Nerve pain problems

[jawful]

Im a little over 3 months out from my 2nd HT surgery with a very respected hair clinic. I have a spot on my back of my head, just above the donor, that is painful when I rub or scratch it. It sends waves of pain through the area when I do this. This is to go along with the numbness and needle prick sensation I feel when I lay my head down to try and sleep.

DR says it's a nerve that is healing but I have not seen any members on here go through this at this stage of the recovery which has me concerned

Anyone have a similar experience??

Any thoughts or comments are appreciated.

[Blake Bloxham]

Jawful,

 

Do you see a primary care physician? If so, I think it may be useful to schedule an appointment with your regular doctor and obtain a second opinion.

 

Let us know what you find out!

[Dr. Glenn Charles]

I have had a couple of patients over the years.with similar prolonged pain and numbness. The issues did ressolve with time. It can take 6-12 months in some cases. Hang in there.

[jawful]

Thank you Dr Charles and Future HT Doc.I appreciate your responses and your advice.

This has been a little tough to deal with and am hoping that time will heal all.

Any other advice to help the healing process? Things I can do or take?

[Shampoo]

Any other advice to help the healing process? Things I can do or take?

 

jawful...i know this is long-shot, but you are absolutely sure when your staples/sutures were removed that one wasn't left behind? That could cause the pain. The reason I ask....is when I had my staples removed by a local plastic surgeon he actually missed one and I had to go back to have him remove the one he missed.

[gillenator]

That happened to me as well on my last procedure when staples were used. One of them had recessed a tad bit into the scalp tissue so my primary doc had to somewhat dig out one end of the staple and then remove it which was no fun.

 

It only stung for a few seconds but it was a relief to get it out. I had no idea it was there because I could not see that area where the staples were. But whenever I touched that area, there was a little bump and it was very sensitive to the touch.

 

There are many nerves and blood vessels that run throughout our scalps. They both heal with time as Dr. Charles pointed out.

 

The minor stinging sensation is not abnormal and does subside eventually.

 

Best wishes to you in your regrowth! :cool:

[Shampoo]

jawful....

 

you may also consider that Hasson/Wong post-op instructions state that patients should get a good Vitamin B Complex supplement, because B-Complex has been shown to help some patients with nerve healing.

[Dr. Glenn Charles]

You cannot go wrong with B complex vitamins. Certainly worth a try.

[gillenator]

My understanding is that Vitamin C supplements also can facilitate the healing process. There are other health benefits with Vitamin C as well.

[Dr. Glenn Charles]

Vitamin C does promote wound healing. Not sure if it has any effect on nerve regeneration or repair. Again, not going to hurt if not taken in excessive doses.

[aaron1234]

I will say the nerves (feeling) around my donor area have not fully returned to normal - nor do I expect them to. My donor area has been opened three times, so it's just not the same. It's not painful - just different. I'm not completely numb but I haven't regained all of the feeling back there. I'm used to it now and don't consider it a big deal. Life goes on. But if you are experiencing pain - that's a little different.

[Dr. Carlos Wesley]

Here's another approach that also works, you can have your doctor directly administer an anti-inflammatory to calm the nerve irritation a bit more rapidly.

 

We recently published an article specifically about this thread: post-op nerve sensitivity. Studying 552 patients of all shapes, sizes, genders, and numbers of sessions they'd had, we found that the only statistically significant factor that led to a higher instance of what jawful is describing was having a follow-up session with a different surgeon than the one who performed your initial session.

 

Here's the study:

 

Factors influencing postoperative hyperesthesia in hair restoration surgery - Wesley - 2011 - Journal of Cosmetic Dermatology - Wiley Online Library

 

There are a number of theories as to why this may be and, if you guys are interested, we can go over them.

[Shampoo]

We recently published an article specifically about: post-op nerve sensitivity. Studying 552 patients of all shapes, sizes, genders, and numbers of sessions

 

Dr. Wesley thank you for sharing the interesting article.

 

Althought the incidence of this kind of post-op lingering pain from donor area nerve damage appears to be rare (3.4%); I wonder if this should be of any consideration when a patient is deciding between FUT vs FUE?

[gillenator]

The many nerves and blood vessels that are established in the scalp can be potentially severed whether FUHT or FUE. The main difference is that a larger segment of scalp tissue is typically excised from the scalp with strip. Numerous smaller segments of scalp are extracted with FUE.

 

Some are of the opinion that one technique is more invasive than the other, namely strip because of the two long lateral incisions that are made to harvest the strip specimen from the scalp.

 

Yet I know of guys that had larger FUE sessions and still comment of the lingering post-op numbness.

