Post-Op Instructions

WHAT TO DO THE DAY OF YOUR PROCEDURE: Make sure to take it easy for the rest of the day. Avoid any strenuous activities. Eat a good meal when you get home. Take one or two of the Tylenol #3 pain pills if you need to (white pills in blister pack). You will need to take six of the Prednisone (tiny white pills) shortly after eating to help prevent inflammation and swelling. Apply an icepack to the forehead (not on grafts!), every 2 hours for 5 to 10 minutes while awake. When you go to bed, be sure to sleep at a 45 degree angle to elevate your head for four nights. Take your antibiotic (pink capsule) as directed.

 

WHAT TO DO THE DAY AFTER YOUR PROCEDURE: Wait until the day after your procedure to perform the first hair wash. Gently pat the transplanted area with lathered shampoo on a 4 x 4 dressing. DO NOT RUB GRAFTS OR USE CONDITIONER. Do not expose the grafts to direct shower pressure. Use a plastic cup or pitcher and pour water on grafted areas to rinse. Don't use a towel or hair dryer on grafts!. Follow instructions for Prednisone.

 

GRAFTCYTE: If you purchased the recommended Graftcyte kit, follow the instructions in the kit for care of the donor and recipient areas. You will need to purchase a spray bottle and saline and spray the grafts every hour while you are awake if you didn't purchase the Graftcyte kit.

 

SWELLING: Forehead swelling is normal and is an expected response in most patients after surgery. When swelling occurs, it can range from very mild puffiness around the forehead to more severe swelling with some eyelid involvement when swelling occurs it is not immediate and will typically be noticed 2-4 days post-operatively. The severity of the swelling has no effect on the outcome of the procedure and is not dangerous, usually subsiding in 2-3 days. Even though harmless, you will still want to prevent swelling as much as possible. This is the reason you received a Dexamethasone shot (anti-inflammatory) immediately before your surgery. This is also the reason it is important to take all of the Prednisone pills (anti-inflammatory) as directed and sleep with your head up at least at a 45 degree angle for the first four nights. Avoid strenuous activities and avoid bending over. You can use an ice pack on the forehead (not on the grafts) for several days as frequently as possible starting the day of surgery. This will decrease the risk of swelling and speed the resolution if swelling occurs.

 

SLEEPING: Keep your head elevated for the first four nights. Sleeping in a recliner will be the best way to achieve this. A recliner will also prevent you from rolling around in your sleep. If sleeping in a bed, use pillows to prop your head up at least 45 degrees. Resting your head on your donor incision is OK and will not harm it. You can rest your head on an ice pack or frozen corn in a zip lock bag. Sleep on your back, and not on your side or on your stomach. When going to sleep, make sure none of the transplanted areas are touching the resting surface so as to avoid trauma to the grafts.

 

ACTIVITY: Avoid any strenuous activity for the first week. No heavy lifting, running, or weight lifting during this time. Normal daily activities are fine. Avoid heavy weight lifting for 3 weeks, as this can stretch your incision and can lead to a widened scar.

SUN EXPOSURE AND WEARING A HAT: Do not expose your scalp to the sun for an extended period of time for the first six weeks. Sunscreen can be used after two weeks, although wearing a hat will give more reliable protection from the sun. Make certain the hat does not rub or come in contact with the grafts.

 

SCABS (CRUSTS) AND SHAMPOOING: Providing these instructions are followed, most of the scabs will be gone within five to seven days. Do not pick or scratch these crusts as this could dislodge grafts. Crusts are attached to the transplanted hair, which is still attached to the underlying graft follicle. For the first four days you should only pat these crusts while shampooing. Beginning on day five, you need to gently rub the grafted areas in a small circular motion with your finger tips (no nails!) while shampooing 2 times a day to remove scabs. It is at this time that you need to allow the grafted areas to be directly struck by the shower stream. Failure to transition from patting to gently rubbing the grafts while shampooing or "protecting" the grafts from the shower stream will delay the shedding of the scabs and will also delay the healing process. If most of the scabs remain at 7 days, try shampooing 3 to 4 times a day as recommended. Allow warm water to directly strike the scabs. Lather your shampoo and rinse several times during each shampoo to dislodge and remove the scabs. Remember that most scabs should be gone in 5-7 days. All scabs should be gone before your appointment for suture removal. If you are "behind this schedule" shampoo even more often, 4 or more times per day. Do not be concerned if some of the transplanted hairs come out with the scabs. As long as there is no bleeding, the follicle is still in place. These crew-cuts hairs may even grow for a few weeks and then shed. Again, if there is no bleeding, this is also OK. Hair will grow in time. If there is ever any bleeding in the transplanted area simply apply pressure. After the scabs are gone, there may be some residual redness which will dissipate over the ensuing days to weeks (depending on your complexion) and is no more noticeable than a slight sunburn.

