What after the Hair Transplant !

Medicines-and when to take them

Name of Medicine Day
Before
Day of
Procedure
Day 1 Day 2 Day 3 Day 4 Day 5
Prednisolone 10 mg 2 tablet 2 tablet 2 tablet 1 tablet
  10 pm 6 am 8 am 8 pm      
    2 tablet 2 tablet        
    6 pm 8 pm        
Diclofenac 50 mg +   1 tablet 1 tablet 1 tablet 1 tablet 1 tablet 1 tablet
Paracetamol 500 mg 10 am 6 am 6 am 6 am 8 am 10 pm
    1 tablet 1 tablet 1 tablet 1 tablet 1 tablet  
    4 pm 2 pm 2 pm 2 pm 8 pm  
    1 tablet 1 tablet 1 tablet 1 tablet    
    10 pm 10 pm 10 pm 10 pm    
Azithromycin 500 mg 1 tablet 1 tablet
12 pm
1 tablet
12 pm
Ranitidine 300 mg 1 tablet
10 pm
1 tablet 1 tablet
12 pm
1 tablet
12 pm
Alprazolam 0.25 mg 1 tablet
10 pm
1 tablet 1 tablet
10 pm
1 tablet
10 pm

POST OPERATIVE CARE

Pink Shampoo:

  • Wet hair first with sterile solution (up to 5 days) and mineral water (from 6 to 12 days)
  • Apply pinkshampoo(2-3dropsonly) with a folded, sterile, saline-wetted gauze piece over the planted area and immediately wash it off by a strong jet of medical water (NS- Normal Saline – plastic bottles provided).
  • Make sure that all shampoo has been washed off.
  • Dab dry with sterile gauze.
  • Allow hair to dry at room temperature or by standing under the fan for one minute.
  • Do not use a hair dryer/ blower or dry your hair in the sun.
  • Now you are ready for the next step of antiseptic application.

Blue Antiseptic Spray:

  • Make sure that hair is completely dry.
  • Spraying antiseptic over wet hair reduces its efficacy.
  • Close your eyes and cover them with hand towel completely.
  • Hold the bottle vertical and keep nozzle directed towards procedure area.
  • Press plastic nozzle and sprinkle antiseptic over the area.
  • You may require about 2-3 spray shots for the whole planted area.
  • Keep about Two feet distance from the surface while spraying.
  • Allow antiseptic to evaporate in about a minute.
  • Remove the towel and open your eyes.
  • By accident if antiseptic goes in the eyes wash eyes immediately with lots of cold water and consult an eye specialist.

Aloe vera Water in Purple top plastic container:

  • Remove the lid and open the jar.
  • Wash your hands with soap and water.
  • Shake them dry.
  • Do not dry with towel.
  • Make sure hands are completely dry.
  • From the spray small bottle apply antiseptic over the hand and fingers you are going to use for application of gel.
  • Rub the antiseptic dry on your hands.
  • Wet your fingertips from the container and apply gently over the recipient area creating a very thin layer of wetness over the planted area only.
  • Do not apply with cotton Gauze.
  • Use second finger if you require more aloe vera water.
  • Please do not dip the same finger you have used before to get more liquid out of the container because this will contaminate the liquid for future use.Quantity of gel should be such that it will form a thin protective coat over the planted area.
  • Allow aloe vera water to dry.
  • Wear the cap and you are ready to go to work.

BANDANA / CAP :

  • We request you to wear only our bandana as it is designed specially for your care.
  • Use it only for out door activity. After 3 days wear our cap.
    Do not wear any woolen cap. for 6 months.
  • Cap should not touch any planted area. Make sure the cap rests over your brow because if it does not, it is resting either on the planted areas over the hairline or the temple triangles.
  • Wear it loose and do not press it tight across your head.
  • Remove it by lifting it from back to front as was demonstrated by the clinic.

