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BHR Clinic Patient Advisor
Healing is an important factor when deciding when to undergo a hair transplant, work issues, friends/family and just getting out and about without feeling totally conscious of how you look. Healing can be subjective to many factors, the size of the wound, the amount of wounds, natural skin characteristics, wound repair and post-operative wound care to name a few important aspects.
The healing process can vary around the scalp, from scalp donor to traditional recipient, to scar tissue to body/beard areas. The healing process may take different durations on different body areas on the same person even when the very same protocol is used, similarly, the healing may differ in different people depending on their skin types.
A study report in 1975 by Dr. Fitzpatrick helped to classify variants in skin healing and developed a classification system for skins; the classification is also useful in body hair transplant to predict the course that the healing will follow; a brief outline below of Dr. Fitzpatrick s classification:
Fitzpatrick skin types and their description-
Skin type 1- Extremely fair skin (always burns on excessive exposure to sunlight but never tans).
Skin type 2- Fair skin (always burns and sometimes tans).
Skin type 3- Medium skin (sometimes burns, always tans on sun exposure).
Skin type 4- Olive skin (Rarely burns, but always tans).
Skin type 5- Moderately pigmented Brown skin (never burns, but always tans).
Skin type 6- Markedly pigmented black skin (never burns but always tans).
An outline of the healing process for Skin type 1, 2 and 3 as an exampleduring the healing phase,
Redness (erythema) that gradually diminishes to spots, white scarring, depending on various factors the complete healing may take from 4 to 18 months. Rarely 24 months. The more melanocytes (pigment producing cells), then greater the chance of transient hyperpigmentation in the healing phase. Those with the skin types 3 and 4 (and maybe 2), may follow any of the above 2 patterns of healing.
Under considered conditions this reference gives an idea of the healing process involved and what the skin goes through over the days and weeks before it is truly healed; obviously it does not take into consideration changes or impairment of the repair process and how it may elongate areas of healing, making this irrelevant.
The healing goes through a number of processes, visible and within the skin, both are important to the overall healing and the visible cosmetic effects. It is important to adhere to protocols for the best healing possible and there are also aspects you can personally do to aid the healing, dietary intake, smoking habits for example.
Wounds usually affect the outer most skin layer known as the epidermis. Wound healing would be slow or fast, depending upon the cause and size of the wound and also upon your physical fitness, for instance, elevated blood sugar levels can slow down wound healing process. Wound healing process involves mainly four wound healing stages.
The Inflammatory Phase
The inflammatory phase begins with the injury itself as the wound starts bleeding in the first phase and the formation of clots at the site of the wound. Certain chemical substances produced by the body, are released right into the wound site for the healing process to begin. If inflammation continues it will normally mean healing has been impaired in some way in the early stages, leading to continued formation of cells but also the body wanting to build a clot at the site of the wound. Vasodilation is responsible for the erythema, edema, and heat observed after tissue injury. Vasodilation is an important means by which the wound can be exposed to increased blood flow, accompanied by the necessary inflammatory cells and factors that fight infection
The Proliferative Phase
During the proliferative phase, formation of cell latticework or matrix accumulation occurs, the new skin cells and new blood vessels are formed on the matrix formation. These newly formed blood vessels, known as capillaries, provide nutrients and oxygen to the rebuilding cells. Thus, new cells grow.
The Remodelling Phase
The remodelling phase begins some days after the injury. It can be seen that collagen is better organised by this time. Now, the tissues are strengthened by collagen. As the blood vessels become less dense, the wound loses its pink colour. As the injured area becomes strong, the wound heals up to 70% of the original skin.
Epithelialisation
Epithelialisation involves the laying down of epithelial cells for the formation of new skin. Among the four stages of wound healing, this is the last stage, during which the skin forms a protective barrier between the body and its outer environment. This barrier protects the wound from bacterial infection and excessive loss of water.
