Before surgery: what to prepare
Stop aspirin, ibuprofen, naproxen, fish oil, vitamin E, ginseng, and ginkgo for 7–10 days. No alcohol for 48 hours. Wash your hair the morning of surgery. Stop topical minoxidil (Rogaine) 2 weeks before to reduce scalp vascularity and intraoperative bleeding. If you are taking finasteride, continue it. Bring a button or zip top (you cannot pull anything over your head). Bring sunglasses and a loose-fitting bucket hat or hood that does not press on the recipient site for the trip home, tight caps and beanies that compress freshly placed grafts can dislodge them. Plan to take a few days off; the scalp looks visibly post-op for the first week. For large sessions (3,000+ grafts), the volume of local anaesthetic with epinephrine is significant; mention any heart, kidney, or seizure history at consultation.
The day of surgery
Hair transplant is performed under local anaesthesia, runs 4–8 hours depending on the number of grafts (typically 2,000–4,000 follicular units in one session), and discharges same-day. You leave with a soft headband over the donor area at the back of the scalp, no dressings on the recipient site (the transplanted area is left open so the grafts settle), and small pinpoint bleeding at both sites for the first hour or two.
Days 1–3: peak swelling
Scabbing forms over each implanted graft within 24 hours. The scalp is tender, swollen, and sometimes itchy. Some forehead swelling appears day 2–3 as fluid tracks down from the recipient site; this is normal and resolves within a few days. Sleep with head elevated 45 degrees for the first 3–4 nights. Do not touch, scratch, or rub the recipient area. Do not wear hats that touch the grafts.
Week 1: stitches out, bruising fades
Spray the recipient area with the saline mist the clinic provides 3–4 times a day to keep the scabs soft. Gentle hair washing usually starts at day 2–3 following the clinic's specific technique (no rubbing, no direct shower spray). Office work from day 4–5; the recipient area looks pink and scabbed but is concealable under a loose hat or with strategic hair styling. The scabs fall off naturally between day 7–14; do not pick them.
Weeks 2–4: back to public
Scabs fully gone by end of week 2. The transplanted hair shafts begin shedding as early as week 2; this is normal and expected. The follicle stays alive in the scalp, the shaft is what falls out, and new hair grows from the follicle starting around month 3. The recipient area can look much like it did before surgery during this phase, and pinkness or mild scalp redness commonly persists for 2–4 weeks. Some patients also experience temporary shedding of pre-existing native hair near the recipient site (shock loss), this is distinct from graft shedding, is triggered by the surgical trauma, and regrows over 3–6 months. Strict sun protection on the scalp (hat or SPF) for at least 4 weeks; healing scalp pigments easily.
Months 2–3: swelling resolves
Shedding peaks around weeks 6–8 and begins to reverse from month 3. New thin hairs start to emerge from the transplanted follicles. Small pimples (folliculitis) as hairs push through are common; most resolve on their own with warm compresses, but persistent or painful folliculitis warrants topical or oral antibiotics rather than ignoring it (untreated cases can scar or kill a graft). Donor-area shaving is grown out.
Months 6–12: the final result
Hair growth progresses month by month. By month 6 about 40–60% of the final density is visible; by month 9 about 70–80%; final density at month 12 with continued maturation through month 15–18 (crown transplants are the slowest area to fill in). Transplanted hair is DHT-resistant because it came from genetically protected donor sites, so it is durable, but it is not literally permanent: it stays subject to senile alopecia (age-related thinning) over decades. Existing native hair may also continue to thin, so a planned multi-stage transplant or maintenance medication (finasteride, minoxidil) is often part of the long-term plan.
Red flags: when to call the clinic
Call the clinic the same day for: fever over 38°C, sudden severe swelling beyond the expected day 2–3 forehead swelling, pus or yellow discharge from the donor or recipient sites, increasing redness, scalp skin that turns dusky white or black at the recipient site (rare but serious, vascular compromise from over-dense graft packing, an emergency), or visible hair-follicle loss in clumps rather than the expected gradual shedding. If the donor area shows visible patchy thinning (a moth-eaten look) past month 2, raise it with the clinic, this can occur with overharvesting in large sessions and may be partially addressable with low-level laser, PRP, or topical minoxidil to the donor zone. Persistent or painful folliculitis past 2 weeks needs antibiotic treatment, not patience. Go to an emergency room for severe headache combined with vision changes, or chest pain. Pinpoint bleeding for the first hour, scabbing, itching, the shedding phase between weeks 2–4, and small folliculitis pimples at month 2–3 are not red flags.