Foam:

  • Wet your hair first with normal saline/ mineral water.
  • After having done the shampoo procedure and before drying the planted area apply a thin layer of foam with fingers.
  • Apply it all over normal hair as well as over the planted and donor areas.
  • Leave for two minutes.
  • Wash off with mineral water or normal saline completely.
  • Then dab dry with sterile gauze over planted and donor areas.
  • Lift the gauze from back to front after dabbing.
  • Dry at room temp or fan dry.

PROBLEMS THAT MIGHT OCCUR & HOW TO TACKLE THEM

  1. OOZING: This normally occurs during first few hours or at the most on first day.

(a) From Plantation Area:
As the roots are planted in the normal skin either on bald area or between hair with very fine blades, small amount of blood and serum oozes out- a drop from each site. For this we need to spray saline every 20 minutes on the evening after the procedure and every 2 hours the next day onwards till morning of 4th day post procedure.

(b) From the donor area:
A dressing is applied. This dressing is removed on the second day after the procedure. The night after the procedure you can expect some blood staining of the applied dressing. This is normal. You have been provided a sterile towel in your kit to spread over the pillows used to lift up your head while you sleep. This towel shall prevent contamination of the donor area and will also prevent your donor area from staining the hotel pillows for which you may have to pay!

(c) From single root in the planted area:
Accidentally either due to scratching or increased blood pressure within the skin or by accidental injury while getting in/ out of the car, one or more planted roots may pop out. This may cause slight amount of oozing of blood from that particular hole & a streak of blood may come forward up to the forehead like water runs down the hill.
Do not panic- go near the bathroom mirror & try to locate the oozing spot and then with the tip of your clean forefinger exert gentle pressure right over the bleeding hole & hold the pressure for up to 5 minutes. Oozing will stop in natural course. Do not keep taking finger onto the hole every few seconds or minutes to check whether bleeding has stopped or not. Due to frequent checking at shorter intervals oozing may not stop & continue for longer time- so just press on the spot & wait patiently. Do not put too much pressure so that surrounding roots start popping out & create further bleeding. Once the bleeding has stopped, spray antiseptic over the oozing spot from 2 feet away. Do not make any attempt to replace out root on your own.On getting up the next morning, you may notice some blood stain over the dressing pad and over the pillow cover if you have not placed the towel properly. This will usually happen but is not alarming. The open pores of harvest (donor area) close completely in 12 hours time.

2. PAIN:
Because of our advanced technology using cooling, acupressure, vibration & local anesthetic during the procedure, there is minimal discomfort. Our clients have claimed the procedure to be almost “Pain Free”. Pain or discomfort at the site of operation after any procedure would be felt even when client comes out from general anesthesia. A little bit of discomfort is inevitable when you come out from the operation theatre but can easily be controlled with tablets taken as recommended by Dr Bhatti. Post procedure discomfort is maximally felt at the back of head after strip surgery and not after FUE. You will be very fresh the next morning when you come to the clinic at 9 AM/ or as advised by the staff.

3. SWELLING:
After any type of surgery, normally body reacts and produces swelling of that particular area-this is a normal bodily response and it continues up to 3 days from the time of injury. In hair transplantation this area is on the top of the head. So some swelling of the scalp skin is bound to occur. The amount of swelling would greatly depend on number of roots planted, site of area, (Front or Back), size of area (large or small) skin laxity & individual body tendency to react against trauma. With lesser swelling there will be less tension leading to lesser pain and better healing. If the swelling is less in the initial phase it will resolve quickly. We recommend that at least first three nights the head should be higher than the level of your heart and to achieve this we request you to sleep in semi upright position for 3 nights after transplantation. You can use 2 large pillows which shall lift up your head to this position. If you have had grafts implanted into your earlier strip scar, you will need to use a travel pillow (not the hotel pillow) so that the head does not touch the pillow or bed. alternately, hotel towels can be rolled and used as a travel pillow.
The swelling is more when more number of roots are transplanted in the front area in clients with lax skin. They notice a bump like swelling on the forehead usually appearing on the 2nd/3rd day after the procedure. This swelling is more bothersome to people who look at the client rather than to the client.

