Very Dissapointed in post op instructions given.

[Skeptic1st]

I had my first transplant performed three days ago and although I carefully read and followed all the immediate post op instructions,the practice of keeping my head recipient area moist was never told to me written or verbally.The instructions I were given were to simply remove the skull cap two days after surgery,and use a 50/50 mix of water and peroxide sprayed lightly over the donor and recipient area.Several hours later, I lightly shampoo'd it allowing shampoo drip over my head,and I was told to use a hair dryer on COOL setting. The next 24 hours or more,(besides shampooing again),I allowed my scalp to dry out and I thought there was nothing more I should be doing according to my doctor. I even called his office and was told that additional topicals or sprays werent neccesary.NOW im kicking myself because after reading more information,Ive found that continually keeping the recipient area moist IS IMPORTANT to minimize or possibly keep from any scabbing at all.WHY WASNT THIS IN THE FOLLOW UP INSTRUCTIONS? WHY was I told(in my instructions) to use a hair dryer after a mild shampoo and rinse if the would dry my scalp faster?Well, I now have a spray mist bottle and a large supply of saline that Im using every two hours(I warm the saline a bit first).Im even going to continue this through the night if I can wake up.Now I understand that this probably wont keep my transplant area from scabbing, but maybe it will?And what if its not as bad as if I let my head go dry between washings?Now on a related subject, I plan on going back to work in two days. Since I work outdoors, and it IS January here in New Jersey,Im considering a few differant options for my head.Once again,my doctors assistant told me a knit hat would be fine and not to worry.I think it was easy for her to comment that way without it being her head. Im thinking that especially in the cold weather, I need to keep my new tranplants moist?I saw someone else comment on here about using large amounts of aloe(but only 10 days post op).Can anyone comment on that or any other methods of some non threatening topical I could use for winter weather exposure?The day I return to work will be just 5 full days post op.
Thanks for your replys.
Dale

[SpencerKobren]

Hair Transplant Post Operative Care

I had my first transplant performed three days ago and although I carefully read and followed all the immediate post op instructions,the practice of keeping my head recipient area moist was never told to me written or verbally.The instructions I were given were to simply remove the skull cap two days after surgery,and use a 50/50 mix of water and peroxide sprayed lightly over the donor and recipient area.Several hours later, I lightly shampoo'd it allowing shampoo drip over my head,and I was told to use a hair dryer on COOL setting. The next 24 hours or more,(besides shampooing again),I allowed my scalp to dry out and I thought there was nothing more I should be doing according to my doctor. I even called his office and was told that additional topicals or sprays werent neccesary.NOW im kicking myself because after reading more information,Ive found that continually keeping the recipient area moist IS IMPORTANT to minimize or possibly keep from any scabbing at all.WHY WASNT THIS IN THE FOLLOW UP INSTRUCTIONS? WHY was I told(in my instructions) to use a hair dryer after a mild shampoo and rinse if the would dry my scalp faster?Well, I now have a spray mist bottle and a large supply of saline that Im using every two hours(I warm the saline a bit first).Im even going to continue this through the night if I can wake up.Now I understand that this probably wont keep my transplant area from scabbing, but maybe it will?And what if its not as bad as if I let my head go dry between washings?Now on a related subject, I plan on going back to work in two days. Since I work outdoors, and it IS January here in New Jersey,Im considering a few differant options for my head.Once again,my doctors assistant told me a knit hat would be fine and not to worry.I think it was easy for her to comment that way without it being her head. Im thinking that especially in the cold weather, I need to keep my new tranplants moist?I saw someone else comment on here about using large amounts of aloe(but only 10 days post op).Can anyone comment on that or any other methods of some non threatening topical I could use for winter weather exposure?The day I return to work will be just 5 full days post op.
Thanks for your replys.
Dale

Hey Dale,

At this point, I am unaware of any truly universal post operative care protocol that has been established in the field.

Preventing crust formation after a hair transplant would be wonderful for several reasons. The typical crusting or scabbing that forms on transplanted grafts actually extends the period of time that grafts are at risk for possible dislodging.

