The postoperative period begins the moment the patient leaves the operating room and lasts until the hairs from the transplanted follicles start to appear. The post-procedure care of the patient is the most important part of the postoperative period and plays a significant role both in the final outcome and in the patient’s psychology, helping them to perceive the process positively — a factor that will encourage them to return for additional sessions and completion of the result, if necessary.
Postoperative Period
The overall care of a patient who has undergone a hair transplant is divided into two stages:
- Immediate postoperative care
- Subsequent care
It is essential to always provide clear, easy-to-understand written instructions for the postoperative period, addressing all possible questions the patient may have, and the physician must remain constantly available to the patient.
- Immediate postoperative care
Immediate postoperative care is primarily the responsibility of the patient, who must strictly follow the written instructions provided by their physician. Below are the main guidelines depending on the complication or the area/symptom, and they apply to both hair transplant techniques, FUT and FUE, unless otherwise specified.
Wound care:
The goal is to prevent the formation of scabs (crusts) on the wounds of both the donor and recipient areas—commonly known as “scabbing.” This is achieved by regularly spraying these areas with normal saline solution. Maintaining moisture conditions promotes the healing of injured tissues and reduces discomfort.
Neither the donor nor the recipient area requires bandaging; the patient simply leaves with a gauze pad and a tight elastic headband that keeps the gauze in place over the incision at the occipital (back) area while also minimizing swelling in the forehead region.
In the FUT method, the grafts in the donor area heal first, followed by the recipient area, whereas in the FUE method, the opposite occurs.
Regular spraying of the areas with 0.9% NaCl normal saline is absolutely essential, and it is the patient’s responsibility for the first 3–4 days to spray the grafts every 30–60 minutes while awake. The patient cannot “over-spray” the grafts or cause damage from spraying or moisture—this is important for them to understand.
Some surgeons recommend the application of copper peptide products, while others suggest antibiotic ointments or other topical preparations. Although copper peptide products have been found effective, none of the other practices have been proven to offer any advantage; in fact, some of these formulations have been associated with allergic reactions and should therefore be avoided.
Pain:
If the surgical procedures were performed correctly and the surgeon avoided excessive manipulation, postoperative pain is mild. Patients typically report a sensation of tightness and a feeling of heaviness in the head (mild headache) after the procedure, even after the anesthetics used during surgery have worn off.
Mild painkillers are sufficient and are preferably administered every 8 hours for the first 2 days, regardless of whether the patient feels pain or not.
Additionally, the use of Low-Level Laser Therapy (LLLT) has been suggested for pain relief, showing fairly good effectiveness.
Swelling:
Swelling is a normal reaction to surgical trauma and is not considered a complication. It begins during the operation but becomes noticeable on the first postoperative day. It may extend down to the eye sockets, causing bruising (ecchymosis) and, in more severe cases, even temporary visual discomfort.
Several methods have been proposed to reduce swelling after hair transplantation — both practical and pharmacological:
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Practical methods include using a headband placed below the hairline and applying a cold pack (ice compress).
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Pharmacological methods involve administering steroids, either orally or intramuscularly.
Perhaps the most effective solution is the intraoperative injection of tumescent solution containing triamcinolone, a technique first proposed by craniofacial surgeon Neil-Dwyer, whose effectiveness in hair transplantation procedures was later confirmed by Gholamali et al. and Abbasi.
Postoperatively, sleeping position can affect the lymphatic drainage of swelling. It is therefore recommended that patients sleep on their side during the first 3 postoperative days.
Bleeding:
With the FUT technique, this complication is rare and typically occurs within the first 24 hours, mainly in the donor area. It appears almost exclusively in patients who have undergone multiple hair transplant sessions or have extensive scars from previous punch graft procedures.
Simple pressure is usually sufficient to achieve hemostasis, and only in rare cases is the addition of stitches or vessel ligation required.
Bleeding that occurs on the 4th–5th postoperative day is usually due to the release of a hematoma and generally does not affect wound closure.
Special care should be taken to ensure that hypertensive patients do not skip their medication after surgery.
With the FUE technique, postoperative bleeding has not been reported.
Graft Dislodgement:
This is a common fear among patients after a hair transplant. It occurs rarely, typically between the 1st and 5th postoperative day, and is usually associated with the presence of scabs over the grafts.
In most cases, graft dislodgement results from direct trauma to the recipient area and cannot occur from simple touching.
In rare cases, the dislodged grafts may survive long enough to be reimplanted into the recipient area — but only if the patient manages to place them immediately in a makeshift saline solution or contact lens solution and then promptly returns to their surgeon
According to an extensive study by Bernstein and Rassman, pulling on a graft hair can lead to graft dislodgement up to the 2nd postoperative day. After that point, however, the grafts are completely secure and firmly anchored in their new position within the recipient area
Itching:
Itching is a common symptom that occurs in both the donor and recipient areas, typically reported by patients during the first 5–7 days after surgery.