PLEASE DO NOT APPLY ICE OR ICE PACK ANY WHERE
We teach you how to shift the fluid side ways from the front of the forehead and prevent it from coming lower down below the eyebrows into the eyelids and between nose and the eyes.
You are advised to press over the swelling against the forehead bone gently starting from midline going out wards (Not upwards towards the roots) maintaining uniform pressure taking time- up to 15 to 30 seconds each time. You may have to repeat this 20 times every 2 hours while awake.
If gravity wins and the fluid is collected around and between the eyes, you are advised to leave the swollen skin alone and DO NOT PRESS OVER THE EYE BROWS ANY MORE. Any facial swellings below the eyebrows have to be left alone. This may result in giving you a ‘Chinese-eye’ look for two more days till water runs down the cheek. First it will disappear from upper eyelids and then from lower eyelids. You may not have to restrict your reading, watching TV or other working activities due to swelling of eye lids.

4. CRUSTING:
In hair transplantation hundreds of hair roots are planted in a very small area within close proximity. From each planted side a drop of blood and serum oozes through. So on day one the planted side looks like an area covered with red spots. As time passes by, the dried drop of blood & serum starts looking black & the whole area of planted hair is covered with a thin crust. Every day the whole area is soaked & cleaned with shampoo and antiseptic is sprayed over. As the planted area starts healing, the new hair continues to grow and lift the crust away from the normal skin. Between 5 to 10 days after the procedure the crust starts cracking & is gradually washed out with the shampoo. One can move the tip of the finger slowly to remove the crust which is loose and hanging on the hair latest by the end of second week.
Most of the crust falls off and small stiff bristle (brush) like new planted hair is felt & seen growing through the normal looking skin. If one wishes to remove the dry black crust it can be safely removed mechanically by a special medical technique at the clinic by an expert or by gently moving the fine teeth comb through the planted area by yourself but this only after 2 weeks. Do not use Gillette foam, etc. after 2 weeks. Start the normal routine advised-Johnson Baby shampoo on alternate days with daily washing of the hair with tap water. after 2 weeks if crust persists, go under the shower, pour baby shampoo lather from a tumbler/mug on planted area & tease the crusts off with gentle rotatory movements of the fore & middle fingers together.

5. ITCHING:
Itching is considered as a sign of healing. This starts any time after 5 days. Use of spray and aloe vera water over the planted area; and aloe vera lotion over donor area gives an extra healing touch and reduces itching. Irresistible ‘sweet’ itching can be tackled during the day time by gentle touch of pointed end of folded sterile gauze or hand-kerchief, but should not be tackled with finger nails.

6. NUMBNESS:
On the day of the procedure, numbness over the plantation and harvested areas is produced by cooling, acupressure, vibration and local anesthetic. During the post procedure phase, numbness of the scalp on the plantation area remains because of internal swelling (edema). As days pass by, the numbness is reduced and the feeling of touch comes back gradually.
Sometimes it takes around 12 weeks before it becomes almost normal. During this time you may feel that during combing or touching someone is touching the skin over a thick plastic sheet. Gradually as the internal swelling reduces, it will feel as if this plastic sheet is getting thinner & thinner with return of sensation. Even if the return of sensation takes place a couple of weeks later it is not a matter of concern. The sensation at times may take 3 months to return fully.

7. TIGHTNESS:
As soon as the effect of local anesthetic wears off one begins to feel tightness. One describes this feeling as if skin is pinched tightly all the time- more of a discomfort than pain but this shall soon respond to medication.

8. SCAB WITH PLANTED HAIR:
Quite often between 5th & 10th post procedure days, one notices scab falling out from the hair. Sometimes this is accompanied by a small planted hair adherent to the scab. You will naturally worry and feel the planted hair has come out and have lost one root. In reality one can compare hair root with ice candy where the stick of candy is hair & ice-cream attached to the stick can be compared with soft tissue of hair root with stem cells attached to hair. Hair in the hair root acts only as a stand to keep the soft tissue in position during plantation. When the planted hair falls off the ice-cream like soft tissue remains buried inside the skin from which new hair will grow. Any hair falling off after 6 days of the procedure does not carry the root with it – so be reassured that the root shall grow a new hair, provided you are on medication advised.
During the course of recovery between 3 & 10 weeks, most of the planted hair fall out and the new spurt of fine soft hair is seen coming through the skin 14 weeks after plantation and that hair continues to grow at the rate of 1cm per month. The first result can be expected only at 24 weeks and no earlier than this timeline. 60-85% of the result in our practice is obtained at 6 months after the procedure and the remaining growth is mostly completed between 9-12 months depending on your age and other factors like medication.

