Q- What precautions should I take before undergoing hair transplantation?
Ans.- Patient should tell the treating doctor about various medications allopathic, homeopathic, ayurvedic or any other medication which he is taking or has taken earlier. Patient should also tell the doctor about the medications he is allergic to or had some adverse affect in the past. Some of the most commonly advised precautions are:
- Patients should stop all aspirin-containing medications, vitamin E, and ginkgo preparations (eg Revital) 10 days before the proposed date of procedure.
- All non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen should be stopped 5 days before hair transplantation.
- Cigarette smoking should be stopped completely for 7 days before the procedure.
- Alcohol intake should be stopped 3 days before the day of hair transplantation.
- It is advisable to take vitamin C 2000 mg daily for 1 week before surgery.
- If the patient is to receive intravenous sedation during the procedure then they should take from mouth after the midnight on the day before the surgery.
- Tablet alprazolam 0.5 mg can be taken at bedtime on the day before surgery to reduce the anxiety and stress of procedure in an anxious patient.
- Patient should take light dinner on the night before surgery and if no sedation is to be given then patient can have light breakfast on the day of the hair transplantation.
Q- Are there any tests before undergoing the procedure?
Ans.- When healing or bleeding characteristics are concerns, consider performing screening blood tests, including tests of following:
- CBC count with platelets
- Prothrombin time (PT)
- Activated partial thromboplastin time (aPTT)
Further testing (eg, chemical profile) is occasionally performed as the patient’s medical condition dictates.
In female patients, extensive workup is indicated to rule out potentially treatable causes of the hair loss. Include tests of the following:
- CBC count
- Total iron and ferritin
- Thyroid function tests and thyroid-stimulating hormone
- Total and free testosterone
- Dehydroepiandrosterone (DHEA) sulfate, in cases of irregular menses
Further testing (eg, ECG) is occasionally performed as the patient’s medical condition dictates. It also may be prudent to screen for antibodies to HIV hepatitis B and C
Q- Will I get natural looking hairline from hair transplant?
Ans.- An aesthetic hairline design is crucial for providing a natural-appearing result appropriate for the individual at present and in the future. An aesthetic hairline design requires a hairline which is irregular and wavy in appearance, with a slight to substantial fronto-temporal recessions depending upon the individual case scenario. In basic hairline design, the central portion of the hairline is placed 8-10 cm above the nasion (root of the nose). From there the hairline is carried laterally in a posterior-sloped direction. This design results in the central aspect of the hairline being the anterior most. In some patients creation of a slight widow’s peak improves the natural appearance.
In patients with substantial posterior recession of the superior aspect of the temporal hairline, transplanting to this area is done to increase hair density superiorly. Here fine grafts containing 1-2 hair follicles are used to create a thin but natural-appearing hairline. The resulting temporal horns allow the lateral hairline to join with the superior temporal hairline, even if the transplanted hairline is high and thereby preventing an isolated frontal tuft.
While transplanting hair follicles in the crown region a more conservative approach is used because of the likelihood of progressive enlargement of the bald area over the crown. In future additional grafting can be required to avoid the appearance of a donut-shaped area of bald scalp surrounding a central circle of transplanted hairs. Usually the anterior one half to two thirds of the crown is transplanted densely, while the remaining area is less densely transplanted by scattering 1- or 2 hair micrografts to provide some minimal coverage to avoid the appearance of a shiny area.
Q- Is hair transplant very painful procedure?
Ans.- Preoperative analgesic and anti-anxiolytic medications are given to the patients prior to the surgery and intravenously throughout the procedure. In addition, local anesthetic drug is administered slowly, using a fine 30-gauge needle to minimize the local discomfort. 1-2% lignocaine with 1:100,000 conc. epinephrine is infiltrated along the donor area to provide local anaesthesia and minimise intra-operative bleeding. For recipient area anaesthesia one can block the nerves supplying the anterior scalp or can give a ring block anterior to the recipient area or can infiltrate the whole recipient area with the prepared anaesthetic solution. Best pain control is with combination of any two of these techniques along with intravenous sedation. Care should be taken to limit the lignocaine dose to 7 mg/kg with epinephrine (maximum 500 mg) or 4.5 mg/kg without epinephrine (maximum 300 mg). After 2 hours, the local anesthetic should be supplemented with 0.25%-0.5% bupivacaine with 1:100,000 epinephrine (maximum dose of 200 mg). This will prolong the anesthetic effect to last for more than 4 hours.
Q- what are the precautions to be taken and how long will be the follow up?
The patients can leave the office bandage free. There can be some upper eyelid swelling in few cases for which a strip of elastic tape can be placed across the patient’s forehead. This tape is worn for the next 3 days and can be easily concealed by wearing a hat.
The patient is placed on oral antibiotics and analgesics for 5 days. Some clinicians prescribe oral corticosteroids in tapering doses to prevent patient discomfort and facial edema. Oral supplementation of Vitamins and Minerals is beneficial in all cases. Rest on the day following the hair transplant procedure is not mandatory but advisable.
On postoperative day 1, the patient returns to the office for a hair wash and checkup. The occasional “popped” graft is returned to the recipient site during this visit.
From the postoperative day 3, the patient can wash their head by gently applying any mild shampoo and rinse it with slow flowing water.
Sutures are usually removed on days 10-12. By this time, all the crusting should be gone and the scalp appears entirely normal.
Following the procedure patients are advised to avoid exertion for the first 48 hours. After 48hrs light exercises can be resumed. After postoperative day 5, no further activity restrictions are placed except for swimming, which must be delayed until the postoperative day 14.
Patients are advised that more than 80% of transplanted hairs fall out between postoperative days 14 and 21. With follicular-unit grafting approximately 20% of the transplanted hairs may continue to grow. The transplanted hairs which have fallen will reappear 3-4 months later and will continue to grow for the rest of his life. To shorten this interval of hair regrowth, patients are instructed to apply minoxidil daily for the first 3 months.
Approximately 50% of the patients choose to undergo a second hair-transplant procedure after some time. This can be performed as soon as 5 months after the first procedure. The most common reasons for patients demanding a second procedure are to increase the hair density and to cover more areas that could not be covered in the first procedure. In second procedure the donor site is chosen almost always along the first procedure’s donor site to give a continued single incision line and minimal scarring.