Post-op ny-blue-updated nov 2, 2010 for next printing

Post-Operative
Instructions

Date/Time of Bandage removal: __________________________
Post-Operative Check (optional):_______________________________________

Suture removal: _________________________________________
Emergency phone number: ______________________________________

MANAGING DISCOMFORT & NAUSEA
After your surgery, before you leave the office, your nurse will have given you an
envelope containing your post-operative instructions, an appointment for the next day for
bandage removal, an appointment for suture removal in 7-10 days, a roll of gauze, and
small envelopes containing your medications. The envelopes numbered 1, 2 and 3 are
your medications for any discomfort or pain.
• Envelope #1 contains Tylenol #3 which contains codeine that may cause
• Envelope #2 contains Vicodin. Please follow the instructions below.
• Envelope #3 contains Percocet (may also cause constipation). Please
• Envelope containing Ambien, for sleep, if needed (1/2 to 1 tablet).
• Envelope containing anti-nausea pills.

Take Tylenol #3 as directed on the envelope if you experience any discomfort. If it
continues after 30-45 minutes, take Vicodin, but not before taking the anti-nausea pills
15 minutes before the Vicodin. Although it would be unusual, if you are still
experiencing discomfort 30-45 minutes later, take the Percocet as directed on the
package. Continue taking the medications in 3-4 hour intervals as they will help control
the discomfort. Even if you experience no pain prior to bedtime, we recommend you
take a Vicodin for overnight comfort.
The anti-nausea pills should not be taken more than once every 4-6 hours. Some patients
will be directed to “skip” the Tylenol #3, if their tolerance to medications is higher than
average. Patients should not drive a car while taking any of the medications listed above.
Your reflexes will be impaired and driving could be dangerous. For any mild discomfort
you may have after the first few days, you may also want to purchase some extra-
strength Tylenol.

NOURISHMENT
After your surgery when you leave our office, it is very important that you have a good
meal (dinner) and drink plenty of fluids, especially water, during the course of the
evening.
THE HEAD BANDAGE
Please do not attempt to lift or check under your bandage. It is important that the bandage
maintains firm, even pressure on the donor and recipient areas and not shift overnight.
You will have been given a long piece of gauze. Before you go to sleep for the evening,
please wrap it over the top of the bandage and tie it underneath your chin to hold it in
place and to keep it from shifting.

SHOULD BLEEDING OCCUR
Significant bleeding rarely occurs after surgery. If bleeding should occur after regular
office hours: Apply firm, steady pressure over the bleeding area for 10-15 minutes
without lifting the bandage. If the blood spot on the bandage continues to increase in
size, call the phone number listed on the front cover of this pamphlet. Please do not take
any fish oil, aspirin, or medications containing aspirin for two days following your
surgery. Please do not drink any alcohol while on medication.
BANDAGE REMOVAL DAY
PLEASE EAT A GOOD BREAKFAST BEFORE YOUR APPOINTMENT. Due to
our scheduled surgeries each morning, we ask that you please be on time. Baseball caps
are provided for all patients on bandage removal day. Female patients may prefer to bring
a scarf to wear after the bandage is removed.
We suggest you take one Tylenol #3 for your comfort one hour before your scheduled
appointment time. If you are driving, please take two extra–strength Tylenol instead
of the Tylenol #3 as the latter could impair your driving ability.
You will also begin your post-operative Prednisone with breakfast on this day—unless
contraindicated. It’s important that you do not exert yourself for the first few hours
following bandage removal. Exertion can cause bleeding.
We will give you some gauze to take with you following bandage removal. Occasionally,
there is a small amount of bleeding from the recipient or donor areas and you can use the
gauze to apply firm pressure with the pads of your fingertips to the bleeding area for 5-10
minutes. Call the office if the bleeding continues.
The night of bandage removal, you do not need to soak, massage, or shampoo your head.
Just apply minoxidil and Surgilube, both of which are provided.
MINIMIZING SWELLING
Most patients will experience some degree of swelling after hair transplant surgery. To
help prevent swelling and bruising, it will be very useful if you follow the instructions
below:
You will be given two reusable ice packs on bandage-removal day. Apply ice packs to
forehead, temple, and eye areas as well as the nape of your neck. DO NOT PLACE
COLD PACKS DIRECTLY ON THE GRAFTS. We recommend using the packs 10
minutes on and 20 minutes off, as much as possible for the first few days after your
surgery.
Try sleeping with your head at a 45° angle by using three or four pillows, or sleep on a
reclining chair for one to five nights following your surgery. This will help to minimize
the swelling. Even better, do the opposite, and try to sleep flat with no pillows. Any
swelling that develops will be pulled by gravity away from your face.
Note: If swelling should occur, we are sorry if this inconveniences you. Unfortunately, if
you call the office, there is no further treatment or medication available. Nature must take
its course. The swelling will gradually subside over a three- to seven-day period.