9. IRRITATION OVER RECIPIENT & DONOR AREAS:
During the first 3 days one feels little tightness at the back because of the swelling of skin. After that period the tension (pulling sensation) disappears and the spots begin to heal. One feels itching around 5th day onwards. Immediately after the shampoo in the morning and evening one feels the comfort of softness for a while. To maintain this softness we recommend application of provided aloe vera water (purple top small plastic jar) for the planted area and aloe vera lotion for the donor area after the blue antiseptic spray.

10. ACIDITY AND HEAVINESS IN STOMACH:
Most of the medications used to control pain, swelling & infection after hair transplantation procedure can produce a feeling of acidity & heaviness in the stomach. Those, who commonly suffer from hyper acidity will be affected more.
To prevent this we recommend you to take tablets at the exact time as shown in the time-table. Keep minimum interval of two hours between different tablets. We also request you not to take these tablets on empty stomach. Please have something to eat before taking medication. However in spite of all the measures if one develops acidity one is advised to take chewable tablet REFLUX FORTE from your local chemist as & when required. With each passing day, pain/discomfort is much reduced- after 3rd day you are advised to reduce the dose of 3 tablets per day to 2 tablets & lastly once at night. In case of uncontrollable hyper acidity please stop all pain medications without worrying if it still persists see a physician.

11. SWEATING:
Sweat gland & hair root are two different structures of the skin.Sweating from and around the planted areas is normal occurrence after hair transplantation procedure, because of external high temperature or following walking. If one notices excessive sweating, that is not harmful. Sweat will evaporate or will be washed away during the shampoo procedure. After all sweat is sterile and it only keeps the area wet. It is not harmful at all also, the skin is water-tight at 36 hours from procedure.

12. FALLING OF PLANTED HAIR AND AREA LOOKING BALD AGAIN:
You can compare the hair root structure with an ice-cream candy where the stick is hair & when root is transplanted with hair the cells revive and get nutrition from the surrounding tissue. You would naturally be keen to know when your hair would start growing. Planted hair which is about I mm in length can be felt like stiff stubble. Up to 3- 8 weeks after the procedure hair continues to grow longer with each passing day & you will feel happy about it. This happens because from the very next day the new hair starts growing under the planted hair, while the old hair is pushed up & up with time; this makes it look feel as if it is growing! Anytime between 3-12 weeks planted hair is more out than in the skin- and because of lack of support it falls off. When you notice this you shall be unhappy about the situation and naturally would start worrying. In reality new hair growth is occurring just under the skin and is not seen outside. After the 12th week, you will see the soft hair coming out through the skin and they continue to grow at the rate of 1cm per month. DO NOT EXPECT ANY VISIBLE RESULT TILL 24 WEEKS AFTER THE PROCEDURE IF YOU ARE BELOW 30 YEARS OF AGE AND 28 WEEKS IF YOU ARE OLDER.

13. COMBING
Most people opt to be trimmed before the procedure. However, if your hair has not been trimmed short, you may be allowed to comb your existing hair as there is no bandage or dressing.
You are advised to keep the teeth of the comb away from the skin during combing avoiding direct contact of teeth with the planted area and adherent hair stuck around and over it. If you already have long existing hair we may show you a suitable combing style so that planted area becomes almost invisible- covered by surrounding existing long hair and it may look as if nothing has been done.

FAQs

Question: What phone no. should I call in case of emergency or query?
Answer: Our help line contact number is 9814531111. However, in case there is no urgency,best is to e-mail at dearbhatti@gmail.com Mails are never missed. Phone calls may not get you to the doctor since he remains busy in the operation room the whole day.

