Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The first six weeks are the “security phase.” The flaps or grafts have been placed, but the connection is fragile. The blood vessels are growing across the incision lines. Any shearing force—like rubbing the head, hitting it against a headboard, or wearing a tight hat—can disrupt this healing.
Patients are instructed to minimize head and neck movement that stretches the incision. Activity is restricted to walking; no heavy lifting or straining (Valsalva) is allowed, as elevated intracranial pressure can cause delayed bleeding.
Hygiene is a balance between keeping the wound clean and avoiding disruption of the repair. Once cleared to shower (usually 48-72 hours), patients use a mixture of baby shampoo and water to gently cleanse the hair. The incisions are patted dry, never rubbed.
Crusting along the staples is common. Patients may be instructed to gently clean these crusts with hydrogen peroxide or saline to prevent bacteria from becoming trapped beneath the scab. Antibiotic ointment is applied to keep the edges moist and supple.
Scalp staples are typically removed between days 10 and 14. Because the scalp is under tension, removing them too early can cause the wound to split open (dehiscence). Removing them too late can damage the hair follicles.
The removal process can be uncomfortable but is generally quick. Once removed, the wound is reinforced with steri-strips or left open to air. Patients are advised to continue treating the area gently for another 2 weeks.
If tissue expanders were placed, the maintenance phase involves active expansion. Starting 2-3 weeks post-op, the patient visits the clinic weekly. Sterile saline is injected into the port. The patient feels tightness for 6-12 hours, which then fades as the skin stretches.
This phase lasts 2-4 months. The scalp will deform, creating odd shapes. Patients often wear loose scarves or hats to conceal the expanders. Maintaining scalp skin hygiene over the expander is critical to prevent erosion.
Scalp scars can be wide because the skin is thick and tight. As they mature, they may be red or pink for several months. Scar massage is recommended starting at week 4 to soften the tissue and prevent adherence to the underlying bone.
Silicone gel is difficult to use in hair-bearing areas. Instead, keeping the scalp moisturized with oils or lotions helps. If the scar widens significantly (stretch scar), secondary revision can be considered after a year.
“Shock loss” (telogen effluvium) is a common phenomenon where hair surrounding the incision falls out temporarily due to the stress of surgery. This can be alarming but is usually reversible. The hair follicles go into a resting phase and typically regrow within 3 to 6 months.
Patients are counseled to be patient. Minoxidil (Rogaine) may be recommended after the incisions are fully healed to stimulate regrowth. Gentle brushing and avoiding heat styling protect the fragile, recovering follicles.
The reconstructed scalp, especially skin grafts or scars, is susceptible to UV radiation. Sunburn on a fresh graft can cause blistering, permanent pigment changes, or even graft loss. Skin grafts initially lack the natural protection of melanin.
Strict sun protection is mandatory. Patients must wear UV-protective hats whenever outdoors for the first year. Sunscreen sprays or lotions should be applied to any exposed scalp areas once the wounds are healed.
If the reconstruction left a bald patch (like a skin graft), long-term management involves camouflage or correction. Small patches can be hidden by changing the hairstyle (“comb-over”).
For permanent correction, tissue expansion or serial excision can be performed later. Hair transplantation (follicular unit extraction) is also an option, grafting hair follicles into the scar tissue or into the skin to restore density.
Sensation in the scalp takes a long time to return. Flaps are initially numb. As nerves regenerate (1mm/day), patients may experience itching, tingling, or “zaps” (dysesthesia). This is a sign of healing.
Occasionally, a cut nerve can form a painful nodule called a neuroma. If a specific spot on the scar is exquisitely tender to the touch, injection with steroids or surgical revision may be needed. Most sensory issues resolve or become tolerable over the first year.
If the surgery was for skin cancer, long-term surveillance is life-saving. The scalp is a high-risk area for recurrence because tumors can spread silently under the skin or along nerve sheaths.
Patients require regular dermatological checks of the reconstruction site and the surrounding scalp. Any new lump, ulcer, or persistent crusting should be biopsied immediately.
For patients with total scalp loss or significant defects where reconstruction was not entirely possible, craniofacial prosthetics (custom wigs or hairpieces) play an essential role in maintenance. These can be attached with medical adhesives or clipped onto osseointegrated implants (titanium posts in the bone).
Maintenance involves daily cleaning of the scalp under the prosthetic and regular visits to a prosthetist for adjustments. This provides a high-quality aesthetic result when surgery has reached its limits.
Send us all your questions or requests, and our expert team will assist you.
No, skin grafts typically do not contain hair follicles, so that they will remain bald. The goal of using a graft is to safely close the wound. Later, we can discuss removing the graft and replacing it with hair-bearing scalp using tissue expansion.
Tightness is very common after scalp closure because we have pulled the skin edges together. The scalp will naturally stretch and relax over the first 3 to 6 months, and the feeling of tension will gradually disappear.
You must wait until the incisions are completely healed and there are no scabs or open areas. This is usually about 6 to 8 weeks after surgery. Chemical dyes can cause severe irritation or infection if they penetrate unhealed skin.
Shock loss is when the hair around the surgery site falls out due to the stress of the procedure. It can look like the bald spot is getting bigger. Don’t panic; this hair almost always grows back within 3 to 6 months.
The best protection is a hat. If you cannot wear a hat, use a high-SPF sunscreen spray or lotion on the scar. Scars that get sunburned can turn permanently dark and become very visible.
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