Wound contraction begins almost concurrently with collagen fusion. Contraction, easier defined as the closing of the wound edges that effectively seals the closure, is generally up to around 15 days after the wound is formed. Loose tissues contract more than tissues with poor laxity, and square wounds tend to contract more than circular wounds. Contraction results in a decrease in wound size, the appearance and long term visibility and overall quality of the wound healing. With a hair transplant we have wounds in the recipient and donor sites, and both can react differently and have different healing times.
The open wound slits of the recipient are packed with the graft soon after being made, the healing process between the skin tissues is relatively fast with the formation of the capillary vessels and the contraction of the wound. The area remains red for some time, some maybe a few weeks whereas others maybe months, can be dependent on the number and proximity to each other of the wounds and healing characteristics. Recipient sites in less conventional areas, impaired skin, old scars or in areas of pitting or ridging may behave differently and healing may take longer or be impaired, if previous scarring is so bad that healing never fully concluded it is advisable to not re-enter the areas again. The recipient is generally going to have many multiple wounds and infection is greater, so cleaning regularly and allowing the crust that appears to remove is vital, not to pick at the crust but allow to hydrate and dehydrate the crust will aid the natural healing.
The donor area, conventionally the back and sides of the scalp, and harvested using either the Strip or FUE techniques; each will have different healing characteristics.
The removal of the Strip, position, length, width, depth of incision will all effect, too deep an incision for example can lead to increased fibrosis collection under the skin, resulting in possibly a wider scar or a raised scar area. It is important that during the first weeks of healing the area is kept clean and washed regularly, the suture type is removed as suggested by your doctor. Not cleaning the area can leave bacteria and unable to remove the suture, causing the skin to react against the suture and impair healing. Due to the linear nature and position stretching is also a consideration and it is prudent before doing any type of physical work that may put pressure on the area to fully allow the wound to relax and the skin return to normality. This may mean a few months in some cases but it has to be considered a small price to pay for minimal cosmetic scarring as well as leaving the donor in better condition for future procedures.
FUE donor healing is sometimes thought or considered to be faster and better than Strip but still holds many complications, and can still leave a visible sign of scarring in some cases. Multiple open wounds create their own problem for the body to heal all consistently becomes harder the more wounds that are made.
Body hair is becoming a more common use with FUE, this area can involve area of the body more commonly used to constant attention such as close shaving and touch and more susceptible to infection due to added trauma or abrasiveness. Due to this greater care has to be taken in the earlier days of healing but it does not mean slower healing will occur under normal post-operative circumstances.
Due to the BH areas, chest, legs, beard etc. there is more chance of abrasion and trauma during the healing process. During healing the skin may appear relatively normal, not be sensitive to the touch for example, but outward forces. Shaving for example, a remnant of hair is left in the hair follicle. As this starts to grow out of the follicle, it may immediately curve round into the surrounding skin, because there is nothing to keep it straight. Besides the healing of the skin still in a progressive state the ingrowing hair irritates the skin and can cause a reaction. The next abrasive action the area is caught again, worsening the inflammation and perhaps allowing an infection to occur. This can occur when the skin externally and internally has not gone through the stages of healing and still requires time to correctly form the protective barrier, or new skin on the surface and healing is complete. The problem being the more trauma caused during week one and two of healing can exacerbate the entire healing process from weeks to months, dependent on conditions, skin characteristics etc.
As said contraction healing can take around 15 days, before this although the wounds are small the skin is still susceptible to a prolonged healing pattern, and it is not as simple as starting again and expecting the sequence of healing to refresh, the pattern of healing has been interrupted and now takes on a different regime of healing.
Although FUE wounds are individually small does not detract that each is a separate wound and has to go through the same processes of healing. Due to the wound being smaller it can be thought either less care needs to be taken or healing is faster, this is not the case and an interruption or impairment in the healing process can cause healing to be slowed down as the wounds have not had time to properly repair and heal.
How to improve wound healing, it can be as simple or as complicated, from simply allowing the wound to naturally regenerate the natural properties required to improving areas of your diet and life. What is important is good healing time is respected and not tried to be rushed. Choose your moment for a hair transplant when you can allow for healing to take the natural course, not always easy but important as the final result is never today or even tomorrow but the rest of your life.