 

HAIR GROWTH: After the scabs fall off, the hair follicles remain buried within the scalp. During this time you need to be patient. Hair growth will start 3 to 4 months after the procedure. It will take a full year and in some cases up to 15 months before all the grafts have surfaced. Initial hair is fine and may be curly or kinky. As the hair grows, it will thicken and regain its normal character. During the early growth phase you might notice a swollen area which is sensitive to the touch, similar to a pimple. This is an in grown-hair. Apply a warm wash cloth to the area for a few minutes to bring it to a head. If it continues to give your problems, please call the office.

 

STITCHES AND THE DONOR AREA: It is not unusual to have a little bleeding or oozing from the donor area in the day’s right after surgery. If this occurs please use some of the gauze provided and apply pressure to the area for ten minutes. With your back facing the shower, direct shower water may strike the suture line (not the grafts!) starting the day after surgery. Nylon stitches will need to be removed ten days to two weeks after surgery.

 

ITCHING: Shampooing 2 or more times per day may help relieve annoying itching that occurs frequently in the transplanted area. Benadryl 25 mg 2 or 3 times daily (available without prescription) may also be helpful. Itching will resolve in time.

 

NUMBNESS: Some loss of sensation in the donor and the transplanted area is to be expected. On occasion, numbness can persist for weeks to months but is temporary and full sensation will be restored in time.

 

ON GOING HAIR CARE AND COLORING: Gels, mousse or hair spray may be applied 7 days after your procedure. Hair coloring may be applied 3 weeks after the surgery. Once your hair begins to grow, you can treat it as your own normal hair and nothing special is required. You may consider using some of our excellent Anagen Hair Therapy products.

 

PROPECIA AND ROGAINE : Neither Propecia® nor Rogaine® are required after hair restoration. However Dr. Porcaro sees his best results in patients who are no longer continuing to loose their untransplanted hair; i.e. patients taking Propecia® and using Rogaine®. Propecia® can be started before or anytime after the surgery. Dr. Porcaro will be glad to provide you with a prescription for this pill taken daily.

 

Dr. Porcaro recommends using Rogaine® starting from around the 3rd-5th day after the transplant. Rogaine® is available without a prescription (minoxidil 5% for men and 2% for women). Even though Rogaine® is recommended for crown (vertex) balding by the manufacturer, Dr. Porcaro recommends the product be applied directly to the transplants, as well as the crown area. This liquid should be sprayed on the scalp 2 times a day. Patients using Rogaine® after their transplant procedure will often see their grafts grow quicker than patients who don't use Rogaine® in the grafted area. Rogaine® also thickens hair, keeps hair in the growth phase longer and stimulates resting follicles to enter the growth phase. Rogaine® can also minimize shock loss that can ocurr for several weeks after hair restoration.

 

Both Propecia® and Rogaine® require continued use. Stopping either medication will result in loss of all the hair "saved" by the use of the medication(s).. No transplant will be lost as a result of stopping Propecia® or Rogaine®, however.

 

LASER HAIR THERAPY: Transplanted follicles may grow quicker in patients who use our AlphaLase immediately after their procedure. This painless Low Level Laser may also stimulate growth in non-transplanted areas of your scalp, further enhancing your result. Alphalase can be started as soon as the day after your procedure. Please schedule your laser sessions with the receptionist. You may choose to purchase a Laser Comb from our office to use at home if you are unable to take advantage of the AlphaLase.