Hair Transplant – Post Surgery FAQ

When can I color my hair?

If someone colors their hair regularly, it is best to color at least two weeks before and at least two weeks after any surgery, just to avoid potential irritation of the scalp.

When can I get a haircut?

The earliest you can get a haircut is post op day four after an FUE procedure, but in general it is best to wait until any crusting on either the recipient or the donor area has resolved, which is usually about a week.  After an FUT procedure wait for a haircut until the stitches have been out for at least a day – about 10 days – just to avoid having your barber or hairstylist catch a stitch on a suture and pull – ouch!. 

When can I use Rogaine/products in hair?

In general it is best to wait until any crusting on either the recipient or the donor area has resolved before using any products, which is usually about a week.  Rogaine and products do not necessarily cause harm, but they do make things messy

The same goes for topical hair fibers like California Hair Fibers (generally keratin).  These substances are inert (i.e. they don’t interact with anything), but they tend to clump around any little skin flake so if you use them too early after a hair transplant they look odd.  Usually a week is needed before things improve enough – and then any product is fair game (except hair dyeing- see question #1).

When will the redness go away?

Hard to tell because this answer varies greatly with each individual patient’s skin type.  For some patients redness lasts less than a week.  For others, a slight pink tone can persist for months (especially with lighter skin types).  Either way, a pink tone in either the donor or recipient areas from either FUE or FUT surgery will slowly fade with time.  Topical steroids can help speed the process a little, but no matter how slowly it fades, it is usually gone by the time the hair has all grown in.

How long will it be noticeable? How long will it be before I look “normal”?

The definition of “normal” varies from patient to patient, and what is “noticeable” depends on the patient and the surgery that was done.  Most patients report that the top of their head – generally the recipient zone – looks “normal” enough that they feel comfortable going out in public as soon as the crusting is gone (or immediately hidden if they have hair to cover it). 

The visibility of the donor area – generally the back of the head – varies depending on the surgery:

  • For a linear surgery, most patients report they felt they looked “normal” at about a week.
  • For FUE surgeries where the back and sides of the head are shaved, it takes a bit longer to grow the hair back out and cover the area so ten days is what patients report they need to feel that they look “normal.” Long Hair FUE surgeries are smaller but do not require shaving.
  • For a “hybrid” surgery where both linear and FUE are done simultaneously, it takes a little over a month for patients to re-grow a desirable amount of hair

Can I wear a hat?

Yes. Avoid hats that touch the grafted areas for the first three days (day 0 is the day of surgery and so the day after surgery is day 1). That being said, any hat that touches on the forehead and/or the back of the head (donor area) works fine after a surgery.  So bandanas, fedoras, cowboy hats, berets, newsboy caps, etc. are “all good.” 

 The hat everyone tries to wear though – a baseball cap – usually should wait until day 4 or later.

When will the swelling go away? How long will bruising/swelling last?

Swelling typically peaks 2-3 days after surgery and resolves 2-3 days after that, so the whole process is complete within a week.  Bruising is rare outside of eyebrow restoration surgery (I have not had a case where it occurred for years).  IF it occurs, the resolution can range from 1-3 weeks (and again, depends on the individual).

When will I start to see some growth? What are the stages of hair growth after getting a hair transplant?

Grafts start to re-establish their blood supply within hours after being placed in their new home.  This process, called neovascularization, takes roughly 72 hours, which is why the first three days are critical for a hair graft to survive and re-grow. 

A week or two after a hair transplant crusting is usually gone, and tiny short hairs (or long ones if doing a long-hair preview surgery) remain.  These hair shafts may seem like the goal of the hair transplant, but in fact it is the follicle and stem cells attached to the hair (now safely tucked under the skin) that we are after.  When these visible hair shafts shed, many patients think they are losing the grafts they worked so hard to get, when in fact it is the follicle entering the shedding phase (Catagen) in order to produce a new hair.  Native hair may shed at this point as well, and this whole temporary and reversible process is known as “shock loss.” 

Growth (under the skin) starts 3-4 months after surgery – and the first sign is often…ingrown hairs!  Ug. VISIBLE growth takes longer because the hairs have to get some length in order to be seen, so 6 months is the typical waiting time.  Full growth takes a year, and sometimes up to 18 months in certain cases!  The take-home message is: be patient!

Does everyone qualify to get PRP?

Since Platelet Rich Plasma (PRP) is your own blood product, re-injected back into your own body, there is nothing* that would really “disqualify” someone from getting the treatment.  (*ok – there is a rare exception to this.  It is a disease called idiopathic thrombocytopenia and in these cases patients don’t make very many platelets at all – which would make it impossible to collect and re-inject them!)

Platelet Rich Plasma injections are one of those treatments that won’t harm you, and “may” help you.  MAY help you…and may NOT!  The problem with PRP is that doctors have not figured it out yet.  Much of the science indicates that it should work, but none of it proves that it does yet, or exactly how these injections should be done.  Right now, all doctors can do is make their own best guesses. 

