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After Surgery

WARNING! – DO NOT DRIVE OR DRINK ALCOHOL WHILE TAKING PAIN MEDICATION, ATARAX, VALIUM OR AMBIEN

Do not drive, ride a vehicle, or otherwise put yourself in any position where alertness and balance are essential while you are taking your pain, muscle relaxant and/or sleeping medications, such as Valium (Diazepam), Ambien, Tylenol with Codeine, and Vicodin. All medications need to be taken after eating to avoid nausea and/or upset stomach.

 

MEDICATIONS:

1. After surgery you will receive a prescription for antibiotic capsules or tablets. These are usually Cephalexin, Cipro, Ery-C or Bactrin DS. Take them as instructed.

2. After surgery, you will also receive a prescription for Mupirocin (Bactroban), an antibiotic ointment.  Apply a thin coat to the graft and suture areas daily after shampooing on post-op days 4, 5 and 6.

3. You were given a prescription to control discomfort before you left the office. This is usually Norco, Vicodin, or Percocet. Use it as instructed on the label. Take Atarax (for nausea, itching, and sleep) with it, if so instructed.

4. ITCHING: Take Atarax for itching. Do not drive as it will make you drowsey.

5. You can use an ice pack on your donor area for comfort and on your forehead to reduce swelling. If you get swelling, use an ice pack for 10 minutes 1 or 2 times an hour for the first 1-3 days. (Frozen peas in a bag work well, if you do not have an ice pack.) You will probably not get swelling,

6. Zofran is for nausea.

 

TRADE NAME – GENERIC NAME
Tylenol – Acetaminophen or APAP
Valium – Diazepam
Vicodin – Acetaminophen with Hydrocodone
Norco – Acetaminophen with Hydrocodone
Toradol – Ketoralac Tromethamine
Talwin – Pentazocine
Restoril – Temazepam
Atarax – Hydroxyzine
Zofran ODT – Ondansetron
Percocet  – Acetaminophen with Oxycodone

Note: DO NOT put ice on your grafts.
Your Doctor or Nurse will review meds at discharge

 

MEDICATION INSTRUCTIONS:

•    Cephalexin 500 mg. (Substitute with Bactrim or Cipro if allergy). Take one (1) capsule every morning and evening until gone. This prevents internal infection. Start after you get home the first night. Take with food. You were given a capsule at the office before surgery.

•    Bactroban Ointment (Mupirocin). Apply thin coat to your stitches (sutures) and grafts daily after shampoo on days 4, 5 & 6.

•    Norco (Hydrocodone) Take one-two every four hours for discomfort. Start 1-2 hours after surgery. After 24 to 36 hours, three – four (3-4) Advil/Motrin should be sufficient.

•    Restoril (Temazepam) This is for sleep. Request prescription if needed.

•    Shampoo: Head and Shoulders Smooth & Silky, no conditioner.
•    Atarax (Hydroxizine): Take for itching. Take with Norco to prevent nausea.

•    Fioricet: Take two every six hours for headache. May take with Norco if needed the first night.

•     Zofran ODT: Dissolve under tongue for nausea.

 

CLEANING GRAFTS AND SUTURES:
Do not use pure alcohol or pure peroxide to clean your grafts. This could kill the grafts!

 

CARE AND CLEANING OF GRAFTS AND STITCHES:

 

FIRST NIGHT INSTRUCTIONS & MEDICATIONS

1.     Pain Medication: Atarax is for nausea, itching, sedation and swelling. Take one Atarax with each Norco, and two at bedtime. Take the first Atarax as soon as you get home, then eat something, then begin taking your pain pill after four to five bites of food.

2.     Norco Doses:  A) Up to 200 lbs body weight; 1-2 every 4 hours for pain as needed. B) Over 200 lbs body weight; 2-3 every 4 hours for pain as needed for FUT, probably one for FUE.

3.     Ice (This is optional): Use a bag of frozen peas alternating between forehead and donor site at one-half hour intervals. Have three to four bags so you can keep a frozen one in use. Continue this for the first two days. DO NOT put ice on grafts.

4.     Position: You need to keep your body and head propped up at least 30 degrees for the first few nights. You can use a reclining chair or a stack of three pillows, or an arm chair pillow (see photo next page). Also, you may have an air pillow for use around your neck. Use the air pillow for at least the first three days. This prevents your grafts from rubbing on the pillow case. Put a clean pillowcase on every night.

5.    Oozing: Slight oozing of the donor is normal. This would appear as red, clear, or amber translucent bubbles. These should be blotted with the provided 4×4 gauze which you were given. By blotting these gently, you will prevent larger crusts. For continuous oozing, apply gentle pressure for 30 minutes using a damp gauze.Or lay an ice pack under the oozing area for 60 minutes. A medical staff member will clean the crusts at the office in the morning.

