Post FUE Hair Transplant Vademecum – Firstduty and Mayhemag

What should one do after an FUE transplant?

This short guide should be seen as a summary of various opinions, studies and research on how best to deal with the post-op period after an FUE hair transplant. Written by First Duty and Mayhemag, it contains a lot of information from two long-standing Bellicapelli users who have experienced a hair transplant with the FUE method first hand. Always keep in mind that every clinic, therefore every doctor, provides his or her own post-op protocol, which you should refer to first. As post-operative protocols may differ from one clinic to another even on fundamental points, some points in the protocol provided by the clinic may contain instructions or indications that differ from those in this guide.
Of course, the protocol provided by the doctor who operated on you should be your primary reference.

The first days after the hair transplant operation

For the first 10 days it will be very important to avoid bumps, rubbing and contact with the skin in the recipient area, in order to avoid losing any grafts (2-3 mm long) that have not yet taken root and are firmly anchored (it may happen that some are lost carelessly after a strong involuntary blow to the head); therefore be careful while sleeping and during the day, and also with the same hat.

After the first 10 days all the UFs (follicular units, synonymous with grafts) will already be firmly attached to the skin. To be on the safe side, we advise you to take two weeks off and stay at home and rest (not to take any risks, but also to keep your head free to heal, and avoid the hat).

No washing with shampoos not supplied by the clinic in the first 5/6 days, as there is still a healing process going on..

Some of the grafted hair falls out together with the scabs in the first 15 days. Most of the remaining grafted hair falls out in the next 20 days. It is preferable to have no more scabs at the end of the 15-20 days. If scabs remain, they must be removed by gently massaging them in during washing, using the fingertips and not the nails (never tearing or scratching them off).
To help the scabs fall off, Bepanthenol lotion or spray can be used from the tenth postoperative day, leaving the product on for 5-10 minutes before shampooing.
As many will know, up to 1/2 months the grafted hair will grow normally, and then fall out and grow back (this is the psychologically toughest phase, because there is a worsening of the appearance and a sort of return to the initial phase, but in reality the bulbs are correctly grafted into the skin and one just has to wait for them to grow back).

Disconnected transplanted hair

Another part of hair, however, will not grow because it is already completely disconnected. Disconnected hairs are internally detached, and not destined to grow, but will have to fall out to allow new hairs to grow in from underneath, generated by the transplanted bulb.
To recognise a disconnected hair, a month after the transplant, it is sufficient to assess its regrowth over a couple of weeks (if it remains the same length, especially compared to the others, then it is disconnected!).

It can happen that this disconnected hair does not fall out on its own (as one would hope) but remains attached to the skin for months, preventing the new hair underneath from coming out. In such a case, when you have recognised the phenomenon due to the characteristics described above, you can try to remove the disconnected hair by pulling it very gently with tweezers (hardly any force is needed, as the hair is not attached to the bulb), thus facilitating the future release of healthy hair. If you accidentally pull out a functional hair, don’t worry, the follicle is under the skin and will produce a new one. But if you see that the hair offers resistance to pulling, then it is not a disconnect and you should leave it where it is.

Directly grafted hair

A small part of the transplanted hair (usually 5-10%, but percentages can vary a lot) will not go through the shedding process before growing back, but will directly take root from the start. And of course another very small percentage (in some cases zero), may not grow back (but if the surgery goes well, we don’t even notice it!).

Integration and supportive therapy

Immediately after the transplantation, it is possible to start a long-term therapy of B vitamins (especially high-dose biotin), zinc and magnesium plus MSM (Methylsulfonylmethane), which contain useful nutrients for the hair and can facilitate better and faster hair growth. With regard to B vitamins, a supplement based on brewer’s yeast tablets (also rich in B vitamins and not only, but also copper, zinc, selenium, etc. – and known for its ability to promote hair growth) can also be used as a source.

From the point of view of pharmacological treatment, Finasteride should never be interrupted, neither before nor after nor during the days of the transplant (although interrupting it for a few days never leads to any consequences) to ensure the maintenance of the natives. For Minoxidil, on the other hand, you must ask your doctor (some recommend suspending it for long periods, others for short periods, others for life). Normally Minoxidil is suspended for about 15 days before the transplant and is only resumed once it has healed (about 1 month, but it depends on the case and the surgeon’s protocol).

You can also take a quality Omega 3/6/9 complex (I say quality because the cheapest and cheapest ones often contain residues of heavy metals), maintaining a dose of 2-3 grams per day for the rest of your life (the benefits to your heart and health in general go without saying).

Sun exposure and hair regrowth after transplantation

As far as sun exposure is concerned, absolutely avoid direct exposure in the first few months; around 5/6 months it is possible to apply protective cream/spray (at least 40 FPS), but in general it is preferable to avoid prolonged sun exposure (free tanning with consequent risk of sunburn) for the whole of the first year.
It is important to note that from about the 3rd month onwards, regrowth is mainly lengthwise (the new hairs sprout), while from about the 7th to the 15th month it is also thicker (so as not to discourage those who do not notice a substantial improvement in density in the first few months). This tells us that the results are fully appreciable around 12 months, but the actual results of the transplant can be fully assessed a little later, at around 15 months.

