Instructions before and after hair transplant surgery

• Preoperative medical examination

Before performing hair transplant in healthy patients under 55 years of age, it is usually not necessary Not with medical permission. But for those patients who are 55 years old or older, with the permission of Medical certificate from a primary physician as well as an electrocardiogram (EKG) we need

Medical permission for younger patients with medical history such as diabetes or problems A known heart is also required. Also, for women of childbearing age, a gonadotropin test Human placenta (B-HCG) or the same test Preoperative pregnancy to confirm the absence of pregnancy of patients - as many drugs Used during this procedure is not approved for pregnancy - it is required.

Refer to Table 1 for a summary of preoperative medical examinations.

When the patient decides to have surgery, a health questionnaire to him is given to fill it,

To learn about the health questionnaire, see Table 2.

On the day of the operation, an additional health questionnaire should also be filled in detail And the patient's surgical records raise questions and whether the patient's previous antibiotics Have taken surgery (if prescribed) or taken sedatives in the previous day (which may interfere with preoperative sedation) or in Consumption of any alcohol or minoxidil in the last 24 hours (which may increase the risk of bleeding). raise the operation) asks the patient for an explanation. To get familiar with the health questionnaire Day of surgery, see Table 3.

Table 1: reviews Medicine before hair transplant surgery

Medical certificate from a doctor Primary for all patients aged 55 and older (men and women)

Check and test from the primary physician for patients younger than 55 years with medical records such as Diabetes or known heart problems, but Not limited to them

Take a pregnancy test All women of reproductive age

We also talk about the possible side effects of patients and a They will be given a consent form to sign before the day of their operation. for information See Table 4 from the list of hair transplant complications. Table 5 is also a list of important points that It must be observed in the hair transplant surgery consent.

Medications Anticoagulants

From patients who take anticoagulants such as aspirin, warfarin, Vitamin E, rivaroxaban, dabigatran, apixaban, is requested to be with the doctor Talk to your primary care or cardiologist regarding whether anticoagulants can be safely cut off before surgery. For many patients, these drugs They are medically necessary and should not be discontinued. If these conditions exist, hair transplant surgery It is not performed due to the increased risk of bleeding complications. For those patients in terms of Doctors are able to stop their anti-coagulants, it is requested 10 days before implantation Stop taking medications. Alcohol is also anti-coagulant, so the patient may We want them to refrain from drinking alcohol 24 hours before the operation and 1 to 3 days after the operation.

Table 2. Sample health questionnaire for hair transplant surgery—completed before the day of surgery.
Sample health questionnaire for hair transplant surgery - which is completed before the day of surgery.	yes	no	Description
Are you allergic to any medication or treatment? In this case, please, drugs and reactions Mention:
Have you ever had a severe allergic reaction to something? If so, please list the relevant ingredients and reactions:
Have you ever had a history of any of the following: (1) heart disease, (2) high blood pressure, (3) hepatitis and (4) peptic ulcer
Do you have a chronic illness or other special condition? If so, please mention them Do:
Have you donated blood in the last 10 years?
Have you taken the following medications in the past 6 months: 1. Steroids 2. Contraceptive pills 3. Antibiotics 4- Anticoagulants 5- Thyroid drugs 6. Heart medicine 7. Aspirin / Ibuprofen (Advil) 8- Sedative / antidepressant 9. Sleeping pills/painkillers and painkillers 10. Medicines for diabetes 11- Blood pressure medication 12. Vitamins If the answer is yes, mention the name of the drug:
Are you currently being treated for a medical problem? Do the history of any of the cases You have the following: 1. Heart problems (high blood pressure, heart attack, heart valve problems, palpitations heart / irregular heartbeat, heart disease, chest pain) 2. Diabetes 3. Thyroid problems 4- Liver or kidney problems 5- Infections (herpes, hepatitis, yellow fever) 6. Seizures or epilepsy 7. Asthma 8- Bleeding areas are you pregnant Date of last menstrual period ______________ Do you have a history of other medical problems? If so, please list here:
Have you ever been hospitalized or had surgery? If so, please Mention here:
do you smoke If yes, how much is it?
do you drink alcohol If yes, how much?
Have you ever had an unusual reaction to anesthesia? If so, what? Mention whether there was a reaction?
Is there anything else about medical records? Are there any we should know about? If yes, mention.

