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FUT (Strip Method) With Stitches
What to Chose?
What care you need to take and how should you expect the progress after your transplant?

Immediately after the procedure the heaviness, numbness or tightness may be there for a few hours.

There is also some swelling of your forehead and temple area due to the anesthetic and surgical reaction this is normal and do not get scared when you see your face in mirror immediately after the procedure. Sleep on the back or on your sides but do not sleep on your tummy otherwise the swelling tend to gravitate on your face and eyes.

Rarely some patients may feel momentary dizziness esp. while standing up from the lying down position on the procedure table.

There is some oozing of blood stained fluid from grafted site as well as in donor area (both in case of Strip or FUE). Banding forward of the neck can stretch the stitches and can initiate some more oozing from the stitches therefore keeping the chin up by using neck collar can help to relax the skin in the stitch area for a first few days. Using a clean cap to cover the area can not only be more aesthetic but can also protect the operated area from dust, flies and sun exposure esp. when you are out door for at least first 5 to 7 days.

Spray the saline or water every hour or 2 on the grafted and recipient site to reduce the scabbing ( scab is nothing but dried blood)

After 6 to 10 hours stitch site tends to give some discomfort or some pain and tightness esp. while sleeping due to wearing off of anesthetic effect. FUE donor site usually remains painless

There may be blood stain on the pillow from the donor area if you have not kept any clean cover on the pillow you may directly spoil the pillow.

Although most swelling will go today some swelling will stay for another week to 10 days. 

Usually first head wash after 8 hours is desirable to keep good hygiene and also to reduce scab formation. When possible first wash is best done at the clinic the next morning. Use the spray bottle for using Mild Baby shampoo and thereafter for rinsing with the water in the morning and evening. Avoid rubbing or scrubbing in the grafted area (only use spay wash) for 10 days there after it is safe to scrub and rub in grafted area because the roots are well fixed by 10 days in the skin and there is no risk of dislodging them after 10 days as studies have shown (although the hairs in the grafts along with the scabs will be shed while washing and this is normal and you may also notice some sticky white soft substance under the dark scab along with the shedding hairs. This white substance is not root if you see them shedding after 10 days. This is a normal phenomenon and occurs with every patient.)

Stitch area need to scrubbed well from the first day by rubbing with your own clean hand other wise under the hair it may not remain clean and the remains of the blood scabs may invite infection and the overlying hair may get stuck to the stitches and difficult to comb and will give you lots of discomfort and tightness too.

Every time you wash some white grain like elevations area seen the grafted area this is because a small part of the graft or Follicle remains above the surface and with the water contact it tends to swell up temporarily and becomes more noticeable for an hour or so and thereafter it will again become less conspicuous. This may occur for first 10 days. This is normal.

You may be more aware about the tightness in the area of stitches and occasionally some numbness above the area of stitches. The numbness in the grafting area can also be experienced by some patients. The grafting area numbness will go by 3-4 weeks usually. The numbness above stitches may last at times take 3-6 months.

There is a mild scabbing if you have washed well on initial 2 days otherwise the scabs may be large and at times remain stubborn for 2-3 weeks.

Stitches tend to dissolve and the loops of the thread separate and shed after 20 days. It may be possible to get rid of the threads on the surface after 12 days by help of a doctor or a nurse. Removal after 12 days of the threads does help to give you a better scar.

Some scales or crusts dryness and itching in grafted and donor site scalp may be experienced. This need to be cleaned well to get rid of and one may use emollient like hair oil to make skin suppler. Poor or inadequate hygiene can lead to infection and pustule in grafted and stitch area as well.

The transplanted hairs (about 70% of them) will shed gradually during this period and about 30% may not shed at times) This is natural phenomenon and happens to every patient. Shedding of hair during this period does not mean that your newly transplanted roots are also shed or gone. By 10 days the roots get well fixed in the skin and they will re grow the hair after about 4 months.

Avoid exercise, Gym and swimming like activity for about 3 weeks to allow safe healing of the stitches.

