FAQ – Safety

In the last few years doctors have used smaller and smaller graft sizes. In the past, large “plugs” — groups of up to 25 hair roots — were transplanted together, but now the tiny grafts contain just one to six hairs. We've learned that fewer hairs per graft produce a more natural result, and the problem of handling large numbers of grafts has also been solved. The techniques for “harvesting” hair from the back of the head have improved too. These new techniques result in less damage to the hair, less healing time, less discomfort, and a better look.

The methods for doing hair transplantation have improved vastly in recent years, with much better results, less patient discomfort and less recovery time. Our patients are mostly quite comfortable during and after their hair transplantation. Some medications for pain relief are prescribed for the first week; however, lots of patients say that they do not have to take any medication beyond the first day or two after their operation.

In many cases, a patient may wish to return for additional transplants several months after the first surgery. When large quantities of hair need to be implanted, repeat sessions can be scheduled every 6-12 months. Some patients who are persistent with their process sometimes have as many as ten sessions, but this is most often unnecessary with the large number of grafts transplanted using modern methods. More commonly, men are very satisfied with at most, 2,000 to 3,000 grafts for an area of baldness that extends over much of the top of the scalp. If you have more hair to begin with, you will probably need fewer grafts.

Use of prophylactic antibiotic in hair transplant surgery is recommended because it can decrease the risk of wound infection. The most common kind of antibiotic used is Ciprofloxacine Cap. 500 mg. one every 12 hours from 3 days befor surgery to 4 days after it. A single dose of intramuscular corticosteroid (Dexamethasone) to reduce postoperative swelling is also used. Some patients require oral analgesic for the first few days after hair transplantation. Usually, Acetaminophen codeine is sufficient to alleviate most postoperative discomfort.

The medical term for the very onerous sounding "shock fall out" is "effluvium" which literally means shedding. It is usually the miniaturized hair i.e. the hair that is at the end of its lifespan due to genetic balding that is most likely to be shed. Less likely, some healthy hair will be shed, but this should regrow. Rarely, but sometimes, we notice some shedding of hair from a prior transplant when transplants are spaced less than one year apart. However, this hair grows back completely. For most patients, effluvium is not a major issue and should not be a cause for concern. In the typical case, a patient looks a little thinner during the several month period following the transplant, when the transplanted hair is in its latent phase. It ends when the transplanted hair begins to grow. The thinning is often more noticeable to the patient himself, than to others. Shedding is generally noted as a thinning, rather than of "masses of hair falling out", as the term "shock fall out" erroneously suggests. In general, the more miniaturization one has and the more rapid the hair loss, the more likely will be shedding from surgery. Young, actively balding patients would be at the greatest risk. Older patients with stable hair loss would have the least risk.

The first is using medication, the second is timing the transplant properly, and the third is performing a procedure using a sufficient number of grafts. Finasteride 1mg reverses or halts the miniaturization process in many individuals and is thus the logical way to decrease the risk of shedding following a transplant. Although many physicians have the clinical feeling that that this assumption is correct, there has been no controlled studies to date that prove this. Timing and the size of the transplant are the most important issues. It is important to wait until a patient is ready to have a transplant, and then to perform one of sufficient size so that if there is some shedding, the procedure will more than compensate for it - and be worthwhile. A problem that patients often run into is that they present to their doctor with early hair loss but with a significant amount of miniaturization. The doctor performs a small procedure and it doesn't even compensate either for potential shedding or for progression of the hair loss. The result is that the patient is thinner (or more bald) than he was before the procedure. The doctor rarely blames the problem on the fact that the procedure was too small or that there the miniaturization was not taken into account, but only that the patient continued to bald. The better solution is to treat early hair loss with medication, but once you make a decision to begin surgery, and then have a procedure large enough to make a significant cosmetic improvement. As a final point, it is a fallacy that some doctor's techniques are so impeccable that they can avoid effluvium or those "small" procedures will avoid shedding. Of course, bad techniques and rough handling will maximize effluvium, but effluvium is what hair naturally does when the scalp is stressed and it is stressed during a transplant from the anesthetic mixture and the recipient site creation. It cannot be totally prevented. In sum, the best way to deal with effluvium is to treat with Finasteride when hair loss is early, perform a transplant only when indicated and finally, to perform a procedure of Follicular Unit Transplantation with skill and with a sufficient number of grafts.

You may think of surgical hair restoration as minor surgery compared to major procedures such a hip replacement and organ transplantation. While those and other major surgical procedures are long, complex operations, hair restoration surgery is not major surgery and has proven to be very safe. As with all surgical procedures, the more risk factors a patient has, the greater the possibility for postoperative complications. Risk factors are factors that increase a patient’s risk for harm. Some risk factors are associated with the surgical procedure. Patient risk factors are those associated with the patient. Patient risk factors important in surgical hair restoration are those that increase risk for postoperative infection, excessive bleeding, and delayed healing. The hair restoration surgeon will determine risk factors based on the information given by the patient prior to any surgical procedure. Some important patient risk factors the physician will want to know about include: Tobacco use, especially long-term cigarette smoking Alcohol abuse or heavy drinking Obesity Malnutrition, including bulimia and anorexia Use of immunosuppressive drugs, including corticosteroids and chemotherapy Use of herbal supplements Immunosuppressive disease—e.g., HIV-AIDS Diabetes or other chronic metabolic disease Chronic disease of the heart, liver, kidneys, lungs or gastrointestinal system Chronic or recurrent skin infections such as boils Chronic or recurrent bacterial or viral infections Medications that decrease the ability of the blood to clot, such as anti-inflammatory drugs Conditions that require antibiotics prohylaxis, such as artificial joints or valves A prospective candidate for surgical hair restoration should answer questions about risk factors as fully as possible. For the patient’s own safety it is essential for the physician to know in advance if there are risk factors that increase the possibility for postoperative complications—even if risk factors such as tobacco or alcohol use are somewhat embarrassing for the patient to discuss. The presence of risk factors will rarely deny a hair restoration procedure to the patient, but the physician will be aware of the possibility of complications associated with the risk factors.