Prophylaxis antibiotics

AntibioticsProphylaxis Usually for implant surgery Hair is not prescribed, because hair transplant is considered a clean procedure. However Some hair transplant surgeons prescribe prophylactic antibiotics for high-risk patients Infections such as immunocompromised patients and diabetic patients are prescribed. Also many From surgeons, prophylactic antibiotics for patients at high risk of infections Prosthesis Joint are also considered, such as those in the first 2 years after replacement head joint, or those who have a history of previous joint prosthesis infection.

Also, patients at high risk of endocarditis (inflammation of the pericardium) are possible preventive prophylaxis antibiotics For conditions such as prosthetic heart valve (artificial heart valve), previous history of endocarditis Infectious, congenital heart diseases, and patients Those with a history of heart transplantation who have heart valve disorders should receive it. In addition, Surgery is performed only if a certificate and medical permission from the primary doctor is presented for the patient be.

Table 6 lists the conditions in which antibiotics before The operation is considered for hair transplant surgery.

Table 3: Sample health questionnaire - day of surgery
Sample health questionnaire - day of surgery	yes	no	Description
Have you taken your antibiotics (if prescribed)?
Have you consumed alcohol in the last 24 hours?
In the last 10 days, have you taken vitamin E, aspirin or Have you taken any anticoagulants?
Have you taken prescription sedatives or anti-anxiety drugs in the last 24 hours? are you
Have you ever taken minoxidil?
Have you read the instruction sheet?
Are you allergic to any medication or treatment? In this case, please, drugs and reactions Mention:
Have you ever had a severe allergic reaction to something? If so, please list the relevant ingredients and reactions:
Have you ever had a history of any of the following: (1) heart disease, (2) high blood pressure, (3) hepatitis and (4) peptic ulcer
Do you have a chronic illness or other special condition? If so, please mention them Do:
Have you donated blood in the last 10 years?
Has your body temperature risen to 100.4 degrees Fahrenheit or higher in the past week? If So, when was the last fever?
Have you had any changes in your health or any active medical conditions in the past week? have you seen
Have you had breakfast this morning?

Table 4: List of side effects of hair transplant surgery. The patient must sign a consent form who certifies that he has read and understood the list of all possible complications below is
More common complications	Rare side effects (partial list only)
Nausea and vomiting caused by pain relievers	Coloid formation in the donor area
Bleeding (<5%)	No growth of transplanted hair
Infection (<1%)	Constant pain in the scalp
Excessive swelling/bruising	Falling and complete loss of implanted hair
Temporary headache	Permanent numbness of the scalp
Temporary numbness of the scalp	Significant scarring in the donor area
Wounds and scars around the hair graft	Allergic reaction or drug-related problems
Allergic reactions to drugs (<1%)	Other unforeseen medical emergencies that may arise
Fainting (1%)
Short hair growth leads to the formation of cysts (<10%)
Temporary or permanent loss of hair in the transplant area on the scalp

Anti Prophylactic antibiotics, if prescribed, should be taken 30 to 60 minutes before surgery. for Patients who are not allergic to penicillin, regular regimen of cephalexin 2 g or dicloxacillin 2 grams orally is prescribed. In patients allergic to penicillin, clindamycin 600 mg, azithromycin 500 mg or clarithromycin 500 mg can be Administered orally. If there is an increased risk of staphylococcus aureus resistant to Methicillin (MRSA) in the community, a physician Can before the operation a tablet Bactrim Double Strength and Penicillin-VK 500 mg or Consider clindamycin 600 mg orally.

Summary You can see the recommended regimen of antibiotics before skin surgery in the table See 7.

