Cosmetic Procedures
Hair Transplant: What to Expect Before, During, and After

If you are concerned about thinning hair, your dermatologist may recommend a cosmetic procedure called a hair transplant. This procedure has changed dramatically since the days of the hair plug. Results are now so natural looking that even hair stylists cannot tell when a person has had a hair transplant. The following explains what happens before, during, and after a hair transplant.

What Happens Before a Hair Transplant
A consultation is essential. Your dermatologist will ask about your expectations, examine your hair and scalp, and take a complete medical history. Be sure to tell your dermatologist about any bleeding problems, past hair-loss treatments, scalp surgeries, and medical conditions.

Your dermatologist also needs to know about all prescriptions, over-the-counter medications, vitamins, and herbal remedies that you take. If you are taking warfarin, aspirin, ibuprofen, vitamin E, or even garlic supplements, tell your dermatologist.

After some discussion, you will know if you are a candidate for a hair transplant.

Before the procedure is scheduled, you will need to get some blood tests. If the results indicate that a hair transplant is appropriate, the procedure will be scheduled.

You will be given instructions to follow before the procedure. This may include stopping certain medications and supplements as well as starting an antibiotic before the procedure. Alcohol should not be consumed for 3 to 4 days before a hair transplant. You will need to shampoo the night before.

What Happens During a Hair Transplant
A hair transplant may be performed in a dermatologist’s office or hair transplant center.

On the day of the procedure, the following will be performed:

• A small strip of the scalp that has good hair growth will be removed from the back of your scalp.

• The removed strip containing the hairs will be prepped.

• The prepped strip will be divided into sections and transplanted into an area(s) of the scalp that is thinning or balding.

This procedure is generally performed under local anesthesia. After a strip of the scalp is removed, the area is carefully sutured. While the patient is being sutured and prepped for the transplant, highly skilled technicians divide the removed strip into slivers of tissue. These slivers are then dissected into grafts that contain 1 to 3 hair follicles, which will be transplanted to the site or sites that need hair. 

Depending upon the extent of the surgery, this procedure can last from 5 to 6 hours or 6 to 10 hours.

To give patients the best possible results, another hair-restoration procedure may be combined with a hair transplant. A scalp reduction, scalp expansion, or scalp flaps can improve the overall results.

Many patients require only 1 treatment session. When more than 1 treatment session is needed, the next procedure is usually scheduled for 6 to 12 months after the first one.

What to Expect After Hair Transplant
You will be given post-procedure instructions. Be sure to carefully follow these instructions. Care must be taken after a hair transplant or any other hair-restoration procedure. The area will be sore and require at-home treatment to prevent infection.

It takes about 5 days for the transplanted hair to attach. During this time, it is important to be very gentle with the scalp. Apply medication as instructed, taking care not to rub the area. Most patients will be asked to shampoo the area, but to do so very gently. Rubbing can cause the transplanted hair to fall out.

Scabs will develop where the hair was transplanted. It is important not to pick at the scabs as picking generally causes the transplanted hair to fall out. Scabs tend to disappear in 10 to 14 days. 

Physical activity must be avoided for 7 to 10 days. This helps prevent the transplanted hair from falling out. Normal activity, including exercise, can be resumed after 7 to 10 days. 

References:
Sadick N. “Hair Transplantation.” In: Sadick N, Lawrence N, Moy R et al. Concise Manual of Cosmetic Dermatologic Surgery, China, McGraw-Hill Companies; 2008. p. 73-9.

Stough DB, Whitworth JM, Seager DJ. “Hair Restoration.” In: Bolognia JL, Jorizzo JL, Rapini RP et al, editors. Dermatology. Spain, Mosby Elsevier; 2008. p. 2355-68.

Unger WP. “Hair Transplantation.” In: Kaminer MS, Dover JS, Arndt KA, editors. Atlas of Cosmetic Surgery. United States of America, W. B. Saunders Company; 2002. p. 231-63.