Keeping the wounds moist helps relieve itching, as does the use of mild topical steroids for about two days. This can be combined with first-generation antihistamines taken before bedtime, which not only reduce itching but also have a sedative effect, improving sleep quality that may otherwise be disturbed by the itching.
Hair Washing:
The patient returns to the doctor or clinic on the first postoperative day for a follow-up check and a hair wash performed by a nurse or technician.
After about three days, the grafts have already shed their superficial epithelial layer, have revascularized, and the patient can wash their hair independently, using gentle movements and only a mild, hypoallergenic shampoo.
High-pressure showering directly onto the scalp should be avoided for 7 days due to the small risk of graft dislodgement, although this risk becomes minimal after the 3rd day.
Suture/Clip Removal:
In incisions without tension, sutures or clips are removed after 7–10 days. However, if tension is present, it is advisable to keep them in place for up to 14 days.
If the sutures are removed before the initial necessary “maturation” of the scar, there is a risk of wound reopening and the formation of a wide scar.
Generally, there is no risk in leaving the sutures in place for a few extra days, as modern sutures cause minimal tissue reaction.
With the FUE technique, no sutures are used, and the donor area punctures heal by secondary intention (naturally without stitching).
Return to Work/Exercise:
The time a patient should refrain from work depends on the nature of their occupation.
- FUT Technique:
Individuals engaged in intense manual labor should take more than 10 days off after the FUT procedure. Additionally, bending the head forward or performing deep flexion movements should be strictly avoided.
The patient’s personal preference also plays a role—some may choose to delay returning to work to avoid drawing attention to the donor or recipient areas until the signs of surgery are no longer noticeable. Conversely, if there are no social or professional restrictions (e.g., self-employed individuals), they may return to work whenever they wish.
Strenuous exercise should be avoided for 2–4 weeks, especially activities involving the neck muscles or those with head contact risk, such as team sports.
Any activity that increases tension or pressure in the donor area (e.g., rubbing, pressing, or abdominal exercises—particularly those with hands placed behind the head) should be avoided for at least 8 weeks. If the patient still feels tightness in the back of the head after this period, or has slower healing, the restriction period should be extended to 3–6 months.
Swimming, on the other hand, is allowed from the 4th postoperative day.
- FUE Technique:
Individuals performing physically demanding jobs should take 3–4 days off. The same general recommendations for returning to work as above apply here as well.
Avoiding intense exercise is only necessary for about 7 days, but sports involving head contact should be avoided for 2 weeks..
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Later Postoperative Period – Care
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Θυλακίτιδα-Κύστες: Η είσφρυση τριχών, οι κύστες και η θυλακίτιδα μπορούν να εμφανιστούν, τόσο στη δότρια, όσο και στη λήπτρια περιοχή. Οφείλονται σε αντίδραση του ιστού σε τραύμα, λοίμωξη, έκθεση σε χημικά (προϊόντα περιποίησης μαλλιών) ή σε ξένο σώμα, συχνότερα τρίχες που έχουν απομείνει μέσα στο τριχωτό. Η συχνότητα εμφάνισης θυλακίτιδας στη μεταμόσχευση είναι 1,1-20,6% και η βαρύτητα κυμαίνεται από ήπια, επιφανειακή φλεγμονή μέχρι εν τω βάθει φλεγμονή με πύον, κύστες και φλύκταινες. Ειδικότερα στη δότρια περιοχή, θυλακίτιδα εμφανίζεται μέρες ή εβδομάδες μετά τη συνεδρία FUE, καθώς οι κυλινδρικές τομές κλείνουν κατά δεύτερο σκοπό και συχνά εγκλωβίζουν τρίχες από FUs που ακρωτηριάστηκαν ή αφαιρέθηκαν μερικώς (capping). Με την τεχνική FUT και ειδικότερα με την «τεχνική της τριχοφυτικής σύγκλεισης», εμφανίζονται ενίοτε μικρές κύστες στα χείλη του τραύματος και, συγκεκριμένα, αν δεν προστατευτεί ο σμηγματογόνος αδένας των τριχοθυλακίων του χείλους που «κόβεται», το φαινόμενο είναι συχνότερο. Στη λήπτρια περιοχή, κύστες και θυλακίτιδα μπορεί να εμφανιστούν μετά από 4-6 μήνες κατά την επανέκφυση των τριχών, ενώ αναφέρεται πως η χρήση MTS μπορεί να αποτελέσει επιπλέον επιδεινωτικό παράγοντα. Η θυλακίτιδα τις περισσότερες φορές είναι επιφανειακή, η φλεγμονή δεν επεκτείνεται βαθύτερα από τον ισθμό και επουλώνεται χωρίς ουλοποίηση. Αν όμως η θυλακίτιδα παραμείνει για μεγάλο χρονικό διάστημα, μπορεί να επεκταθεί στα βαθύτερα στρώματα, να οδηγήσει σε κυτταρίτιδα και σε καθυστέρηση στην ανάπτυξη των μοσχευμάτων. Ζεστές κομπρέσες, τοπική επάλειψη mupirocin, τοπικά στεροειδή για 3-5 ημέρες επαρκούν. Αν η φλεγμονή είναι έντονη, εν τω βάθει και δεν ανταποκρίνεται στη συντηρητική αγωγή, τότε χορηγείται per os αντισταφυλοκοκκική αντιβίωση. Σε κάθε περίπτωση είναι επαρκή τα παραπάνω μέτρα και δεν υπάρχει ανησυχία για παραμονή ουλής στα φλεγμένοντα σημεία.