Some people tend to have redness or darkness of the grafted area skin. They should avoid sun exposure by use of cap and use of sunscreen cream on the grafted area. Some times steroid cream is prescribed to reduce this redness.

One can have Hair cut, hair styling and hair treatment after 3 weeks.

One may start using Minoxidil after 10 days of transplant in the recipient area.

Most people start growing new hair from the transplanted roots by about 4 months the period up to 4 months is called panic period because patients tend to lose patience during that period and tend to keep calling the clinic because they have shed the transplanted hair and they do not see any growth during first 4 months. Well some people grow new hair by even 2 months and some may grow as late as 8 to 9 months. BHT hairs may grow even later than that at times.

Emergence of new hairs from the grafted site may show appearance of pimples which usually subside on their own. If you see pustules or infected pimples it is best to take help of Doctor who may prescribe you with a course of mild antibiotics.

Well initial hairs are thin, light coloured and less in number and it takes may be up to 6-9 months for all the hairs to grow from the transplanted roots. The initial baby hairs then grow in length and thickness and mature in their texture and colour and this may take about 12 to 18 months before you get the permanent final result of your transplant.

Some people may experience some hair fall and even some hair loss in the pre transplant existing hairs this is called Telogen Effluvium. This is more common in females than in males. Use of medications like Finasteride (only for males) and Minoxidil can help to control this hair loss.

The grafted hairs have grown to some length and most people get some appreciable result although the improvement usually continues till 12 to 18 months

This is the time when the skin on the donor area has become suppler and transplants have usually grown some length so it is possible to judge whether you need more transplant or not ( another session)

The full permanent result is achieved by 1 to 1 and a half year. The growth rate of the grafted hair is usually over 90 % in most patients although rare cases may have poor growth due to some unexplained reasons. It should also be known that it is not usually possible to get as much density as the nature gives or as much as you may had in your young age. Hair Transplant is will not make you look like a film star.

Special issues after Transplant- explained below:

1. Head wash and bath & how to use caps?  Usually we recommend having the 1st wash after the transplant on the next morning at our clinic. This is a thorough wash that removes most of the dried blood and makes area cosmetically clean and more presentable. This also cleans the donor area (including stitches in the Strip Surgery). This makes your task of washing (with the spray that we give) easier. This also eliminates the chance of any problems of stitches due to poor hygiene and reduces the pain of the stitches (dried blood if at all sticking on the stitches make the cleaning difficult on your own and may even give you more discomfort).

How to use caps after HT?
How to spray wash after HT?

2. Growth and shedding of transplanted hair:  For almost all patients the transplanted hair falls out gradually from two to four weeks following transplantation. During this period some of the hairs actually grow (pseudo growth) before falling out. Sometimes the hairs come out when the crusts fall off the skin (attached to the crust) or they may remain to fall out later. Rarely, some of the hairs may not fall out and will continue to grow without interruption. (This is not a problem – you can cut the hairs if you want)

3. Regrowth and Development of Transplanted hairs

  • A. The first 3 -4 months- Dormant Period: 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 may extend even up to 6 months. It is uncommon to see any re growth of new hair during this period. At the end of this dormant time the first of the new hairs begin to appear.
  • B. Months 4 - 5 through 8- Emergent Period: The new hairs gradually appear during this period. For most patients by 8 months 90% of the hairs have emerged. For a small percentage of patients there may be a delay of 3 to 6 additional months before full emergence of hair has occurred. Newly emerged hairs are very fine. Hairs along the hairline often appear before those further back, and commonly the crown hairs are the slowest to appear. It is common to see irregular or patchy hair emergence in the beginning that evens out toward the end of this period.
  • C. Months 9 – 12 - Maturation Period: During this period the new hairs thicken and mature. For patients with coarse hair, the hair may actually get somewhat frizzy during this period before relaxing in another three to four months. For 95% of patients the full result of their transplant is achieved one year after their procedure. For a few patents it takes and additional 3 to 6 months to see the full result.

