Hair transplant aftercare: your questions answered by Dr Cinik

 A revision hair transplant is a hair restoration procedure performed to correct, improve, or refine the results of a previous hair transplant. It may be considered when the first procedure did not achieve the desired appearance or when certain areas require further improvement.

A revision procedure can focus on issues such as insufficient density, an unnatural hairline, uneven graft distribution, or visible problems resulting from the previous transplant. The aim is to improve the overall appearance while creating a more natural and balanced result.

Before planning a revision hair transplant, the existing hair, donor area, previously transplanted grafts, and the results of the earlier procedure should be carefully evaluated. The available donor area is particularly important because the number of grafts that can be used for the revision procedure depends on the remaining donor capacity.

In some cases, the revision may involve adding density to areas that appear sparse. In other cases, the focus may be on correcting the hairline or improving the distribution and direction of the transplanted hair.

Because a revision hair transplant involves an area that has already undergone a previous procedure, careful planning is essential. The procedure should be designed according to the existing hair pattern, the condition of the donor area, and the specific problems that need to be addressed.

Mild depression and the use of fluoxetine 20 mg are not, in themselves, a contraindication to hair transplantation.

Patients who are receiving psychiatric treatment can generally undergo a hair transplant if their condition is stable and they are taking their medication regularly. Having a psychiatric diagnosis or receiving ongoing treatment does not automatically prevent a patient from having a hair transplant.

One important consideration is that fluoxetine is an SSRI (selective serotonin reuptake inhibitor). SSRIs can affect platelet function and may therefore cause a slight tendency toward bleeding. For this reason, it is important to inform your hair transplant doctor that you are taking fluoxetine 20 mg before the procedure.

Your doctor can take this medication into consideration when evaluating your suitability for the procedure and planning your hair transplant.

Since you had testicular cancer in 2019, had one testicle removed, did not receive chemotherapy or radiotherapy, and have remained well without any problems for the past seven years, there is generally no obstacle to undergoing a hair transplant.

However, it would still be advisable to consult the doctor who has been following you regarding the hair transplant procedure. If your blood tests are within normal ranges, there is no suspicion of cancer recurrence, and you are continuing to live a healthy life, you can undergo a hair transplant.

In your situation, the fact that the cancer occurred seven years ago, that only one testicle was removed, and that you did not require chemotherapy or radiotherapy are important factors to consider. Nevertheless, your current health status and follow-up results should be evaluated before proceeding with the procedure.

Yes, you may be able to undergo a hair transplant. Based on the information you have provided, you have a congenital mild heart valve condition, but you have remained symptom-free for many years, you are physically active and able to exercise, and, most importantly, your cardiologist recently evaluated you and told you that you no longer require regular cardiology follow-up. This indicates that your doctor did not identify an ongoing cardiac problem requiring continued monitoring.

However, a hair transplant is still a surgical procedure. It can involve some blood loss and may take approximately 8–9 hours to complete. In addition, adrenaline (epinephrine) may be used as part of the local anaesthetic during the procedure, so your cardiac history should be considered before surgery.

For this reason, before undergoing the hair transplant, you should be examined by a cardiologist at the clinic where you will have the procedure, and an echocardiogram (ECHO) and electrocardiogram (EKG) should be performed. Once the cardiologist has evaluated you and gives approval for the procedure, there should be no contraindication to proceeding with the hair transplant based on the information you have provided.

A three-week interval can generally be sufficient if you have not experienced any complications, infection, bleeding, or similar problems following your breast implant surgery. However, you should obtain approval from the plastic surgeon who performed your breast implant procedure before proceeding with the hair transplant.

For the hair transplant, Manual FUE would be recommended because it allows you to avoid lying face down during the procedure. This helps prevent pressure on the breast area and reduces the risk of putting unnecessary pressure on the newly placed breast implants while you are undergoing the hair transplant.

If your multiple sclerosis (MS) is stable and you are not currently experiencing a relapse, you do not have an active infection, your blood test results are suitable for the procedure, and your neurologist, who is monitoring your MS, has evaluated your condition and approved the hair transplant, the procedure can be performed.

However, if you have experienced an MS relapse recently, have recently received high-dose corticosteroid treatment, or are currently using strong immunosuppressive treatment, it would be more appropriate to postpone the hair transplant to a later date.

Your current MS status and treatment should therefore be taken into consideration before scheduling the procedure. Since your neurologist has already evaluated you and has stated that you can undergo a hair transplant, this medical approval is an important part of the assessment. The final decision should also take into account your current clinical condition, blood test results, and whether there are any signs of infection or other complications that could affect the procedure.

Yes. With the unshaven FUE technique, it is possible to perform a hair transplant without completely cutting or shaving your hair. Only a small area in the donor region is trimmed to create a window that allows the medical team to access and extract the grafts.

This approach allows the majority of your existing hair to remain at its current length, making the procedure much less noticeable. The donor area is kept largely covered by your surrounding hair, so the fact that you have undergone a hair transplant may be difficult for other people to notice.

The unshaven approach can therefore be particularly suitable for patients who have long Afro-textured hair and do not want to cut their hair before the procedure.

A similar no-shave approach was used for Rio Ferdinand’s hair and beard transplant. According to the clinic, he underwent a no-shave DHI procedure, with the treatment performed without completely shaving his hair.