HOMEOPATHIC REMEDY (OPTIONAL)
The following are recommended by many cosmetic surgeons to promote healing,
minimize bruising and swelling. The evidence to support this is mostly anecdotal and
thus we recommend it as an optional addition to the regular post-operative instructions.
• Arnica Montana (30c) pellets: Immediately post-operatively: place 5 pellets
under your tongue every hour until bedtime. For the rest of the first two weeks post-operatively, place 5 pellets under your tongue three times daily. • Arnica Gel: Apply gel to any bruised or swollen areas, twice daily for two weeks
post-operatively. Do not put on any grafted or sutured areas and avoid
contact with eyes.

SHAMPOOING
On the 2nd day after your surgery, and until your sutures are removed from the donor
area, you should wash your hair TWICE daily, in the following manner:
• Fill the bathtub with warm water; lie back in the water until the water covers the donor area (sutures). Epsom salts are recommended to add to the bathwater to aid in healing • Soak the donor area for 10 minutes, and then for another 10 minutes continue soaking, while massaging the donor area, with as much pressure as you can tolerate, using the pads of your fingertips. • At the same time while you have been soaking and massaging for 20 minutes, apply a wet facecloth to the recipient area continuously wetting it with bathwater. This helps to dissolve the Surgilube. • Gently shampoo your whole head with a mild shampoo that contains no medications and don’t be afraid to get a good lather. Bring a cup into the bath and with clean, warm tap water, rinse off the shampoo. Continue washing your hair in this way for the first seven days. • Gently towel-dry your hair or blow dry it on a “cool” setting. Apply minoxidil
3% to the grafts to potentially accelerate the healing process.
• Next, apply the water-based Surgilube to the recipient area and the donor area. • In order to avoid disturbing your grafts, it is best to simply use your fingertips to style your hair. If you must use an instrument, a comb is generally better than a brush, unless the brush has rounded knobs on the end to minimize graft trauma.
SUTURE REMOVAL DAY
You may want to take one or two extra–strength Tylenol one hour before you come to
the office to alleviate any slight discomfort that you may experience. After your sutures
have been removed, wash your hair daily in the shower until all the crusts have fallen off.
EXERCISE
We recommend that you do not exercise for one week; however, you may engage in
light walking or mild activity. If you do begin exercising after 7 days, or otherwise
engage in activities that cause you to perspire, please wash you hair as soon as possible after the activity. This is to prevent infection. Maximum weight-lifting or any kind of heavy lifting must be avoided for 14 days following surgery. You may swim in a clean lake or a clean private pool beginning the day after surgery. Wait two weeks before swimming in a public pool or in water of uncertain cleanliness. FREQUENTLY ASKED QUESTIONS
When may I cut my hair again?
How long until I may get my hair straightened? Travel within North America is allowed 24 hours after surgery. However, we encourage all patients to allow 48 hours prior to traveling internationally. Once you are off narcotic pain medications. However, if you experienced increased bleeding, please ask the surgeon when you may resume alcohol consumption. A little sun is helpful in the healing process, but be cautious to avoid getting a sunburn. Avoid sun during the peak hours of 11am to 3pm. It is better to have your head open to the air rather than within a warm, moist environment. However, as long as the hat is clean, you may wear it right away (but as little as possible for the first week). After 7-10 days, you may wear your hat normally. If I wear a hair piece, when may I wear it again? Not for the first week after surgery and then as little as possible for the 2nd and 3rd weeks post-operatively. After the third week, you may wear it normally. Should I use minoxidil solution and for how long? The transplanted hair will grow without minoxidil. However, we recommend it for 3 weeks postoperatively to (theoretically) accelerate healing and minimize postoperative loss of any original hair in the area. It may also accelerate the regrowth of transplanted hairs so some patients use it until they feel stubble growing (after approximately 2½ - 3 months).

Source: http://www.drrobinunger.com/assets/PDF/post-op-instructions.pdf