The healing process can vary around the scalp, from scalp donor to traditional recipient, to scar tissue to body/beard areas. The healing process may take different durations on different body areas on the same person even when the very same protocol is used, similarly, the healing may differ in different people depending on their skin types.
A study report in 1975 by Dr. Fitzpatrick helped to classify variants in skin healing and developed a classification system for skins; the classification is also useful in body hair transplant to predict the course that the healing will follow; a brief outline below of Dr. Fitzpatrick s classification:
Fitzpatrick skin types and their description-
Skin type 1- Extremely fair skin (always burns on excessive exposure to sunlight but never tans).
Skin type 2- Fair skin (always burns and sometimes tans).
Skin type 3- Medium skin (sometimes burns, always tans on sun exposure).
Skin type 4- Olive skin (Rarely burns, but always tans).
Skin type 5- Moderately pigmented Brown skin (never burns, but always tans).
Skin type 6- Markedly pigmented black skin (never burns but always tans).
An outline of the healing process for Skin type 1, 2 and 3 as an exampleduring the healing phase,
Redness (erythema) that gradually diminishes to spots, white scarring, depending on various factors the complete healing may take from 4 to 18 months. Rarely 24 months. The more melanocytes (pigment producing cells), then greater the chance of transient hyperpigmentation in the healing phase. Those with the skin types 3 and 4 (and maybe 2), may follow any of the above 2 patterns of healing.
Under considered conditions this reference gives an idea of the healing process involved and what the skin goes through over the days and weeks before it is truly healed; obviously it does not take into consideration changes or impairment of the repair process and how it may elongate areas of healing, making this irrelevant.
The healing goes through a number of processes, visible and within the skin, both are important to the overall healing and the visible cosmetic effects. It is important to adhere to protocols for the best healing possible and there are also aspects you can personally do to aid the healing, dietary intake, smoking habits for example.
Wounds usually affect the outer most skin layer known as the epidermis. Wound healing would be slow or fast, depending upon the cause and size of the wound and also upon your physical fitness, for instance, elevated blood sugar levels can slow down wound healing process. Wound healing process involves mainly four wound healing stages.
The Inflammatory Phase
The inflammatory phase begins with the injury itself as the wound starts bleeding in the first phase and the formation of clots at the site of the wound. Certain chemical substances produced by the body, are released right into the wound site for the healing process to begin. If inflammation continues it will normally mean healing has been impaired in some way in the early stages, leading to continued formation of cells but also the body wanting to build a clot at the site of the wound. Vasodilation is responsible for the erythema, edema, and heat observed after tissue injury. Vasodilation is an important means by which the wound can be exposed to increased blood flow, accompanied by the necessary inflammatory cells and factors that fight infection
The Proliferative Phase
During the proliferative phase, formation of cell latticework or matrix accumulation occurs, the new skin cells and new blood vessels are formed on the matrix formation. These newly formed blood vessels, known as capillaries, provide nutrients and oxygen to the rebuilding cells. Thus, new cells grow.
The Remodelling Phase
The remodelling phase begins some days after the injury. It can be seen that collagen is better organised by this time. Now, the tissues are strengthened by collagen. As the blood vessels become less dense, the wound loses its pink colour. As the injured area becomes strong, the wound heals up to 70% of the original skin.
Epithelialisation
Epithelialisation involves the laying down of epithelial cells for the formation of new skin. Among the four stages of wound healing, this is the last stage, during which the skin forms a protective barrier between the body and its outer environment. This barrier protects the wound from bacterial infection and excessive loss of water.
Wound contraction begins almost concurrently with collagen fusion. Contraction, easier defined as the closing of the wound edges that effectively seals the closure, is generally up to around 15 days after the wound is formed. Loose tissues contract more than tissues with poor laxity, and square wounds tend to contract more than circular wounds. Contraction results in a decrease in wound size, the appearance and long term visibility and overall quality of the wound healing. With a hair transplant we have wounds in the recipient and donor sites, and both can react differently and have different healing times.
