Hair grooming and styling are the final steps in giving a person the desired appearance after surgical hair restoration. Transplantation or other surgical hair restoration procedures (see Surgical Hair Restoration Treatments for information about procedures) restore hair to scalp areas where it was lost. Hair grooming and styling, when well done and regularly maintained, improve the final result of hair restoration. If dismissed as unimportant or badly done, hair grooming and styling can adversely affect appearance no matter how successful the outcome of hair restoration.
The physician hair restoration specialist can provide grooming and styling recommendations for the individual patient. This update provides some general suggestions and observations.
Hair Grooming and Hair Grooming Products
In the immediate postsurgical period, a patient should follow hair-grooming instructions of the physician hair restoration specialist. Both physician and patient want to have hair grooming become a part of normal lifestyle as soon as possible. In the immediate postsurgical period hair grooming products (shampoos, conditioners, etc.) that might interfere with healing must be avoided.
After healing is completed, patient can use shampoos, conditioners and styling aids to improve hair manageability and enhance cosmetic appearance.
Shampoos have the multiple purposes of (1) removing excess oil from the hair and scalp, (2) cleansing the hair of environmental dirt and dead skin cells, and (3) reducing the number of bacteria and other micro-organisms that live on the hair and scalp. All commercially available "big brand" shampoos accomplish these purposes. The choice of the shampoo is largely a matter of personal preference, including the usefulness of a shampoo in preparing the hair for styling.
Baby shampoos are mild, and generally leave the hair in good condition for styling. Shampoos sold for adult use may combine cleansing detergents with a number of conditioners to improve hair flexibility—for example, a strong-cleaning detergent such as a lauryl sulfate may remove so much oil that hair becomes unmanageable and subject to static electricity unless appropriately "conditioned". It may be necessary for the patient to experiment with several shampoos before finding one that is suitable.
Patients with skin conditions such as atopic dermatitis, psoriasis, allergic contact dermatitis and acne should continue to use the shampoos and other hair-care products they have found to be least likely to aggravate their skin condition. The physician hair restoration specialist may have specific recommendations for the individual patient with a skin condition.
Styling of tightly curled or kinky hair may be made easier by use of a shampoo formulated specifically for this type of hair. Shampoos for kinky hair are usually conditioning shampoos that aid in detangling hair and reducing grooming trauma caused by combing tangled hair.
A hair conditioning agent may be used with, or after, a shampoo to make the hair easy to comb and more manageable for styling. An appropriate conditioner can also add to the luster of transplanted hair. The physician hair restoration specialist may have specific recommendations for the individual patient regarding selection and use of a conditioner.
The general types of hair conditioners are:
Short-contact conditionersare applied during or immediately after shampooing, and are left on the hair for a few minutes before being rinsed off. The short contact time provides little or no long-lasting conditioning, but the hair is made more manageable for wet combing.
Deep "protein" conditionersare applied after shampooing, and left on the hair for up to 30 minutes before removal by a second shampoo. These products contain hydrolyzed proteins derived from animal tissue. The protein conditioners temporarily strengthen hair shafts and repair split ends; to maintain the effect, the conditioner must be reapplied after every shampoo. Protein conditioners are especially useful when hair styling is made difficult by hair damage from dyeing, permanent waving or daily grooming.
Leave-in conditionersare applied after the hair is dried following a shampoo, and left on the hair as a styling aid. The conditioner is removed with the next shampoo. Some of these products are formulated and labeled specifically as blow-dry conditioners [see discussion of blow-drying below], or as conditioners for people with tightly curled or kinky hair. The oldest hair-thickening "leave-in" conditioners are pomades and glycerine-based products that are applied to the hair to aid in combing and improve manageability. Newer products cover hair shafts with a thin coating of a polymer. The polymer coating temporarily repairs hair shafts, gives hair more luster, and eliminates static electricity as a styling problem. Hair thickeners and polymer coatings are not usually appropriate for use on fine-caliber hair, as the weight of the coating makes it difficult to style fine hair.
Styling aids are gels, mousses and sprays applied to the hair after shampooing. Their principal value is to add shine to hair and increase the ability of hair to "hold" a style. Gels and mousses are usually applied before styling, as a styling aid; sprays are usually applied after styling to "hold" the style.
Styling aids can be very useful in (1) holding hair in place and camouflaging freshly transplanted areas, and (2) holding hair in a position to make "less" appear to be "more". None of the styling aids should be used before postsurgical healing is completed; while not harmful, they can cause stinging and burning on unhealed scalp.
The simplest forms of styling after surgical hair restoration are combing and parting. Both combing and parting may be revised as necessary when transplantation is accomplished in several sessions over a period of months.
Parting is esthetically most acceptable when the hair is parted in areas where hair growth is uniform. The part should not be made so as to reveal large areas of bare scalp. As transplantation proceeds through several sessions, the part may be done differently after each session to achieve the best possible appearance until hair restoration is completed and the part stabilized.
As the transplanted hair matures, grows in length and increases in diameter, more volume will be realized. Volume is proportional to width of the hair shaft and length of the hair. Hair length can be controlled by the patient; the longer the hair, the more volume is present. Increased volume can be attained by combing the hair to the side of straight back. With the part in the appropriate position, the hair can be combed to the left or right to increase the density horizontally. This is usually limited to four or five inches. When the hair is combed back, the increased volume can help to cover the area behind the transplants and/or the crown. Usually, more length and hence volume can be realized by combing the hair back versus to the side.
Combing can be used to sweep hair over areas of the scalp where an appearance of greater hair fullness is desired. With the use of styling aids such as gels and mousses, hair can be combed into a desired style and maintained in that style until the next shampoo.
Styles that are not as popular after transplants include the "flattop" and "bangs". A large amount of density is necessary to create the flattop look. Unless a significant amount of hair is present in the area prior to transplantation, or the patient has thick hair shafts, the flattop style cannot easily be accomplished. In order to have bangs, the patient must have isolated frontal hair loss with good density behind the hairline and frontal half of the scalp. Combing thr hair forward reveals any thinning behind the hairline and frontal half of the scalp.
For many patients, careful blow-drying can add body and volume to transplanted hair. Blow-drying is often facilitated by use of a blow-dry conditioner [see discussion of conditioners above]. The physician hair restoration specialist may have recommendations for the individual patient.
Hair dyes are sometimes used to create an impression of greater hair density, or of younger age, after hair transplantation. Before using a dye, the patient should check with the physician hair restoration specialist for any specific, individualized recommendations.
Draelos ZK. Hair care products. In: Stough DB, Haber RS (eds.) Hair Replacement. Medical and Surgical. St. Louis: Mosby; 1996:387-395.
Freedberg IM et al (eds.) Fitzpatrick’s Dermatology in General Medicine, 5th ed. New York: McGraw-Hill; 1999: Ch. 43 (Psoriasis), Ch. 73 (Diseases of Sebaceous Glands), Ch. 122 (Allergic Contact Dermatitis), Ch. 124 (Atopic Dermatitis).
Unger WP. Postoperative course. In: Unger WP (ed.) Hair Transplantation, 3rd ed. New York: Marcell Dekker, Inc.; 1995:353-362.