Swelling (edema) after hair transplantation

Swelling after hair transplantation

Despite hair transplantation’s high success and safety rate, the postoperative stage is often accompanied by swelling (edema). Although this is a transient and harmless condition, its occurrence is expected to cause patient concern.

The swelling usually appears within 1-2 days after the operation and peaks between the third and fifth day. In most cases, it gradually subsides within 3-4 days. However, in a small percentage of patients, the swelling may last longer, as its severity and duration are influenced by factors such as the extent of the surgery, the technique used, and each patient’s individual reaction.

The causes

Swelling after hair transplantation is usually caused by tissue injury, fluid build-up, or inflammation, often associated with poor-quality surgery. The healing process involves increased blood flow and vasodilation in the area, which facilitates the influx of immune system cells and fluids into the tissues to achieve repair, causing swelling in the area. The swelling is more pronounced in areas such as the forehead and periocular area due to the effect of gravity.

Poor quality of surgical technique

The modern FUE (Follicular Unit Extraction) hair transplantation technique offers the possibility of implanting hair follicles without creating sockets (holes) in the scalp, significantly reducing the chance of swelling (1-2%). However, for convenience, speed and cost reduction, many clinics insist on the older implantation method, regardless of the hair follicle extraction technique (FUE or FUT). This method involves drilling holes in the recipient area before placing the hair follicles with forceps or an implanter, often leading to increased bleeding and swelling.

Anaesthesia dosage

The dosage of local anaesthesia plays an essential role in the occurrence and extent of oedema after hair transplantation. Local anaesthetics, such as lidocaine in combination with adrenaline, are necessary to control pain and reduce bleeding during the procedure. However, these substances can also interfere with normal fluid flow and contribute to postoperative edema. The use of minimum effective doses of anaesthetics and saline is essential to minimise the risk of edema.

Additional factors

Additional factors that increase the risk of developing or worsening oedema after hair transplantation include a history of oedema after surgery or trauma, conditions such as hypothyroidism or lymphatic disorders, and taking medications such as non-steroidal anti-inflammatory drugs (NSAIDs), vitamin E or certain dietary supplements with anticoagulant activity (e.g. ginger, ginseng, ginkgo biloba).

Degree of severity of oedema

The severity of oedema varies between patients and is usually assessed using the following grading system:

  • Grade 0: No oedema.
  • Grade 1: Mild swelling, mainly in the upper part of the forehead.
  • Grade 2: Moderate swelling over the entire forehead.
  • Grade 3: Significant swelling, extending to the eyes and cheeks.
  • Grade 4: Severe swelling, accompanied by ‘black circles’ in the periocular area and possible temporary impairment of vision.

Risks associated with swelling

While post-transplant swelling is usually temporary and not a health problem, severe or persistent swelling carries some risks:

Functional weakness

Severe swelling around the eyes can affect vision and make daily activities difficult, requiring extra care and potentially lengthening recovery time.

Severe swelling

Unusually persistent or extreme swelling probably indicates an infection, allergic reaction or poor wound healing and requires immediate medical attention.

Psychological effects

Swelling often affects the patient’s psychology, causing distress or dissatisfaction with the surgical outcome. Clinical studies have shown that patients with severe post-transplant swelling express lower satisfaction with the procedure and higher levels of anxiety and depression.

Anaphylaxis

Although rare, anaphylaxis is a severe allergic reaction that can occur after the use of local anesthetics such as lidocaine. Symptoms include difficulty breathing, tachycardia and a sudden drop in blood pressure. This is a medical emergency that requires immediate treatment.

When to seek medical help

Patients should contact their surgeon if they experience any of the following symptoms:

  • Swelling that persists beyond two weeks or worsens over time
  • Severe swelling that affects vision or causes severe discomfort
  • Signs of infection, such as redness, heat or fluid secretion at the surgical site
  • Symptoms of anaphylaxis

Treatment of edema

Effective management of postoperative oedema improves patient comfort and speeds up recovery.

Cold compresses

Cold compresses for 10 minutes every hour for the first two days after surgery help significantly to reduce swelling. This is because the low temperature causes vasoconstriction, restricting blood flow and fluid build-up in the area of the operation.

Sleep position

Keep the head elevated, especially during sleep, as this will help drain the anaesthetic fluids, which, due to gravity, will drain downwards. After surgery, sleep with the head propped up on several pillows for the first few nights. Be sure to lie down with a 45-degree elevation angle during sleep to minimise the risk of swelling.

Healthy diet

Stay hydrated and maintain a balanced diet that includes anti-inflammatory ingredients such as tomatoes, blueberries, oranges, green leafy vegetables, omega-3 fatty acids and antioxidants. Avoid eating salty foods, as they can lead to fluid retention and worsening of swelling.

Hairband

Using a perimetric hairband, such as those worn by tennis players, or a bandage around the forehead and ears will help minimise swelling by applying gentle pressure to drain fluids.

Massage

A gentle massage of the swollen area can help circulate and drain fluids, reducing swelling and speeding up healing.

Physical activity

For at least 7 to 10 days after surgery, avoid lifting heavy objects, strenuous exercise, and other activities that may increase blood pressure and swelling.

Medications

Postoperative care includes careful management of several medications that may worsen swelling. It is essential to avoid non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen and diclofenac, as they can worsen swelling and increase the risk of bleeding. Paracetamol is preferred because it has minimal impact on inflammation.

It is important to follow postoperative instructions and report any unexpected complications in the healing process to your surgeon. Keep appointments with your surgeon to monitor the healing process and address any concerns.

Book a free information appointment now

At Advanced Hair Clinics, we follow strict protocols during our hair transplant procedures to minimise the chance of post-procedure swelling, as evidenced by our patient testimonials.

If you are considering hair transplantation or have already undergone the procedure and are unsatisfied with the results, contact us for a free consultation. We will examine you, discuss your questions and concerns in detail, and recommend personalised maintenance treatments to ensure a comfortable experience and a result that fully meets your expectations.

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