Instructions Before hair transplant surgery

to Patients who undergo local anesthesia for their hair transplant are advised that before Eat a proper meal. Patients are advised to avoid drinking Alcohol for 24 hours before the operation and for 1 to 3 days after the operation because of the increased risk Avoid bleeding.

Table 5: Key points that should be considered in the hair transplant surgery consent form to be

Satisfaction with surgery and any necessary services during the procedure.

The patient is aware that more than one hair transplant may be required. doctor It should estimate that (X) number of hair transplant surgeries for Achieving satisfactory results is necessary.

stating that there is no guarantee of good growth or good cosmetic results; Because of the possibility of hair loss and variables such as availability of hair from the hair transplant area and quality There will most likely be hair in this area that affects the result.

State that the patient, (1) complications and (2) instructions before and after the operation He has studied and understood.

Stating that the patients hair transplant surgery method and reasonable results and that after the operation They realize that their hair will not be completely filled with hair transplant.

Saying that a scar is created with surgery that is usually not visible It will be visible if the hair is shaved.

Stating that the patient knows that complications may occur (list of possible complications It is given to the patient. To see the list of complications caused by hair transplant surgery, read Table 4 do).

Stating that the patient is satisfied if local anesthesia or IV solutions are used if necessary.

To state that the patient's permission to perform hair transplant surgery has been declared by the doctor and assistants and hair transplant technicians.

Stating that the patient is well informed and knows that the results of cosmetic surgery cannot be guaranteed

Stating that the advantages/disadvantages/alternatives of hair transplant include doing nothing. including wearing hairpieces or wigs, using drugs, or a combination of the above can't These pros/cons/alternatives or other options are discussed.

Saying that hair loss is likely to happen in the future and may appear Transplanted hair affects. Although transplanted hair usually lasts in some cases have, they will fall after 1 to 10 years. A small percentage of men (<10%) most donor area hair (implantation hair), which can affect the final results and scars or show the implant site scar.

Stating that the patient has been advised to use minoxidil or the anti-hair loss drug Propecia to keep the existing hair Hair regrowth helps, and if the patient chooses not to use drugs, It affects the density and appearance of the hair after the transplant operation.

State that this consent is without the influence of drugs that may cause drowsiness It has been signed and read.

State that the implant procedure and form have been fully explained to the patient, and are understandable And the patient understands all the contents of the consent form.

Table 6: Patients for whom antibiotics are considered before hair transplant surgery.

Patients with weak immune system

Patients with diabetes

Patients with a history of joint prosthesis replacement in the last 2 years

Patients who have had a history of joint prosthesis infection

Patients at high risk of developing endocarditis

Patients with certain congenital heart disease

Heart transplant patients with heart valve disorders

Table 7: Preoperative antibiotic regimens for skin surgery.
	Not allergic to penicillin	In case of allergy to penicillin
Areas with low prevalence of MRSA	Cephalexin (2 g) or Dicloxacillin (2 g)	Clindamycin (600 mg) or Azithromycin (500 mg) or Clarithromycin (500 mg)
Areas with high prevalence of MRSA	Bactrim DS PO and Penicillin VK 500 mg	Clindamycin (600 mg)

(MRSA: methicillin-resistant Staphylococcus aureus; DS: double strength).

Also They are instructed to consume for 7 days before and 3 days after the operation Discontinue minoxidil due to its possible vascular property in increasing the risk of bleeding. They are also recommended

10 days before the hair transplant surgery, stop any anticoagulant medication. until approved by their primary doctor.

Possible Is the anti-shedding use of Propecia in The duration of the surgery should be continued.

Also Patients are asked if they have a temperature greater than 100.4 degrees Fahrenheit or Inform any other active medical condition that occurs before the day of surgery.

For View a summary of pre-operative instructions, which are given to patients before hair transplantation is provided, see Table 8.

Instructions After the hair transplant operation

Patients They leave the office with a bandage on the hair transplant site. We recommend that the bandage keep it until the next day.