4. Getting Haircuts as the new hair grows in: Because the new hairs come in gradually and are fine in caliber, the vast majority of patients find that they do not have any problem with their appearance as the transplant develops. However, some patients find that keeping their hair short all over their head as the new hair grows in, makes the process even less evident. It is ok to cut the newly growing hair without fear of any damage. The hair can be cut as short as a number one clipper setting if desired.

5. Use of Rogaine (Minoxidil): If you have been using Rogaine before your procedure you should continue to use it. If you have not used Rogaine prior to your procedure, you should not start using it unless the doctor has specifically told you to. Contrary to internet rumors, there is no scientific basis to the belief that applying Rogaine to the transplanted scalp will make the hairs grow in faster or better. Rogaine can be very irritating to healing skin, so do not put it on the part of your scalp that has been transplanted until 10 days after treatment. If you have been applying it to a part of your scalp that was not transplanted you can continue to apply it without interruption following your procedure – just take care to not let it get on the healing transplanted scalp in the first week. If you have been using Rogaine for 4 months or longer, abruptly stopping it for longer than a week can cause increased shedding of hair.

6. Activities:

  • A. Sun Exposure: Protect the transplanted scalp form the sun for two more weeks, either with a hat or SPF 45 sunscreen spray when outdoor for more than 5 – 10 minutes. This is to prevent forming dark spots on the healing skin. As is always true, sun exposure after this time should be judicious and use of sunscreen is always advisable as good health practice.
  • B. Exercise and Sports: There are No Restrictions. After 3 weeks in case of strip method and after 5-7 days in case of FUE. You can swim, run, do aerobics, weight lifting, and even contact sports without fear of damaging your transplant.
  • C. Sexual Activity: There is No Restrictions after 3 weeks for strip method and after 3-5 days in FUE.

Activities After Procedure:

  Indoor Activities Day 1
  Hair Wash Day 1
  Office Work Day 2
  Travel by Flight Day 2
  Alcohol Day 4
  Hair Gel, Spray, Moose,oil After 1 Week
  Gentle exercise After 3 Weeks
  Hair Cut / Dye After 3 Weeks/ 6 weeks
  Heavy Exercise / Gym After 4 Weeks
  Swimming After 4 Weeks
  Sauna Not for a few months
  Walk Day 1
  Smoking after 6-8 months

7. Hair Cuts: Wait 3 weeks after HT to get a haircut. It is best to keep the hair at the level of the donor incision 1 inch or longer with your first 3- 4 haircuts. It takes 8 to 12 months for the donor incision to reach its final stage of healing and for all the hair to grow back around the incision. For some skin types it is common for the incision line to be pink for several weeks to a few months before fading to pale color. For some patients there may be temporary shedding of hair adjacent to the donor incision. It takes 6 to 12 month for full recovery of these sheded hairs.

8. Hair Care Products and Hair Cosmetics: You can return to use of any of your preferred hair care products: shampoos, conditioners, gels, mousses, etc. The Head and Shoulders and Neutrogena product lines are excellent for maintaining hair and scalp health, but you can use the products you know the best. You can color your hair beginning one month after your treatment. It is safe to use semi-permanent or permanent coloring agents. Try to avoid strong bleaching agents as these can be damaging to your hair whether transplanted or native. You can also use alopecia masking cosmetics such as Toppik (http://www.toppik.com/toppik.asp) or Dermmatch (http://www.dermmatch.com) . You can use a laser comb if you like. We know this will not hurt anything. Although there are claims otherwise we have not seen adequate scientific evidence that low level laser therapy prevents hair loss or restores lost hair. There is evidence that ongoing use promotes thickening of existing individual hair shafts. It is OK to use this if you want. We have no preference of models or manufacturers.

9. Diet: Do not over eat the night after surgery. It is normal to feel a bit of nausea.
Can eat anything but not too salty for 3 days to reduce swelling of the forehead.

10. Getting into Cars or rickshow Be careful when you get into a car! Make sure your head will not hit the rim of the door or the roof - the transplanted grafts can be dislodged. For the same reason beware of the cupboard door.

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