In most cases it takes about week to ten days for transplanted grafts to be securely anchored after a hair transplant, and grafts are at the greatest risk between days 1 and 4 in my opinion. The longer the scabs remain on the scalp the longer the risk of accidentally scratching or pulling a graft out. Lessening the crusting period would also make it easier for patients to return to their normal daily activities, barring heavy workouts etc.

One thing is for certain, all hair transplant surgeons will advise their patients to avoid scratching or picking at the transplanted area and most will advise that patients begin washing their scalp between the 24 hour and 48 hour mark.

Keeping the area moist, might help, but there are no guarantees that this will lesson crusting time.

The key is to disturb your grafts a little as possible for the first ten days to insure proper anchoring. There is no reason to believe that keeping the area saturated or moist will effect the final result of the hair transplant in anyway. Some experts might disagree, but then again many of these experts also sell their own hydrating solution for post operative care.

So don’t panic and don't be disappointed. This is the protocol that your physician believes in and it is in the best interest of both of you for the outcome of your procedure to be successful.

Hope this helps,

[SpencerKobren]

I wouldn't stress over it too much. I don't know who your doctor was or what his philosophy is, but I wouldn't worry to much.

I never tell my patients to keep their recipient area moist, nor do I have them spray it regularly with peroxide/H2O. That may have had usefulness years ago when large minigrafts and plugs were used, but I don't see any use for it today. Back in the day the peroxide/water spray was used to break up the massive crusts formed by dry blood that originally leaked out of the relaitively large holes. Today's much smaller folliclular units don't require such attention.

As for the Aloe, it's not required at all. It may allow the crusts to come off sooner and easier, but in the end it has nothing to do with overall growth. Remember, the important parts of the grafts are under the surface where they are protected by the greatest environment possible...your own skin. All the graft's moisture needs are met very readily. The external part of the grafts are just epidermis or very shallow dermis. The whole point is for them to fall off so that the graft can heal FLUSH to the skin. That is, without a bump.

My patients are encouraged to take a shower starting the night after the surgery. After three or four days 90% of the scabs are gone with no further input on the part of the patient.

So my guess is that your grafts are fine and that you were not remiss in doing anything. When in doubt, go visit with your doctor.

That's an interesting tidbit about the proxide/H2O solution Dr. Feller. I had no idea that it was used for that purpose back in the day. I simply thought that hydrogen peroxide solution mixed with water was used as an antiseptic to decrease the possibility of bacterial colonization, but I guess it would break up the scabs when I think about it.

That's what I love about this place, there's always something new to be learned.

[Gregory Pistone, MD]

Yes Spencer, a number of things have carried over from the old days that are really not necessary anymore. The Hydorgen peroxide is one of them. While it may play an antiseptic role, that was not the main reason it was used. Besides, the scalp is so vascular that infections are very rare and I doubt peroxide solutions would make any difference at all.

Another carry over is the use of Alcohol in the recipient area after surgery. Notice that it's use is in direct contradiction to the use of moisturizers advocated by some clinics; once again demonstrating the lack of consensus amount HT doctors.

For my part I think alcohol can actually be dangerous to the recipeint area because it can cause a chronic or sub-acute irritation that in turn can negatively affect the new follicles.

But in the end, the scalp is a real tough structure and I suspect even if house paint were poured over the head after a transplant that the grafts would still grow. But I don't recommend anyone trying this out.

Dr. F

Hello all,

I have to agree completely with Dr Feller, although I continue to use dilute peroxide solution, not necessarily for it's antibiotic effect, although that can't hurt, but mostly because it dissolves the crusts quickly and enhances healing in my experience. You certainly can keep your scalp moist continuously from day 1 with saline, but I think it's more of a risk that your grafts will be disturbed, than by wearing a compression cap for 2 days, as I do. The most important thing is that the grafts remain undisturbed and allowed to take root.

If you want to kill tissue, just pour some alcohol on it. It has an immediate toxic effect.

I imagine if you really want to try to kill your grafts (and get pneumonia), you could go out with a wet scalp in frigid weather. A little frost bite might ensue and really make your life interesting. The late great Dr Jim Arnold often used a wool cap as a post op dressing and even sold them in his A to Z catalog. I have to credit him with that little trick.