Table 8: Instructions before hair transplant surgery.

10 days before the operation, vitamin E, Coumadin, aspirin and other anticoagulants Discontinue the other (unless approved by the primary or prescribing physician, be). If you are taking medication for a medical condition, always check with your doctor before stopping consult

For 24 hours before the operation and for 1 to 3 days after the operation from consuming drinks Avoid alcohol because it increases the risk of bleeding.

Stop taking minoxidil or Rogaine 7 days before the operation and resume Rogaine 3 days after the operation. This will not cause any hair loss.

Propecia may continue to cause hair loss.

Women of reproductive age should have a negative pregnancy test (b-HCG) before the operation.

Men and women aged 55 and older must have a medical certificate from their doctor, including an ECG.

Women and men under the age of 55 with any active medical problem, must also have a certificate from their doctor to present

Please, if you have a fever above 38 degrees (body temperature of 100.4 degrees Fahrenheit or higher) or any other active illness or medical condition that may have occurred during the previous week Let us know about your action.

If antibiotics are prescribed, please take them 30-60 minutes before surgery.

Please have a meal before coming to the office if the procedure is performed under local anesthesia have a taste

If you will be under IV sedation for the implantation procedure, after midnight - the night before the operation - food and drink do not eat

Please wear a full button-down shirt for surgery, to avoid any problems with your bandages do not

(ECG: electrocardiography; IV: intravenous; β-HCG: human chorionic gonadotropin test (B-HCG) or the same test Pregnancy before the operation to confirm the non-pregnancy of patients.

Table 9: Post-operative drugs prescribed for hair transplantation

Tylenol with codeine, #3 (300 mg Tylenol/30 mg codeine) Prescription as 1 tablet e 4-6 hours in case of pain 6 numbers

Prednisone tablet 40 mg * Administration as 1 tablet orally, the night of operation, then in the morning for 2 days 3 numbers

* Only to prevent forehead/face swelling in skin surgery The front head of the forehead is prescribed

to Patients who have taken valium or other sedatives are told not to drive or use public transportation. A responsible adult should accompany them at home.

to Patients are told to take a shower and water daily after waking up after the operation They should pour it slowly on their scalp. It is emphasized to them that 1 to 2 weeks later The skin of the wounds on the head should not be manipulated from hair transplant surgery, this will cause destruction Going and shedding the transplanted grafts.

to Patients are advised to avoid lifting heavy objects and for at least 4 days, in the state Ideally, 7 days after surgery, they should not do strenuous exercise.

So From the operation for the first 48 hours, we recommend not bending down to tie shoes or pick up objects Avoid on the ground due to the increased risk of bleeding.

We We also recommend to minimize the risk of bleeding, from 24 hours after the operation Avoid drinking alcohol during hair transplant.

We For patients, take Tylenol #3 For pain relief, we recommend taking it every 4 to 6 hours with food until nausea minimize Patients can also, if the pain is not severe, as which is included on the packaging label of this medicine, take stronger Tylenol.

For Patients who have hair transplant surgery on the front of their head, also prednisone tablets 40 mg, Daily one number for 3 days for at least We prescribe skin swelling and swelling of the forehead and face after the operation. They should be the first pill Take it in the afternoon or evening of the operation day and take the next pills in the morning for another 2 days do If the patient has some swelling in the forehead and face, it is normal And it will resolve itself in a few days. Prednisone is commonly used for surgeries Hair transplantation is not recommended in areas other than the frontal area of the scalp, because the swelling of the forehead and The face after surgery is common and normal in these areas. Table 9 is a list of postoperative medications It shows hair transplant surgery.

In In case of bleeding, it is recommended to the patient to press the dressing firmly and continuously for 15 minutes. If the bleeding continues Continue, this will be repeated for another 15 minutes. After that, if If the bleeding continues, the patient is advised to remove the bandage and find the exact point of bleeding and press the same place directly for 15 minutes. If you still bleed with this work Do not stop, the patient should call the clinic or office or go to the nearest emergency room slow.