[Dr. Carlos Wesley]

Gillenator does make some very valid points. However, I'd have to say that, as a general rule, it's not so much the length of the incision that matters as much as the regions through which the blade (whether it be a scalpel or FUE punch) passes. I've attached an image of the nerve distribution in the back of a scalp. Any cut along the pathway of the greater/lesser occipital or post-auricular nerves (seen as green in the image) may lead to a change in sensitivity.

 

Even a very small percentage of patients who have elected for FUE after having undergone a strip harvest previously may experience this hypersensitivity in the donor area. It's clear when I'm performing the harvest that they have aberrant nerves (nerves that, after having previously been severed, grow back in a path that is not anatomically "normal"). What is normally numbed by a traditional nerve block that addresses these pathways (in green), does not work when a patient has developed an aberrant nerve.

 

So, to answer the question as to whether "a follow-up FUE or strip session is better?": While FUE is traditionally more comfortable, it's still not a 100% guarantee.

[gillenator]

Thank you Dr. Wesley for your contributions. When I stated that "some are of the opinion that strip is more invasive because of the two longer lateral incisions", that does not include myself in that opinion.

 

My opinion is that whenever the human scalp is invaded by a scalpel (strip) or a punch (FUE) there is going to be damage done to both nerves and blood vessels throughout the donor zone and recipient area.

 

It does seem by observations over the past 30 years that more of the nerve pain is associated in the occipital zone compared to the frontal zone or midscalp where typically smaller incisions are being made.

 

We do appreciate some of the clarifications that you have made Dr. Wesley.

[ELondon]

I had the same experience with lost staples and pain following my 1st strip HT. The numbness was terrible for around 18 months. But no pain as such.

 

I have just undergone a 2nd HT and it has been so much better. Already the sensation feels better, less numbness. No pain. The Dr took a lot more time and care to remove the strip and avoided connnected nerve tissue where possible. He also used non absorbable stitches which are very comfortable.

 

But also I am now entirely against the use of staples. They are painful and prevent proper rest after surgery which impairs healing. They are also a pain to remove. My scar was made much worse by a nurse digging around trying to find staples. I removed 2 of them myself a week later!

 

I would not recommend you go to you GP. I recommend you go back to the hair clinic and ask them to check the problem. At the very least they should be able to remove the damaged nerve which will cause numbness but should stop the pain and heal in time. Your GP will just refer you to the hospital and you will wait at least 8 weeks to be seen etc etc.

 

Best of luck!

[gillenator]

I definitely agree that staples are more uncomfortable and I also had one that got lodged and hidden while the incision healed. Although my PCP was very good at removing my staples, she did not see the one that got lodged under the epidermis and I had to go back and have her dig it out without any numbing so it hurt quite a bit. I now have a small bump with a tiny bare spot where the staple was.

 

My surgeon was way out of my area and why I had my PCP remove them. As I look back I still believe that my surgeon did the best closure with staples because my laxity was not the best on my 4th HT and he and I were both more concerned that I did not end up with my scar stretching. And as it turned out, my scar did not stretch and I do believe the staples made a difference for my situation.

 

Staples do have their place but IMHO, only as a last resort. :rolleyes:

[genegrin13]

HI, unfortunately I have had a bad experience and suffer from nerve damage pain for the last 10 years after my last hair transplant. I havent had much relief and some pain medicine i was prescribed by neurologists I have developed a high tolerance for and therefore pain killers are not that effective anymore. Doctor, I was wondering what options are there to get lasting relief from nerve damage to the head (maybe a nerve block?) It started when the hair transplant doctor recommend I come in just a month after surgery to get scar revision surgery.

[Shampoo]

the only statistically significant factor that led to a higher instance of what jawful is describing was having a follow-up session with a different surgeon than the one who performed your initial session. There are a number of theories as to why this may be and, if you guys are interested, we can go over them.

 

Yes Dr. Wesley what in your opinion would cause an increase in

post-op nerve pain simply by choosing a different surgeon for a follow-up surgery?

[gillenator]

HI, unfortunately I have had a bad experience and suffer from nerve damage pain for the last 10 years after my last hair transplant. I havent had much relief and some pain medicine i was prescribed by neurologists I have developed a high tolerance for and therefore pain killers are not that effective anymore. Doctor, I was wondering what options are there to get lasting relief from nerve damage to the head (maybe a nerve block?) It started when the hair transplant doctor recommend I come in just a month after surgery to get scar revision surgery.

 

Never heard of someone having scar revision surgery so soon after their HT procedure. The scalp is still tight and takes a full year to regain enough laxity for the average individual and why most need to wait at least twelve months for any revision.

[rev333]

genegrin13

 

i have heard that BOTOX injections can help with this sort of nerve pain

 

worth a consult to a cosmetic dermatologist or ps