Post-Operative Redness and Sebum

Dr. Rassman, thanks for starting the ‘Post-Operative’ section. It has been 5 weeks now since my FUE megasession. In the past 2 weeks, I have shed abt 30-40% of my transplanted hair…a condition I had been told is normal, does occur but am happy it has now stabilised. The only hair that I still lose now are those that come off with these thick crusts that form on my scalp every morning after I have applied Minoxidil the previous night. I have been using the 5% strength Minoxidil for abt 4 weeks. I now see redness on the scalp and the area around the red spots is sticky. I won’t call them pimples as another person writes in his message (pimples in transplanted area). But your inference in that post that ‘The more likely cause is the remnants of the sebaceous glands which survive and grow while the hair has not yet started to grow’ seems true to me.

I don’t know why there is this extra sebum production on those reddish areas and why it dries up to form a thick crust? By hit and trial, I found that instead of pealing of this crust if I just wash my head with a pH neutral or baby shampoo, there is much relief. What about your recommendation in that post about frequent soaks…do you mean something like applying a damp towel to the scalp? And could there be any relation between Minoxidil generated redness and sebum production? I don’t use Finasteride, so stopping Minoxidil is difficult for me though I am thinking of going in for reduced strength if this redness aggravates. Pls advise Dr. Rassman.

If you have lost the recently transplanted hair from the FUE, this is normal. The hair that remains may continue to grow. At 5 weeks, I would have expected that all of the crusts would be off. In my practice I get the crusts off in a week or less (often in the first few days with good washing daily). You should take them off in the shower with baby shampoo by gently rubbing them with your fingers.

Redness around a graft may be a sign of infection (folliculitis), so be sure to see your doctor relatively quickly as these may cause permanent loss of the transplanted follicle. Sometimes when crusts stay behind, bacteria will invade through the crusts into the skin and cause local inflamation. Soaks with a damp wash cloth placed on your head prior to shampoo will work for removing the crusts. Minoxidil is an irritant and it may cause increased sebum as your body responds to irritation. I can not advise you on Minoxidil and how to take it. Focus upon the red spots and the scabs that need to come off. That might solve all of the problems. If I were you, I would speak directly to your doctor about these problems and pay him a visit if it is possible, sooner rather than later.