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It’s 8 weeks after my hair transplant and last night in my sleep, for the first time and probably due to dry scalp and itchiness, I scratched my head so much that in the morning I noticed there was a lot of hair shedding with the bulb but no bleeding. However later on that day I scratched my head again and I noticed there was minor bleeding here and there. I am worried that I have damaged the grafts and may have lost some. Could you let me know if this is the case?

By 8 weeks after hair restoration surgery, there is little to no danger of harming the follicular unit grafts by scratching your head one evening. However, if the itchiness persists and your repeated scratching results in scarring of the scalp tissue, you can certainly cause permanent hair loss.

To reduce the itchiness and related scratching, I recommend using a dandruff shampoo like Nizoral or simply applying aloe vera gel to your scalp.

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

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Technorati Tags: hair transplant, hair restoration, follicular unit, hair loss, Nizoral

This question, from a member of our Hair Loss Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. Glenn Charles:

I got a follicular unit hair transplant approximately two months ago by the strip method. I got a wound closure called trichophytic and self-dissolving stitches. The donor area felt pretty sore for a while at first and I found it somewhat difficult to sleep as one would expect. However, this subsided greatly after a month and it would have seemed to have healed up very well so far.

On a few occasions, including earlier this evening, I picked at some scabs in the donor area. A few times the scabs that came off in my finger had hairs in them. They were purely white flaky scabs with absolutely no blood. It would seem that the hairs were going through the scabs.

Could somebody please tell me if there is a possibility that I pulled hair follicles out from my head when picking at these scabs or are the hairs that I see interwoven in the scabs simply hairs only that will grow back again?

You cannot pull out the hair follicles at this point (1 month post-op). I do agree with gentle rubbing/messaging to get the scabs off.

Keep in mind that, for the first few months after the procedure, the original hair in the areas that were transplanted and close to donor wound are more fragile.

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This question comes from a member of our hair loss social community and discussion forums:

I’m undergoing hair transplant surgery and want to make sure I’m taking care of the new grafts after the procedure. I know cigarettes and direct heat exposure should be avoided after surgery, but what about caffeine? Can drinking caffeine after hair transplant surgery affect the newly implanted grafts and final yield? Should I avoid caffeine after hair transplantation?

The post-operative period is an important time for the newly implanted follicular unit grafts. To help protect the new grafts and eventually obtain good growth, hair restoration surgeons provide patients with a strict set of post-operative instructions. These instructions help patients care for the new grafts, and also provide information about what type of substances and activities should be avoided in the post-operative period. Although avoiding some activities and substances, like tobacco cigarettes and excessive sunlight, are recommended by all hair transplant surgeons, other doctors may have more specific requests, like avoiding caffeine.

However, while many hair transplant surgeons could argue that excessive amounts of caffeine in the post-operative period may cause constriction of blood vessels in the scalp or inappropriate physiological stress, most state that caffeine is okay in moderation. For example, when asked about caffeine usage in the post-operative period, Coalition hair transplant surgeon Dr. Glenn Charles said the following:

In order to increase the ultimate survival, caliber, and even the rate at which hair follicles grow after transplantation, patients and hair restoration physicians alike are looking for methods to best care for them when they are in the precarious state out of the body (after extraction, but before implantation).  Dr. Carlos K. Wesley will lecture to fellow physicians on “New Frontiers in Surgical Hair Restoration” at the Mount Sinai Medical Center Multi-Specialty Spring Symposium in New York City in which he will discuss the various advancements in hair follicle storage prior to transplantation.

Sentiment in the field of surgical hair restoration is increasingly favoring the use of platelet rich plasma (PRP) as a possible storage solution to achieve the three goals stated above.  Dr. Wesley has even noted the benefit of incorporating PRP into the intra-operative graft storage process as patients appear to produce transplanted hair growth slightly earlier than the standard timeline at which transplanted hairs are normally appreciated.

While these observations related to PRP are promising, the mystery behind this product remains: What is it about PRP that may produce this benefit?  Is there a particular element within the autologous solution that is most critical in the stimulation of hair growth and development?  To shed light on this question, Dr. Wesley collaborated with immunologists at Mt. Sinai Medical Center to investigate the following variables on hair characteristics:

1. The degree of physiologic concentration of platelets in PRP

2. The specific concentration of certain growth factors thought to be involved in the stimulation cascade:

Just wondering; if balding is a progressive condition, why would patients opt for surgery (be it strip/extraction)? Won’t we have to deal with it once the hair falls out?

You are correct. Androgenic alopecia is a progressive condition and there is no hair loss cure. This is the very reason why hair transplants are not recommended for very young balding men and also why most hair restoration surgeons highly recommend medically stabilizing hair loss with Propecia (finasteride) and Rogaine (minoxidil).

The older we become, the easier it is to more accurately judge just how far on the Norwood Scale our hair loss will progress. This helps doctors and patients agree on a long-term plan that will make the best use of grafts in order provide for adequate donor hair to address future balding. Medical treatments can prolong the life of existing hair and, in some cases, even regrow hair. The right patient with the right plan can achieve a natural and aesthetically pleasing result that will last a lifetime.

It’s important to remember that not everyone is a candidate for surgical hair restoration. Patients have to find a skilled and ethical hair transplant surgeon that they trust to give them the best advice.

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David (TakingThePlunge)
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community

This question, from a member of our Hair Loss Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. Glenn Charles:

I just had my hair transplant a few days ago with Coalition hair restoration physician Dr. Damkerng Pathomvanich who said that my scalp was very loose. So loose that it might result in a large donor scar. He said I can take a drug called Enalapril to help reduce the appearance of the hair transplant scar. The only possible downsides are coughing and discolored urine. He said it’s inexpensive and I would only have to take it for about 3 months.

Does anybody have some more information on this? I am probably going to take it just to ensure that I have the smallest scar possible for when I want to cut my hair short.

Also if you guys know any other tips to keep my scar from widening I would be interested to hear them.

I have not heard of that drug being used for the purpose of reducing scar formation. However, Dr. Pathomvanich may have some insight that other doctors do not currently have. You really want to avoid excessive flexion of the neck (no chin to chest movements).

People have a tendency to want to test things out to see if there is any pain (like purposeful over flexion of neck to see if donor area is still painful). Don’t try it for several months.