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Hair Sciences Center - A RESTORE Partner

James A Harris MD, FISHRS
Shelly Lovitt, MD
In case of an emergency, call Dr. Harris
at 303-694-9381 Ext. 9

POST-OPERATIVE INSTRUCTIONS

PLEASE READ ALL OF THESE PAGES CAREFULLY

The success of the procedure we have just performed is not solely determined by the abilities of the physician and the transplant team, but it is also determined by the degree to which our patients follow the post-operative instructions.  If you have any questions regarding these instructions, please contact the office and a nurse will explain the process in greater detail.  Thank you for your cooperation and patience in following all the instructions.

THE FIRST NIGHT OF YOUR SURGERY PAIN:
You will be sent home with pain medications.  If you need pain medication other than what we can provide from our office a prescription will be written for you to fill at your pharmacy.

This moderate pain and discomfort may be present for 24-72 hours following the procedure; however, it should diminish with time and healing.  You have been supplied with a pain reliever (Motrin 800mg) for mild pain, as well as a narcotic pain reliever for moderate pain.  Follow the instructions on the outside of the packet provided for you.  If you are given a prescription to fill at a pharmacy, follow the instructions on the front of the container.  DO NOT drink alcohol or take over the counter pain medications while taking these medications.  If you are suffering from discomfort that is not being relieved by the prescribed medications, please contact the office.

ATP SPRAY:
When grafts are transplanted, there is an interruption of blood flow to the grafts, which mean the grafts aren’t getting the necessary oxygen.  The ATP spray that has been provided to you provides oxygen to the grafts until a blood supply is established.  For the first 48 hours, the transplanted area is to be sprayed every 1-2 hours and covered with the shower cap (the shower cap helps keep in the moisture).  After 48 hours, spray every 3-4 hours until the solution is gone.  The more you use the shower cap the quicker the scabs will resolve.

ITCHING:
If you experience any itching at the donor or recipient site, you can apply topical Benadryl cream or take an oral Benadryl 50 mg take one capsule.  If the itching is in the recipient area you will need to be extra careful as you apply to the scalp not to disturb the new grafts.

ICING: 
Ice your forehead the night of your surgery; this will reduce the risk of swelling.  Apply an ice pack to your forehead (not the transplanted area). You should apply the ice four to six times a day for 20 minutes a session.  The icing should be continued for at least 3 days.  If you are experiencing any discomfort to the donor area, you may also apply the ice packs to this area.

SWELLING:  
There is less than a 5% chance of swelling, but should it occur it is not harmful to you or the grafts.  Even if you follow all of these suggestions, you may still experience swelling.

During your surgery you have been given an injection of Depo-Medrol (if there was no evidence of an allergy to this), a medication to help reduce swelling. 

We urge you to begin icing the forehead (not the transplanted area) according to the instructions above. 

You may have been provided with a special tape that was applied to your forehead during surgery; this should be kept on your forehead for three days after surgery.  If there is evidence of swelling above the tape, leave the tape in place until it resolves.  Massage any fluid that may be in your forehead starting from the center region and pushing the swelling fluid toward the sides (temple area) as this will help prevent the fluid from descending toward the eyes.  

If the swelling gets into your eyes and nose the next step is trying to expedite its departure.  Use ice-cold moist compresses or washcloth on the eyes. You can use a bowl of ice water to moisten the compress then place it on your eyes until it warms.  Repeat this process as often as possible.  You can also use warm, wet (squeezed) tea bags will help soothe the tissues and place them over your eyes in the evening after a day of cold compresses.  Swelling in the eyes may cause bruising.  DO NOT massage the eyes.   The swelling can take up to 72 hours or longer in some cases, to dissipate.

ELEVATION OF HEAD:
For the first three nights after surgery sleep lying on your back with your head at a 20-30-degree angle (one or two pillows under your head).  This will help minimize the risk of forehead swelling.  This mainly applies to patients that have had grafts placed in the frontal hairline area.

BLEEDING: 
Your grafts may ooze during the night, this is normal.  It is normal for the stitches or FUE extraction sites to ooze as well.  You have been provided with blue protector for your pillow.

If a graft or the donor area bleeds the night of surgery, apply pressure with gauze moistened with tap water.  If bleeding does not stop with firm pressure applied for 10 minutes, call the office immediately.

NAUSEA: 
You have been given multiple medications during the procedure.  To avoid nausea, avoid eating greasy foods in combination with pain medications.  You may want to eat lighter meals and drink plenty of water.  If you have persistent nausea, call the office.

DAYS FOLLOWING YOUR SURGERY
Cleaning the donor area after the FUE method of graft harvest:

The day after your procedure, remove any dressing that was applied to the donor area (dressings are only used on patients that have the donor area shaved). Wash the donor area with your regular shampoo.  

Cleaning the donor area after the Strip method graft harvest:

A thin layer of Polysporin ointment should be applied to the stiches at the back of your head once a day for 7 days following your surgery; the ointment will be provided.  The stitches are absorbable and may take up to 2-3 weeks to dissolve. The sutures will not wash out if you have persistent crusts and the area may become infected. Clean the donor/stitched area well when shampooing.  If you have stitches that are not absorbable you will be instructed to return to the office for removal.