Table 10: Instructions after hair transplant surgery.

Please arrange your return trip from the clinic or office. as you You are most likely sedated and unable to drive yourself Travel by public transport. Please ask a friend or relative to take you from the office after the operation Go home. If you cannot bring someone with you, please come to the office in advance notify

After leaving the office, eat something.

Take prescription Tylenol 3# with food to avoid nausea. Don't wait until it hurts feel

At least 4 days after the operation, ideally for 7 days after the operation, from lifting Avoid heavy equipment and vigorous exercise. Do not bend over to put on or tie your shoelaces, or For the first 48 hours after the operation, do not lift objects from the floor, because it may cause to bleed

For 24 hours before and 1 to 3 days after the hair transplant operation, from consuming alcoholic beverages refrain For 4 days after the operation, avoid using all non-prescription chemicals do it

Get a good night's rest. Sleep with one or two pillows for your head if possible raise the

In case of bleeding, to the patient It is recommended to press the dressing firmly and continuously for 15 minutes. If If the bleeding continues, this is repeated for another 15 minutes. so From that, if the bleeding continues, the patient is advised to remove the bandage and the exact point find the bleeding and press the same place directly for 15 minutes. If you still bleed with this work does not stop, the patient should call the office or if he is out of town to Go to the nearest emergency room.

The day after the surgery, remove the dressing (since there is no adhesive, you have to easily removed). There are small scaly scars around the transplanted hair. Do not manipulate or pick at these wounds or scars, as this This can damage the transplanted follicles. take a shower Pour the water slowly Touch the transplanted hair, but do not rub or scratch the area. planting area Do not shampoo the hair, you can shampoo the area and the skin behind the head. If you feel comfortable You can gently shampoo the grafted area for 2 days after the procedure.

Bacitracin or Aquafor ointment once or twice a day in the donor area (back skin head) for 1 week or until the stitches are removed. On the areas The graft will scar and harden over the first few days from tearing Or avoid scratching these scaly wounds, doing so can damage the hair transplanted harm. They will fall out naturally within 1-2 weeks.

If you are prescribed prednisone for postoperative swelling (swelling) of the forehead and eyes At a minimum, take the first prednisolone tablet in the afternoon or evening of surgery. Then every Take one prednisone tablet in the morning for 2 days. A total of 3 days of prednisone you will Taking this pill should minimize the swelling in the forehead area. If swelling occurs, The problem is not serious and will resolve itself within a few days.

Return to the office 7 to 10 days after the operation to remove the stitches. activity You can resume full physical activity after the stitches are removed.

Transplanted hair starts to grow in 6 to 9 months after the operation. Complete planting results Hair can be seen in 10 to 14 months after the operation. During this time, you should make an appointment Schedule your transplant to follow up.

Please return or dispose of unused medications (Tylenol #3, prednisone, antibiotics) to the office, they They are for your use only.

Please contact us at the office in case of an emergency.

Care From the wound after surgery

Day After the operation, it is recommended that patients remove the dressing and take a shower. And be careful Let the water pour slowly on the grafted area.

The patient He may gently shampoo the back and around the head, but the clinic already recommends that Avoid touching the grafted areas for the first day after surgery. On the second day after the operation, the patient can, if he wishes, Gently shampoo the implant recipient. They are advised not to pluck and manipulate the shell In the recipient area, avoid because this may damage the transplanted hair follicles harm.

.

Also Patients are instructed to apply Aquaphor or Bacitracin ointment twice daily for 7 days on the skin of the donor site. Use behind the back until the stitches are removed.

to Patients are explained that the transplanted hair will grow within 6 to 9 months after the operation slow Full results can be seen 10 to 14 months after the operation. Patients are advised a Schedule an appointment for follow-up and visit the clinic about 1 year after the implantation procedure do Table 10 is a summary of post-operative hair transplant instructions for patients.