Crust Formation:
Crusts typically appear during the first 2–3 days, coinciding with the exudative phase of healing, and they form only when wound care is insufficient—that is, when the patient fails to spray the recipient area frequently and adequately.
In most cases, crust formation does not affect graft survival, but it may reduce the natural appearance of the scalp. Furthermore, studies have shown that it increases the risk of graft dislodgement.
Once formed, a crust is difficult to remove, and mechanical removal of crusts in the recipient area may lead to graft dislodgement for up to the 8th postoperative day. This is yet another important reason why crust formation should be actively prevented.
Hypoesthesia – Anesthesia:
These symptoms occur in the donor area following the FUT technique, appearing in almost every case, typically affecting the midscalp and vertex regions.
They usually resolve within 3–6 months and rarely persist longer. The cause is injury or transection of sensory nerve branches of the scalp during the procedure
Central Necrosis of the Recipient Area:
This complication is rare but serious, as the shedding of the resulting crust leaves behind an area of scarring alopecia.
It is most likely caused by a disturbance of the terminal vascular branches of the centripetal blood supply to the scalp, which converge toward the center of the midscalp. The most probable cause is excessive vasoconstriction during the hair transplant procedure due to the overuse or high concentration of epinephrine.
Aggravating factors include smoking, diabetes mellitus, the presence of preexisting scars, actinic (sun-induced) damage, and previous transplants.
Keeping the affected area moist and applying mupirocin as a conservative treatment may help limit the damage. However, definitive correction can only be achieved through surgical excision or a repair hair transplant at a later stage.
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Loss of Hairs in the Recipient Area
This type of postoperative hair shedding occurs almost always when terminal or intermediate follicles remain in the recipient area after transplantation. It may present as either anagen or telogen effluvium and is caused by:
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Direct trauma to existing follicles during the creation of recipient sites
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Microvascular injury
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Vasoconstriction resulting from tumescent anesthesia
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Swelling (edema) that disrupts local blood supply
The creation of thousands of micro-incisions in the recipient area, combined with the injection of vasoconstrictive agents such as epinephrine, can induce tissue shock and local ischemia, often leading to delayed graft growth.
It is believed that the larger the session, the higher the risk of extensive effluvium of pre-existing hairs in the recipient area. Smaller sessions are less likely to cause shedding. In some megasession cases, it is hypothesized that the recipient area may not adequately support all grafts nutritionally, due to insufficient blood supply—though this theory has never been scientifically proven.
Hair loss in the recipient area usually occurs 2–4 weeks after transplantation, most commonly in patients with existing intermediate follicles and in women undergoing the procedure.
Generally, if the patient is not in an active phase of androgenetic alopecia—with a large number of follicles undergoing miniaturization—the shed hairs will regrow after several months.
Some follicles may not recover, but the majority enter the anagen phase again after 3–4 months. The use of Minoxidil following hair transplantation has been reported to reduce postoperative shedding in the recipient area.
In some cases, the shedding is mild and goes unnoticed, while in others, it can be so significant that the patient appears to have less coverage than before surgery. For this reason, great care must be taken when operating on a recipient area with remaining terminal or intermediate follicles.
The most critical factor is the atraumatic placement of grafts in the recipient sites.
Brandy notes that using 2.5×–3.5× magnification instinctively encourages gentler handling of the grafts and should always be combined with strong Xenon lighting for optimal visibility and precision.
Loss of Hairs in the Donor Area
This is a much rarer complication, appearing within 4–6 weeks postoperatively, either along the incision line in FUT (strip) procedures or throughout the donor area where the FUE technique was applied.
It is most likely caused by a temporary disruption of tissue blood supply and presents as anagen effluvium.
However, with proper surgical technique, this condition is extremely uncommon, and in most cases, the affected follicles recover spontaneously without the need for intervention.
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