Question: What things can I carry in hand baggage during my air travels? And how do I manage shampooing during air travel?
Answer: You may not be allowed to carry any liquid medication, shampoo or solution for hair wash in larger quantity than 90 ml. So please put them in your check in baggage. We advise you to carry 10 ml antiseptic and saline spray with you. You will be allowed to carry tablets for medication in cabin baggage. The prescription has been provided to you.

Question: What do I do for immigration clearance at airport due to my changed look?
Answer: If you are traveling during 1st 3 days of procedure post operative swelling on the forehead near the nose around the eyes or face or other part of the face may alter your physical appearance which may be questioned by an alert immigration officer at the port of entry. We advise you to collect a certificate issued by Dr Bhatti with seal & sign stating that you have undergone hair transplant procedure by him on the dates mentioned.
Keep the certificate with passport henceforth till you get a new passport made after the present one expires.

Question: When do I start Finasteride (Propecia), Biotin and Minoxydil (Rogaine)?
Answer: You can start Tablets Finasteride & Biotin immediately or after the antibiotics and pain killers have stopped (3 days after the procedure).
2% Minoxydil is to be started after 14 days and is to be applied over the planted area at night after washing the hair with plain water and drying with a clean towel. Please read detailed instructions contained in the carton before using Minoxydil. After 6 weeks, you can switch to 5% Minoxydil. Minoxydil is available in solution or foam or spray forms. You can choose what suits you best.
The above medications shall continue till 6 months after the procedure. If you are travelling abroad you are advised to buy these medicines in India since they are 10-15 times cheaper in India. However, please check expiry dates before you pay for the medicines. My office can help you in procuring these medications. The typical cost of all medicines for 6 months is INR 2700 (under USD 50). The cost of these medications is not included in the hair transplant fees charged.

Question: The spray bottle does not work?
Answer: Please interchange the nozzle with the other bottle; and we are sending you a replacement.

Question: I forgot all medication in Chandigarh. Now what?
Ans. You can buy the following from any large pharmacy-

  1. Pink shampoo- 2% Chlorhexidine gluconate
  2. Aloe Vera Water- Aloe vera of ‘Forever Living Products’.
  3. Sterile gauze
  4. Normal Saline

Question: 2 weeks are over and the crusts are off. When do I apply Baby Oil/ 2% Minoxidil?
Answer: At night wash you hair with water (shampoo only if its due) and dry hair. Then apply a thin layer of 2% Minoxidil over the planted and other areas. Leave this on till morning when you wash it off under the shower, dry the scalp and apply just a few drops of baby oil to the planted area. The same process is repeated day after day till 6 months.
5% Minoxidil starts after 2 weeks of having used 2% Minoxidil.

Question: I accidentally spilt the aloe vera water while traveling home. Now what?
Answer: Use baby oil instead.

Question: Today is the 7th day after the procedure. I was fine earlier, but the pain in the donor area when I rest my head on a pillow, does not let me sleep. What do I do?
Answer: This is uncommon. Now that you have this issue, please read the instructions for management of pain on the reverse of the prescription sheet (overleaf).
Pain after FUE is not unusual and happens in a small minority of cases. However it will gradually pass away by 6-12 weeks of the procedure.
Please take the following precautions-

  1. Sleep on a soft pillow.
  2. Do not wear a tight fitting cap.
  3. Do not get head massage done till 3 months after the procedure
  4. Do not rub aloe vera lotion vigorously over the donor area

However if you are not doing any of the above pleaes take-

  1. Tab Combiflam 1 tablet twice a day
  2. Tab Alprax 1 tablet at night

If after 3 days of the above medication, the pain is still bothering you, please start the following for 7 day-

  1. Tab Combiflam 1 tablet twice a day
  2. Tab LYRICA (PREGABOLIN) 75 MG TWICE A DAY

Wish you a speedy recovery.

Question: How do I groom my hair?
Answer: If your hair have not been fully troimmed, on the 5th day you can apply the Gillette shaving foam on the entire head, wait for 5 minutes and wash off with a strong stream of bottled/ RO water. This will clean the matted long hair like shampoo does. You can comb the hair without the teeth of the comb touching the planted area. This Gillette foam application can be done every day when you are applying it for removing the crusts on the planted area.