How much time do I need to take off until I can go back to work? Can I go to work next day? Should I take off 3 days or 10 days?

As usual, this answer depends on the patient and the surgery that was done.  Unless a patient’s profession involves heavy physical labor (like construction work, or anything that involves lifting), many patients feel that they can work even the next day after either a linear or an FUE surgery. 

On the other hand, if a patient has a job that requires a lot of personal interaction with clients or co-workers, or simply personal appearances (like actors, politicians, managers, or salespeople), the swelling that might happen on day 2-3 might look noticeable.  If a patient anticipates they might feel self-conscious, about a week (linear surgery) to ten days (FUE surgery) out of the public eye is needed.

One last note; if a patient has hair remaining in the area to be transplanted or can use other hair to cover the recipient areas (like a female patient, or someone with diffuse loss, or longer hair combed to the side), it is much easier to camouflage within even a day after a surgery.  This is one of the reasons we at California Hair Surgery do not shave a patient’s entire head for surgery.  It is much easier to get back to your normal routine and the surgery causes less disruption if we can work with you to preserve your hair length.  Pre-op planning will include an individualized discussion so that each patient can plan their post-operative recovery to fit their lifestyle.

Can I go swimming?

That depends on if you have learned to swim!  Just kidding. 

Swimming is not completely off-limits.  For instance, patients can go in a hot tub as long as they do not immerse their head.  Due to the wide variety of places to swim (and the relative cleanliness of those locations!), I recommend avoiding swimming for 10 days in FUE cases, or until any stitches are removed.

When can I wash my hair? Do I need to rub the recipient area when washing?

Please wash your hair!  Moist wounds heal the best, so keeping the surgical areas clean and moist is key.  There are several ways to accomplish this;

  • frequent washing (2-3 times per days the first three post-operative days)
  • misting the hair (with saline or water or special medicated solutions)
  • medicated soaks (solution-soaked gauzes and wraps, like copper peptide or other solutions, over the donor and recipient areas)

Our office often meets with our patients the morning after the surgery to demonstrate the technique for patting the hair with foam to wash it, but the concept is simple.  For the first few days, only PAT the recipient area with lather in an up and down motion.  Avoid “shear forces” (i.e. sideways) motions and rinse with a cup filled with warm water.  Pat dry gently.

On the fourth day after the surgery (recall that day 0 is the day of surgery and so the day after surgery is day 1), any crusting that might have formed should be gently rubbed off in small circles over the days.  Typically, this is best done in the shower after 5 solid minutes of soaking.  It is good to remove the crusts, because they have the potential to pull out a hair if left in place.

How long do I have to sleep upright?

Sleeping at a 45 degree angle (i.e. NOT upright, just elevated) helps reduce swelling.  The swelling peaks at day 3 post-operatively, SO sleeping elevated the first three nights helps avoid excessive swelling.

The best way to accomplish this is to use about 3-4 pillows behind one’s back in bed or to use a recliner.  Neck pillows or a rolled-up towel help stabilize the neck.  A pillow under each arm is likewise tremendously comfortable.

Keep in mind that the swelling doesn’t hurt anything – it is simply unsightly and inconvenient.  If a patient is forced to choose between sleeping at all and sleeping upright, lay in the position you are most comfortable, and get the healing power of sleep.  Any resulting swelling, however severe, will pass in a few days.

For FUE surgeries, should I have shaved my head?

It is not necessary to shave before the surgery since we also own a set of clippers to trim to the needed length.  Professional hairstylists will be able to accomplish a more aesthetically pleasing “fade,” and help you with blending the longer and shorter hair as soon as 4 days post procedure, but it is not necessary to inform them you are having or have had a procedure. 

Misinformation on the Internet may lead some patients to believe that completely shaving the entire scalp is necessary, or even desirable, but this is not the case.  Not only does the remaining hair help to determine the correct angulation for both donor and recipient areas, leaving hair in place as much as possible has been shown to reduce post-op infections, and helps patients camouflage in the potentially difficult post-operative period. 

When can I drink alcohol/coffee?

Usually, the day after surgery.  (This is our most popular question!)

When can I lift my toddler/baby? When can I work out workout/heavy lift/exercise?

This is our second most popular question!  Here’s what you need to know; lifting anything heavier than a gallon of milk pulls at the back of the head where grafts were taken and where the scars from their removal are healing.  Plan to let the healing happen.  It takes 21-25 days for most scars to heal 80% of the way.  The last 20% will take the rest of the year, so at least spend ~ 3 weeks babying it.

For exercise, plan on getting light exercise as soon as the day after surgery.  Avoid exercises that pull on the back of the head or anywhere on the body that grafts might have been removed.  The emphasis should be on walking, not running, and on light weights with slower and more repetitions, rather than high weights with few reps. Take a little longer with your exercise, and you will get the same cardiovascular benefit, without compromising your short term healing.

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