The open wound slits of the recipient are packed with the graft soon after being made, the healing process between the skin tissues is relatively fast with the formation of the capillary vessels and the contraction of the wound. The area remains red for some time, some maybe a few weeks whereas others maybe months, can be dependent on the number and proximity to each other of the wounds and healing characteristics. Recipient sites in less conventional areas, impaired skin, old scars or in areas of pitting or ridging may behave differently and healing may take longer or be impaired, if previous scarring is so bad that healing never fully concluded it is advisable to not re-enter the areas again. The recipient is generally going to have many multiple wounds and infection is greater, so cleaning regularly and allowing the crust that appears to remove is vital, not to pick at the crust but allow to hydrate and dehydrate the crust will aid the natural healing.
The donor area, conventionally the back and sides of the scalp, and harvested using either the Strip or FUE techniques; each will have different healing characteristics.
The removal of the Strip, position, length, width, depth of incision will all effect, too deep an incision for example can lead to increased fibrosis collection under the skin, resulting in possibly a wider scar or a raised scar area. It is important that during the first weeks of healing the area is kept clean and washed regularly, the suture type is removed as suggested by your doctor. Not cleaning the area can leave bacteria and unable to remove the suture, causing the skin to react against the suture and impair healing. Due to the linear nature and position stretching is also a consideration and it is prudent before doing any type of physical work that may put pressure on the area to fully allow the wound to relax and the skin return to normality. This may mean a few months in some cases but it has to be considered a small price to pay for minimal cosmetic scarring as well as leaving the donor in better condition for future procedures.
FUE donor healing is sometimes thought or considered to be faster and better than Strip but still holds many complications, and can still leave a visible sign of scarring in some cases. Multiple open wounds create their own problem for the body to heal all consistently becomes harder the more wounds that are made.
Body hair is becoming a more common use with FUE, this area can involve area of the body more commonly used to constant attention such as close shaving and touch and more susceptible to infection due to added trauma or abrasiveness. Due to this greater care has to be taken in the earlier days of healing but it does not mean slower healing will occur under normal post-operative circumstances.
Due to the BH areas, chest, legs, beard etc. there is more chance of abrasion and trauma during the healing process. During healing the skin may appear relatively normal, not be sensitive to the touch for example, but outward forces. Shaving for example, a remnant of hair is left in the hair follicle. As this starts to grow out of the follicle, it may immediately curve round into the surrounding skin, because there is nothing to keep it straight. Besides the healing of the skin still in a progressive state the ingrowing hair irritates the skin and can cause a reaction. The next abrasive action the area is caught again, worsening the inflammation and perhaps allowing an infection to occur. This can occur when the skin externally and internally has not gone through the stages of healing and still requires time to correctly form the protective barrier, or new skin on the surface and healing is complete. The problem being the more trauma caused during week one and two of healing can exacerbate the entire healing process from weeks to months, dependent on conditions, skin characteristics etc.
As said contraction healing can take around 15 days, before this although the wounds are small the skin is still susceptible to a prolonged healing pattern, and it is not as simple as starting again and expecting the sequence of healing to refresh, the pattern of healing has been interrupted and now takes on a different regime of healing.
Although FUE wounds are individually small does not detract that each is a separate wound and has to go through the same processes of healing. Due to the wound being smaller it can be thought either less care needs to be taken or healing is faster, this is not the case and an interruption or impairment in the healing process can cause healing to be slowed down as the wounds have not had time to properly repair and heal.
How to improve wound healing, it can be as simple or as complicated, from simply allowing the wound to naturally regenerate the natural properties required to improving areas of your diet and life. What is important is good healing time is respected and not tried to be rushed. Choose your moment for a hair transplant when you can allow for healing to take the natural course, not always easy but important as the final result is never today or even tomorrow but the rest of your life.
