advice on scalp redness

Dear All,

I am seven weeks after a HT, and my skin appears to be still rather irritated and red. I am also noticing some swelling and possible pitting, which I didn't seem to have one week after the surgery (see photos). I am also feeling pain in a few specific spots on the scalp.
Is all this normal? What could I do to reduce scalp irritation?

Many thanks!

Clobetasol

Thanks @TheBigMan, I will talk to a doctor about it! I am also wondering if the fact that I am constantly wearing a hat is contributing. I am of course avoiding the sun, but at present I wear a hat all the time, when I am out and/or with people. Does anybody know if hats are good, neutral or bad?

Just looking at your complexion, you probably have the worst skin for redness... are you Irish? Have a look at 'Dermovate' it was supplied to me by ASMED Clinic, not just my own recommendation

Also you mentioned irritation. They provided me with 'TERRAMYCIN' for pimples, apparently very good.

What you have are local pimple due to retaining the hair follicles in the grafts following the transplant. These follicles are dead and they need to come out. Your body is reacting to them by forming pimples and trying to get rid of the hair follicles. the live part of the follicle is still in the skin, but the dead hair shaft needs to come out. I can't see frank pitting in these photos. I'm not saying you don't have pitting. I just can't verify you have pitting. I do see the grafts are in rows rather than staggered however.

These dead follicles are foreign bodies. They are like a splinter in your skin. Once removed, the problem goes away on its own. If you don't get rid of them, they pimples will keep coming especially as the new hair begins to grow in. You can use a wash cloth and soap to aggressively remove these follicles. Another option is to use tweezers to remove the follicles. They should come out easily like removing a pin from soft butter. If you have to jerk on them, leave them in place. This is not an infection so you don't need an antibiotic and you also don't need a steroid. The second shot looks like you applied some sort of cream. Rubbing the grafted area can make it appear pinker. the general appearance is pinker in the second photo.

Many thanks for the opinion Dr Cole. The second picture was taken a week after the surgery, the others seven - sorry for the confusing order. I never applied any cream to date, but will try what you suggest. So, if I understand the instruction, i rub the scalp with soap on a cloth? I also read about rubbing the pimples with alcohol - would that work? What if do nothing: will it resolve itself, or will the follicles die?

Yes, I found the design rather disappointing, as I expected it to look more natural. However, the surgeon was rather experienced and I have seen other HT with aligned hairs, so I am not sure how I should rate the work overall. The extraction was done seemingly well. How would you rate it, if you can share your opinion?

Thanks!

Excellent, thanks @TheBigMan, will look them all up! I am English, and in the past have had acne and eczema issues.

This explains why the second photo is more pink than the other photos.

You have to remember that when a graft containing hair is transplanted, the hair will elongate for about 11 days. Then the follicles producing hairs goes dormant. The shaft is what remains from the actively growing hair implant. The hair shaft is dead to begin with. In days when larger grafts were performed, the scabs would come out and take the hair with them. When we began doing total follicular unit transplantation between 1990 and 1993, we saw that hairs often remained after the scabs came off. Eventually, these hairs need to come out because they cause a local irritation. This irritation will manifest in pimples or tender, red bumps. This is just your body trying to get rid of them. It usually does not require a great deal of effort to remove these hair follicles. If they are not getting longer, get rid of them. It is better to be slick bald at this point rather than to have these little follicles. Eventually, they can block the exit of new hair. Usually, these bumps get worse about the time new hair begins to grow. So, be aggressive in removing anything that is not growing. You can't hurt the grafts at this point unless you sunburn your scalp.

Hair does not grow in rows, but many physicians chose to graft in this way. I'm not sure why. With the hair longer, I imagine all will be ok. The rows are apparent with the hair short. Of course, this row patterning can be resolved in a future procedure should it present an issue for you.

you can culture these pimples all day long and they will not show pathogens that need treatment. therefore, antibiotics are not required. The solution is to remove any follicles that are not growing and to pop pimples.