Antibiotic use
Significant controversy remains regarding the use of prophylactic antibiotics in hair transplant surgery, since few studies support the use of antibiotics. Although prophylactic antibiotics can decrease the risk of wound infection, the risk of hypersensitivity reactions and the emergence of resistant organisms need to be considered. The most appropriate time to administer prophylactic oral antibiotics (as single dose) is 1 hour preoperatively; however, if endocarditis prophylaxis is necessary, an additional postoperative dose is administered.
For most patients, first-generation cephalosporin is used, unless a history of cephalosporin allergy exists. If cephalosporin hypersensitivity exists, azithromycin or ciprofloxacin may be substituted. Some surgeons also use topical antibiotics during the postoperative period to reduce risk of wound infection, although no benefit has been established yet. Some surgeons use oral antibiotics for 3-5 days postoperatively to reduce risk of infection.
Corticosteroids
Many surgeons administer oral or intramuscular corticosteroids to reduce postoperative swelling, although few data are available supporting this practice.
Pain medications
Some patients require oral narcotics for the first few days after hair transplantation. Usually, Tylenol with codeine # 3, Percocet, or Lortab 5 is sufficient to alleviate most postoperative discomfort.
Postoperative dressings
Most surgeons advocate use of surgical dressings to minimize risk of graft loss. Many surgeons apply (1) topical antibiotic, (2) Telfa nonstick gauze, (3) gauze, (4) Kerlix gauze, and (5) Coban wrap to create a turbanlike dressing. Most often, this dressing is removed after 24 hours; no dressing is required thereafter. Some surgeons use no postoperative dressing and require patients to wear a baseball cap.
Complications
As with any surgical procedure, a risk exists of the following infrequent complications:
· Bleeding
· Infection
· Scarring at donor site
· Scarring at recipient sites
· Dyspigmentation at recipient sites
· Cobblestone appearance at recipient sites
· Failure of graft
· Cyst formation
Postoperative edema is expected; therefore, it is not a complication, although it can be severe.
