that causes this itch and possibly discomfort. Therefore moisturizing helps. One more thing is to make sure the saline spray stops during that time as the salt residues on both recipient and donor areas tends to make itching worse after that time. 

It goes without saying ofcourse to follow up the instructions given by your specific surgeon. Each practice could have specifics that they strongly believe in and should therefore respect their protocols afterall. Good luck

23 hours ago, s14a said:

 

Thank you for this. The scalp massage and use of seafood was new to me, I will use this advice! 

I have guidance but nothing on scalp condition, I was concerned about any dandruff I may have which may hinder the process or result. Perhaps I'm overthinking!

You're welcome. The seafood thing is something we just observed by chance. i don't think it is a routine pre-instruction in many clinics but I believe in it. There is no real harm stopping fish for few days anyway to avoid whatever slight chance of popping that it can cause. Scalp condition is really important. I test dandruff and sebum levels on all clients either weeks before or on the day of the procedure so that treatment can go hand in hand with the transplant. 

You should really have clear instructions from your clinic about preparing the scalp prior to HT. Don't go by what I will suggest as this can vary from one practice to the other. For us, I usually advise massaging the donor area few weeks before FUE and one month before FUT as this helps with wound healing, skin tension and circulation. It is extremely important for FUT in my opinion but also has good effect in FUE. I stop all topical hair loss meds 2 weeks before surgery including minoxidil. Finasteride can resume normally. I tend to stop all vitamin supplements too as some of them thin the blood. I stop all seafood/ fish oil supplements 10 days before surgery as I've noticed that people who consume a lot of seafood products/meals can have slippery grafts when placing them. This leads to some popping and makes the placement a bit more tedious. As for the dandruff, we test the scalp during the consultation or on the morning of surgery and make sure it is treated well in advance or at least immediately before surgery. There are other instructions concerned with smoking and alcohol etc. 

Again, your clinic is the one that should dictate what to do or not to do. These are some of my personal ones based both on known literature and some personal observations.  

I agree with @Shera. Grow it longer to see the extent of coverage. It shouldn't look like this 18 months post op, but growing it can give a slightly different insight as to what the best line of action is. 

Thank you @Shera for posting that link. Yes I did suspect some unusual pattern there. I was worried about you having some scarring alopecia of some sort considering your temporal pattern or some triangular alopecia, but traction alopecia makes sense now with you wearing a turban. I guess now the real question is will you be still wearing the turban following surgery? There will always be a risk of ongoing traction post surgery ofcourse. So this is a very important consideration. It is a similar situation to trichotillomania (people pulling their hair) which in itself is a contra-indication to surgery. 

Yes I think she will be happy with the results. All the best @gillenator

@Kickbuttmario it will be nice to see photos of your pre surgery pattern. Your temporal recession is quite pronounced for a classic male pattern balding. Please share them here if you have any of those. Ofcourse Hasson and Wong are excellent and one of the recommended here.

@LaserCapwow that is some really risky move, especially in this time. I agree that staff can get deskilled quickly of they dont get the volume they need. That’s not even considering the boredom they go through!

Interesting topic!

Apart from the actual medical and surgical aspects of running a hair restoration clinic (surgeries, consultations, follow ups etc), waiting list management is a true operational process. It is not easy to manage it , maintain it and even more importantly control it. While a very long waiting list can mean that a practice is busy, it can also mean that the doctor is away for extended periods (whether he or she has commitments in different cities, or meetings etc), or simply has certain days of the week booked for surgeries only (which pushes the waiting times longer). Nonetheless, while some clients are encouraged to book because of the long waiting list (buying a Ferrari), what you dont know is that we often lose some other clients because of that. 

So managing the waiting list is an administrative skill. Some clinics can maintain the same load but have a more managed waiting list by being more dynamic about working days, hours, seasonal changes, offering price incentives based on cancellations and even in some cases having incentives for far away dates and keep the ones closer at the normal price.

So in Summary, a long waiting list will mean that a practice is busy ofcourse, but a reasonable waiting list could mean that they are efficient in managing it. Ofcourse provided that they maintain the same level of service.