Question: When can I get a head massage?
Answer: Vigorous scalp massage can be done after 6 months. Head massage even after 6 months will break telogen hair and will decrease the density. It is not advised. Very gentle massage is fine.

Question: When can I apply nourishing oil to my hair?
Answer: After six month.

Question: Can I apply 10% Minoxidil?
Answer: You can apply any medication that is advised by your doctor, but only after 6 months of the procedure.

Question:. Can I take protein supplements?
Answer. Yes you can take protein supplements that do not contain whey protein till 6 months of the procedure.

Question. I Have finished my medication course for 6 months after the procedure. I wish to continue taking them to prevent further balding. Can you courier the medications to me.
Answer. Since we do not have a drug license, it is not possible to do so.

DO’S AND DON’T’S

DOs:

  1. Take your medication at specific time of the day as advised on the schedule.
  2. Keep upright and sleep in semi setting position for minimum first three nights after the procedure so that head is higher than the heart.
  3. Water the roots minimum every 20 minutes on the evening after the procedure till you sleep and every 2 hours the next morning onwards.
  4. Spray antiseptic three times in a day (once in the morning after the shampoo after drying, second in the afternoon after lunch and 3rd time in the evening after shampoo and drying). This should be done from arm’s length away- 2 feet.
  5. Restart your other medications at your routine time as you were taking them prior to the procedure.
  6. Keep your eyes closed & covered with towel during antiseptic spray.
  7. Take shower and tap water bath below shoulders only till 2 weeks.
  8. Do continue your routine work or even brisk walk. you can do moderate workouts at 7 days and Cardio at 2 weeks.
  9. You may have normal sex life after 3 nights.
  10. Do keep the procedure area covered with cap for all outdoor activities up to 3 weeks to avoid direct exposure of dust, heat and sunlight.
  11. Keep pressing the forehead skin from midline outwards to prevent the swelling going into your eyes & shifting it to the side of the face.
  12. While drying the planted area with swab after shampoo, dab dry backward to forward only and if your temple triangles have been worked upon, do this to top to bottom.
  13. Do use a travel pillow if you have got a previous strip scar repaired lest it touches the pillow. In such cases you shall have to lie upright for 5 days.
  14. Do not hesitate to call helpline in case of any query (9 AM- 5 PM) or in an emergency 24×7. For routine queries, e-mail is recommended for a comprehensive reply. dearbhatti@gmail.com
  15. Use sterile medical water provided in the kit for 5-days & then use potable mineral water. However since usually the medical normal saline water is left over, you can continue to use this till it finishes, after which you can start using mineral/ bottled water.

DONTs

  1. Do not sleep flat for the first 3 days.
  2. Do not consume alcohol till 3 day.
  3. Do not pour tap water over the procedure site.
  4. Do not do heavy exercise, gym, aerobics, heavy weight lifting or yoga for one week.
  5. Do not bend down or forward to tie your shoe lace or to pick up objects from the ground for the first 3 days.
  6. Do not use hair dryer.
  7. Do not scratch the procedure area with you finger-nail.
  8. Do not allow teeth of your comb to touch the procedure area while combing.
  9. Do not apply any ice or cold pack over the procedure area, forehead or any part of the face.
  10. Do not stroke the planted area with gauze from forward to backward.
  11. Do not use any shampoo, washing solution or antiseptic other than what is supplied/ recommended.
  12. Do not take steam or sauna bath for 6 weeks.
  13. You can use your own loose cap/ hat after 7 days of the procedure or you can wear a bandana. We request you to wear only our cap as it is designed specially for your care. Use it only for out door activity. Do not wear any woolen cap.No turban for 8 weeks after the procedure. No helmet for 6 weeks after the procedure. Cap should not touch any procedure area. Wear it loose and do not press it tight across your head. Remove it by lifting it from back to front.
  14. Do not go to the barber for 6 weeks after the procedure.
  15. Do not color your hair before 6 weeks of the procedure.
  16. After the first 2 weeks do not unnecessarily keep the hair covered with a cap. Give them air for a healthy growth.
  17. If you develop dandruff, you may use Ketoconazole shampoo 2 days a week.
  18. If the beard is the donor site, do not shave it for 3 days after the procedure. Till 3 days you can shave your beard and use a trimmer for the shadow area from where grafts have been take.
  19. Do not use shampoo more than on alternate days.
  20. Do not wear the cap when on a long haul flight out of India since it will be uncomfortable. Tie a loose bandana over the scalp. it is provided.
  21. Do not swim in a pool or in the sea for 3 weeks after the procedure.
  22. A window seat while flying home is safer. while disembarking, be the one of last passengers to do so, this avoids injury.
  23. Do not smoke after a hair transplant.
  24. No swimming for 3 weeks.
  25. Keep cap on in the sun for 3 weeks.