SHAMPOOING THE GRAFTED AREA:
You may begin shampooing gently the day after your surgery.  This process should utilize a gentle stream of water using a cup to pour water over your head instead of standing under the shower head. The transplanted area should not be manipulated with your fingernails.  To avoid manipulating the area, put shampoo and water into a cup and pour over the transplanted area.  Do this for three days.  This allows the suds and the water gently wash over the grafts.  DO NOT aggressively manipulate the transplanted area with fingertips or fingernails for the first three days after the procedure. On the fourth day after surgery you may shampoo gently in a circular motion with your fingertips if comfortable of else 1 week after surgery you shampoo as regular.  Increase the circular motion pressure while shampooing for the remainder of the seven days.  You should be back to washing your hair normally after seven days. DO NOT SUBMERSE YOUR HEAD UNDER WATER FOR SEVEN DAYS.  

Your crusts may start to come off on the 4th or 5th day.  It may take 7-10 days for all the crusts to fall off.

Hair combing may resume the day after surgery. However, the comb should not touch the grafts.

EXERCISE: 
Avoid swimming or submersing your head under water or any activity that requires the use of a helmet for 7 days after surgery.   

If you have had a strip graft harvest-procedure avoid exercising and raising your heart rate above 100 for 7 days after surgery.

If you have had an FUE graft harvest-procedure you may resume full exercise 3 days after surgery.

REGROWTH AND DEVELOPMENT OF TRANSPLANTED HAIRS:  

  1. Dormant Period-the first 3-4 months.  Once the hairs have shed the newly transplanted follicles go into a resting period before they start to produce hair.  This period is usually three to four months but in a small percentage of patients it may extend up to 6 months.  It is uncommon to see any regrowth of new hair during this period.  At the end of this dormant time the first of the new hairs begin to appear.
  2. Emergent Period-months 4-8.  The new hairs gradually appear during this period.  For most patients by 8 months 50-80% of the hairs have emerged.
  3. Maturation Period-months 9-10.  During this period patients will have 90-100% growth.  For some patients it can take a full 12 months for total growth.

NUMBNESS:
Numbness may occur in the donor as well as the transplanted areas.  It will usually resolve on its own within 3-6 months or less.

SHOCK LOSS:
If we have transplanted grafts in the areas where you have thinning hair, you may experience a temporary thinning out of this hair.  Although it is temporary, it may at times be severe and alarming.   

The use of Minoxidil pre-and post-operatively will decrease this loss and hasten the regrowth (as long as you’re not allergic to Minoxidil). 

TRANSPLANTED AREA:
The transplanted area will heal quickly, within two weeks.  You may experience some dandruff-like scaling, redness or itching during the first month after the procedure.  Over the counter hydrocortisone cream or lotion can be used in the area 2-4 times daily until it is cleared up. Topical Benadryl can also be applied to the areas that itch in both the donor and recipient area.  Some “ingrown hairs” or pimples may occur during the regrowth phase after the procedure; you might experience 8-10 ingrown hairs per 1000 grafts.  To take care of the “ingrown hairs” type pimples use a sterile pin to pop the pimple and use acne astringent to the area to help dry up the oils causing the ingrown hair.  If there are significantly more of these ingrown hairs, or evidence of infection, please call the office.  Do not let these fester, as they can become points of infection requiring antibiotics.

FOLLOW-UP APPOINTMENT:
If at any time you have a concern or issue, contact our office and we will address the concern either by phone or see you in person.  Otherwise, you will be contacted by our office through an email for a follow-up appointment 10 months after the procedure.  We look forward to seeing your great results!

INSTRUCTIONS Number of days post-surgery

Washing Hair Grafted Area: Mix shampoo and water in a cup and pour over the grafted area several times. Rinse by pouring water from the cup.

Donor area: Shampoo the donor area as you normally shampoo your scalp

Days 1-3

Shampoo the grafted area with a light circular motion using your fingertips.

After day seven wash all areas as you did prior to your surgery.

Days 4-7
ATP Spray: Shake the bottle before spraying. For the first 48 hours spray the solution to completely moisten the recipient area every 1-2 hours (including during the night) and cover with a shower cap. After the 48 hours spray every 3-4 hours during the day until the solution is completely used. Days 1-3

Apply Polysporin (For Strip graft harvest):                               Apply Polysporin ointment to the donor area for seven days. The ointment will be provided.

Days 1-7

Sun Exposure: Protect the transplanted area with either a hat or SPF 45 sunscreen spray when outdoors for more than 5-10 minutes.

Days 1-14

Hair Care: Brushing hair, hair dryer, mousse, gels and hairspray in the non-grafted area.

Day 1

Brushing your hair normally and getting a haircut including the grafted area.

Day 7

Removing Foam tape from your forehead:                                 Remove at day 3 unless there is significant swelling above the tape then leave the tape on for one more day.

Day 3

Intense exercise (After FUE harvest):                                         Running, aerobics and weight lifting.

Day 3

Rogaine Foam/minoxidil 5%: (if not allergic)                                Start patting foam lightly the in the grafted area once daily.
Starting day seven apply foam as usual. Continue using Rogaine/ Minoxidil once daily.

Day 3

Intense exercise (After Strip harvest):                                           Running, aerobics, weight lifting

Day 7