Preparing scalp for fue

[s14a]

Hi all, I have booked in for FUE in 4 weeks and I was wondering about my scalp.

Is there anything I can do before the procedure to ensure it is in peak condition for the doctor? Is scalp condition a factor?

I currently take Kirkland minoxidil and use Ketoconazole 2% shampoo - at time my scalp can get dry and leaves white dandruff(?). 

I did search the forums but could not find anything, thank you for your time!

[DrTBarghouthi]

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.  

[gillenator]

Lots of wisdom provided...and very informative...

[s14a]

On 6/5/2019 at 10:57 PM, DrTBarghouthi said:

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.  

 

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!

[LaserCap]

Dandruff, briefly, is just dry skin typically caused by dryness of the scalp. .  Perhaps you are using an abrasive shampoo.  Change to a shampoo that has no alcohol as this will dry the scalp.  Try baby shampoo and report if there is a change in the condition.

Since you are talking about what you should do prior to surgery, I'll add...avoid exercise.  Raising your blood pressure will only lead to the procedure taking longer.  Grafts start popping, more bleeding, etc....

[s14a]

3 minutes ago, LaserCap said:

Dandruff, briefly, is just dry skin typically caused by dryness of the scalp. .  Perhaps you are using an abrasive shampoo.  Change to a shampoo that has no alcohol as this will dry the scalp.  Try baby shampoo and report if there is a change in the condition.

 Since you are talking about what you should do prior to surgery, I'll add...avoid exercise.  Raising your blood pressure will only lead to the procedure taking longer.  Grafts start popping, more bleeding, etc....

I've been using a 2% ketoconazole shampoo 5 times a week for 7 years as previously I did get dandruff quite badly with the minoxidil (8 years usage). Sometimes the minoxidil makes my scalp feel slightly gummy and from time to time this leaves white flakes.

Thanks for the additional advice, I've not long to go!

[DrTBarghouthi]

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. 

[s14a]

13 hours ago, DrTBarghouthi said:

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. 

I will be travelling to another country for FUE so unfortunately a scalp test before hand isn't possible. It's 3 weeks away now, I just googled Sebum levels and I would say my skin isn't oily and I stay hydrated so hopefully they are fine - perhaps stopping minoxidil now will improve my scalp condition as it could be the reason for the dandruff. Thank you for your time, if theres anything further you think I should do, please let me know.

[elduterino]

Avoiding food that thin blood and loading on foods that thick blood 

Calcium supplement, milk, green leafy vegetable, blueberries etc

 

[DrTBarghouthi]

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

[gillenator]

No question that minoxidil can dry out the scalp.

[LaserCap]

On 6/9/2019 at 7:15 AM, s14a said:

I've been using a 2% ketoconazole shampoo 5 times a week for 7 years as previously I did get dandruff quite badly with the minoxidil (8 years usage). Sometimes the minoxidil makes my scalp feel slightly gummy and from time to time this leaves white flakes.

Thanks for the additional advice, I've not long to go!

What you are currently using contains alcohol and will contribute to the dryness.  Have you tried the 5% Minoxidil foam?  Just get a cap full, put it in your palm and place it on any one area of the scalp.  Press down and rub in the same area.  Not necessary to spread out as the medication is systemic.  The next day you can change the area.  This should help keeping dryness to a minimum.

 

 

[s14a]

1 minute ago, LaserCap said:

What you are currently using contains alcohol and will contribute to the dryness.  Have you tried the 5% Minoxidil foam?  Just get a cap full, put it in your palm and place it on any one area of the scalp.  Press down and rub in the same area.  Not necessary to spread out as the medication is systemic.  The next day you can change the area.  This should help keeping dryness to a minimum.

 

 

I tried the rogaine foam 8 years ago but it didnt go far as my hair is 3-4 inches long on the top and it seemed to soak it all up! I'll maybe give the foam a go after FUE if I can find a decent supplier. 

Kirkland 5% liquid is easy to get in the UK which is why I have been using it and it seemed to spread easier on my scalp. Thanks

[elduterino]

I started oral minox a week after the HT

5mg a day 

[s14a]

To summarise, I followed the advice given and had no problems with scalp condition or bleeding. My initial concern was my flaky scalp which appeared to be completely down to the minoxidil as my scalp was in good/normal condition prior to surgery. Some points of note:

• I stopped all vitamins and minoxidil about 15 days before.
• I did some scalp exercises, my scalp was moving quite freely anyway.
• No seafood for 14 days before (I wouldn't normal eat too much seafood).
• I had a few glasses of wine 4 days before which didn't have an effect (official guidance from Dr was no alcohol 3 days before).
• I took quite a lot of calcium on board through drinking milk.

Thanks all