What after the Hair Transplant?

Now that you have received your hair transplant with us, though Dr Bhatti will be with you throughout your hair regrowth journey and even after, the exhaustive care has to be diligently done as in the booklet provided online. It is of the utmost importance for you to  strictly adhere to the instructions to ensure recovery and proper growth. So much money, emotion, effort and time has gone into the hair transplant and we have t together make it work for you.  

Pain

In most of the cases, patients don’t feel the pain. But, in some cases the patient may feel a small amount of pain which is more of pins and needles type of pain and this mostly happens around the 5-7 day mark and is due to irritation of the sore nerves. It happens in only 5% of patients and is self-limiting. However if it prevents your sleep, kindly follow instructions on the reverse page of the prescription sheet signed by Dr Bhatti and handed over to you the day after the procedure when you were explained how to shampoo and take care of the recipient and donor areas.

Regular washing and shampooing

Regular cleaning and application of ‘pink shampoo’ is essential after the hair transplant surgery. Some patients may feel that doing so will affect the grafts, but if it is done as recommended, theer is nothing to be perturbed about. The twice a day procedure  helps remove the dirt, crust, blood and oil from the recipient sites. Diligent care as advised will remove crusts within 2 weeks and this is needed for proper growth.

It is needed to emphasise that proper hygiene helps prevent the infection. Keeping the recipient area moist in the first few days with saline spray promotes early healing and assists in better growth. healing.

Itching in donor & recipient areas

You are likely to experience itching  for the first few days after the surgery in the donor and the recipient areas. This is mostly a sweet itch. Scratching the donor and recipient areas can cause trauma and hence is to be condemned. Keeping th operated areas free  from debris, crusts, or any accumulation of dirt and ointment will mitigate the itching. Scratching these areas with the fingernails can easily dislodge grafts, which may cause mild bleeding, but more importantly, can cause loss of one or more of those valuable grafts,. Since this is a ‘sweet itch’ even pressing the area with the palm with give substantial relief. Another process by which recipient area itch can be resolved is by spraying chilled saline/bottled water. For the donor area apply copious amount of aloe vera moisturisers after 5-7 days. The aloe vera lotion given in the kit is helpful.

What to Expect and when to expect it?

By a process of anagen effluvium, withing 4-6 weeks most of the planted hair will be seen falling off in abundance. This is telogen effluvium and is not a cause of concern since the roots are retaing under the skin and are growing a new hair which is pushing the planted hair out of the body as it grows. The old hairs become loose around 4-6 weeks as their tail end reached the skin surface and when they have no support, they fall off. Most people get anxious and this is natural.  60-90% of the  grafts fall off. By the end of the first year, the new hair should be as robust as the remaining. They will also gain length at the same rate as non-transplanted hairs. Sometimes during the initial period after the transplant, the patient may notice small hairs being shed along with their bulbs. They may even come out along with the small "crusts" within the first week or two. All this is normal and unless there is bleeding at a graft site, there has been no loss of a viable graft.

Infrequently, there is some textural change in the transplanted hair. It may become curlier than it was, or even somewhat wiry. When examined microscopically, these hairs reveal some changes in the cuticle. This is temporary and resolves as time proceeds.