Aloe Vera in the post-hair transplant period

Many people have talked about the use of Aloe Vera in the post-transplantation period, sometimes creating a bit of confusion that has mistakenly led to the belief that it can be used for scabs. This is wrong.
Aloe Vera has several notable beneficial properties, some of which are not insignificant in our case: regenerating, stimulating the regrowth of epithelium on wounds; proteolytic and cicatrizing, which serves to promote the dissolution and absorption of dead or damaged cells, aiding the regenerative process; anti-inflammatory, moisturising, antibacterial, antipyretic (giving relief from fever and burns), relieves itching and has a haemostatic action (reducing blood loss). In short, it is a perfect candidate for post-ht care, but in a precise phase which is that following the fall of the scabs.
Therefore, to favour the fall of the scabs it is advisable to use Bepanthenol lotion or spray; while when the scabs have completely disappeared Aloe Vera gel can be used to allow a better recovery of the recipient area and to reduce the post-operative redness (in this case, also for the donor area, which sometimes tends to be neglected and where the redness lasts for several weeks).

Summary of the article

• • 1st-10th day: do not carry out ordinary washing (wait at least until the 6th day to start), do not hit the recipient area, do not scratch, do not pull the scabs. Do only and exclusively what the post-operative protocol provided by the clinic says. From now until the 7th-8th month, completely avoid exposure to the sun (using a cotton hat). Begin possible supplementation with B-complex, high-dose biotin, Omega-complex, MSM, and continue Finasteride treatment (for minox you must ask your doctor).

• • 11th-30th day: wash as described and make sure that by day 20 the scabs have fallen off completely, if this does not happen do not force it but ask your surgeon if you can increase the frequency of washings. Once the scabs have fallen off, you can stop using Bepanthenol and start applying Aloe Vera (optional). After about one observe the length of the remaining transplanted hair, to detect (and if so, very gently remove) any disconnected hair from the follicle. Disconnected hairs are those that do not grow and do not fall out.

• • 2nd-3rd month: the toughest phase, during which most of the transplanted hair will probably fall out (normal post-operative loss), but will then grow back.

• • 4th-12th month: the hair will grow back in length and thickness, and after about a year you will be able to see the final results of the transplant and assess its success. After the 10th month, exposure to the sun can be resumed (it is advisable to ask your surgeon).
  • 12th- 15th month: the final regrowth in thickness takes place, therefore a conclusive, although usually marginal, improvement in density in the recipient area can be seen.

Hair transplantation support information

According to some studies and empirical evaluations, the percentage of transplanted hairs that grow back, in the case of an ad hoc transplant, is about 90-95% on average, with even peaks of 99% for multi-follicular grafts (2/3/4/5 hairs). The reason for the lower rooting capacity of single FUs is said to be that they are more delicate and subject to handling and drying trauma, which is less likely for multiple FUs, where there is a greater layer of adipose tissue to act as a protective barrier to the follicles. In any case, be aware that the real chance of success will depend almost entirely on the skill of the surgeon and his staff.

An interesting study (conducted in 2006) was carried out on 42 patients to determine how soon after transplantation the new UFs took full root. The method simply consisted of pulling the hairs with tweezers (as described in the guide). On the first two days pulling the hair resulted in total loss of the follicular units; on the sixth day pulling more gently did not cause the follicle to leave the site, but pulling more forcefully on an adjacent scab resulted in the loss of the follicle.

In conclusion: the presence of scabs in the recipient area increases the chances of the follicular units being lost in the days following the transplant, so preventing excessive scab formation (or facilitating its fall within the set time by means of the procedures indicated by the surgeon) can reduce the period of risk and therefore greatly increase the chances of success, and obviously the patient’s return to everyday life more quickly.

It should be remembered that each transplant is in any case a case in itself, since it depends almost absolutely on the characteristics of the subject, also in relation to the size of the transplant (one thing is 1500 uf for a touch-up, another 5000 for a reconstruction). There are too many variables to define an objective procedure. For example, there is the case of a bellicapelli user who suffered from dermatitis before undergoing surgery, which recurred after the transplant, forcing him to use a shampoo that was suitable for the problem but too aggressive for the circumstance (post-transplant). Always consult your surgeon for any doubts or needs, and of course use the forum.

Post-transplant hair trimming

Again, each surgeon dictates his own timetable. Generally speaking, for the donor, any instrument (scissors or machine/clipper) can be used once the area has healed, i.e. after about two weeks. As far as the recipient is concerned, it is best to wait at least 50 days for a gentle cut using scissors and about 70-80 days for the machine.

Hair specialist doctor

A last clarification that could clarify some doubts for those who want to approach this kind of intervention and are looking for a doctor: a dermatologist is a doctor specialised in dermatology (the branch of medicine that studies the skin and its parts, including hair), while trichology is the part of dermatology that deals more specifically with hair, and in which one can become more expert through post-graduate or post-specialisation courses or masters (not compulsory).
Both specialisation and courses/masters are optional, and do not preclude the ability to perform surgery, at least in Italy.
Any doctor, who is not specialised, comes out as a Surgeon according to Italian law, so by law he/she can operate and do any kind of surgery (including an FUE), even if he/she has no specialisation in the field.
Therefore, before relying on any doctor who moves in the field of Aesthetic Surgery, make sure he is specialised in the field of interest (this is certainly true for Italy, in other states the degree courses and obligations by law may differ).

DISCLAIMER

This is not a real guide but more a set of notions and reflections (most of them taken from various interventions on the forum bellicapelli) aimed at removing doubts and helping users to manage in the best possible way the post-ht (which, contrary to what is believed, as for most surgical interventions, depends largely on the post-op and its management).

These are clearly general indications as the response to surgery is subjective and some measures may not be suitable for certain circumstances (often treatment is based on one’s own responses).

Some of these notions may not be endorsed by some clinicians, so please refer to the above..