6.     Shampoo: None the first 3 nights.

 

1ST THROUGH 3RD DAY AFTER SURGERY

Shower from ears down leaving ointment on grafts and stitches

 

4TH THROUGH 6TH DAY AFTER SURGERY

Shower, letting water run full force on top of head; shampoo sides. GENTLY towel dry
Apply ointment to grafts and stitches.

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7TH THROUGH 14TH DAY AFTER SURGERY

1. Resume shampooing in a full strength shower. Let water flow on head for about 10 minutes to soften scabs. Apply shampoo & use FINGERTIPS or SPONGE in gentle circular motion on BOTH grafts & stitches. Stop ointment.

2. Resume normal exercise routine. Do not hit your head.

3. You may begin to use cosmetic coverups such as Dermatch or Couvre.

4. Freshly washed pillowcase daily.

5. DO NOT PICK OR FORCE OFF CRUSTS. Crusts will generally be gone in 10 to 14 days.

6. Sutures are removed from your donor site after 12-16 days. You have an appointment for this. We will remove any crusts that remain at this visit.

7. Hypoallergenic skin tone cosmetics can be used to hide pinkness.

8. You may resume Rogaine, starting on the 14th day, if you have used it before your procedure, or continue the Minoxidil 2.5 mg pill (Rogaine) throughout the procedure.

 

FOLLOW-UP: Your first follow-up visit is1-4 days after surgery. Suture removal is 12-16 days. The doctor will want to see you at five months and one year following your procedure, then annually.

ACTIVITY: Avoid any activity that may result in hitting your head, such as contact sports, piggy back rides for kids, etc. Be careful getting into and out of cars.

WEIGHTLIFTING: After first 5 days, weight lifting can be resumed. Cut back 25% and work back to normal weights after stitches are removed.

EXERCISE: Jogging, running, golfing, tennis, etc. is OK – AFTER 5 days.

SWIMMING: In pool after 7 days or in ocean/lake after 14 days.Always shower/shampoo after swimming.

AVOID SUNBURN: Use hat or sun block outdoors for 30 days in summer.. Wear a freshly washed hat when outside for 2-3 weeks.

Healing Process

The following series of photographs depicts the progression of graft healing during an 8 day period. Photographs were taken for 8 consecutive days. Patient had transplant procedure within the hairline area.

Showing the healing process over an eight-day period

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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NORMAL EVENTS ASSOCIATED WITH PROCEDURE

You may get some swelling of the face. This usually begins on the second day after surgery. It is most common when grafts are placed in the front of the head. DO NOT lie flat until the swelling is gone. Keep your head up. The longest known time for swelling to last is five days. You have been given steroids to help prevent swelling. You do not need more steriods. Sitting up and using ice packs are your best defense against swelling. Atarax also helps.

SLEEPING: Sleep sitting up at a 30 degree angle until the swelling is gone. Use pain medication to help with discomfort. Request a prescription for sleep if needed. Purchase bed chair, see photo. Use of a recliner or four or five pillows are other options. Use ice packs on forehead 10 minutes every 30 to 40 minutes while awake for the first three (3) days. A bag of frozen peas works well for an ice pack. Wrap ice pack in a towel or washcloth.

ITCHING: Atarax (Hydroxizine) 25 mg by mouth at bedime will relieve itching which may occur after a few days.
NUMBNESS or tingling is usually temporary and will usually disappear in a few to several months. It is the result of cutting nerves during the course of the surgery. In donor harvesting, occasionally, an area will persist with permanent loss of feeling.

THE FIRST NEW HAIRS APPEAR IN 3 MONTHS. Hair in the grafts will disappear 2 to 3 weeks after the procedure. The follicle, which is responsible for growth, remains. You must be patient. It will take several months for the hair to start growing again and reach styling length. After several procedures, grafts will take longer to begin growing.

MINOR COMPLICATIONS ASSOCIATED WITH PROCEDURE

BLEEDING: Apply direct pressure with icepack to stop. If bleeding continues, apply the same pressure again and call the office which will forward to the Pacific Hair answering service.

GRAFT COMES OUT: If clean, put in saline solution (available at pharmacy), call for appointment (must be within 1-3 days) for reinsertion. If soiled or lost, let site heal, use ointment. We will replace with next treatment.

RAISED OR RED AREA: If area with pimple-like appearance occurs 3-5 days after surgery, call the office for a follow-up appointment. Apply Bactroban ointment to the area and keep clean.

 

Smoker’s Warning:
You shouldn’t smoke at least ten days before & after your procedure (or just quit). If you smoke, you may develop large crusts in your central scalp, minor infections, minor dents under crusts, slow healing, and slow growth. If you start again, you will slow hair growth.  So, at least, minimize your smoking.