Lymphatic fluid accumulates along the newly crafted hairline, the forehead, and upper eyelids for the same reason Newton discovered with the apple that fell on his head many years ago: GRAVITY. 

You prevent this and in more instances than one there will be no swelling.

So do you need to worry if you get excessive swelling after your hair transplant?

If the swelling after the hair transplant you just got is painless, there is nothing to worry.

If it is red and painful, hang on and watch this video.

If your swelling has persisted beyond the 7th day, you are a diabetic, and there is redness, throbbing pain and fever, switch off this video, pick up your phone  and immediately call your doctor.

Because, infection if not controlled in time can be devastating.

In this video I will discuss the causes, the dangers, the prevention and the treatment for swelling that may occur after a hair transplant.

If proper care is used both by the surgeon & his team and the patient in the immediate 24 hours after hair transplant, I have yet to see swelling descending to the eyes in my patients.

Swelling happening after a hair transplant can be shocking and socially restrictive.

Moreover, patients from out of town or worse still from out of the country will not be allowed to board a flight with swollen sick looking faces and eyes that cannot see. Staying out of town for extra recovery time or in the country you have travelled to where every day adds can be a costly proposition if you have not budgeted for this extra expense.

That is why you often see mechanical prevention in the form of tight bands constricting the forehead in after hair transplant pictures on the net. However, these are not good to use since they do not allow free drainage, can cause accumulation of edema fluid , cause fibrosis and consequent poor healing and poor hair growth.

Mild swelling is natural. It will always happen. It is a part of the inflammatory process after any surgical intervention.

The cardinal signs of Inflammation were described by Celsus some 2000 years ago. They are-

Rubor, Tumor, Dolor, Calor & Functio Laesa. 

As long as the inflammatory process is limited to the healing process, there is nothing to worry. But if there is no sign of this process abating worse things can happen. Functio laesa or loss of function happens when disaster strikes when  severe infection sets in, and this usually happens  in the backdrop of uncontrolled diabetes. 

Like in the case of the Pakistani actor who lost his eye a few years ago. The same thing happened in a clinic in southern India in 2016. In both cases the patients had not been evaluated properly before the procedure.

The cause of swelling can be either one or more of the following 5 reasons:

  1. Large amount of injected tumescence
  2. Inadvertent vessel rupture during nerve block
  3. Using needles for slit making
  4. Infection
  5. Not using corticosteroid

Usually swelling in my clinic if it happens, sunsides by 5-7 days after the procedure. Only once or twice in a year do I have a patient who reports swelling descending down into the eyes. With proper surgical care and patient follow-up it is not a big issue. But there are clinics where swelling is the norm. This is nothing but poor technique.

How does a surgeon prevent swelling from happening?

  1. Giving preop medications that prevent swelling
  2. Avoid aspirin and ibuprofen before procedure
  3. Proper lab investigations to rule out underlying disorders
  4. Minimally invasive procedure
  5. Triamcinolone acetonide during procedure
  6. Proper postoperative instructions
  7. Anti-inflammatory drugs to facilitate healing

How do you as a patient do your bit in preventing swelling?

  1. Avoid exercise
  2. Do not talk animatedly
  3. Do not bend forwards in the first 3 days
  4. Try not to work on a PC
  5. Forehead massage to change the direction of flow from center of forehead to towards the temples.
  6. Stay at a hotel and not with relatives when you are from out of town so you are not bound socially to engage in polite conversation especially if you are meeting them after many years.
  7. 45 degrees elevation on first night. 30 degrees for the next 4 nights. Face upwards towards the ceiling. Elevation helps by decreasing venous and lymphatic pressure. This “gravity position” flow along lymphatic channels falong occipital and  temporo-parietal scalp preventing facial swelling.

Activities of daily living like eating, going to the bathroom, tying shoelaces are no problem at all because edema fluid moves very slowly. It takes at least 1 or 2 days for lymphatic fluid to move from below the hairline to center of the forehead.

Once edema has begun, steroid, ice packs, and other physical methods have little or no effect. Therefore, prevention is the best treatment.

There is so much more that can be done to prevent swelling but that is the subject of another talk.

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