All said, there are probably as many post op techniques used by successful doctors as there are doctors. They all have their pros and cons I suppose, but in the end, they all work. I've changed my technique numerous times during my career and will probably change it again some day. But for now, given that we've had thousands of happy patients with excellent results, I think I'll hold on to it a little longer.

Keep asking questions. We all learn a little from each one.

[Skeptic1st]

Thank you Spencer,Dr. Feller, and Dr. Pistone for your replys to my original question regarding keeping the scalp moist to limit scabbing/flaking.I lost all my scabs on day#8 post op and it felt SO much better to have flexible hair again. There is another blogger on this site named TeeJay73 that said his doctor applied Vaseline to his scalp immediately post op and he used it everyday for an entire week.. I cut and pasted the thread right here.

[QUOTE]
Hey Fellas,
Just thought I'd chime in here and let you know my experience. When I had my hair transplant, about 1 year ago, my doctor (Doctor McAndrews) had me keep my transplanted area entirely covered in vaseline for a full week. I had to apply it twice per day. About one week after my surgery, when I returned to the doctor's office for removal of my stitches, they also washed away the vaseline out of my hair for me. And, I had no scabbing or crusting at all. The vaseline entirely prevented it. So, if you're interested in this route, talk to your doctors about it.TeeJay73[/QUOTE[
If that was a cure all method to prevent any and all scabbing, why wouldint it be routine procedure for all surgeons? I know it would be nasty to have vaseline on your head for a week, and there would be no way to wash and shampoo it correct?And what about bacterial infection from not actually cleaning it?
Any thoughts on this particular method ?

I have another question if any of you care to comment.Will my transplant hairs(not the grafts) fall out guaranteed?If so, when can I expect that?They feel great right now!
Dale

[Gregory Pistone, MD]

Wound healing...continued

Well, as mentioned in previous posts, the scalp heals so well and has such a rich vascular supply, that getting an infection or having poor healing is extremely unlikely no matter what post op instructions are followed. My directions focus on several issues: making them as simple as possible, require the least amount of work and life disruption for my patients, and most importantly, involve as little tampering as possible with the grafts, especially in the critical first 48 hours. I also like to remain as economical as possible with my patients' hard earned cash and therefore do not generally use supplemental wound healing kits which may add $500 to a procedure with no well-proven advantages. In my experience, the more grafts are fussed with, the more likely something will accidentally be done to cause them to fall out.

For day to day wounds such as cuts and excisions, the current thinking is to apply only petroleum jelly or something like Aquaphor healing ointment instead of Neosporin or Bacitracin. The reasoning behind this is that the antibiotics often can cause an allergic reaction. So I suppose it would not be unreasonable to apply this to the donor area. So along these lines, it sounds like Dr Mcandrew's protocol is quite reasonable as long as one is careful not to disrupt the grafts. Again, many roads lead to Rome, and it's best to stick to what works best for your doctor.

[the B spot]

I found the use of Graftcyte to help quite a bit after my hair transplants.

I think the light misting spray helps reduce the urge to scratch or pick at the scabs and the overall mixture of the spray is supposed to help healing and post-op redness. Of course, nothing has been proven as to Graftcytes effectiveness, but I believe it helps.

Another great point in this thread is that there is no real generally accepted post operative "norm" other than don't bump your head around after surgery!

I believe many patients just do not know what to expect after their 1st HT's and just how uncomfortable the process can be for some patients. That same patient on his 2nd or 3rd HT with the same clinic is often much more familiar with the process, how long he or she needs to be off work, etc..... and YES, most if not all those recently transplanted little guys will be jumping ship in the next few weeks

So don't stress to much Skeptic, relax and let things take their normal course-can't wait to follow your progress!!!!

Take Care,
Jason

[Kelmf01]

The whole topic of HT after care looks to be a very sensitive & subjective area. Every clinic has their way of doing things. It would of been better for patients if there was universally acceptable & published steps for optimum recovery. This would minimize the failure rates of surgery procedures. In addition, self after care is not the same as being treated by knowledgeable clinic staff. This could be provided as a add on post procedure service or part of the HT value add.