Importance of Pre-Operative Preparation in Hair Transplantation

As in every surgical branch, pre-operative preparation is of great importance in hair transplant surgery. With good pre-operative preparation, most complications that may arise during and after the operation can be prevented, and the success of the surgical intervention can be increased.

A separate information and evaluation form should be filled out for each patient before the operation. The information form should include the patient’s identity details, reason for admission, medical history, family history, medications used, habits, and a systematic review. This form should be accompanied by an informed consent form signed by both the patient and the doctor.

The information that should be included in the form can be detailed as follows:

1) Identity Information:

Name, surname, age, occupation, contact details

2) System Evaluation:

a) Cardiovascular System:

History of hypertension, angina, myocardial infarction, and arrhythmia must be questioned. This history is crucial in terms of the use of epinephrine during local anesthesia.
An assessment should be made for Raynaud’s phenomenon and other peripheral vascular diseases.

b) Respiratory System:

Asthma and chronic obstructive pulmonary diseases should be questioned.
In patients using oxygen support, it should be noted that oxygen sources may cause fires during electrosurgical applications.

c) Hematological System:

Coagulation disorders can cause severe bleeding during surgical procedures.
Even though small surgical procedures such as biopsies do not pose a significant problem, for larger excisions, flap or graft applications, a detailed assessment regarding coagulation disorders should be made.
If there is any suspicion of abnormality, tests such as platelet count, prothrombin time, and activated partial thromboplastin time should be requested, and hematologists should be consulted if necessary.

d) Hepatic System:

Liver diseases can cause serious problems, especially in drug metabolism and the coagulation system.

e) Renal System:

Kidney failure can also significantly affect drug metabolism and the coagulation system.

f) Endocrine System:

Diabetes mellitus and hypothyroidism can cause problems in wound healing after surgery.
Diabetes mellitus is also an important risk factor for postoperative infections.
Hyperthyroidism poses a risk concerning the use of adrenaline in local anesthesia.

g) Nervous System:

The patient’s cognitive functions are essential for obtaining consent and ensuring cooperation during the procedure.

h) Infections:

Hepatitis B, hepatitis C, HIV, syphilis, and chronic furunculosis may lead to impaired wound healing and an increased risk of postoperative infections.
Knowing the presence of these infections is also important for the surgeon’s protection against transmission.
In cases with a history of recurrent herpes infections in the operation area, the risk of a postoperative herpes outbreak is high. Prophylactic antiviral treatment may be considered for such cases.

3) Assessment of Wound Healing:

Previous issues such as delayed wound healing, keloid formation, or pigmentation disorders after surgeries may pose a risk for the upcoming procedure.
The patient should be informed about this, and necessary precautions should be taken.

4) Presence of Prostheses:

Patients should be asked whether they have any prostheses in their bodies before the surgical procedure.
The presence of prostheses is important in terms of electrocautery use and antibiotic prophylaxis.

5) Allergy Assessment:

It is crucial to determine whether patients have allergies, particularly to anesthetics and antibiotics.
If there is an anesthetic drug allergy, selecting an anesthetic from a different group usually solves the problem.
If a patient has a penicillin allergy, macrolide antibiotics are generally preferred.
Allergies to adhesive tapes should be considered for postoperative care.
Latex allergy is more common in healthcare workers, atopic children, and patients with spina bifida who have undergone frequent surgeries.
If latex allergy is suspected, a preoperative prick test should be performed. If positive, vinyl surgical gloves should be used instead of latex.

6) Habit Inquiry:

Smoking reduces tissue oxygenation and collagen synthesis, posing a risk for wound healing.
In smokers, flap and graft necrosis occur more frequently. If such procedures are planned, reducing smoking at least one week before surgery and avoiding it for at least two days postoperatively is recommended.
In heavy smokers, complex surgical procedures should be avoided.
Alcohol consumption may cause bleeding during and after the operation due to its vasodilatory effects.
Therefore, alcohol intake should be stopped in the perioperative period.

7) Medication Use:

It is crucial to determine the medications used by the patient.
Specific medications (e.g., isotretinoin, aspirin, warfarin, NSAIDs) should be directly inquired about.
Herbal supplements and vitamins should also be questioned, as some (e.g., ginkgo biloba, vitamin E, and garlic) increase the risk of intra- and postoperative bleeding.
Such medications should ideally be discontinued at least two weeks before surgery.
For patients using aspirin, NSAIDs, or warfarin due to a history of myocardial infarction, angina, transient ischemic attack, or stroke, treatment should not be interrupted.
However, if these drugs are used for pain relief and a high-risk procedure (e.g., flap, graft application) is planned, aspirin should be stopped 10 days before, and NSAIDs/warfarin 3 days before surgery. These medications can be resumed 3 days postoperatively.

8) Pregnancy Assessment:

Elective surgical procedures should preferably be postponed until after childbirth.
However, in critical cases such as malignant melanoma, surgery cannot be delayed, and pregnancy termination may even be necessary.
Generally, surgeries should be performed during the second trimester of pregnancy.

Physical Examination

After the patient interview, a physical examination should be conducted, generally guided by the patient’s complaints.
For example, in a patient with a malignant lesion, regional lymph nodes should be palpated.
In limb-related operations, peripheral pulses should be checked.
Cardiac, pulmonary, and upper respiratory tract examinations should be performed in terms of sedation and anesthesia.

Antibiotic Prophylaxis

Prophylactic antibiotic treatment is generally not required in most dermatological surgical operations.
However, in high-risk cases such as joint prostheses, heart valve prostheses, procedures on the nose, oral mucosa, lower extremities, and genital areas, and in cases of severe inflammatory diseases, prophylactic antibiotics may be administered.

Pre-Operative Laboratory Tests

Apart from simple procedures such as incisional or small excisional biopsies, routine blood and biochemistry tests, coagulation profiles, and hepatitis markers should be evaluated to determine the patient’s general health status.

Photography

Photographs should be taken before and after all surgical operations.
This is crucial for objectively evaluating the surgical outcome and is also beneficial for educational purposes.

Informed Consent Form

Before any surgical procedure, detailed verbal and written information about the planned intervention should be provided to the patient.
The patient’s questions should be answered, and the informed consent form related to the procedure should be signed.

According to the Turkish Ministry of Health Patient Rights Regulation:

Obtaining the patient’s consent is a prerequisite for any intervention.
The patient must be informed about the diagnosis, treatment options, benefits and risks, potential effects on health, treatment duration, possible discomfort, and consequences of accepting or refusing treatment.
The informed consent form should be completed and signed well in advance of the procedure, allowing the patient enough time to reflect, consult with relatives, and make a well-informed decision.

Pre-Operative Preparation in Hair Transplantation