Post-Op

The Concept of Risk

Doctors have to be honest and patients realistic about the concept of risk. As one can see from the list of
possible complications below, the risk of these occurring is small but can never be zero. Science has not
conquered the vagaries of mother nature. Fortunately the consequences of a post-operative problem
occurring can be significantly mitigated if it is treated correctly and in timely fashion. The importance of
a long-term relationship with the clinic is vital to minimise the consequences of any possible post
operative complications and hence ensure an optimal outcome. As a consultant plastic surgeon who has
very significant experience of such conditions, especially through my NHS referrals, patients can rest
assured they will receive the best possible advice in this regard.

1. Bruising

The degree of bruising is unpredictable but is usually limited to the recipient sites at the hairline. However, if one has a hairstyle which is long enough, this will help to disguise the area for the first number of days. The bruising rapidly settles within days and will thus be less conspicuous to others in relatively rapid fashion. A break from work (or social occasions) may be desirable if one is concerned about others seeing any bruising.

2. Pain

Usually the process has very minimal pain. The local anaesthetic works for a number of hours after the surgery. If there is any need for painkillers post operatively, this is usually minimal i.e. in the form of paracetamol, and this will be given to you on the day of the surgery. All patients have a different pain threshold but in general it is unusual to require any analgesia after the surgery.

3. Infection

Having such an abundant blood supply, infection is rare (1%). Some infections may require antibiotics while other infections may be in the form of localised collections of pus. The regular washing of hair minimises the risk of either. In the strip harvest technique of transplantation (where there are stitches in the skin) the risk of skin infection is increased through the presence of a ‘foreign body’ - the stitch. In the FUE process there is no need for sutures and this reduces the potential risk of infection.

4. Graft failure/poor growth

The risk of graft failure is small. There is approximately only a 5% risk of some of the grafts failing. The process of any grafting process means that skin requires in-growth of new blood vessels into the hair follicle grafts. This is a process open to the vagaries of natural wound healing. Overall, the chances of success are however very good (greater than 95%).

5. Shock loss

This refers to the phenomenon of temporarily losing adjacent normal hair, either in the region of the recipient site or the donor site. Shock loss again is extremely rare and occurs in <1% of patients. The shock loss is a temporary phenomenon and the hair grows back within a number of months. Fortunately, with the FUE process, there is no stitching of skin and therefore no tension on the donor-site skin. This means there is potentially a lower risk of donor-site shock loss.

6. Cysts/pustules

As mentioned above, localised infections can occur (rarely) around hair follicle sites or donor sites. These are managed with regular cleaning and release of any pustule within the clinic. Occasionally cysts can develop in the skin which, if troublesome, may require surgical excision, but again, this is rare (<1%).

7. Scalp numbness

Like any surgical procedure, there can be numbness in the scalp which can last for a number of months. In the vast majority of cases, sensation returns - although in a very small number of cases residual numbness can be permanent.

8. Scarring

One of the benefits of the paradigm FUE procedure is that the scars are virtually invisible even with a shaven head. The small and randomly-sited pinpoint scars of an FUE process contrast with the long continuous linear scar that is seen in the alternative strip harvest technique. This different configuration of the scarring enables the tiny FUE scars to be disguised by the surrounding hair. Only with a fully shaven head could such FUE scarring be discerned - but even then only on very close inspection. All scarring is unpredictable to a degree, but the risk of forming a troublesome lumpy scar eg a keloid
scar is very small ~1/1000.