You can see the example here: Rio Ferdinand’s Hair and Beard Transplant

After reviewing your photographs, I can see that you have a large FUT scar, and your current level of hair loss appears to be approximately Norwood 7.

Considering the extent of the baldness, covering the entire area would require approximately two hair transplant procedures. During the first procedure, we would aim for approximately 70% coverage of the affected area.

Based on the current condition of your donor area, we could potentially extract approximately 3,500–4,000 grafts from the scalp donor area. In addition, your beard donor area appears to be in good condition, and we could potentially obtain approximately 1,200–1,500 grafts from the beard area.

It is also possible to transplant grafts into the existing FUT scar. However, because the scar consists of scar tissue rather than normal scalp tissue, the results of transplantation into this area cannot always be guaranteed to be successful.

Overall, based on the photographs, a treatment plan involving approximately two procedures would be required, with the first procedure aiming to achieve around 70% coverage, using grafts from both the scalp donor area and, if appropriate, the beard area.

Photo 1 (right profile)

What I see: Deep frontotemporal recession, thinning across the mid-scalp, and an exposed crown area.

How the surgery relates to this view: This angle shows us how far back the bald zone extends and lets the surgeon plan the hairline design and zone boundaries. In surgery, the bald area is mapped into zones: Zone 1 (front hairline), Zone 2 (mid-scalp), Zone 3 (crown/vertex). Because your frontal third is the most cosmetically important area, the densest packing of grafts would be placed here — single-hair follicular units along the hairline edge, with 2–3 hair units behind them to build density.

Photo 2 (frontal view)

What I see: A high, receded frontal hairline with sparse coverage and visible scalp on the frontal third; forehead is broad.

How the surgery relates to this view: This is the view used to design the new hairline. A natural hairline is not drawn straight — it follows a slightly irregular, “feathered” pattern with a transition zone of single hairs at the very front. On the day of surgery:

1. The hairline is drawn with you sitting upright (like in this photo) so gravity and facial proportions are accounted for.
2. Local anesthesia is administered across the recipient area.
3. Recipient sites are made with blades or needles at specific angles — typically 10–30 degrees — mimicking the direction your natural hair grew. Correct angle is critical; if grafts are placed too perpendicular, the result looks unnatural.

Photo 3 (left profile)

What I see: Symmetric recession to the right side, confirming the pattern is stable and bilateral; crown thinning extends backward.

How the surgery relates to this view: Symmetry matters. This view confirms both temples need to be rebuilt to frame the face. The temple points (the small corners where the hairline meets the sideburns) are reconstructed with fine single-hair grafts, since coarse multi-hair grafts in the temples look artificial. This photo also helps the surgeon estimate how many grafts are needed for lateral coverage, which affects the total count (which is why 3,500–4,000 scalp grafts plus possibly 1,200–1,500 beard grafts is the estimated range — beard grafts are often reserved for the mid-scalp and crown, where coarser hair is acceptable).

Photo 4 (back view)

What I see: The crown/vertex shows significant baldness; the lower occipital region (around and above the nape) retains relatively dense, healthy hair; the old FUT strip scar sits within this donor zone.

How the surgery relates to this view: This is the donor area photo — the most important one for planning extraction.

• FUE extraction: Individual follicular units (groups of 1–4 hairs) would be removed one by one using a micro-punch (typically 0.8–1.0 mm), distributed evenly across the donor zone so no visible bald patch is left behind. Your remaining donor hair appears dense enough in the photos to support roughly 3,500–4,000 grafts, but exact density must be measured with a densitometer in person.
• The FUT scar: Because grafts are being placed into the scar, the surgeon will:
  1. Assess the scar’s blood supply and thickness (sometimes a test batch of 50–100 grafts is placed first to check survival).
  2. Place grafts at slightly wider spacing than in normal scalp, since scar tissue is less hospitable.
  3. Position them to break up the linear, shiny appearance of the scar so it blends with surrounding hair when grown out.

Taking lithium and lorazepam does not constitute an absolute contraindication to undergoing a hair transplant. Lorazepam is generally not considered a major concern in this context. However, lithium requires greater caution, and the suitability of the procedure should be assessed based on the extent of the planned hair transplant, kidney function, and fluid status.
A hair transplant can generally be performed under local anaesthesia, but given the use of lithium, it would be preferable to have the procedure performed at a centre where a doctor and, preferably, an anaesthesiologist are available.
It is also advisable to consult the physician who follows your cluster headaches and prescribed lithium. They can assess your kidney function and determine whether the medications that will be used during the hair transplant are appropriate and whether there are any potential drug interactions that need to be considered.
Therefore, lithium and lorazepam use does not automatically prevent you from having a hair transplant, but the procedure should be planned after an appropriate medical assessment, particularly regarding lithium, kidney function, fluid status, and medication interactions.

There is no single shampoo that can treat every type of hair loss. The appropriate shampoo, like paraben free shampoos, depends on the underlying cause of the hair loss.

A gentle shampoo with a mild cleansing formula can help maintain scalp hygiene without unnecessarily irritating the scalp. If you have dandruff or seborrheic dermatitis, a medicated shampoo containing an active ingredient such as ketoconazole, zinc, caffeine may be appropriate under medical guidance.

However, shampoos generally have a limited role in treating conditions such as androgenetic (pattern) hair loss because they cannot address the underlying follicular miniaturization. If you are experiencing persistent or progressive hair loss, a dermatologist should determine the cause and discuss evidence-based treatments appropriate for your condition.